Minnesota Legislature
HF 2128
4th Engrossment - 92nd Legislature (2021 - 2022) Posted on 05/19/2021 09:25am
3.44 3.45
3.46 3.47 3.48 3.49
4.1 4.2 4.3 4.4 4.5
4.6 4.7 4.8 4.9 4.10
4.11 4.12 4.13 4.14
4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28
5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19
5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 8.34 8.35 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26
9.27 9.28 9.29 9.30 9.31 9.32 10.1 10.2 10.3 10.4
10.5
10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15
12.16 12.17
12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 12.34 13.1 13.2 13.3
13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 14.34 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9
15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27
15.28
16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26
16.27 16.28 16.29 16.30 16.31 16.32 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24
17.25 17.26 17.27 17.28 17.29 17.30 18.1 18.2
18.3 18.4 18.5
18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 19.1 19.2 19.3
19.4 19.5 19.6
19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28
19.29
19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 24.1 24.2 24.3 24.4 24.5
24.6 24.7 24.8
24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 24.34 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30
25.31 25.32 25.33 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19
26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28
26.29 26.30 26.31 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22
28.23 28.24
28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 29.33 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15
31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 32.1 32.2
32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28
33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 33.35 33.36 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 35.35 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8
36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25
40.26
40.27 40.28 40.29 40.30 40.31 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31
42.1
42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17
42.18
42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28
42.29
42.30 42.31 42.32 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28
48.29 48.30 48.31 48.32 48.33 48.34 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 50.1 50.2 50.3 50.4 50.5 50.6
50.7 50.8 50.9
50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 51.1 51.2 51.3 51.4 51.5 51.6
51.7 51.8
51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15
52.16 52.17 52.18
52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26
53.27 53.28 53.29
53.30 53.31 53.32 53.33 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3
55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 56.1 56.2 56.3 56.4 56.5 56.6
56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20
56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32
58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 58.35 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 59.35 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 60.32 60.33 61.1 61.2
61.3 61.4 61.5 61.6
61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 62.34
63.1 63.2 63.3 63.4 63.5 63.6
63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17
63.18 63.19 63.20 63.21
63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 63.33 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12
64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27
64.28 64.29 64.30 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3 66.4 66.5
66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30
68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 68.33 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 69.33 69.34 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16
70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 70.33 70.34 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 72.1 72.2 72.3
72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18
72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30
73.1 73.2 73.3 73.4 73.5
73.6
73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20
73.21 73.22 73.23
73.24 73.25 73.26 73.27
73.28
73.29 73.30 73.31 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9
74.10
74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25
74.26
74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2
75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12
75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16
76.17
76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11
78.12 78.13
78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23
78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21
79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28
81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27
81.28 81.29
82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13
82.14 82.15 82.16 82.17
82.18
82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 84.1 84.2 84.3
84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17
84.18 84.19 84.20
84.21 84.22 84.23 84.24 84.25
84.26 84.27 84.28 84.29 84.30 85.1 85.2
85.3 85.4
85.5 85.6 85.7
85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26
85.27 85.28 85.29 85.30 85.31 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17
86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 87.33 87.34 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16
88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 88.33 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32
90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8
91.9
91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 92.1 92.2 92.3 92.4 92.5 92.6
92.7
92.8 92.9 92.10 92.12 92.11 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 92.33 92.34 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 93.34 93.35 93.36 93.37 93.38 93.39 93.40 93.41 93.42 93.43 93.44 93.45 93.46 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 94.36 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21
96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15
99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11
101.12
101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15
102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18
103.19 103.20 103.21 103.22 103.23 103.24
103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2
104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13
104.14 104.15 104.16 104.17
104.18 104.19 104.20 104.21 104.22
104.23 104.24 104.25 104.26 104.27 104.28 104.29 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 108.33 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30
113.31 113.32 114.1 114.2
114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6
120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31
121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11
121.12 121.13 121.14 121.15 121.16
121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26
121.27 121.28 121.29 121.30 121.31 121.32 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8
123.9 123.10 123.11 123.12 123.13 123.14 123.15
123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 124.1 124.2 124.3 124.4 124.5 124.6 124.7
124.8
124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9
125.10 125.11 125.12 125.13
125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9
126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25
126.26 126.27 126.28
126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10
127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18
127.19
127.20 127.21 127.22 127.23 127.24 127.25
127.26 127.27 127.28 127.29 127.30 127.31 128.1 128.2 128.3
128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16
129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16
130.17
130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 131.1
131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 132.34 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25
134.26
134.27 134.28 134.29 134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 136.1 136.2 136.3 136.4 136.5 136.6 136.7
136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26
136.27 136.28 136.29 136.30 136.31 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18
137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29
138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 139.1 139.2 139.3 139.4 139.5
139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11
140.12
140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24
141.25
141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 142.1 142.2 142.3 142.4 142.5 142.6
142.7
142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17
142.18
142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4
143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16
143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 144.1 144.2 144.3
144.4 144.5 144.6 144.7 144.8 144.9
144.10
144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20
145.21
145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30
145.31 145.32 145.33
146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26
146.27 146.28 146.29 146.30 146.31 146.32 146.33 147.1 147.2
147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15
147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24
147.25 147.26 147.27 147.28 147.29 147.30 147.31 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22
148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10
150.11 150.12 150.13 150.14
150.15 150.16 150.17 150.18
150.19
150.20 150.21
150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31
151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30
151.31
152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22
152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28
154.29 154.30 154.31 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17
156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14
157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13
161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19
166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 171.1 171.2 171.3
171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15
171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19
172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24
175.25
175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30
176.31 176.32 176.33 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15
177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24
178.25 178.26 178.27 178.28 178.29 178.30 179.1 179.2 179.3 179.4 179.5 179.6 179.7
179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 180.1 180.2 180.3 180.4 180.5
180.6
180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26
181.27
181.28 181.29 181.30 181.31 181.32 181.33 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20
182.21
182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11
183.12
183.13 183.14 183.15 183.16 183.17
183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17
184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31
185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13
185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 186.1 186.2
186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 186.34 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25
188.26 188.27 188.28 188.29 188.30 188.31 188.32 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20
190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 191.1 191.2 191.3 191.4
191.5 191.6 191.7 191.8 191.9 191.11 191.10 191.13 191.12 191.14 191.15 191.16 191.17 191.19 191.18 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 191.33 191.34 191.35 191.36 191.37 191.38 191.39 192.2 192.1 192.4 192.3 192.5 192.6 192.8 192.7 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 192.34 192.35 192.36 192.37 192.38 192.39 192.40 192.41 192.42 192.43 193.1 193.2 193.3 193.5 193.4 193.6 193.7 193.8 193.9 193.10 193.11 193.13 193.12 193.14 193.15 193.17 193.16 193.18 193.19 193.20 193.21 193.22 193.23 193.25 193.24 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 193.34 193.35 193.36 193.37 193.38 193.39 193.40 194.1 194.2
194.3 194.4 194.5 194.6 194.8 194.7 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 194.34 194.35 194.36 194.37 194.38 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.10 195.9 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 195.34 195.35 195.36 195.37 195.38 195.39
196.1 196.2 196.3 196.4 196.5 196.6
196.7 196.8 196.9 196.10 196.11 196.12 196.13
196.14 196.15 196.16 196.17 196.18
196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 197.1 197.2 197.3 197.4 197.5
197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30
198.31 198.32 198.33 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27
199.28 199.29 199.30 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11
201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13
202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29
202.30 202.31 202.32 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 203.34 204.1 204.2 204.3 204.4 204.5 204.6 204.7
204.8 204.9 204.10 204.11
204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18
205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28
206.29 206.30 206.31 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11
208.12 208.13
208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25
208.26 208.27 208.28 208.29 208.30
208.31 208.32
209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28
209.29
209.30 209.31 209.32 209.33 209.34 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14
210.15 210.16
210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 214.33 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25
215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5
216.6 216.7 216.8 216.9 216.10 216.11 216.12
216.13
216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30
217.31
218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14
218.15
218.16 218.17 218.18 218.19 218.20
218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11
219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 220.33 220.34 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21
221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23
222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 224.1 224.2
224.3
224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22
224.23
224.24 224.25 224.26 224.27 224.28 224.29 224.30 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14
226.15
226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23
228.24 228.25 228.26 228.27 228.28
228.29 228.30 228.31 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 230.1 230.2
230.3 230.4 230.5 230.6 230.7 230.8 230.9
230.10 230.11 230.12 230.13 230.14 230.15 230.16
230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22
231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9
232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31
233.1 233.2
233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 248.1 248.2 248.3 248.4
248.5 248.6
248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 252.1 252.2 252.3 252.4 252.5
252.6 252.7
252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22
252.23 252.24 252.25 252.26
252.27 252.28 252.29 252.30
253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14
253.15 253.16 253.17 253.18
253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 254.1 254.2 254.3 254.4
254.5 254.6 254.7 254.8 254.9 254.10 254.11
254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22
254.23 254.24 254.25 254.26 254.27 254.28
255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27
256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12
256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21
256.22
256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24
257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13
258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22
259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25
260.26 260.27 260.28 260.29 260.30 260.31 260.32 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 261.34 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5
263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22
264.23 264.24 264.25 264.26 264.27 264.28 264.29
265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22
265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30
266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16
266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17
267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11
268.12 268.13
268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 269.1 269.2 269.3 269.4 269.5 269.6 269.7
269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 270.1 270.2 270.3 270.4 270.5 270.6
270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27
270.28 270.29 270.30 270.31
271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8
271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16
271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22
272.23
272.24 272.25 272.26 272.27 272.28
272.29
273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15
273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25
273.26 273.27 273.28 273.29 273.30 273.31 273.32 273.33 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29
274.30 274.31 274.32 274.33 275.1 275.2 275.3 275.4 275.5
275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22
275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 275.33 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19
276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28
277.29 277.30 277.31 277.32
278.1 278.2 278.3
278.4 278.5
278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28
279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20
279.21
279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12
280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 281.1 281.2 281.3 281.4 281.5 281.6 281.7
281.8
281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26
281.27 281.28 281.29 281.30 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20
282.21
282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30
283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18
283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26
283.27 283.28 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33
285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14
285.15 285.16
285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8
286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28
287.1 287.2 287.3 287.4
287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21
288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 289.1 289.2 289.3
289.4 289.5 289.6 289.7 289.8
289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5
290.6 290.7
290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27
291.28 291.29 291.30 291.31 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27
292.28
292.29 292.30 292.31 292.32 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26
293.27 293.28 293.29 293.30 293.31
293.32
294.1 294.2 294.3 294.4 294.5 294.6 294.7
294.8
294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3
295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 295.32 295.33 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 297.33 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16
299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26
299.27 299.28 299.29 299.30 299.31 299.32 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9
301.10
301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19
302.20
302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9
303.10
303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19
303.20
303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12
304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20
304.21 304.22 304.23 304.24 304.25 304.26 304.27
305.1 305.2
305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 306.33 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 307.33 307.34 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 309.33 310.1 310.2 310.3
310.4 310.5
310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 311.1 311.2
311.3 311.4
311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15
311.16 311.17
311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32
312.1
312.2 312.3 312.4 312.5 312.6 312.7 312.8
312.9 312.10
312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27
312.28 312.29
313.1 313.2 313.3 313.4
313.5 313.6
313.7 313.8 313.9 313.10
313.11 313.12
313.13 313.14 313.15 313.16
313.17 313.18
313.19 313.20 313.21 313.22 313.23
313.24 313.25
313.26 313.27 313.28 313.29 313.30 314.1 314.2 314.3 314.4 314.5 314.6 314.7
314.8 314.9
314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 315.1 315.2 315.3 315.4 315.5 315.6 315.7
315.8 315.9
315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23
316.24 316.25
316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3
317.4 317.5
317.6 317.7 317.8 317.9 317.10
317.11 317.12
317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 318.33 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19
320.20 320.21
320.22 320.23 320.24 320.25 320.26
320.27
321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22
321.23 321.24
321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16
325.17
325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 326.1 326.2 326.3 326.4 326.5
326.6
326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 326.33 326.34 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 329.1 329.2 329.3 329.4 329.5 329.6 329.7
329.8
329.9 329.10 329.11 329.12 329.13 329.14
329.15 329.16 329.17
329.18 329.19 329.20 329.21 329.22 329.23
329.24
329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13
330.14
330.15 330.16 330.17 330.18
330.19 330.20 330.21
330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28
333.29 333.30 333.31
334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13
334.14 334.15
334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 336.33 337.1 337.2 337.3 337.4 337.5
337.6 337.7 337.8
337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 338.1 338.2
338.3
338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 340.1 340.2
340.3
340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24
342.25 342.26
342.27 342.28 342.29 342.30 342.31 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18
344.19 344.20
344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29
344.30 344.31 344.32
345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18
347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 348.34 348.35 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24
352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 352.34 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11
353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 354.33 354.34
355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 355.32 355.33 355.34 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26
356.27 356.28
356.29 356.30 356.31 356.32 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33 357.34 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15
358.16 358.17
358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32
359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19
360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31
361.1 361.2 361.3 361.4 361.5 361.6 361.7
361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31
362.1 362.2 362.3 362.4
362.5 362.6 362.7 362.8 362.9
362.10 362.11 362.12 362.13 362.14 362.15
362.16 362.17
362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29
362.30
363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23
363.24
363.25 363.26 363.27 363.28 363.29
363.30
364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13
364.14
364.15 364.16 364.17 364.18 364.19 364.20 364.21
364.22
364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10
365.11
365.12 365.13 365.14 365.15 365.16
365.17
365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 366.1 366.2 366.3 366.4 366.5 366.6
366.7
366.8 366.9 366.10 366.11 366.12 366.13 366.14
366.15 366.16 366.17 366.18 366.19 366.20 366.21
366.22
366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9
367.10 367.11 367.12 367.13
367.14
367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25
367.26
367.27 367.28 367.29 367.30 367.31 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10
368.11
368.12 368.13 368.14 368.15
368.16
368.17 368.18 368.19 368.20
368.21
368.22 368.23 368.24 368.25 368.26 368.27
368.28
369.1 369.2 369.3 369.4 369.5
369.6
369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26
369.27 369.28
370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27
370.28
370.29 370.30 370.31 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11
371.12
371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23
371.24 371.25
371.26 371.27 371.28 371.29 371.30 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25
372.26 372.27 372.28 372.29 372.30 372.31 372.32 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11
373.12 373.13 373.14 373.15 373.16
373.17 373.18 373.19 373.20 373.21 373.22
373.23
373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20
374.21
374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 375.1 375.2 375.3
375.4
375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14
375.15
375.16 375.17 375.18 375.19 375.20 375.21
375.22
375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12
376.13
376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24
376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32
377.1
377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11
377.12
377.13 377.14 377.15 377.16
377.17
377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9
378.10 378.11
378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21
378.22
378.23 378.24 378.25 378.26 378.27 378.28 378.29 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17
379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22
380.23 380.24 380.25
380.26 380.27 380.28 380.29 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 385.1 385.2 385.3 385.4 385.5
385.6
385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21
385.22
385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24
386.25
386.26 386.27 386.28 386.29 386.30 386.31 386.32 387.1 387.2 387.3 387.4 387.5 387.6 387.7
387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17
387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25
388.26 388.27 388.28 389.1 389.2 389.3
389.4 389.5
389.6 389.7
389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 390.1 390.2 390.3 390.4
390.5
390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 390.33 391.1 391.2 391.3 391.4
391.5 391.6 391.7
391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19
391.20
391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 392.33 392.34 392.35 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12
393.13
393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26
393.27
393.28 393.29 393.30 393.31 393.32 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 394.33 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15
395.16
395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33 396.1 396.2
396.3
396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 398.1 398.2 398.3
398.4
398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 398.34 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20
399.21
399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9
400.10 400.11
400.12
400.13 400.14
400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 401.33 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27
402.28 402.29 402.30 402.31 402.32 402.33 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20
403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 403.32 403.33 403.34 404.1 404.2
404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 404.33 404.34 405.1 405.2 405.3 405.4 405.5 405.6 405.7
405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 405.32 405.33 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12
406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10
407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8
408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22
408.23 408.24 408.25 408.26 408.27 408.28 408.29
409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11
409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31 410.1 410.2 410.3
410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11
410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21
410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18
411.19 411.20 411.21 411.22 411.23 411.24 411.25
411.26 411.27 411.28 411.29 411.30 411.31 411.32 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17
412.18 412.19 412.20 412.21 412.22 412.23
412.24 412.25 412.26 412.27 412.28 412.29 412.30
413.1 413.2 413.3 413.4 413.5
413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 414.1 414.2
414.3 414.4
414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 416.1 416.2 416.3
416.4
416.5 416.6 416.7 416.8 416.9 416.10
416.11
416.12 416.13 416.14 416.15 416.16
416.17
416.18 416.19 416.20 416.21 416.22
416.23
416.24 416.25 416.26 416.27 416.28
416.29
417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9
417.10
417.11 417.12 417.13 417.14 417.15
417.16
417.17 417.18 417.19 417.20 417.21
417.22
417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 418.1 418.2
418.3
418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 425.33 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 428.1 428.2 428.3 428.4 428.5 428.6
428.7
428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 428.33 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29
430.30
431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8
432.9
432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 432.33 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 434.1 434.2 434.3
434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20
434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 435.1 435.2
435.3
435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 435.33 435.34 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 436.34 436.35 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15
437.16
437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13
438.14
438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 438.32 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8
439.9
439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8
440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 442.32 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21
443.22
443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 443.32 443.33 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31 444.32 444.33 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31
445.32
446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29
447.30
448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18
449.19
449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 451.33 452.1 452.2
452.3
452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29
452.30
453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16
453.17
453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 454.32 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 455.32 455.33 455.34 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12
456.13
456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22
456.23
456.24 456.25 456.26 456.27 456.28 456.29 456.30 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9
459.10
459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32 460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 460.31 460.32 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 462.1 462.2 462.3 462.4 462.5 462.6 462.7
462.8
462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 463.1 463.2 463.3 463.4 463.5
463.6
463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24
463.25
463.26 463.27 463.28 463.29 463.30 463.31 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14
464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 464.33 465.1 465.2 465.3 465.4 465.5 465.6
465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32 466.1 466.2
466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18
466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26
466.27
466.28 466.29 466.30 466.31 466.32 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9
467.10 467.11 467.12 467.13
467.14 467.15
467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22
468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 468.33 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 469.32 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 471.1 471.2 471.3
471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24
471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 471.33 472.1 472.2 472.3 472.4 472.5
472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17
472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19
474.20
474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9
476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23
477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 478.33 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 480.34 481.1 481.2 481.3 481.4 481.5
481.6 481.7 481.8 481.9
481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19
481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9
482.10
482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20
482.21
482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 483.32 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 484.31 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 485.32 486.1 486.2 486.3
486.4 486.5
486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14
486.15 486.16
486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27
488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 488.32 488.33 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29
490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11
490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10
491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 491.32 491.33 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14
492.15 492.16 492.17
492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 492.33 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 493.32 493.33 493.34 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 494.31 494.32 494.33 494.34 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 495.33
496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 496.32 496.33 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 497.33 497.34 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21
498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 499.33 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10
500.11 500.12 500.13
500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16
501.17 501.18 501.19
501.20 501.21 501.22 501.23 501.24 501.25
501.26
501.27 501.28 501.29 501.30 501.31
501.32
502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10
502.11
502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25
503.26 503.27 503.28 503.29 503.30 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31 504.32 504.33 504.34 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20
505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 506.31 506.32 506.33 506.34 507.1 507.2 507.3 507.4
507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13
507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11
508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22
508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32
509.1 509.2 509.3 509.4 509.5 509.6 509.7
509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29
510.1 510.2 510.3 510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32
511.1 511.2 511.3 511.4 511.5
511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20
511.21 511.22 511.23 511.24 511.25
511.26 511.27 511.28 511.29
511.30
512.1 512.2
512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10
512.11 512.12
512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 512.32 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26
513.27 513.28 513.29 513.30 513.31 513.32 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 514.32 514.33 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 515.32 515.33 515.34 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 516.31 516.32 516.33 516.34 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24
517.25
517.26 517.27 517.28 517.29 517.30 517.31 517.32 517.33
517.34
518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8
518.9 518.10 518.11 518.12 518.13 518.14
518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28 518.29 518.30 518.31 519.1 519.2 519.3 519.4 519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 520.32 520.33 520.34 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 521.32 521.33 521.34 521.35 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10
522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 522.31 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21
523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 523.31 524.1 524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 524.31 524.32 524.33 524.34 524.35 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16 527.17 527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 527.32 527.33 527.34 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22
528.23 528.24
528.25 528.26 528.27 528.28 528.29 528.30 528.31 528.32 528.33 528.34 529.1 529.2 529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22
529.23 529.24 529.25
529.26 529.27 529.28 529.29 529.30 529.31 529.32 529.33 529.34 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 530.33 531.1 531.2 531.3 531.4 531.5
531.6 531.7 531.8
531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 531.30 531.31 532.1 532.2 532.3 532.4
532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14
532.15 532.16 532.17 532.18 532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29
533.1 533.2 533.3 533.4 533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23 533.24 533.25 533.26 533.27 533.28 533.29 533.30 533.31 534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14
534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22
534.23 534.24 534.25 534.26 534.27 534.28 534.29
534.30
535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8
535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27 535.28 535.29 535.30 535.31 535.32 536.1 536.2 536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15
536.16 536.17 536.18
536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14
537.15 537.16 537.17
537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31
538.32 538.33 538.34
539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24
539.25 539.26 539.27
539.28 539.29 539.30 539.31 539.32 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 540.32 540.33 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 541.31 541.32 541.33 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13
547.14 547.15 547.16
547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 549.31 549.32 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13
550.14 550.15 550.16
550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 551.30 551.31 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28
552.29 552.30 552.31
553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20
554.21 554.22 554.23
554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29
557.1 557.2 557.3
557.4 557.5 557.6 557.7 557.8
557.9 557.10 557.11
557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 557.33 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 558.31 558.32 558.33 558.34 559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 559.31 559.32 559.33 559.34 559.35 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 560.31 560.32 560.33 560.34 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21
561.22
561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 563.1 563.2 563.3 563.4 563.5 563.6 563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 563.32 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24 564.25 564.26 564.27 564.28 564.29 564.30 564.31 564.32 564.33 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31 565.32 565.33 566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8 566.9 566.10 566.11 566.12 566.13 566.14 566.15 566.16 566.17 566.18 566.19 566.20 566.21 566.22
566.23 566.24 566.25
566.26 566.27 566.28 566.29 566.30 566.31 566.32 567.1 567.2 567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27 567.28 567.29 567.30 567.31 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27 568.28 568.29 568.30 568.31 569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17 569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27 569.28 569.29 569.30 569.31 569.32 570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9 570.10 570.11 570.12 570.13 570.14 570.15 570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 571.1 571.2 571.3 571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12 571.13 571.14 571.15 571.16 571.17 571.18 571.19 571.20 571.21 571.22 571.23 571.24 571.25 571.26 571.27 571.28 571.29 571.30 571.31 571.32 571.33 571.34
572.1 572.2 572.3
572.4 572.5 572.6 572.7 572.8 572.9 572.10 572.11 572.12 572.13 572.14 572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24 572.25 572.26 572.27 572.28 572.29 572.30 572.31 572.32 572.33 572.34 573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10 573.11 573.12 573.13 573.14 573.15 573.16 573.17 573.18 573.19 573.20 573.21 573.22 573.23 573.24 573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 573.33 573.34 574.1 574.2
574.3 574.4 574.5 574.6 574.7 574.8 574.9 574.10 574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21 574.22 574.23 574.24 574.25 574.26 574.27 574.28 574.29 574.30 574.31 574.32 574.33 575.1 575.2 575.3 575.4
575.5
575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15 575.16 575.17 575.18 575.19 575.20 575.21 575.22 575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 575.32 575.33 576.1 576.2 576.3 576.4 576.5 576.6 576.7 576.8 576.9 576.10
576.11 576.12 576.13 576.14 576.15 576.16 576.17 576.18 576.19 576.20 576.21 576.22 576.23 576.24 576.25 576.26 576.27 576.28 576.29
576.30
576.31 576.32 576.33 577.1 577.2 577.3 577.4 577.5 577.6 577.7
577.8 577.9 577.10
577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20 577.21 577.22 577.23
577.24
577.25 577.26 577.27 577.28 577.29 577.30 577.31 577.32 578.1 578.2 578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17 578.18 578.19 578.20 578.21 578.22 578.23 578.24 578.25 578.26 578.27 578.28 578.29 578.30 578.31 578.32 579.1 579.2 579.3 579.4 579.5 579.6 579.7 579.8 579.9 579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29 579.30 579.31 579.32 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12 580.13 580.14 580.15 580.16 580.17 580.18 580.19 580.20 580.21 580.22 580.23 580.24 580.25 580.26 580.27 580.28 580.29 580.30 580.31 581.1 581.2 581.3 581.4 581.5 581.6 581.7 581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16 581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24 581.25 581.26 581.27 581.28 581.29 581.30 581.31 582.1 582.2 582.3 582.4
582.5
582.6 582.7 582.8 582.9
582.10 582.11 582.12 582.13 582.14 582.15 582.16 582.17 582.18 582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 582.30 582.31 582.32 583.1 583.2 583.3
583.4 583.5 583.6 583.7 583.8 583.9 583.10 583.11 583.12
583.13 583.14 583.15 583.16 583.17 583.18 583.19
583.20 583.21 583.22 583.23 583.24 583.25 583.26 583.27 583.28
583.29 583.30 583.31
584.1 584.2 584.3 584.4 584.5 584.6 584.7 584.8 584.9 584.10 584.11 584.12 584.13 584.14 584.15 584.16 584.17 584.18 584.19 584.20 584.21 584.22 584.23 584.24 584.25 584.26 584.27 584.28 584.29 584.30 584.31 584.32 584.33 585.1 585.2
585.3 585.4 585.5 585.6 585.7 585.8 585.9 585.10 585.11 585.12 585.13 585.14 585.15
585.16 585.17 585.18
585.19 585.20 585.21 585.22 585.23 585.24 585.25 585.26 585.27
586.1 586.2
586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18 586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29 586.30 587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8 587.9 587.10 587.11 587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19 587.20 587.21 587.22 587.23 587.24 587.25 587.26 587.27 587.28 587.29 587.30 587.31 587.32 587.33 588.1 588.2 588.3 588.4
588.5 588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26 588.27 588.28 588.29 588.30 588.31 588.32 588.33 589.1 589.2 589.3 589.4 589.5 589.6 589.7 589.8 589.9 589.10 589.11 589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27 589.28 589.29 589.30 589.31 589.32 589.33 589.34 590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10 590.11 590.12 590.13 590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22 590.23 590.24 590.25 590.26 590.27 590.28 590.29 590.30 590.31 590.32 590.33 590.34 591.1 591.2 591.3 591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19 591.20 591.21 591.22 591.23 591.24 591.25 591.26 591.27 591.28 591.29 591.30 591.31 591.32 591.33 592.1 592.2 592.3 592.4 592.5 592.6 592.7 592.8 592.9 592.10 592.11
592.12 592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21 592.22 592.23 592.24 592.25 592.26 592.27 592.28 592.29 592.30 592.31 592.32 592.33
593.1 593.2 593.3 593.4 593.5 593.6 593.7 593.8 593.9 593.10 593.11 593.12 593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22 593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 593.31 593.32 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28 594.29 595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12 595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23 595.24 595.25 595.26 595.27 595.28 595.29 595.30 595.31 595.32 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11 596.12 596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24 596.25 596.26 596.27 596.28 596.29 596.30 596.31 596.32 596.33 597.1 597.2 597.3 597.4 597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14 597.15 597.16 597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 597.30 597.31 597.32 598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21
598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 598.31 598.32 599.1 599.2 599.3 599.4 599.5 599.6 599.7 599.8 599.9
599.10 599.11 599.12 599.13
599.14 599.15 599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24 599.25 599.26 599.27 599.28 599.29 599.30 599.31 600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8
600.9 600.10 600.11 600.12 600.13 600.14 600.15 600.16 600.17 600.18 600.19 600.20 600.21 600.22 600.23 600.24 600.25 600.26 600.27 600.28 600.29 600.30 601.1 601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13 601.14 601.15 601.16 601.17 601.18 601.19 601.20 601.21 601.22 601.23 601.24 601.25 601.26 601.27 601.28 601.29 601.30 601.31 601.32 602.1 602.2 602.3 602.4
602.5 602.6 602.7 602.8 602.9 602.10 602.11 602.12 602.13 602.14 602.15 602.16 602.17 602.18 602.19 602.20 602.21 602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 602.30 602.31 603.1 603.2 603.3 603.4 603.5 603.6 603.7
603.8 603.9 603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23 603.24 603.25 603.26 603.27 603.28 603.29 603.30 603.31 604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 605.1 605.2 605.3 605.4 605.5
605.6 605.7 605.8 605.9 605.10 605.11 605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24 605.25 605.26 605.27 605.28 605.29 605.30 605.31 605.32 606.1 606.2 606.3 606.4 606.5 606.6 606.7
606.8 606.9 606.10 606.11 606.12 606.13 606.14 606.15 606.16 606.17 606.18 606.19 606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15 607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25 607.26 607.27 607.28 607.29 607.30 607.31 608.1 608.2 608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10 608.11 608.12 608.13 608.14 608.15 608.16 608.17 608.18 608.19 608.20 608.21 608.22 608.23 608.24 608.25 608.26 608.27 608.28 608.29 608.30
609.1 609.2 609.3 609.4 609.5 609.6 609.7 609.8 609.9 609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28 609.29 609.30 609.31 610.1 610.2 610.3 610.4 610.5 610.6 610.7 610.8 610.9 610.10 610.11 610.12 610.13
610.14 610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 610.32 611.1 611.2 611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14
611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30 611.31 612.1 612.2 612.3 612.4 612.5 612.6 612.7 612.8 612.9 612.10 612.11 612.12 612.13 612.14 612.15
612.16 612.17 612.18 612.19 612.20 612.21 612.22 612.23 612.24 612.25 612.26 612.27 612.28 612.29 612.30 612.31 613.1 613.2 613.3 613.4 613.5 613.6 613.7 613.8 613.9 613.10 613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21 613.22 613.23 613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32 614.1 614.2 614.3 614.4 614.5 614.6 614.7 614.8 614.9 614.10 614.11 614.12 614.13 614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26
614.27 614.28 614.29 614.30 614.31 615.1 615.2 615.3 615.4 615.5 615.6 615.7 615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15
615.16 615.17 615.18 615.19 615.20 615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15
616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25 616.26 616.27 616.28 616.29 616.30 616.31 616.32 616.33 617.1 617.2 617.3 617.4 617.5 617.6 617.7 617.8 617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 617.31 617.32 617.33 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11
618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 618.30 619.1 619.2 619.3 619.4 619.5 619.6 619.7 619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8 620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21
620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 621.1 621.2 621.3 621.4 621.5 621.6 621.7 621.8 621.9 621.10 621.11 621.12 621.13 621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28
622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8 622.9 622.10 622.11 622.12 622.13 622.14 622.15 622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27 622.28 622.29 622.30 622.31 622.32 623.1 623.2
623.3 623.4 623.5 623.6 623.7 623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17 623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11
624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 625.1 625.2 625.3 625.4 625.5 625.6 625.7
625.8 625.9 625.10 625.11 625.12 625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 625.31
626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16 626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 626.32 626.33 626.34 626.35 627.1 627.2 627.3 627.4
627.5 627.6
627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21 627.22 627.23 627.24 627.25 627.26 627.27 627.28 627.29 627.30 627.31 627.32 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 628.32 629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 629.32 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 630.31 630.32 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 631.31 632.1 632.2 632.3 632.4
632.5 632.6 632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16 632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22
633.23 633.24 633.25 633.26 633.27 633.28 633.29 633.30 633.31 633.32 634.1 634.2 634.3 634.4 634.5 634.6 634.7 634.8 634.9 634.10 634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19 634.20 634.21
634.22 634.23 634.24 634.25 634.26 634.27 634.28 634.29 634.30 635.1 635.2 635.3 635.4 635.5 635.6 635.7 635.8 635.9
635.10 635.11 635.12
635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20
635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28
636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26 636.27 636.28 636.29 636.30 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16 637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 637.32 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 640.1 640.2 640.3 640.4
640.5 640.6 640.7 640.8 640.9
640.10 640.11 640.12
640.13 640.14 640.15 640.16
640.17 640.18 640.19 640.20 640.21 640.22 640.23
640.24 640.25 640.26 640.27
641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16 641.17 641.18 641.19 641.20 641.21 641.22
641.23 641.24 641.25 641.26 641.27
641.28 641.29 641.30 641.31 641.32 642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17 642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26 642.27 642.28 642.29 642.30 642.31 642.32 643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 643.31 643.32 644.1 644.2 644.3 644.4 644.5 644.6 644.7 644.8 644.9 644.10 644.11
644.12 644.13 644.14 644.15 644.16 644.17
644.18 644.19 644.20 644.21 644.22 644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 645.1 645.2 645.3 645.4 645.5 645.6 645.7 645.8 645.9 645.10 645.11 645.12 645.13 645.14
645.15 645.16 645.17 645.18 645.19 645.20 645.21 645.22 645.23 645.24 645.25 645.26 645.27 645.28 645.29 645.30 645.31 645.32 645.33 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18 646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28
646.29 646.30 646.31 646.32
647.1 647.2
647.3 647.4 647.5 647.6 647.7 647.8 647.9 647.10 647.11
647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 647.31 648.1 648.2 648.3 648.4 648.5 648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14 648.15 648.16 648.17 648.18 648.19 648.20 648.21 648.22 648.23 648.24 648.25 648.26 648.27 648.28 648.29 648.30 648.31 648.32 649.1 649.2 649.3 649.4 649.5
649.6 649.7 649.8 649.9 649.10 649.11 649.12 649.13 649.14 649.15 649.16 649.17 649.18 649.19 649.20 649.21 649.22 649.23 649.24 649.25 649.26 649.27 649.28 649.29 649.30 649.31 649.32 650.1 650.2 650.3 650.4 650.5 650.6 650.7 650.8 650.9 650.10 650.11 650.12 650.13 650.14 650.15 650.16 650.17 650.18 650.19 650.20 650.21 650.22 650.23 650.24 650.25 650.26 650.27 650.28 650.29 650.30 650.31 650.32 650.33 650.34 651.1 651.2 651.3 651.4 651.5 651.6 651.7 651.8 651.9 651.10 651.11 651.12 651.13 651.14 651.15 651.16 651.17 651.18 651.19 651.20 651.21 651.22 651.23 651.24 651.25 651.26 651.27 651.28 651.29 651.30 651.31 651.32 652.1 652.2 652.3 652.4 652.5 652.6 652.7 652.8 652.9 652.10 652.11 652.12 652.13 652.14 652.15 652.16 652.17 652.18 652.19 652.20 652.21 652.22 652.23 652.24 652.25 652.26 652.27 652.28 652.29 652.30 652.31 652.32 652.33 653.1 653.2 653.3 653.4 653.5 653.6 653.7 653.8 653.9 653.10 653.11 653.12 653.13 653.14 653.15 653.16
653.17 653.18 653.19 653.20 653.21 653.22 653.23 653.24 653.25 653.26 653.27 653.28 653.29 653.30 653.31 653.32 654.1 654.2 654.3 654.4 654.5 654.6 654.7 654.8 654.9 654.10 654.11 654.12 654.13 654.14 654.15 654.16 654.17 654.18 654.19 654.20 654.21 654.22 654.23 654.24 654.25 654.26 654.27 654.28 654.29 654.30 654.31 655.1 655.2 655.3 655.4 655.5 655.6 655.7 655.8 655.9 655.10 655.11 655.12 655.13 655.14 655.15 655.16 655.17 655.18 655.19 655.20 655.21 655.22 655.23 655.24 655.25 655.26 655.27 655.28 655.29 655.30 655.31 655.32 656.1 656.2 656.3 656.4
656.5 656.6 656.7 656.8 656.9 656.10 656.11 656.12 656.13 656.14 656.15 656.16 656.17 656.18 656.19 656.20 656.21 656.22 656.23 656.24 656.25 656.26 656.27 656.28 656.29 656.30 657.1 657.2 657.3 657.4 657.5 657.6 657.7 657.8 657.9 657.10 657.11 657.12 657.13 657.14 657.15 657.16 657.17 657.18 657.19 657.20 657.21 657.22 657.23 657.24 657.25 657.26 657.27 657.28 657.29 657.30 657.31 658.1 658.2 658.3 658.4 658.5 658.6 658.7 658.8 658.9 658.10 658.11 658.12 658.13 658.14 658.15 658.16 658.17 658.18 658.19 658.20 658.21 658.22 658.23 658.24 658.25 658.26 658.27 658.28 658.29 658.30 658.31 658.32 658.33 658.34 659.1 659.2 659.3 659.4 659.5 659.6 659.7 659.8 659.9 659.10 659.11 659.12 659.13 659.14 659.15 659.16 659.17 659.18 659.19 659.20 659.21 659.22 659.23 659.24 659.25 659.26 659.27 659.28 659.29 659.30 660.1 660.2 660.3 660.4 660.5 660.6 660.7 660.8 660.9 660.10 660.11 660.12 660.13 660.14 660.15 660.16 660.17 660.18 660.19 660.20 660.21 660.22 660.23 660.24 660.25 660.26 660.27 660.28 660.29 661.1 661.2 661.3 661.4 661.5 661.6 661.7 661.8 661.9 661.10 661.11 661.12 661.13 661.14 661.15 661.16 661.17 661.18 661.19 661.20 661.21 661.22 661.23 661.24 661.25 661.26 661.27 661.28
661.29 661.30 661.31 661.32 662.1 662.2 662.3 662.4 662.5 662.6 662.7 662.8 662.9 662.10 662.11 662.12 662.13 662.14 662.15 662.16 662.17 662.18 662.19 662.20 662.21 662.22 662.23 662.24 662.25 662.26 662.27 662.28 662.29 662.30 663.1 663.2 663.3 663.4 663.5 663.6 663.7 663.8 663.9 663.10 663.11 663.12 663.13 663.14 663.15 663.16 663.17 663.18 663.19 663.20 663.21 663.22 663.23 663.24 663.25 663.26 663.27 663.28 663.29 664.1 664.2 664.3 664.4 664.5 664.6 664.7 664.8 664.9 664.10 664.11 664.12 664.13 664.14 664.15 664.16 664.17 664.18 664.19 664.20 664.21 664.22 664.23 664.24 664.25 664.26 664.27 664.28 664.29 664.30 664.31 664.32 665.1 665.2 665.3 665.4
665.5 665.6 665.7 665.8 665.9 665.10 665.11 665.12 665.13 665.14 665.15 665.16 665.17 665.18 665.19 665.20 665.21 665.22 665.23 665.24 665.25 665.26 665.27 665.28 665.29 665.30 665.31 666.1 666.2 666.3 666.4 666.5 666.6 666.7 666.8 666.9 666.10 666.11 666.12 666.13 666.14 666.15 666.16 666.17 666.18 666.19 666.20 666.21 666.22 666.23 666.24 666.25 666.26 666.27 666.28
666.29 666.30 667.1 667.2 667.3 667.4 667.5 667.6 667.7 667.8 667.9 667.10 667.11 667.12 667.13 667.14 667.15 667.16 667.17 667.18 667.19
667.20 667.21 667.22 667.23 667.24 667.25 667.26 667.27 667.28 667.29 667.30 668.1 668.2 668.3 668.4 668.5 668.6 668.7 668.8 668.9 668.10 668.11 668.12 668.13 668.14 668.15 668.16 668.17 668.18 668.19 668.20 668.21 668.22 668.23 668.24 668.25 668.26 668.27 668.28 668.29 668.30 668.31 669.1 669.2 669.3 669.4 669.5 669.6 669.7 669.8
669.9 669.10 669.11 669.12 669.13 669.14 669.15 669.16 669.17 669.18 669.19 669.20 669.21 669.22 669.23 669.24 669.25 669.26 669.27 669.28 669.29 669.30 669.31 669.32 670.1 670.2 670.3 670.4 670.5 670.6 670.7 670.8 670.9 670.10 670.11 670.12 670.13 670.14 670.15
670.16 670.17 670.18 670.19 670.20 670.21 670.22 670.23 670.24 670.25 670.26 670.27 670.28 670.29 670.30 670.31 671.1 671.2 671.3 671.4 671.5 671.6 671.7 671.8 671.9 671.10 671.11 671.12 671.13 671.14 671.15 671.16 671.17 671.18 671.19 671.20 671.21 671.22 671.23 671.24 671.25 671.26 671.27 671.28 671.29 671.30 671.31 671.32 672.1 672.2 672.3 672.4 672.5 672.6 672.7 672.8 672.9 672.10 672.11 672.12 672.13 672.14 672.15 672.16 672.17 672.18 672.19 672.20 672.21 672.22 672.23 672.24 672.25 672.26 672.27 672.28 672.29 672.30 672.31 672.32 672.33 673.1 673.2 673.3 673.4 673.5 673.6 673.7 673.8 673.9 673.10 673.11 673.12 673.13 673.14 673.15 673.16 673.17 673.18 673.19 673.20 673.21 673.22 673.23 673.24 673.25 673.26 673.27 673.28 673.29 673.30 673.31 674.1 674.2 674.3 674.4 674.5 674.6 674.7 674.8 674.9 674.10 674.11 674.12 674.13 674.14 674.15 674.16 674.17 674.18 674.19 674.20 674.21 674.22 674.23 674.24 674.25 674.26 674.27 674.28 674.29 674.30 675.1 675.2 675.3 675.4 675.5 675.6 675.7 675.8 675.9 675.10 675.11 675.12 675.13 675.14 675.15 675.16 675.17 675.18 675.19 675.20 675.21 675.22 675.23 675.24 675.25 675.26 675.27 675.28 675.29 675.30 675.31 675.32 676.1 676.2 676.3 676.4 676.5 676.6 676.7 676.8 676.9 676.10 676.11 676.12 676.13 676.14 676.15 676.16 676.17 676.18 676.19 676.20 676.21 676.22 676.23 676.24 676.25 676.26 676.27 676.28 676.29 676.30 676.31 676.32 677.1 677.2 677.3 677.4 677.5 677.6 677.7 677.8 677.9 677.10 677.11 677.12 677.13 677.14 677.15 677.16 677.17 677.18 677.19 677.20 677.21 677.22 677.23 677.24 677.25 677.26 677.27 677.28 678.1 678.2 678.3
678.4 678.5 678.6 678.7 678.8 678.9 678.10 678.11 678.12 678.13 678.14 678.15 678.16 678.17 678.18 678.19 678.20 678.21 678.22 678.23 678.24 678.25 678.26 678.27 678.28 678.29 678.30 679.1 679.2 679.3 679.4 679.5 679.6 679.7 679.8 679.9 679.10 679.11 679.12 679.13 679.14 679.15 679.16 679.17 679.18 679.19 679.20 679.21 679.22 679.23 679.24 679.25 679.26 679.27 679.28 679.29 679.30 679.31 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 680.10 680.11 680.12 680.13 680.14 680.15 680.16 680.17
680.18 680.19 680.20 680.21 680.22 680.23 680.24 680.25 680.26 680.27 680.28 680.29 680.30 680.31 681.1 681.2 681.3 681.4 681.5 681.6 681.7 681.8 681.9 681.10 681.11 681.12 681.13 681.14 681.15 681.16 681.17 681.18 681.19 681.20 681.21 681.22 681.23 681.24 681.25 681.26 681.27 681.28 681.29 681.30 681.31 681.32 682.1 682.2 682.3 682.4 682.5 682.6 682.7 682.8 682.9 682.10 682.11 682.12 682.13 682.14 682.15 682.16 682.17 682.18
682.19 682.20 682.21 682.22 682.23 682.24
682.25 682.26 682.27 682.28 682.29 682.30 682.31 683.1 683.2 683.3 683.4 683.5 683.6 683.7 683.8 683.9 683.10 683.11 683.12 683.13 683.14 683.15 683.16 683.17 683.18 683.19 683.20 683.21 683.22 683.23 683.24 683.25 683.26 683.27 683.28 683.29 683.30 683.31 683.32 683.33 684.1 684.2 684.3 684.4 684.5 684.6 684.7 684.8 684.9 684.10 684.11 684.12 684.13 684.14 684.15 684.16 684.17 684.18 684.19 684.20 684.21 684.22 684.23 684.24 684.25 684.26 684.27 684.28 684.29 684.30 684.31 684.32 685.1 685.2 685.3 685.4 685.5 685.6 685.7 685.8 685.9 685.10 685.11 685.12 685.13 685.14 685.15 685.16 685.17 685.18 685.19 685.20 685.21 685.22 685.23 685.24 685.25 685.26 685.27 685.28 685.29 685.30 685.31 685.32 686.1 686.2 686.3 686.4 686.5 686.6 686.7 686.8 686.9 686.10 686.11 686.12 686.13 686.14 686.15 686.16 686.17 686.18 686.19 686.20 686.21 686.22 686.23 686.24 686.25 686.26 686.27 686.28 686.29 686.30 686.31 687.1 687.2 687.3 687.4 687.5 687.6 687.7 687.8 687.9 687.10 687.11 687.12 687.13 687.14 687.15 687.16 687.17 687.18 687.19 687.20 687.21 687.22 687.23 687.24 687.25 687.26 687.27 687.28 687.29 687.30 687.31 687.32 688.1 688.2 688.3 688.4 688.5 688.6 688.7 688.8 688.9 688.10 688.11 688.12 688.13 688.14 688.15 688.16 688.17 688.18 688.19 688.20 688.21 688.22 688.23 688.24 688.25 688.26 688.27 688.28 688.29 688.30 688.31 689.1 689.2 689.3 689.4 689.5 689.6 689.7 689.8 689.9 689.10 689.11 689.12 689.13 689.14 689.15 689.16 689.17 689.18 689.19 689.20 689.21 689.22 689.23 689.24 689.25 689.26 689.27 689.28 689.29 689.30 689.31 689.32 689.33 689.34 690.1 690.2 690.3 690.4 690.5 690.6 690.7 690.8 690.9 690.10 690.11 690.12 690.13
690.14 690.15 690.16 690.17 690.18 690.19 690.20 690.21 690.22 690.23 690.24 690.25 690.26 690.27 690.28 690.29 690.30 690.31 690.32 690.33 691.1 691.2 691.3 691.4 691.5 691.6 691.7 691.8 691.9 691.10 691.11 691.12 691.13 691.14 691.15 691.16 691.17 691.18 691.19 691.20 691.21 691.22 691.23 691.24 691.25 691.26 691.27 691.28 691.29 691.30 691.31 692.1 692.2 692.3 692.4 692.5 692.6 692.7 692.8 692.9 692.10 692.11 692.12 692.13 692.14 692.15 692.16 692.17 692.18 692.19 692.20 692.21 692.22 692.23 692.24 692.25 692.26 692.27 692.28 692.29 693.1 693.2 693.3 693.4 693.5 693.6 693.7 693.8 693.9 693.10 693.11 693.12 693.13 693.14 693.15 693.16 693.17 693.18 693.19 693.20 693.21 693.22 693.23 693.24 693.25 693.26 693.27 693.28 693.29 693.30 693.31 693.32 693.33 693.34 694.1 694.2 694.3 694.4 694.5 694.6 694.7 694.8 694.9 694.10 694.11 694.12 694.13 694.14 694.15 694.16 694.17 694.18 694.19 694.20 694.21 694.22 694.23 694.24 694.25 694.26 694.27 694.28 694.29 694.30 694.31 694.32 694.33 695.1 695.2 695.3 695.4 695.5 695.6 695.7 695.8 695.9 695.10 695.11 695.12 695.13 695.14 695.15 695.16 695.17 695.18 695.19 695.20 695.21 695.22 695.23 695.24 695.25 695.26 695.27 695.28 695.29 695.30 695.31 696.1 696.2 696.3 696.4 696.5 696.6 696.7 696.8 696.9 696.10 696.11 696.12 696.13 696.14 696.15 696.16 696.17 696.18 696.19 696.20 696.21 696.22 696.23 696.24 696.25 696.26 696.27 696.28 696.29 696.30 696.31 696.32 696.33 696.34 697.1 697.2 697.3 697.4 697.5 697.6 697.7 697.8 697.9 697.10 697.11 697.12 697.13 697.14 697.15 697.16 697.17 697.18 697.19 697.20 697.21 697.22 697.23 697.24 697.25 697.26 697.27 697.28 697.29 697.30 697.31 697.32 698.1 698.2 698.3 698.4 698.5 698.6 698.7 698.8 698.9 698.10 698.11 698.12 698.13 698.14 698.15 698.16 698.17 698.18 698.19 698.20 698.21 698.22 698.23 698.24 698.25 698.26 698.27 698.28 698.29 698.30 698.31 699.1 699.2 699.3 699.4 699.5 699.6 699.7 699.8 699.9 699.10 699.11 699.12 699.13 699.14 699.15 699.16 699.17 699.18 699.19 699.20 699.21 699.22 699.23 699.24 699.25 699.26 699.27 699.28 699.29 699.30 699.31 700.1 700.2 700.3 700.4 700.5 700.6 700.7 700.8 700.9 700.10 700.11 700.12 700.13 700.14 700.15 700.16 700.17 700.18 700.19 700.20 700.21 700.22 700.23 700.24 700.25 700.26 700.27 700.28 700.29 700.30 700.31 700.32 701.1 701.2 701.3 701.4 701.5 701.6 701.7 701.8 701.9 701.10 701.11 701.12 701.13 701.14 701.15 701.16 701.17 701.18 701.19 701.20 701.21 701.22 701.23 701.24 701.25 701.26 701.27 701.28 701.29 701.30 701.31 702.1 702.2 702.3 702.4 702.5 702.6 702.7 702.8 702.9 702.10 702.11 702.12 702.13 702.14 702.15 702.16 702.17 702.18 702.19 702.20 702.21 702.22 702.23 702.24 702.25 702.26 702.27
702.28 702.29 702.30 703.1 703.2 703.3 703.4 703.5 703.6 703.7 703.8 703.9 703.10 703.11 703.12 703.13 703.14 703.15 703.16 703.17 703.18 703.19 703.20 703.21 703.22 703.23 703.24 703.25 703.26 703.27 703.28 703.29 703.30 703.31 703.32 704.1 704.2 704.3 704.4 704.5 704.6 704.7 704.8 704.9 704.10 704.11 704.12 704.13 704.14 704.15 704.16 704.17 704.18 704.19 704.20 704.21 704.22 704.23 704.24 704.25 704.26 704.27 704.28 704.29 704.30 704.31 704.32 705.1 705.2 705.3 705.4 705.5 705.6 705.7 705.8 705.9 705.10 705.11 705.12 705.13 705.14 705.15 705.16 705.17 705.18 705.19 705.20 705.21 705.22 705.23 705.24 705.25 705.26 705.27 705.28 705.29 705.30 705.31 706.1 706.2 706.3 706.4 706.5 706.6 706.7 706.8 706.9 706.10 706.11 706.12 706.13 706.14 706.15 706.16 706.17 706.18 706.19 706.20 706.21 706.22 706.23 706.24 706.25 706.26 706.27 706.28 706.29 706.30 706.31 706.32 706.33 707.1 707.2 707.3 707.4 707.5 707.6 707.7 707.8 707.9 707.10 707.11 707.12 707.13 707.14 707.15 707.16 707.17 707.18 707.19 707.20 707.21 707.22 707.23 707.24 707.25 707.26 707.27 707.28 707.29 707.30 708.1 708.2 708.3 708.4 708.5 708.6 708.7 708.8 708.9 708.10 708.11 708.12 708.13 708.14 708.15 708.16 708.17 708.18 708.19 708.20 708.21 708.22 708.23 708.24 708.25 708.26 708.27 708.28 708.29 708.30 708.31 708.32 709.1 709.2 709.3 709.4 709.5 709.6 709.7 709.8 709.9 709.10 709.11 709.12 709.13 709.14 709.15 709.16 709.17 709.18 709.19 709.20 709.21 709.22 709.23 709.24 709.25 709.26 709.27 709.28 709.29 709.30 709.31 709.32 710.1 710.2 710.3 710.4 710.5 710.6 710.7 710.8 710.9 710.10 710.11 710.12 710.13 710.14 710.15 710.16 710.17 710.18 710.19 710.20 710.21 710.22 710.23 710.24 710.25 710.26 710.27 710.28 710.29 710.30 711.1 711.2 711.3 711.4 711.5 711.6 711.7 711.8 711.9 711.10 711.11 711.12 711.13 711.14 711.15 711.16 711.17 711.18 711.19 711.20 711.21 711.22 711.23 711.24 711.25 711.26 711.27 711.28 711.29 712.1 712.2 712.3 712.4 712.5 712.6 712.7 712.8 712.9 712.10 712.11 712.12 712.13 712.14 712.15 712.16 712.17 712.18 712.19 712.20 712.21 712.22 712.23 712.24 712.25 712.26 712.27 712.28 712.29 712.30 712.31 712.32 713.1 713.2 713.3 713.4 713.5 713.6 713.7 713.8 713.9 713.10 713.11 713.12 713.13 713.14 713.15 713.16 713.17 713.18 713.19 713.20 713.21 713.22 713.23 713.24 713.25 713.26 713.27 713.28 713.29 713.30 713.31 713.32 713.33 713.34 713.35 714.1 714.2 714.3 714.4 714.5 714.6 714.7 714.8 714.9 714.10 714.11 714.12 714.13 714.14 714.15 714.16 714.17
714.18 714.19 714.20 714.21 714.22 714.23 714.24 714.25 714.26 714.27
714.28 714.29 714.30 714.31
715.1 715.2
715.3 715.4 715.5 715.6 715.7 715.8 715.9 715.10 715.11 715.12 715.13 715.14 715.15 715.16 715.17 715.18 715.19 715.20 715.21 715.22 715.23 715.24 715.25
715.26 715.27 715.28 715.29 715.30 715.31 716.1 716.2 716.3 716.4 716.5 716.6 716.7 716.8 716.9 716.10 716.11 716.12 716.13 716.14 716.15 716.16 716.17 716.18 716.19 716.20 716.21 716.22 716.23 716.24 716.25 716.26 716.27 716.28 716.29 716.30 716.31 716.32
717.1 717.2 717.3 717.4 717.5 717.6 717.7 717.8 717.9 717.10 717.11 717.12 717.13 717.14 717.15 717.16 717.17 717.18 717.19 717.20
717.21 717.22 717.23 717.24 717.25 717.26 717.27 717.28 717.29 717.30 717.31 717.32 718.1 718.2 718.3 718.4 718.5 718.6 718.7 718.8 718.9 718.10 718.11 718.12 718.13 718.14 718.15 718.16 718.17 718.18 718.19 718.20 718.21 718.22 718.23 718.24 718.25 718.26 718.27 718.28 718.29 718.30 718.31 718.32 718.33 719.1 719.2 719.3 719.4 719.5 719.6 719.7 719.8 719.9 719.10 719.11 719.12 719.13 719.14 719.15 719.16 719.17 719.18 719.19 719.20 719.21 719.22 719.23 719.24 719.25 719.26 719.27 719.28 719.29 719.30 719.31 719.32 720.1 720.2 720.3 720.4 720.5 720.6 720.7 720.8 720.9 720.10 720.11 720.12 720.13 720.14 720.15 720.16 720.17 720.18 720.19 720.20 720.21 720.22 720.23 720.24 720.25 720.26 720.27 720.28 720.29 720.30 721.1 721.2 721.3 721.4 721.5 721.6 721.7 721.8 721.9 721.10 721.11 721.12 721.13 721.14 721.15 721.16 721.17 721.18 721.19 721.20 721.21 721.22 721.23 721.24 721.25 721.26 721.27 721.28 721.29 721.30 722.1 722.2 722.3 722.4 722.5 722.6 722.7 722.8 722.9 722.10 722.11 722.12 722.13 722.14 722.15 722.16 722.17 722.18 722.19 722.20 722.21 722.22 722.23 722.24 722.25 722.26 722.27 722.28 722.29 722.30 723.1 723.2 723.3 723.4 723.5 723.6 723.7 723.8 723.9 723.10 723.11 723.12 723.13 723.14 723.15 723.16 723.17 723.18 723.19 723.20 723.21 723.22 723.23 723.24 723.25 723.26 723.27 723.28 723.29 723.30 723.31 723.32 724.1 724.2 724.3 724.4 724.5 724.6 724.7 724.8 724.9 724.10 724.11 724.12 724.13 724.14 724.15 724.16 724.17 724.18 724.19 724.20 724.21 724.22 724.23 724.24 724.25 724.26 724.27 724.28 724.29 724.30 724.31 724.32 725.1 725.2 725.3 725.4 725.5 725.6 725.7 725.8 725.9 725.10 725.11 725.12 725.13 725.14 725.15 725.16 725.17 725.18 725.19 725.20 725.21 725.22 725.23 725.24 725.25 725.26 725.27 725.28 725.29 725.30 725.31 725.32 725.33 726.1 726.2 726.3 726.4 726.5 726.6 726.7 726.8 726.9 726.10 726.11 726.12 726.13 726.14 726.15 726.16 726.17 726.18 726.19 726.20 726.21 726.22 726.23 726.24 726.25 726.26 726.27 726.28 726.29 726.30 726.31 726.32 726.33 726.34 727.1 727.2 727.3 727.4 727.5 727.6 727.7 727.8 727.9 727.10 727.11 727.12 727.13 727.14 727.15 727.16 727.17 727.18 727.19 727.20 727.21 727.22 727.23 727.24 727.25 727.26 727.27 727.28 727.29 727.30 727.31 727.32 727.33 728.1 728.2 728.3 728.4 728.5 728.6 728.7 728.8 728.9 728.10 728.11 728.12 728.13 728.14 728.15 728.16 728.17 728.18 728.19 728.20 728.21 728.22 728.23 728.24 728.25 728.26 728.27 728.28 728.29 728.30 728.31 729.1 729.2 729.3 729.4 729.5 729.6 729.7 729.8 729.9 729.10 729.11 729.12 729.13 729.14 729.15 729.16 729.17 729.18 729.19 729.20 729.21 729.22 729.23 729.24 729.25 729.26 729.27 729.28 729.29 729.30 729.31 730.1 730.2 730.3 730.4 730.5 730.6 730.7 730.8 730.9 730.10 730.11 730.12 730.13 730.14 730.15 730.16 730.17 730.18 730.19 730.20 730.21 730.22 730.23 730.24 730.25 730.26 730.27 730.28 730.29 730.30 731.1 731.2 731.3 731.4 731.5 731.6 731.7 731.8 731.9 731.10 731.11 731.12 731.13 731.14 731.15 731.16 731.17 731.18 731.19 731.20 731.21 731.22 731.23 731.24 731.25 731.26 731.27 731.28 731.29 731.30 731.31 731.32 732.1 732.2 732.3 732.4 732.5 732.6 732.7 732.8 732.9 732.10 732.11 732.12
732.13 732.14 732.15 732.16
732.17 732.18 732.19
732.20 732.21 732.22 732.23 732.24 732.25 732.26 732.27 732.28 732.29 732.30
733.1 733.2 733.3 733.4 733.5 733.6 733.7 733.8 733.9 733.10 733.11 733.12 733.13 733.14 733.15
733.16 733.17 733.18 733.19 733.20 733.21 733.22 733.23 733.24 733.25 733.26 733.27 733.28 733.29
734.1 734.2 734.3 734.4 734.5 734.6 734.7 734.8 734.9 734.10 734.11 734.12 734.13 734.14 734.15 734.16 734.17 734.18 734.19
734.20 734.21 734.22 734.23 734.24 734.25 734.26 734.27 734.28 734.29 734.30 734.31 734.32 735.1 735.2 735.3 735.4 735.5 735.6 735.7 735.8 735.9 735.10 735.11 735.12 735.13 735.14 735.15 735.16 735.17 735.18 735.19
735.20 735.21 735.22 735.23 735.24 735.25 735.26 735.27 735.28 735.29 735.30 735.31 736.1 736.2 736.3 736.4 736.5 736.6 736.7 736.8 736.9 736.10 736.11 736.12 736.13 736.14 736.15 736.16 736.17 736.18 736.19 736.20 736.21 736.22 736.23 736.24 736.25 736.26 736.27 736.28 736.29
736.30 736.31 736.32 737.1 737.2 737.3 737.4 737.5 737.6 737.7 737.8 737.9 737.10 737.11 737.12 737.13 737.14 737.15 737.16 737.17 737.18 737.19 737.20 737.21 737.22
737.23 737.24 737.25 737.26 737.27 737.28 737.29 737.30 737.31 737.32 737.33 738.1 738.2 738.3 738.4 738.5 738.6 738.7 738.8 738.9 738.10 738.11 738.12 738.13 738.14 738.15 738.16 738.17 738.18 738.19 738.20 738.21 738.22 738.23 738.24
738.25 738.26 738.27 738.28 738.29 738.30 738.31 738.32 738.33 739.1 739.2 739.3 739.4 739.5 739.6 739.7 739.8 739.9 739.10 739.11 739.12 739.13 739.14 739.15 739.16 739.17 739.18 739.19
739.20 739.21 739.22
739.23 739.24 739.25 739.26 739.27 739.28 739.29 739.30 739.31 739.32 740.1 740.2 740.3 740.4 740.5 740.6
740.7 740.8 740.9 740.10 740.11 740.12 740.13 740.14 740.15 740.16 740.17 740.18 740.19 740.20 740.21 740.22 740.23 740.24 740.25 740.26
740.27 740.28 740.29 740.30 740.31 740.32 741.1 741.2 741.3 741.4 741.5 741.6 741.7 741.8 741.9 741.10 741.11 741.12 741.13 741.14 741.15 741.16 741.17 741.18 741.19 741.20 741.21 741.22 741.23 741.24 741.25 741.26 741.27
741.28 741.29 741.30 741.31 741.32 742.1 742.2 742.3 742.4
742.5 742.6 742.7 742.8 742.9
742.10 742.11 742.12 742.13 742.14 742.15 742.16 742.17 742.18 742.19 742.20 742.21 742.22 742.23 742.24 742.25 742.26 742.27 742.28 742.29 742.30 742.31 743.1 743.2 743.3 743.4 743.5 743.6 743.7 743.8 743.9 743.10 743.11 743.12 743.13 743.14 743.15 743.16 743.17 743.18 743.19 743.20 743.21 743.22 743.23 743.24 743.25 743.26 743.27 743.28 743.29 743.30 743.31 743.32 744.1 744.2 744.3 744.4 744.5 744.6 744.7 744.8 744.9 744.10 744.11 744.12 744.13 744.14 744.15 744.16 744.17 744.18 744.19 744.20 744.21 744.22
744.23 744.24 744.25 744.26 744.27 744.28 744.29 744.30 744.31 744.32 745.1 745.2 745.3 745.4 745.5 745.6 745.7 745.8 745.9 745.10 745.11 745.12 745.13 745.14 745.15 745.16 745.17 745.18 745.19 745.20 745.21 745.22 745.23 745.24
745.25 745.26 745.27 745.28 745.29 745.30 745.31
746.1 746.2 746.3 746.4 746.5 746.6 746.7
746.8 746.9 746.10 746.11
746.12 746.13 746.14 746.15 746.16 746.17 746.18 746.19 746.20 746.21 746.22 746.23 746.24 746.25 746.26
746.27 746.28 746.29 746.30 746.31 747.1 747.2 747.3 747.4 747.5 747.6 747.7
747.8 747.9 747.10 747.11 747.12 747.13 747.14 747.15 747.16 747.17 747.18 747.19 747.20 747.21 747.22
747.23 747.24 747.25 747.26 747.27 747.28 747.29 747.30 747.31 747.32 747.33 748.1 748.2 748.3 748.4 748.5 748.6 748.7 748.8
748.9 748.10 748.11 748.12 748.13 748.14 748.15 748.16 748.17 748.18 748.19 748.20 748.21 748.22 748.23 748.24 748.25 748.26 748.27 748.28 748.29 748.30 748.31 748.32
749.1 749.2 749.3 749.4 749.5 749.6 749.7 749.8 749.9 749.10 749.11 749.12 749.13 749.14 749.15 749.16 749.17 749.18 749.19 749.20 749.21 749.22 749.23 749.24 749.25 749.26 749.27 749.28 749.29
750.1 750.2 750.3 750.4 750.5 750.6 750.7 750.8 750.9
750.10 750.11 750.12 750.13 750.14 750.15 750.16 750.17 750.18 750.19 750.20 750.21 750.22 750.23 750.24 750.25 750.26 750.27 750.28 750.29 750.30 750.31 750.32 751.1 751.2 751.3 751.4 751.5 751.6
751.7 751.8 751.9 751.10 751.11 751.12 751.13 751.14 751.15 751.16 751.17 751.18 751.19 751.20 751.21 751.22 751.23 751.24
751.25 751.26 751.27 751.28 751.29 751.30 751.31 752.1 752.2 752.3 752.4 752.5 752.6 752.7 752.8 752.9 752.10 752.11 752.12 752.13 752.14 752.15 752.16 752.17 752.18 752.19
752.20 752.21 752.22 752.23 752.24 752.25 752.26 752.27 752.28 752.29 752.30 752.31 752.32 753.1 753.2 753.3 753.4 753.5 753.6 753.7 753.8 753.9 753.10 753.11 753.12 753.13 753.14 753.15 753.16 753.17
753.18 753.19 753.20 753.21 753.22 753.23 753.24 753.25 753.26 753.27 753.28 753.29 753.30 753.31 754.1 754.2 754.3 754.4 754.5 754.6
754.7 754.8 754.9 754.10 754.11 754.12 754.13 754.14 754.15 754.16 754.17
754.18 754.19 754.20 754.21
754.22 754.23 754.24 754.25 754.26 754.27 754.28 754.29 754.30 754.31 755.1 755.2 755.3 755.4 755.5 755.6 755.7 755.8 755.9 755.10 755.11 755.12 755.13 755.14 755.15 755.16 755.17 755.18 755.19 755.20 755.21 755.22 755.23 755.24 755.25 755.26 755.27 755.28 755.29
755.30 755.31 755.32 755.33 756.1 756.2 756.3
756.4 756.5 756.6 756.7 756.8 756.9 756.10 756.11 756.12 756.13 756.14 756.15 756.16 756.17 756.18 756.19
756.20 756.21 756.22 756.23 756.24 756.25 756.26
756.27 756.28 756.29 756.30 756.31 756.32 756.33
757.1 757.2 757.3 757.4
757.5 757.6 757.7 757.8 757.9 757.10 757.11 757.12 757.13 757.14 757.15 757.16 757.17 757.18 757.19
757.20 757.21 757.22 757.23 757.24 757.25 757.26 757.27 757.28 757.29 757.30 757.31 757.32 757.33 758.1 758.2 758.3 758.4 758.5 758.6 758.7 758.8 758.9
758.10 758.11 758.12 758.13 758.14 758.15 758.16 758.17 758.18 758.19 758.20 758.21 758.22 758.23 758.24 758.25 758.26 758.27 758.28 758.29 758.30 758.31 758.32 759.1 759.2
759.3 759.4 759.5 759.6 759.7 759.8 759.9 759.10 759.11 759.12 759.13 759.14 759.15 759.16 759.17
759.18 759.19 759.20 759.21
759.22 759.23 759.24 759.25 759.26 759.27 759.28 759.29 759.30 760.1 760.2 760.3 760.4 760.5 760.6 760.7 760.8 760.9 760.10 760.11 760.12 760.13 760.14 760.15 760.16
760.17 760.18 760.19 760.21 760.20 760.22 760.23 760.24 760.25 760.26 760.27 760.28 760.29 760.30 760.31 760.32 760.33 760.34 761.1 761.2 761.3 761.4 761.5 761.6 761.7 761.8 761.9 761.10 761.11 761.12 761.13 761.14 761.15 761.16 761.17 761.18 761.19 761.20 761.21 761.22 761.23 761.24 761.25 761.26 761.27 761.28 761.29 761.30 761.31 761.32 761.33 761.34 761.35 761.36 761.37 761.38 761.39 761.40 761.41 761.42 761.43 762.1 762.2 762.3 762.4 762.5 762.6 762.7 762.8 762.9 762.10 762.11 762.12 762.13 762.14 762.15 762.16 762.17 762.18 762.19 762.20 762.21 762.22 762.23 762.24 762.25 762.26 762.27 762.28 762.29 762.30 762.31 762.32 762.33 762.34 762.35 762.36 762.37 763.1 763.2 763.3 763.4 763.5 763.6 763.7 763.8 763.9 763.10 763.11 763.12 763.13 763.14 763.15 763.16 763.17 763.18 763.19 763.20 763.21 763.22 763.23 763.24 763.25 763.26 763.27 763.28 763.29 763.30 763.31 763.32 763.33 763.34 764.1 764.2 764.3 764.4 764.5 764.6 764.7 764.8 764.9 764.10 764.11 764.12 764.13 764.14 764.15 764.16 764.17 764.18 764.19 764.20 764.21 764.22 764.23 764.24 764.25 764.26 764.27 764.28
764.29 764.30 764.31 764.32 765.1 765.2 765.3 765.4 765.5 765.6 765.7 765.8 765.9 765.10 765.11 765.12 765.13 765.14 765.15 765.16 765.17 765.18 765.19 765.20 765.21 765.22 765.23 765.24 765.25 765.26 765.27 765.28 765.29 765.30 765.31 765.32 765.33 766.1 766.2 766.3 766.4 766.5 766.6 766.7 766.8 766.9 766.10 766.11 766.12 766.13 766.14 766.15 766.16 766.17 766.18 766.19 766.20
766.21 766.22 766.23 766.24 766.25
766.26 766.27 766.28 766.29 766.30 766.31
767.1 767.2 767.3 767.4 767.5 767.6 767.7 767.8 767.9 767.10
767.11 767.12 767.13 767.14 767.15 767.16 767.17 767.18
767.19 767.20 767.21 767.22
767.23 767.24 767.25 767.26 767.27 767.28 767.29 767.30 767.31 768.1 768.2
768.3 768.4 768.5 768.6 768.7 768.8 768.9 768.10 768.11 768.12 768.13
768.14 768.15 768.16 768.17 768.18 768.19 768.20 768.21 768.22 768.23 768.24 768.25 768.26 768.27 768.28 768.29 768.30 768.31 769.1 769.2 769.3 769.4 769.5 769.6 769.7 769.8 769.9 769.10 769.11 769.12 769.13 769.14 769.15 769.16 769.17 769.18 769.19 769.20 769.21 769.22 769.23 769.24 769.25 769.26 769.27 769.28 769.29 769.30 769.31 769.32 769.33 769.34 770.1 770.2 770.3 770.4 770.5 770.6 770.7 770.8 770.9 770.10 770.11 770.12 770.13 770.14 770.15 770.16 770.17 770.18 770.19 770.20 770.21 770.22 770.23 770.24 770.25 770.26 770.27 770.28 770.29 770.30 770.31 770.32 771.1 771.2 771.3 771.4 771.5 771.6 771.7 771.8 771.9 771.10 771.11 771.12 771.13 771.14 771.15 771.16 771.17 771.18 771.19 771.20 771.21 771.22 771.23 771.24 771.25 771.26 771.27 771.28 771.29 771.30 771.31 771.32 771.33 772.1 772.2 772.3 772.4 772.5 772.6
772.7 772.8 772.9 772.10 772.11 772.12 772.13 772.14 772.15 772.16 772.17 772.18 772.19 772.20 772.21 772.22 772.23 772.24 772.25 772.26 772.27 772.28 772.29 772.30 773.1 773.2 773.3 773.4 773.5 773.6 773.7 773.8 773.9 773.10 773.11 773.12
773.13 773.14 773.15 773.16 773.17 773.18 773.19 773.20 773.21 773.22 773.23 773.24 773.25 773.26 773.27 773.28 773.29 773.30 773.31 773.32 774.1 774.2
774.3 774.4 774.5 774.6 774.7 774.8 774.9 774.10 774.11 774.12 774.13 774.14 774.15 774.16 774.17 774.18 774.19 774.20 774.21 774.22 774.23 774.24 774.25 774.26 774.27 774.28 774.29 774.30 774.31 774.32 774.33 775.1 775.2 775.3 775.4 775.5 775.6 775.7 775.8 775.9 775.10 775.11 775.12 775.13 775.14 775.15 775.16 775.17 775.18 775.19 775.20 775.21 775.22 775.23 775.24 775.25 775.26 775.27 775.28 775.29 775.30 775.31 775.32 776.1 776.2 776.3 776.4 776.5 776.6 776.7 776.8
776.9 776.10 776.11 776.12 776.13 776.14 776.15 776.16 776.17 776.18 776.19 776.20 776.21 776.22 776.23 776.24 776.25 776.26 776.27 776.28 776.29 776.30 776.31 776.32 777.1 777.2 777.3 777.4 777.5 777.6 777.7 777.8 777.9 777.10 777.11 777.12 777.13 777.14 777.15 777.16 777.17 777.18 777.19 777.20 777.21 777.22 777.23 777.24 777.25 777.26 777.27 777.28 777.29 777.30 777.31 777.32 777.33 778.1 778.2 778.3 778.4 778.5 778.6 778.7 778.8 778.9 778.10 778.11 778.12 778.13 778.14 778.15 778.16 778.17 778.18 778.19 778.20 778.21 778.22 778.23 778.24 778.25 778.26 778.27 778.28 778.29 778.30 778.31 778.32 779.1 779.2 779.3 779.4 779.5 779.6 779.7 779.8 779.9 779.10 779.11 779.12 779.13 779.14 779.15 779.16 779.17 779.18 779.19 779.20 779.21 779.22 779.23 779.24 779.25 779.26 779.27 779.28 779.29 779.30 779.31 779.32 779.33 780.1 780.2 780.3 780.4 780.5 780.6 780.7 780.8
780.9 780.10 780.11 780.12 780.13 780.14 780.15 780.16 780.17 780.18 780.19 780.20 780.21 780.22 780.23 780.24 780.25 780.26 780.27 780.28 780.29 780.30 780.31 780.32 781.1 781.2 781.3 781.4 781.5 781.6 781.7 781.8 781.9 781.10 781.11 781.12 781.13 781.14 781.15 781.16 781.17 781.18 781.19 781.20 781.21 781.22 781.23 781.24 781.25 781.26 781.27 781.28 781.29 781.30 781.31 781.32 782.1 782.2 782.3 782.4 782.5 782.6 782.7 782.8 782.9 782.10 782.11 782.12 782.13 782.14 782.15 782.16 782.17 782.18 782.19 782.20 782.21 782.22 782.23 782.24 782.25 782.26 782.27 782.28 782.29 782.30 782.31 782.32
783.1 783.2 783.3 783.4 783.5 783.6 783.7 783.8 783.9 783.10 783.11 783.12 783.13 783.14 783.15 783.16 783.17 783.18 783.19 783.20 783.21 783.22 783.23 783.24 783.25 783.26 783.27 783.28 783.29 783.30 783.31 783.32 783.33 784.1 784.2 784.3 784.4 784.5 784.6 784.7 784.8 784.9 784.10 784.11 784.12 784.13 784.14 784.15 784.16 784.17 784.18 784.19 784.20 784.21 784.22 784.23 784.24 784.25 784.26 784.27 784.28 784.29 784.30 784.31 784.32 784.33 785.1 785.2 785.3 785.4 785.5 785.6
785.7 785.8 785.9 785.10 785.11 785.12 785.13 785.14 785.15 785.16 785.17
785.18 785.19 785.20 785.21 785.22 785.23 785.24 785.25 785.26 785.27 785.28 785.29 785.30 785.31 785.32 785.33 786.1 786.2 786.3 786.4 786.5 786.6 786.7 786.8 786.9 786.10 786.11 786.12 786.13 786.14 786.15
786.16 786.17 786.18 786.19 786.20 786.21 786.22 786.23 786.24 786.25 786.26 786.27
786.28 786.29 786.30 787.1 787.2 787.3 787.4 787.5 787.6 787.7 787.8 787.9 787.10 787.11 787.12 787.13 787.14 787.15 787.16 787.17 787.18 787.19 787.20 787.21 787.22 787.23 787.24 787.25 787.26 787.27 787.28 787.29 787.30 787.31 787.32 788.1 788.2 788.3 788.4 788.5 788.6 788.7 788.8 788.9 788.10 788.11 788.12 788.13 788.14 788.15 788.16 788.17 788.18 788.19 788.20
788.21 788.22 788.23 788.24 788.25 788.26 788.27 788.28 788.29 788.30 789.1 789.2 789.3 789.4 789.5 789.6 789.7 789.8 789.9 789.10 789.11 789.12 789.13 789.14 789.15 789.16 789.17 789.18 789.19 789.20 789.21 789.22 789.23 789.24 789.25 789.26 789.27 789.28 789.29 789.30 789.31 789.32 790.1 790.2 790.3 790.4 790.5 790.6 790.7 790.8 790.9 790.10 790.11 790.12 790.13 790.14 790.15 790.16 790.17 790.18 790.19 790.20 790.21 790.22 790.23 790.24 790.25 790.26 790.27 790.28
790.29 790.30 790.31 791.1 791.2 791.3 791.4 791.5 791.6 791.7 791.8 791.9 791.10 791.11 791.12 791.13 791.14 791.15 791.16 791.17 791.18 791.19 791.20 791.21 791.22 791.23 791.24 791.25 791.26 791.27 791.28 791.29 791.30 791.31 791.32 792.1 792.2 792.3 792.4 792.5 792.6 792.7 792.8 792.9 792.10 792.11 792.12 792.13 792.14 792.15 792.16 792.17 792.18 792.19 792.20 792.21 792.22 792.23 792.24 792.25 792.26 792.27 792.28 792.29 792.30 792.31 792.32 792.33 793.1 793.2 793.3
793.4 793.5 793.6 793.7 793.8 793.9 793.10 793.11 793.12 793.13 793.14 793.15 793.16 793.17
793.18 793.19 793.20 793.21 793.22 793.23 793.24 793.25 793.26 793.27 793.28 793.29 793.30 793.31 793.32 794.1 794.2 794.3 794.4 794.5 794.6 794.7 794.8 794.9 794.10 794.11 794.12 794.13 794.14 794.15 794.16 794.17 794.18
794.19 794.20 794.21 794.22 794.23 794.24 794.25 794.26 794.27 794.28 794.29 794.30 794.31 794.32 794.33 795.1 795.2 795.3 795.4 795.5 795.6 795.7 795.8 795.9 795.10 795.11 795.12 795.13 795.14 795.15 795.16 795.17 795.18 795.19 795.20 795.21 795.22 795.23 795.24 795.25 795.26 795.27 795.28 795.29 795.30 795.31 795.32 796.1 796.2 796.3 796.4 796.5 796.6 796.7 796.8 796.9 796.10 796.11 796.12 796.13 796.14
796.15 796.16 796.17 796.18 796.19 796.20 796.21 796.22 796.23 796.24 796.25 796.26 796.27 796.28 796.29 796.30 796.31 796.32 796.33 797.1 797.2 797.3 797.4 797.5 797.6 797.7 797.8 797.9 797.10 797.11 797.12 797.13 797.14 797.15 797.16 797.17 797.18 797.19 797.20 797.21 797.22 797.23 797.24 797.25 797.26 797.27 797.28 797.29 797.30 797.31 797.32 797.33 798.1 798.2
798.3 798.4
798.5 798.6 798.7 798.8 798.9 798.10 798.11 798.12 798.13 798.14 798.15 798.16
798.17 798.18 798.19 798.20 798.21 798.22 798.23 798.24 798.25 798.26 798.27 798.28 798.29 798.30
799.1 799.2 799.3 799.4 799.5 799.6
799.7 799.8 799.9 799.10 799.11 799.12 799.13 799.14 799.15 799.16 799.17 799.18 799.19
799.20 799.21 799.22 799.23 799.24 799.25 799.26 799.27 799.28 799.29 799.30 799.31 799.32 800.1 800.2 800.3 800.4 800.5 800.6 800.7 800.8
800.9 800.10 800.11 800.12 800.13 800.14 800.15 800.16 800.17 800.18 800.19 800.20 800.21 800.22 800.23 800.24 800.25 800.26 800.27 800.28 800.29 800.30 800.31 801.1 801.2 801.3 801.4 801.5 801.6 801.7 801.8 801.9 801.10 801.11 801.12 801.13 801.14 801.15 801.16 801.17 801.18 801.19 801.20 801.21 801.22 801.23 801.24 801.25 801.26 801.27
801.28 801.29 801.30 801.31 802.1 802.2 802.3 802.4 802.5 802.6 802.7 802.8 802.9 802.10 802.11 802.12 802.13 802.14 802.15 802.16 802.17 802.18 802.19 802.20 802.21 802.22 802.23 802.24 802.25
802.26 802.27 802.28 802.29 802.30 803.1 803.2 803.3 803.4 803.5 803.6 803.7 803.8 803.9 803.10 803.11 803.12 803.13 803.14 803.15 803.16 803.17 803.18 803.19 803.20 803.21 803.22 803.23 803.24 803.25 803.26
803.27 803.28 803.29 803.30 803.31 803.32 803.33 804.1 804.2 804.3 804.4 804.5 804.6 804.7 804.8 804.9 804.10 804.11 804.12 804.13 804.14 804.15 804.16 804.17 804.18 804.19 804.20 804.21 804.22 804.23 804.24 804.25 804.26 804.27 804.28 804.29 804.30 804.31 804.32 804.33 805.1 805.2 805.3 805.4 805.5 805.6 805.7 805.8 805.9 805.10 805.11 805.12 805.13 805.14 805.15 805.16 805.17 805.18 805.19 805.20 805.21 805.22 805.23 805.24 805.25 805.26 805.27 805.28 805.29 805.30 805.31 805.32 805.33 805.34 806.1 806.2 806.3 806.4 806.5 806.6 806.7 806.8 806.9 806.10 806.11 806.12 806.13 806.14 806.15 806.16 806.17 806.18 806.19 806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28 806.29 806.30 806.31 806.32 806.33 806.34 807.1 807.2 807.3 807.4 807.5 807.6 807.7 807.8 807.9 807.10 807.11 807.12 807.13 807.14 807.15 807.16 807.17 807.18 807.19 807.20 807.21 807.22
807.23 807.24 807.25 807.26 807.27 807.28 807.29 807.30 807.31 807.32 807.33 808.1 808.2 808.3 808.4 808.5 808.6 808.7
808.8 808.9 808.10 808.11 808.12 808.13 808.14 808.15 808.16 808.17 808.18 808.19 808.20 808.21 808.22 808.23 808.24 808.25 808.26 808.27 808.28 808.29 808.30 808.31 808.32 809.1 809.2 809.3
809.4 809.5 809.6 809.7 809.8 809.9 809.10 809.11 809.12 809.13 809.14 809.15 809.16 809.17 809.18 809.19 809.20 809.21
809.22 809.23 809.24 809.25 809.26 809.27 809.28 809.29 809.30 809.31 810.1 810.2 810.3 810.4 810.5 810.6 810.7 810.8 810.9 810.10 810.11 810.12 810.13 810.14 810.15 810.16 810.17 810.18 810.19 810.20 810.21 810.22 810.23 810.24 810.25 810.26 810.27 810.28 810.29 810.30 810.31 810.32
811.1 811.2 811.3 811.4 811.5
811.6 811.7 811.8 811.9 811.10 811.11 811.12 811.13 811.14 811.15 811.16 811.17 811.18 811.19 811.20 811.21 811.22 811.23 811.24 811.25 811.26 811.27 811.28 811.29 811.30 811.31 811.32 812.1 812.2 812.3 812.4 812.5 812.6 812.7 812.8 812.9 812.10 812.11 812.12 812.13 812.14 812.15 812.16 812.17 812.18 812.19 812.20 812.21 812.22 812.23 812.24 812.25 812.26 812.27 812.28 812.29 812.30 812.31 812.32 812.33 813.1 813.2 813.3 813.4 813.5 813.6 813.7 813.8 813.9 813.10 813.11 813.12 813.13 813.14 813.15 813.16 813.17 813.18 813.19 813.20 813.21 813.22 813.23 813.24 813.25 813.26 813.27 813.28 813.29 813.30 813.31 813.32 813.33 814.1 814.2 814.3 814.4 814.5 814.6 814.7 814.8 814.9 814.10 814.11 814.12 814.13 814.14 814.15 814.16 814.17 814.18 814.19 814.20 814.21 814.22 814.23 814.24 814.25 814.26 814.27 814.28 814.29 814.30 814.31 814.32 814.33 815.1 815.2 815.3 815.4 815.5 815.6 815.7
815.8 815.9 815.10 815.11 815.12 815.13 815.14 815.15 815.16 815.17 815.18 815.19 815.20 815.21 815.22 815.23 815.24 815.25 815.26 815.27 815.28 815.29 815.30 816.1 816.2 816.3 816.4 816.5 816.6
816.7 816.8 816.9 816.10 816.11 816.12 816.13 816.14 816.15 816.16 816.17 816.18 816.19 816.20 816.21 816.22 816.23 816.24 816.25 816.26 816.27 816.28 816.29 816.30 816.31 816.32 816.33 817.1 817.2 817.3 817.4 817.5 817.6 817.7 817.8 817.9 817.10 817.11 817.12 817.13 817.14 817.15 817.16 817.17 817.18 817.19 817.20 817.21 817.22 817.23 817.24 817.25 817.26 817.27 817.28 817.29 817.30 817.31 817.32 817.33 818.1 818.2 818.3 818.4 818.5 818.6 818.7 818.8 818.9 818.10 818.11 818.12 818.13 818.14 818.15 818.16 818.17 818.18 818.19 818.20 818.21 818.22 818.23 818.24 818.25 818.26 818.27 818.28 818.29 818.30 818.31 818.32 818.33 819.1 819.2 819.3 819.4 819.5 819.6 819.7 819.8 819.9 819.10 819.11 819.12 819.13 819.14 819.15 819.16 819.17 819.18 819.19 819.20 819.21 819.22 819.23 819.24 819.25 819.26 819.27 819.28 819.29 819.30 819.31 820.1 820.2 820.3 820.4 820.5 820.6 820.7 820.8 820.9 820.10 820.11 820.12 820.13 820.14 820.15 820.16
820.17 820.18 820.19 820.20 820.21 820.22 820.23 820.24 820.25 820.26 820.27 820.28 820.29 820.30 820.31 820.32 821.1 821.2 821.3 821.4 821.5 821.6
821.7 821.8 821.9 821.10 821.11 821.12 821.13 821.14 821.15 821.16 821.17 821.18 821.19 821.20 821.21 821.22 821.23 821.24 821.25 821.26 821.27 821.28 821.29
822.1 822.2 822.3 822.4 822.5 822.6 822.7 822.8 822.9 822.10 822.11 822.12 822.13 822.14 822.15 822.16 822.17 822.18 822.19 822.20 822.21 822.22 822.23 822.24 822.25 822.26 822.27 822.28 822.29 822.30 822.31 822.32 823.1 823.2 823.3 823.4 823.5 823.6 823.7 823.8 823.9 823.10 823.11 823.12 823.13 823.14 823.15 823.16 823.17 823.18 823.19 823.20 823.21 823.22 823.23 823.24 823.25 823.26 823.27 823.28 823.29 823.30 823.31 823.32 824.1 824.2 824.3 824.4 824.5 824.6 824.7
824.8 824.9 824.10 824.11 824.12 824.13 824.14 824.15 824.16 824.17 824.18 824.19 824.20 824.21 824.22 824.23 824.24 824.25 824.26 824.27 824.28 824.29 824.30 824.31 825.1 825.2 825.3 825.4 825.5 825.6 825.7 825.8
825.9 825.10 825.11 825.12 825.13 825.14 825.15 825.16 825.17 825.18 825.19 825.20 825.21 825.22 825.23 825.24
825.25 825.26 825.27 825.28 825.29 826.1 826.2 826.3 826.4 826.5 826.6 826.7 826.8 826.9 826.10 826.11 826.12 826.13 826.14 826.15 826.16 826.17 826.18 826.19 826.20 826.21 826.22 826.23 826.24 826.25 826.26 826.27 826.28 826.29 826.30 826.31 827.1 827.2 827.3 827.4 827.5 827.6 827.7 827.8 827.9 827.10 827.11 827.12 827.13 827.14
827.15 827.16 827.17 827.18 827.19 827.20 827.21 827.22 827.23 827.24 827.25 827.26 827.27 827.28 827.29 828.1 828.2 828.3 828.4 828.5 828.6 828.7
828.8 828.9 828.10 828.11 828.12 828.13 828.14
828.15 828.16 828.17 828.18 828.19 828.20 828.21 828.22 828.23 828.24 828.25 828.26 828.27 828.28 828.29 828.30 828.31 829.1 829.2 829.3 829.4 829.5 829.6 829.7 829.8 829.9 829.10 829.11 829.12 829.13 829.14 829.15 829.16 829.17 829.18 829.19 829.20 829.21 829.22 829.23 829.24 829.25 829.26 829.27 829.28 829.29 829.30 829.31 830.1 830.2 830.3 830.4 830.5 830.6 830.7 830.8 830.9 830.10 830.11 830.12 830.13 830.14 830.15 830.16 830.17 830.18 830.19 830.20 830.21 830.22 830.23 830.24 830.25 830.26 830.27 830.28 830.29 830.30 831.1 831.2 831.3 831.4 831.5 831.6 831.7 831.8 831.9
831.10 831.11 831.12 831.13 831.14 831.15 831.16 831.17 831.18 831.19 831.20 831.21 831.22 831.23 831.24 831.25 831.26 831.27 831.28
832.1 832.2 832.3 832.4 832.5 832.6 832.7 832.8 832.9 832.10 832.11 832.12 832.13 832.14 832.15 832.16 832.17 832.18 832.19 832.20 832.21 832.22 832.23 832.24 832.25 832.26 832.27 832.28 832.29 832.30 832.31 833.1 833.2 833.3 833.4 833.5 833.6 833.7 833.8 833.9 833.10 833.11 833.12 833.13 833.14 833.15 833.16 833.17 833.18
833.19 833.20 833.21 833.22 833.23 833.24 833.25 833.26 833.27 833.28 833.29 833.30 833.31 833.32 834.1 834.2 834.3 834.4 834.5 834.6 834.7 834.8 834.9 834.10 834.11 834.12 834.13 834.14 834.15 834.16 834.17 834.18 834.19 834.20 834.21 834.22 834.23 834.24 834.25 834.26 834.27 834.28 834.29 834.30 834.31 835.1 835.2 835.3 835.4 835.5 835.6 835.7 835.8 835.9 835.10 835.11 835.12 835.13 835.14 835.15 835.16 835.17 835.18 835.19 835.20 835.21 835.22 835.23 835.24 835.25 835.26 835.27 835.28 835.29 835.30 835.31
836.1 836.2 836.3 836.4 836.5 836.6 836.7 836.8 836.9 836.10 836.11 836.12 836.13 836.14 836.15 836.16 836.17 836.18 836.19 836.20 836.21 836.22 836.23 836.24 836.25 836.26 836.27 836.28 836.29 836.30 836.31 836.32 837.1 837.2 837.3 837.4 837.5 837.6 837.7 837.8 837.9 837.10 837.11 837.12 837.13 837.14 837.15 837.16 837.17 837.18 837.19 837.20 837.21 837.22 837.23 837.24 837.25 837.26 837.27 837.28 837.29 837.30 837.31 837.32 837.33 838.1 838.2 838.3 838.4 838.5 838.6
838.7 838.8 838.9 838.10 838.11 838.12 838.13 838.14 838.15 838.16 838.17 838.18 838.19 838.20 838.21 838.22 838.23 838.24 838.25 838.26 838.27
838.28 838.29 838.30 839.1 839.2 839.3 839.4 839.5 839.6 839.7 839.8 839.9 839.10 839.11 839.12 839.13 839.14 839.15 839.16 839.17 839.18 839.19 839.20 839.21 839.22 839.23 839.24 839.25 839.26 839.27 839.28 839.29 839.30 839.31 839.32 840.1 840.2 840.3 840.4 840.5 840.6 840.7 840.8 840.9 840.10 840.11 840.12 840.13 840.14 840.15 840.16 840.17 840.18 840.19 840.20 840.21 840.22 840.23 840.24 840.25 840.26 840.27 840.28 840.29 840.30 840.31 841.1 841.2 841.3 841.4
841.5 841.6 841.7 841.8 841.9 841.10 841.11 841.12 841.13 841.14 841.15 841.16 841.17
841.18 841.19 841.20 841.21 841.22 841.23 841.24 841.25 841.26 841.27 841.28 841.29 841.30 841.31
842.1 842.2 842.3 842.4 842.5 842.6 842.7 842.8 842.9 842.10 842.11 842.12
842.13 842.14 842.15 842.16 842.17 842.18 842.19 842.20 842.21 842.22 842.23 842.24 842.25 842.26 842.27 842.28 842.29 842.30 842.31 843.1 843.2 843.3 843.4 843.5 843.6 843.7 843.8 843.9 843.10 843.11
843.12 843.13 843.14 843.15 843.16 843.17 843.18 843.19 843.20 843.21 843.22 843.23 843.24 843.25 843.26 843.27 843.28 843.29 843.30 843.31 843.32 844.1 844.2 844.3 844.4 844.5 844.6 844.7 844.8 844.9 844.10 844.11 844.12 844.13 844.14 844.15 844.16 844.17 844.18 844.19 844.20 844.21 844.22 844.23 844.24
844.25 844.26 844.27 844.28 844.29 844.30 844.31 844.32 845.1 845.2 845.3 845.4 845.5 845.6 845.7 845.8
845.9 845.10 845.11 845.12 845.13 845.14 845.15 845.16 845.17 845.18 845.19 845.20 845.21 845.22 845.23 845.24 845.25 845.26 845.27 845.28 845.29 845.30 846.1 846.2 846.3 846.4 846.5 846.6 846.7 846.8 846.9 846.10 846.11 846.12 846.13 846.14 846.15 846.16 846.17 846.18 846.19 846.20 846.21 846.22 846.23 846.24 846.25 846.26
846.27 846.28 846.29 846.30 846.31 846.32 846.33 847.1 847.2 847.3 847.4 847.5 847.6 847.7 847.8 847.9 847.10 847.11 847.12 847.13 847.14 847.15 847.16 847.17 847.18 847.19 847.20 847.21 847.22 847.23 847.24 847.25 847.26 847.27 847.28 847.29 847.30 847.31 848.1 848.2 848.3 848.4 848.5 848.6 848.7 848.8 848.9 848.10 848.11 848.12 848.13 848.14 848.15 848.16
848.17 848.18 848.19 848.20 848.21 848.22 848.23 848.24 848.25 848.26 848.27 848.28
849.1 849.2 849.3 849.4
849.5 849.6
849.7 849.8 849.9 849.10 849.11 849.12 849.13 849.14 849.15 849.16 849.17
849.18 849.19 849.20 849.21 849.22 849.23 849.24 849.25 849.26 849.27 849.28 849.29 849.30 849.31 849.32 849.33 849.34 849.35 850.1 850.2 850.3 850.4 850.5 850.6 850.7 850.8 850.9 850.10 850.11 850.12 850.13 850.14 850.15 850.16 850.17 850.18
850.19 850.20
850.21 850.22
850.23 850.24 850.25 850.26 850.27 850.28 850.29 850.30 851.1 851.2 851.3 851.4
851.5 851.6 851.7 851.8 851.9 851.10 851.11 851.12 851.13 851.14 851.15 851.16 851.17 851.18 851.19 851.20 851.21 851.22 851.23 851.24 851.25 851.26 851.27 851.28 851.29 851.30 851.31 851.32 851.33 852.1 852.2 852.3 852.4 852.5 852.6 852.7 852.8 852.9 852.10 852.11 852.12 852.13 852.14 852.15 852.16 852.17 852.18 852.19 852.20 852.21 852.22 852.23 852.24 852.25 852.26 852.27 852.28 852.29 852.30 852.31 852.32 852.33 853.1 853.2 853.3 853.4 853.5 853.6 853.7 853.8 853.9 853.10 853.11 853.12 853.13 853.14 853.15 853.16 853.17 853.18 853.19 853.20 853.21 853.22 853.23 853.24 853.25 853.26 853.27 853.28 853.29 853.30 853.31 853.32 853.33 853.34 854.1 854.2 854.3 854.4 854.5 854.6 854.7 854.8 854.9 854.10 854.11 854.12 854.13 854.14 854.15 854.16 854.17 854.18 854.19 854.20 854.21 854.22 854.23 854.24 854.25 854.26 854.27 854.28 854.29 854.30 854.31 854.32 854.33 854.34 854.35 855.1 855.2 855.3 855.4 855.5 855.6 855.7 855.8 855.9 855.10 855.11 855.12 855.13 855.14 855.15 855.16 855.17 855.18 855.19 855.20 855.21 855.22 855.23 855.24 855.25 855.26 855.27 855.28 855.29 855.30 855.31 855.32 855.33 855.34 856.1 856.2 856.3 856.4 856.5 856.6 856.7 856.8 856.9 856.10 856.11 856.12 856.13 856.14 856.15 856.16 856.17 856.18 856.19 856.20 856.21 856.22 856.23 856.24 856.25 856.26 856.27 856.28 856.29 856.30 856.31 856.32 856.33 856.34 857.1 857.2 857.3 857.4 857.5 857.6 857.7 857.8 857.9 857.10 857.11 857.12 857.13 857.14 857.15 857.16 857.17 857.18 857.19 857.20 857.21 857.22 857.23 857.24 857.25 857.26 857.27 857.28 857.29 857.30 857.31 857.32 857.33 857.34 858.1 858.2 858.3 858.4 858.5 858.6 858.7 858.8 858.9 858.10 858.11 858.12 858.13 858.14 858.15 858.16 858.17 858.18 858.19 858.20 858.21 858.22 858.23 858.24 858.25 858.26 858.27 858.28 858.29 858.30 858.31 858.32 858.33 858.34 858.35 859.1 859.2 859.3 859.4 859.5 859.6 859.7 859.8 859.9 859.10 859.11 859.12 859.13 859.14 859.15 859.16 859.17 859.18 859.19 859.20 859.21 859.22 859.23 859.24 859.25 859.26 859.27 859.28 859.29 859.30 859.31 859.32 859.33 859.34 859.35 860.1 860.2 860.3 860.4 860.5 860.6 860.7 860.8 860.9 860.10 860.11 860.12 860.13 860.14 860.15 860.16 860.17 860.18 860.19 860.20 860.21 860.22 860.23 860.24 860.25 860.26 860.27 860.28 860.29 860.30 860.31 860.32 860.33 860.34 861.1 861.2 861.3 861.4 861.5 861.6 861.7 861.8 861.9 861.10 861.11 861.12 861.13 861.14 861.15 861.16 861.17 861.18 861.19 861.20 861.21 861.22 861.23 861.24 861.25 861.26 861.27 861.28 861.29 861.30 861.31 861.32 861.33 861.34 861.35 862.1 862.2 862.3 862.4 862.5 862.6 862.7 862.8 862.9 862.10 862.11 862.12 862.13 862.14 862.15 862.16 862.17 862.18 862.19 862.20 862.21 862.22 862.23 862.24 862.25 862.26 862.27 862.28 862.29 862.30 862.31 862.32 862.33 862.34 862.35 863.1 863.2 863.3 863.4 863.5 863.6 863.7 863.8 863.9 863.10 863.11 863.12 863.13 863.14 863.15 863.16 863.17 863.18 863.19 863.20 863.21 863.22 863.23 863.24 863.25 863.26 863.27 863.28 863.29 863.30 863.31 863.32 863.33 863.34 863.35 864.1 864.2 864.3 864.4 864.5 864.6 864.7 864.8 864.9 864.10 864.11 864.12 864.13 864.14 864.15 864.16 864.17 864.18 864.19 864.20 864.21 864.22 864.23 864.24 864.25 864.26 864.27 864.28 864.29 864.30 864.31 864.32 864.33 864.34 865.1 865.2 865.3 865.4 865.5 865.6 865.7 865.8 865.9 865.10 865.11 865.12 865.13 865.14 865.15 865.16 865.17 865.18 865.19 865.20 865.21 865.22 865.23 865.24 865.25 865.26 865.27 865.28 865.29 865.30 865.31 865.32 865.33 865.34 865.35 866.1 866.2 866.3 866.4 866.5 866.6 866.7 866.8 866.9 866.10 866.11 866.12 866.13 866.14 866.15 866.16 866.17 866.18 866.19 866.20 866.21 866.22 866.23 866.24 866.25 866.26 866.27 866.28 866.29 866.30 866.31 866.32 866.33 866.34 866.35 867.1 867.2 867.3 867.4 867.5 867.6 867.7 867.8 867.9 867.10 867.11 867.12 867.13 867.14 867.15 867.16 867.17 867.18 867.19 867.20 867.21 867.22 867.23 867.24 867.25 867.26 867.27 867.28 867.29 867.30 867.31 867.32 867.33 867.34 867.35 868.1 868.2 868.3 868.4 868.5 868.6 868.7 868.8 868.9 868.10 868.11 868.12 868.13 868.14 868.15 868.16 868.17 868.18 868.19 868.20 868.21 868.22 868.23 868.24 868.25 868.26 868.27 868.28 868.29 868.30 868.31 868.32 868.33 868.34 868.35 868.36 869.1 869.2 869.3 869.4 869.5 869.6 869.7 869.8 869.9 869.10 869.11 869.12 869.13 869.14 869.15 869.16 869.17 869.18 869.19 869.20 869.21 869.22 869.23 869.24 869.25 869.26 869.27 869.28 869.29 869.30 869.31 869.32 869.33 870.1 870.2 870.3 870.4 870.5 870.6 870.7 870.8 870.9 870.10 870.11 870.12 870.13 870.14 870.15 870.16 870.17 870.18 870.19 870.20 870.21 870.22 870.23 870.24 870.25 870.26 870.27 870.28 870.29 870.30 870.31 870.32 870.33 870.34 870.35 871.1 871.2 871.3 871.4 871.5 871.6 871.7 871.8 871.9 871.10 871.11 871.12 871.13 871.14 871.15 871.16 871.17 871.18 871.19 871.20 871.21 871.22 871.23 871.24 871.25 871.26 871.27 871.28 871.29 871.30 871.31 871.32 871.33 871.34 872.1 872.2 872.3 872.4 872.5 872.6 872.7 872.8 872.9 872.10 872.11 872.12 872.13 872.14 872.15 872.16 872.17
872.18 872.19 872.20 872.21 872.22 872.23 872.24 872.25 872.26 872.27 872.28 872.29 872.30 872.31 872.32 872.33 872.34 873.1 873.2 873.3 873.4 873.5 873.6 873.7 873.8 873.9 873.10 873.11 873.12 873.13 873.14 873.15 873.16 873.17 873.18 873.19 873.20 873.21 873.22 873.23 873.24 873.25 873.26 873.27 873.28 873.29 873.30 873.31 873.32 873.33 874.1 874.2 874.3 874.4 874.5 874.6 874.7 874.8 874.9 874.10 874.11 874.12 874.13 874.14 874.15 874.16 874.17 874.18 874.19 874.20 874.21 874.22 874.23 874.24 874.25 874.26 874.27 874.28 874.29 874.30 874.31 874.32 874.33 874.34 875.1 875.2 875.3 875.4 875.5 875.6 875.7 875.8 875.9 875.10 875.11 875.12 875.13 875.14 875.15 875.16 875.17 875.18 875.19 875.20 875.21 875.22 875.23 875.24 875.25 875.26 875.27 875.28 875.29 875.30 875.31 875.32 875.33 875.34 875.35 876.1 876.2 876.3 876.4 876.5 876.6 876.7 876.8 876.9 876.10 876.11 876.12 876.13 876.14 876.15 876.16 876.17 876.18 876.19 876.20 876.21 876.22 876.23 876.24 876.25 876.26 876.27 876.28 876.29 876.30 876.31 876.32 876.33 876.34 876.35 877.1 877.2 877.3 877.4 877.5 877.6 877.7 877.8 877.9 877.10 877.11 877.12 877.13 877.14 877.15 877.16 877.17 877.18 877.19 877.20 877.21 877.22 877.23 877.24 877.25 877.26 877.27 877.28 877.29 877.30 877.31 877.32 877.33 877.34 877.35 878.1 878.2 878.3 878.4 878.5 878.6 878.7 878.8 878.9 878.10 878.11 878.12 878.13 878.14 878.15 878.16 878.17 878.18 878.19 878.20 878.21 878.22 878.23 878.24 878.25 878.26 878.27 878.28 878.29 878.30 878.31 878.32 878.33 878.34 878.35 879.1 879.2 879.3 879.4 879.5 879.6 879.7 879.8 879.9 879.10 879.11 879.12 879.13 879.14 879.15 879.16 879.17 879.18 879.19
879.20 879.21 879.22 879.23 879.24 879.25 879.26 879.27 879.28 879.29 879.30 879.31 879.32 879.33 879.34 880.1 880.2 880.3 880.4 880.5 880.6 880.7 880.8 880.9 880.10 880.11 880.12 880.13 880.14 880.15 880.16 880.17 880.18 880.19 880.20 880.21 880.22 880.23 880.24 880.25 880.26 880.27 880.28 880.29 880.30 880.31 880.32 880.33 880.34 880.35 881.1 881.2 881.3 881.4 881.5 881.6 881.7 881.8 881.9 881.10 881.11 881.12 881.13 881.14 881.15 881.16 881.17 881.18 881.19 881.20 881.21 881.22 881.23 881.24 881.25 881.26 881.27 881.28 881.29 881.30 881.31 881.32 882.1 882.2 882.3 882.4 882.5 882.6 882.7 882.8 882.9 882.10 882.11 882.12 882.13
882.14 882.15 882.16 882.17 882.18 882.19 882.20 882.21 882.22 882.23 882.24 882.25 882.26 882.27 882.28 882.29 882.30 882.31 882.32 882.33 883.1 883.2 883.3 883.4 883.5 883.6 883.7 883.8 883.9 883.10
883.11
883.12 883.13 883.14 883.15 883.16 883.17 883.18 883.19
883.20
883.21 883.22 883.23 883.24 883.25 883.26
883.27 883.28 883.29 883.31 883.30 883.32 883.33 884.2 884.1 884.3 884.4 884.5 884.6 884.7 884.8 884.9 884.10 884.11 884.13 884.12 884.14 884.15 884.16 884.17 884.18 884.19 884.20 884.21 884.22 884.23 884.24 884.25 884.26 884.27 884.28 884.29 884.30 884.31 884.32 884.33 884.34 884.35 884.36 885.1 885.2 885.3 885.4 885.5 885.6 885.7 885.8 885.9 885.10 885.11 885.12 885.13 885.14 885.15 885.16 885.17 885.18 885.19 885.20 885.21 885.22 885.23 885.24 885.25 885.26 885.27 885.28 885.29 885.30 885.31 885.32 885.33 885.34 886.1 886.2 886.3 886.4 886.5 886.6 886.7 886.8 886.9 886.10 886.11 886.12 886.13 886.14 886.15 886.16 886.17 886.18 886.19 886.20 886.21 886.22 886.23 886.24 886.25 886.26 886.27 886.28 886.29 886.30 886.31 886.32 886.33 886.34 887.1 887.2 887.3 887.4 887.5 887.6 887.7 887.8 887.9 887.10 887.11 887.12 887.13 887.14 887.15 887.16 887.17 887.18 887.19 887.20 887.21 887.22 887.23 887.24 887.25 887.26 887.27 887.28 887.29 887.30 887.31 887.32 887.33 887.34 887.35 888.1 888.2 888.3 888.4 888.5 888.6 888.7 888.8 888.9 888.10 888.11 888.12 888.13 888.14 888.15 888.16 888.17 888.18 888.19 888.20 888.21 888.22 888.23 888.24 888.25 888.26 888.27 888.28 888.29 888.30 888.31 889.1 889.2 889.3 889.4
889.5 889.6
889.7 889.8 889.9 889.10 889.11 889.12 889.13 889.14
889.15
889.16 889.17 889.18 889.19
889.20
889.21 889.22 889.23 889.24 889.25 889.26
889.27 889.28 889.29 889.30 890.1 890.2 890.3
890.4
890.5 890.6 890.7 890.8 890.9
890.10
890.11 890.12 890.13 890.14 890.15 890.16 890.17 890.18 890.19 890.20 890.21 890.22 890.23 890.24 890.25 890.26 890.27 890.28 890.29 890.30 890.31 891.1 891.2
891.3 891.4 891.5 891.6 891.7 891.8 891.9 891.10 891.11 891.12 891.13 891.14 891.15 891.16 891.17 891.18 891.19 891.20 891.21 891.22 891.23 891.24
891.25 891.26 891.27 891.28
892.1 892.2 892.3 892.4 892.5 892.6 892.7 892.8 892.9
892.10
892.11 892.12 892.13 892.14 892.15 892.16 892.17 892.18 892.19 892.20 892.21 892.22 892.23 892.24 892.25 892.26 892.27 892.28 892.29
892.30 892.31 892.32 892.33 893.1 893.2
893.3 893.4 893.5
893.6 893.7 893.8
893.9
893.10 893.11 893.12
893.13 893.14 893.15
893.16 893.17
A bill for an act
relating to state government; modifying provisions governing health, health care,
human services, human services licensing and background studies, health-related
licensing boards, prescription drugs, health insurance, telehealth, children and
family services, behavioral health, direct care and treatment, disability services
and continuing care for older adults, community supports, and chemical and mental
health services; establishing a budget for health and human services; making
forecast adjustments; making technical and conforming changes; requiring reports;
transferring money; appropriating money; amending Minnesota Statutes 2020,
sections 16A.151, subdivision 2; 62A.04, subdivision 2; 62A.10, by adding a
subdivision; 62A.15, subdivision 4, by adding a subdivision; 62A.152, subdivision
3; 62A.3094, subdivision 1; 62A.65, subdivision 1, by adding a subdivision;
62C.01, by adding a subdivision; 62D.01, by adding a subdivision; 62D.095,
subdivisions 2, 3, 4, 5; 62J.495, subdivisions 1, 2, 3, 4; 62J.497, subdivisions 1,
3; 62J.498; 62J.4981; 62J.4982; 62J.63, subdivisions 1, 2; 62Q.01, subdivision
2a; 62Q.02; 62Q.096; 62Q.46; 62Q.677, by adding a subdivision; 62Q.81; 62U.04,
subdivisions 4, 5, 11; 62V.05, by adding a subdivision; 62W.11; 103H.201,
subdivision 1; 119B.011, subdivision 15; 119B.025, subdivision 4; 119B.03,
subdivisions 4, 6; 119B.09, subdivision 4; 119B.11, subdivision 2a; 119B.125,
subdivision 1; 119B.13, subdivisions 1, 1a, 6, 7; 119B.25, subdivision 3; 122A.18,
subdivision 8; 136A.128, subdivisions 2, 4; 144.0724, subdivisions 1, 2, 3a, 4, 5,
7, 8, 9, 12; 144.1205, subdivisions 2, 4, 8, 9, by adding a subdivision; 144.125,
subdivision 1; 144.1481, subdivision 1; 144.1501, subdivisions 1, 2, 3; 144.1911,
subdivision 6; 144.212, by adding a subdivision; 144.225, subdivisions 2, 7;
144.226, by adding subdivisions; 144.55, subdivisions 4, 6; 144.551, subdivision
1, by adding a subdivision; 144.555; 144.651, subdivision 2; 144.9501, subdivision
17; 144.9502, subdivision 3; 144.9504, subdivisions 2, 5; 144D.01, subdivision
4; 144G.08, subdivision 7, as amended; 144G.54, subdivision 3; 144G.84; 145.893,
subdivision 1; 145.894; 145.897; 145.899; 145.901, subdivisions 2, 4; 147.033;
148.90, subdivision 2; 148.911; 148B.30, subdivision 1; 148B.31; 148B.51;
148B.5301, subdivision 2; 148B.54, subdivision 2; 148E.010, by adding a
subdivision; 148E.120, subdivision 2; 148E.130, subdivision 1, by adding a
subdivision; 148F.11, subdivision 1; 151.01, by adding subdivisions; 151.071,
subdivisions 1, 2; 151.37, subdivision 2; 151.555, subdivisions 1, 7, 11, by adding
a subdivision; 152.01, subdivision 23; 152.02, subdivisions 2, 3; 152.11, subdivision
1a, by adding a subdivision; 152.12, by adding a subdivision; 152.125, subdivision
3; 152.22, subdivisions 6, 11, by adding subdivisions; 152.23; 152.25, by adding
a subdivision; 152.26; 152.27, subdivisions 3, 4, 6; 152.28, subdivision 1; 152.29,
subdivisions 1, 3, by adding subdivisions; 152.31; 152.32, subdivision 3; 156.12,
subdivision 2; 171.07, by adding a subdivision; 174.30, subdivision 3; 245.462,
subdivisions 1, 6, 8, 9, 14, 16, 17, 18, 21, 23, by adding a subdivision; 245.4661,
subdivision 5; 245.4662, subdivision 1; 245.467, subdivisions 2, 3; 245.469,
subdivisions 1, 2; 245.470, subdivision 1; 245.4712, subdivision 2; 245.472,
subdivision 2; 245.4863; 245.4871, subdivisions 9a, 10, 11a, 17, 21, 26, 27, 29,
31, 32, 34, by adding a subdivision; 245.4876, subdivisions 2, 3; 245.4879,
subdivision 1; 245.488, subdivision 1; 245.4882, subdivisions 1, 3; 245.4885,
subdivision 1; 245.4889, subdivision 1; 245.4901, subdivision 2; 245.62,
subdivision 2; 245.735, subdivisions 3, 5, by adding a subdivision; 245A.02, by
adding subdivisions; 245A.03, subdivision 7; 245A.04, subdivision 5; 245A.041,
by adding a subdivision; 245A.043, subdivision 3; 245A.05; 245A.07, subdivision
1; 245A.10, subdivision 4; 245A.14, subdivision 4; 245A.16, by adding a
subdivision; 245A.50, subdivisions 7, 9; 245A.65, subdivision 2; 245C.02,
subdivisions 4a, 5, by adding subdivisions; 245C.03; 245C.05, subdivisions 1, 2,
2a, 2b, 2c, 2d, 4; 245C.08, subdivision 3, by adding a subdivision; 245C.10,
subdivision 15, by adding subdivisions; 245C.13, subdivision 2; 245C.14,
subdivision 1, by adding a subdivision; 245C.15, by adding a subdivision; 245C.16,
subdivisions 1, 2; 245C.17, subdivision 1, by adding a subdivision; 245C.18;
245C.24, subdivisions 2, 3, 4, by adding a subdivision; 245C.32, subdivision 1a;
245D.02, subdivision 20; 245F.04, subdivision 2; 245G.01, subdivisions 13, 26;
245G.03, subdivision 2; 245G.06, subdivision 1; 246.54, subdivision 1b; 254A.19,
subdivision 5; 254B.01, subdivision 4a, by adding a subdivision; 254B.05,
subdivision 5; 254B.12, by adding a subdivision; 256.01, subdivisions 14b, 28;
256.0112, subdivision 6; 256.041; 256.042, subdivisions 2, 4; 256.043, subdivision
3; 256.969, subdivisions 2b, 9, by adding a subdivision; 256.9695, subdivision 1;
256.9741, subdivision 1; 256.98, subdivision 1; 256.983; 256B.04, subdivisions
12, 14; 256B.055, subdivision 6; 256B.056, subdivision 10; 256B.057, subdivision
3; 256B.06, subdivision 4; 256B.0615, subdivisions 1, 5; 256B.0616, subdivisions
1, 3, 5; 256B.0621, subdivision 10; 256B.0622, subdivisions 1, 2, 3a, 4, 7, 7a, 7b,
7d; 256B.0623, subdivisions 1, 2, 3, 4, 5, 6, 9, 12; 256B.0624; 256B.0625,
subdivisions 3b, 3c, 3d, 3e, 5, 5m, 9, 10, 13, 13c, 13d, 13e, 13h, 17, 17b, 18, 18b,
19c, 20, 20b, 28a, 30, 31, 42, 46, 48, 49, 52, 56a, 58, by adding subdivisions;
256B.0631, subdivision 1; 256B.0638, subdivisions 3, 5, 6; 256B.0659, subdivisions
13, 21, 24, by adding subdivisions; 256B.0757, subdivision 4c; 256B.0759,
subdivisions 2, 4, by adding subdivisions; 256B.0911, subdivisions 1a, 3a, 3f, 4d;
256B.092, subdivisions 4, 5, 12; 256B.0924, subdivision 6; 256B.094, subdivision
6; 256B.0941, subdivision 1; 256B.0943, subdivisions 1, 2, 3, 4, 5, 5a, 6, 7, 9, 11;
256B.0946, subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947, subdivisions 1, 2, 3, 3a, 5,
6, 7; 256B.0949, subdivisions 2, 4, 5a, by adding a subdivision; 256B.097, by
adding subdivisions; 256B.196, subdivision 2; 256B.25, subdivision 3; 256B.439,
by adding subdivisions; 256B.49, subdivisions 11, 11a, 14, 17, by adding a
subdivision; 256B.4914, subdivisions 5, 6, 7, 8, 9, by adding a subdivision;
256B.69, subdivisions 5a, 6, 6d, by adding subdivisions; 256B.6928, subdivision
5; 256B.75; 256B.76, subdivisions 2, 4; 256B.761; 256B.763; 256B.79,
subdivisions 1, 3; 256B.85, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 11b, 12,
12b, 13, 13a, 15, 17a, 18a, 20b, 23, 23a, by adding subdivisions; 256D.03, by
adding a subdivision; 256D.051, by adding subdivisions; 256D.0515; 256D.0516,
subdivision 2; 256E.34, subdivision 1; 256I.03, subdivision 13; 256I.04, subdivision
3; 256I.05, subdivisions 1a, 1c, 11; 256I.06, subdivisions 6, 8; 256J.08, subdivisions
15, 71, 79; 256J.09, subdivision 3; 256J.10; 256J.21, subdivisions 3, 4, 5; 256J.24,
subdivision 5; 256J.30, subdivision 8; 256J.33, subdivisions 1, 2, 4; 256J.37,
subdivisions 1, 1b, 3, 3a; 256J.45, subdivision 1; 256J.626, subdivision 1; 256J.95,
subdivision 9; 256L.01, subdivision 5; 256L.03, subdivision 5; 256L.04, subdivision
7b; 256L.05, subdivision 3a; 256L.07, subdivision 2; 256L.11, subdivisions 6a,
7; 256L.15, subdivision 2; 256N.25, subdivisions 2, 3; 256N.26, subdivisions 11,
13; 256P.01, subdivisions 3, 6a, by adding a subdivision; 256P.04, subdivisions
4, 8; 256P.06, subdivisions 2, 3; 256P.07; 256S.05, subdivision 2; 256S.18,
subdivision 7; 256S.20, subdivision 1; 257.0755, subdivision 1; 257.076,
subdivisions 3, 5; 257.0768, subdivisions 1, 6; 257.0769; 260.761, subdivision 2;
260C.007, subdivisions 6, 14, 26c, 31; 260C.157, subdivision 3; 260C.212,
subdivisions 1a, 13; 260C.215, subdivision 4; 260C.4412; 260C.452; 260C.704;
260C.706; 260C.708; 260C.71; 260C.712; 260C.714; 260D.01; 260D.05; 260D.06,
subdivision 2; 260D.07; 260D.08; 260D.14; 260E.01; 260E.02, subdivision 1;
260E.03, subdivision 22, by adding subdivisions; 260E.06, subdivision 1; 260E.14,
subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20, subdivision 2;
260E.24, subdivisions 2, 7; 260E.31, subdivision 1; 260E.33, subdivision 1, by
adding a subdivision; 260E.35, subdivision 6; 260E.36, by adding a subdivision;
295.50, subdivision 9b; 295.53, subdivision 1; 325F.721, subdivision 1; 326.71,
subdivision 4; 326.75, subdivisions 1, 2, 3; Laws 2019, First Special Session
chapter 9, article 14, section 3, as amended; Laws 2020, First Special Session
chapter 7, section 1, subdivision 2, as amended; Laws 2020, Seventh Special
Session chapter 1, article 6, section 12, subdivision 4; proposing coding for new
law in Minnesota Statutes, chapters 3; 62A; 62J; 62Q; 62W; 119B; 144; 145; 151;
245; 245A; 245C; 254B; 256; 256B; 256P; 256S; proposing coding for new law
as Minnesota Statutes, chapter 245I; repealing Minnesota Statutes 2020, sections
16A.724, subdivision 2; 62A.67; 62A.671; 62A.672; 62J.63, subdivision 3;
119B.125, subdivision 5; 144.0721, subdivision 1; 144.0722; 144.0724, subdivision
10; 144.693; 245.462, subdivision 4a; 245.4871, subdivision 32a; 245.4879,
subdivision 2; 245.62, subdivisions 3, 4; 245.69, subdivision 2; 245.735,
subdivisions 1, 2, 4; 245C.10, subdivisions 2, 2a, 3, 4, 5, 6, 7, 8, 9, 9a, 10, 11, 12,
13, 14, 16; 256B.0596; 256B.0615, subdivision 2; 256B.0616, subdivision 2;
256B.0622, subdivisions 3, 5a; 256B.0623, subdivisions 7, 8, 10, 11; 256B.0625,
subdivisions 5l, 18c, 18d, 18e, 18h, 35a, 35b, 61, 62, 65; 256B.0916, subdivisions
2, 3, 4, 5, 8, 11, 12; 256B.0924, subdivision 4a; 256B.0943, subdivisions 8, 10;
256B.0944; 256B.0946, subdivision 5; 256B.097, subdivisions 1, 2, 3, 4, 5, 6;
256B.49, subdivisions 26, 27; 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b,
6c, 7, 8, 9, 18; 256D.052, subdivision 3; 256J.08, subdivisions 10, 53, 61, 62, 81,
83; 256J.21, subdivisions 1, 2; 256J.30, subdivisions 5, 7, 8; 256J.33, subdivisions
3, 4, 5; 256J.34, subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256S.20,
subdivision 2; Minnesota Rules, parts 9505.0275; 9505.0370; 9505.0371;
9505.0372; 9505.1693; 9505.1696, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14,
15, 16, 17, 18, 19, 20, 21, 22; 9505.1699; 9505.1701; 9505.1703; 9505.1706;
9505.1712; 9505.1715; 9505.1718; 9505.1724; 9505.1727; 9505.1730; 9505.1733;
9505.1736; 9505.1739; 9505.1742; 9505.1745; 9505.1748; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750;
9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820;
9520.0830; 9520.0840; 9520.0850; 9520.0860; 9520.0870; 9530.6800; 9530.6810.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HUMAN SERVICES HEALTH CARE PROGRAMS
Section 1.
new text begin
[62A.002] APPLICABILITY OF CHAPTER.
new text end
new text begin
Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62C.01, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Applicability. new text end
new text begin
Any benefit or coverage mandate included in this chapter does
not apply to managed care plans or county-based purchasing plans when the plan is providing
coverage to state public health care program enrollees under chapter 256B or 256L.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62D.01, is amended by adding a subdivision to
read:
new text begin Subd. 3. new text end
new text begin Applicability. new text end
new text begin
Any benefit or coverage mandate included in this chapter does
not apply to managed care plans or county-based purchasing plans when the plan is providing
coverage to state public health care program enrollees under chapter 256B or 256L.
new text end
Sec. 4.
new text begin
[62J.011] APPLICABILITY OF CHAPTER.
new text end
new text begin
Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end
Sec. 5.
Minnesota Statutes 2020, section 62Q.02, is amended to read:
62Q.02 APPLICABILITY OF CHAPTER.
(a) This chapter applies only to health plans, as defined in section 62Q.01, and not to
other types of insurance issued or renewed by health plan companies, unless otherwise
specified.
(b) This chapter applies to a health plan company only with respect to health plans, as
defined in section 62Q.01, issued or renewed by the health plan company, unless otherwise
specified.
(c) If a health plan company issues or renews health plans in other states, this chapter
applies only to health plans issued or renewed in this state for Minnesota residents, or to
cover a resident of the state, unless otherwise specified.
new text begin
(d) Any benefit or coverage mandate included in this chapter does not apply to managed
care plans or county-based purchasing plans when the plan is providing coverage to state
public health care program enrollees under chapter 256B or 256L.
new text end
Sec. 6.
Minnesota Statutes 2020, section 174.30, subdivision 3, is amended to read:
Subd. 3.
Other standards; wheelchair securement; protected transport.
(a) A special
transportation service that transports individuals occupying wheelchairs is subject to the
provisions of sections 299A.11 to 299A.17 concerning wheelchair securement devices. The
commissioners of transportation and public safety shall cooperate in the enforcement of
this section and sections 299A.11 to 299A.17 so that a single inspection is sufficient to
ascertain compliance with sections 299A.11 to 299A.17 and with the standards adopted
under this section. Representatives of the Department of Transportation may inspect
wheelchair securement devices in vehicles operated by special transportation service
providers to determine compliance with sections 299A.11 to 299A.17 and to issue certificates
under section 299A.14, subdivision 4.
(b) In place of a certificate issued under section 299A.14, the commissioner may issue
a decal under subdivision 4 for a vehicle equipped with a wheelchair securement device if
the device complies with sections 299A.11 to 299A.17 and the decal displays the information
in section 299A.14, subdivision 4.
(c) For vehicles designated as protected transport under section 256B.0625, subdivision
17, paragraph deleted text begin (h)deleted text end new text begin (g)new text end , the commissioner of transportation, during the commissioner's
inspection, shall check to ensure the safety provisions contained in that paragraph are in
working order.
Sec. 7.
Minnesota Statutes 2020, section 256.01, subdivision 28, is amended to read:
Subd. 28.
Statewide health information exchange.
(a) The commissioner has the
authority to join and participate as a member in a legal entity developing and operating a
statewide health information exchange new text begin or to develop and operate an encounter alerting
service new text end that shall meet the following criteria:
(1) the legal entity must meet all constitutional and statutory requirements to allow the
commissioner to participate; and
(2) the commissioner or the commissioner's designated representative must have the
right to participate in the governance of the legal entity under the same terms and conditions
and subject to the same requirements as any other member in the legal entity and in that
role shall act to advance state interests and lessen the burdens of government.
(b) Notwithstanding chapter 16C, the commissioner may pay the state's prorated share
of development-related expenses of the legal entity retroactively from October 29, 2007,
regardless of the date the commissioner joins the legal entity as a member.
Sec. 8.
Minnesota Statutes 2020, section 256.969, subdivision 2b, is amended to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base yearnew text begin or yearsnew text end for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base yearnew text begin or yearsnew text end and the next base yearnew text begin or yearsnew text end .new text begin In
any year that inpatient claims volume falls below the threshold required to ensure a statically
valid sample of claims, the commissioner may combine claims data from two consecutive
years to serve as the base year. Years in which inpatient claims volume is reduced or altered
due to a pandemic or other public health emergency shall not be used as a base year or part
of a base year if the base year includes more than one year.new text end Changes in costs between base
years shall be measured using the lower of the hospital cost index defined in subdivision 1,
paragraph (a), or the percentage change in the case mix adjusted cost per claim. The
commissioner shall establish the base year for each rebasing period considering the most
recent yearnew text begin or yearsnew text end for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
Sec. 9.
Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision to
read:
new text begin Subd. 2f. new text end
new text begin Alternate inpatient payment rate. new text end
new text begin
Effective January 1, 2022, for a hospital
eligible to receive disproportionate share hospital payments under subdivision 9, paragraph
(d), clause (6), the commissioner shall reduce the amount calculated under subdivision 9,
paragraph (d), clause (6), by 99 percent and compute an alternate inpatient payment rate.
The alternate payment rate shall be structured to target a total aggregate reimbursement
amount equal to what the hospital would have received for providing fee-for-service inpatient
services under this section to patients enrolled in medical assistance had the hospital received
the entire amount calculated under subdivision 9, paragraph (d), clause (6).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256.969, subdivision 9, is amended to read:
Subd. 9.
Disproportionate numbers of low-income patients served.
(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;
(3) a hospital that has receivednew text begin medical assistancenew text end payment deleted text begin from the fee-for-service
programdeleted text end for at least 20 transplant services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than two and
one-half standard deviations above the mean shall receive a factor of 0.2300; and
(6) a hospitalnew text begin that is a level one trauma center andnew text end that has a medical assistance utilization
rate in the base year that is at least two and one-half standard deviations above the statewide
mean utilization rate shall receive a factor of 0.3711.
new text begin
(e) For the purposes of determining eligibility for the disproportionate share hospital
factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and
discharge thresholds shall be measured using only one year when a two-year base period
is used.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end Any payments or portion of payments made to a hospital under this subdivision
that are subsequently returned to the commissioner because the payments are found to
exceed the hospital-specific DSH limit for that hospital shall be redistributed, proportionate
to the number of fee-for-service discharges, to other DSH-eligible non-children's hospitals
that have a medical assistance utilization rate that is at least one standard deviation above
the mean.
deleted text begin (f)deleted text end new text begin (g)new text end An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, new text begin or if the hospital qualifies for the alternative payment rate described in
subdivision 2e, new text end the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed deleted text begin $1,500,000deleted text end new text begin
$9,750,000 in fiscal year 2023 and $14,000,000 per year beginning July 1, 2023new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except that the amendment
to paragraph (g) is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256.9695, subdivision 1, is amended to read:
Subdivision 1.
Appeals.
A hospital may appeal a decision arising from the application
of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would
result in a change to the hospital's payment rate or payments. Both overpayments and
underpayments that result from the submission of appeals shall be implemented. Regardless
of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge
ratios, and policy adjusters shall not be changed. The appeal shall be heard by an
administrative law judge according to sections 14.57 to 14.62, or upon agreement by both
parties, according to a modified appeals procedure established by the commissioner and the
Office of Administrative Hearings. In any proceeding under this section, the appealing party
must demonstrate by a preponderance of the evidence that the commissioner's determination
is incorrect or not according to law.
To appeal a payment rate or payment determination or a determination made from base
year information, the hospital shall file a written appeal request to the commissioner within
60 days of the date the preliminary payment rate determination was mailed. The appeal
request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or
rule upon which the hospital relies for each disputed item; and (iii) the name and address
of the person to contact regarding the appeal. Facts to be considered in any appeal of base
year information are limited to those in existence deleted text begin 12deleted text end new text begin 18new text end months after the last day of the
calendar year that is the base year for the payment rates in dispute.
Sec. 12.
Minnesota Statutes 2020, section 256.983, is amended to read:
256.983 FRAUD PREVENTION INVESTIGATIONS.
Subdivision 1.
Programs established.
Within the limits of available appropriations, the
commissioner of human services shall require the maintenance of budget neutral fraud
prevention investigation programs in the counties new text begin or tribal agencies new text end participating in the
fraud prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other counties
new text begin or tribal agencies new text end provided the expansion is budget neutral to the state. Under any expansion,
the commissioner has the final authority in decisions regarding the creation and realignment
of individual countynew text begin , tribal agency,new text end or regional operations.
Subd. 2.
County new text begin and tribal agency new text end proposals.
Each participating county new text begin and tribal
new text end agency shall develop and submit an annual staffing and funding proposal to the commissioner
no later than April 30 of each year. Each proposal shall include, but not be limited to, the
staffing and funding of the fraud prevention investigation program, a job description for
investigators involved in the fraud prevention investigation program, and the organizational
structure of the county new text begin or tribal new text end agency unit, training programs for case workers, and the
operational requirements which may be directed by the commissioner. The proposal shall
be approved, to include any changes directed or negotiated by the commissioner, no later
than June 30 of each year.
Subd. 3.
Department responsibilities.
The commissioner shall establish training
programs which shall be attended by all investigative and supervisory staff of the involved
county new text begin and tribal new text end agencies. The commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms, which shall be used by the involved countynew text begin
or tribalnew text end agencies. An individual's application or redetermination form for public assistance
benefits, including child care assistance programs and medical care programs, must include
an authorization for release by the individual to obtain documentation for any information
on that form which is involved in a fraud prevention investigation. The authorization for
release is effective for six months after public assistance benefits have ceased.
Subd. 4.
Funding.
(a) County new text begin and tribal new text end agency reimbursement shall be made through
the settlement provisions applicable to the Supplemental Nutrition Assistance Program
(SNAP), MFIP, child care assistance programs, the medical assistance program, and other
federal and state-funded programs.
(b) The commissioner will maintain program compliance if for any three consecutive
month period, a county new text begin or tribal new text end agency fails to comply with fraud prevention investigation
program guidelines, or fails to meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county new text begin or tribal new text end agency shall be required to submit a corrective
action plan to the commissioner within 30 days of receipt of a notice of noncompliance.
Failure to submit a corrective action plan or, continued deviation from standards of more
than ten percent after submission of a corrective action plan, will result in denial of funding
for each subsequent month, or billing the county new text begin or tribal new text end agency for fraud prevention
investigation (FPI) service provided by the commissioner, or reallocation of program grant
funds, or investigative resources, or both, to other countiesnew text begin or tribal agenciesnew text end . The denial of
funding shall apply to the general settlement received by the county new text begin or tribal new text end agency on a
quarterly basis and shall not reduce the grant amount applicable to the FPI project.
Subd. 5.
Child care providers; financial misconduct.
(a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.
(b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The countynew text begin or tribenew text end must send notice in accordance with the requirements of section
119B.161, subdivision 2. If a provider's payment is suspended under this section, the payment
suspension shall remain in effect until: (1) the commissioner, county,new text begin tribe,new text end or a law
enforcement authority determines that there is insufficient evidence warranting the action
and a county, tribe, or the commissioner does not pursue an additional administrative remedy
under chapter 119B or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and
administrative proceedings related to the provider's alleged misconduct conclude and any
appeal rights are exhausted.
(c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.
(d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).
Sec. 13.
new text begin
[256B.0371] ADMINISTRATION OF DENTAL SERVICES.
new text end
new text begin
(a) Effective January 1, 2023, the commissioner shall contract with a dental administrator
to administer dental services for all recipients of medical assistance and MinnesotaCare,
including persons enrolled in managed care as described in section 256B.69.
new text end
new text begin
(b) The dental administrator must provide administrative services, including but not
limited to:
new text end
new text begin
(1) provider recruitment, contracting, and assistance;
new text end
new text begin
(2) recipient outreach and assistance;
new text end
new text begin
(3) utilization management and reviews of medical necessity for dental services;
new text end
new text begin
(4) dental claims processing;
new text end
new text begin
(5) coordination of dental care with other services;
new text end
new text begin
(6) management of fraud and abuse;
new text end
new text begin
(7) monitoring access to dental services;
new text end
new text begin
(8) performance measurement;
new text end
new text begin
(9) quality improvement and evaluation; and
new text end
new text begin
(10) management of third-party liability requirements.
new text end
new text begin
(c) Payments to contracted dental providers must be at the rates established under section
256B.76.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.04, subdivision 12, is amended to read:
Subd. 12.
Limitation on services.
deleted text begin (a)deleted text end Place limits on the types of services covered by
medical assistance, the frequency with which the same or similar services may be covered
by medical assistance for an individual recipient, and the amount paid for each covered
service. deleted text begin The state agency shall promulgate rules establishing maximum reimbursement rates
for emergency and nonemergency transportation.
deleted text end
deleted text begin
The rules shall provide:
deleted text end
deleted text begin
(1) an opportunity for all recognized transportation providers to be reimbursed for
nonemergency transportation consistent with the maximum rates established by the agency;
and
deleted text end
deleted text begin
(2) reimbursement of public and private nonprofit providers serving the population with
a disability generally at reasonable maximum rates that reflect the cost of providing the
service regardless of the fare that might be charged by the provider for similar services to
individuals other than those receiving medical assistance or medical care under this chapter.
deleted text end
deleted text begin
(b) The commissioner shall encourage providers reimbursed under this chapter to
coordinate their operation with similar services that are operating in the same community.
To the extent practicable, the commissioner shall encourage eligible individuals to utilize
less expensive providers capable of serving their needs.
deleted text end
deleted text begin
(c) For the purpose of this subdivision and section 256B.02, subdivision 8, and effective
on January 1, 1981, "recognized provider of transportation services" means an operator of
special transportation service as defined in section 174.29 that has been issued a current
certificate of compliance with operating standards of the commissioner of transportation
or, if those standards do not apply to the operator, that the agency finds is able to provide
the required transportation in a safe and reliable manner. Until January 1, 1981, "recognized
transportation provider" includes an operator of special transportation service that the agency
finds is able to provide the required transportation in a safe and reliable manner.
deleted text end
Sec. 15.
Minnesota Statutes 2020, section 256B.04, subdivision 14, is amended to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies; deleted text begin and
deleted text end
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems;new text begin and
new text end
new text begin
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
new text end
(5) nonemergency medical transportation deleted text begin level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursementsdeleted text end ; and
(6) drugs.
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for deleted text begin special transportation services ordeleted text end
incontinence products and related supplies.
Sec. 16.
Minnesota Statutes 2020, section 256B.055, subdivision 6, is amended to read:
Subd. 6.
Pregnant women; needy unborn child.
Medical assistance may be paid for
a pregnant woman who meets the other eligibility criteria of this section and whose unborn
child would be eligible as a needy child under subdivision 10 if born and living with the
woman. In accordance with Code of Federal Regulations, title 42, section 435.956, the
commissioner must accept self-attestation of pregnancy unless the agency has information
that is not reasonably compatible with such attestation. For purposes of this subdivision, a
woman is considered pregnant for deleted text begin 60 daysdeleted text end new text begin 12 monthsnew text end postpartum.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the deleted text begin 60-daydeleted text end new text begin
12-monthnew text end postpartum period to update their income and asset information and to submit
any required income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.057, subdivision 3, is amended to read:
Subd. 3.
Qualified Medicare beneficiaries.
new text begin (a) new text end A person deleted text begin who is entitled to Part A
Medicare benefits, whose income is equal to or less than 100 percent of the federal poverty
guidelines, and whose assets are no more than $10,000 for a single individual and $18,000
for a married couple or family of two or more,deleted text end is eligible for medical assistance
reimbursement of new text begin Medicare new text end Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Actdeleted text begin .deleted text end new text begin
if:
new text end
new text begin
(1) the person is entitled to Medicare Part A benefits;
new text end
new text begin
(2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
new text end
new text begin
(3) the person's assets are no more than (i) $10,000 for a single individual, or (ii) $18,000
for a married couple or family of two or more; or, when the resource limits for eligibility
for the Medicare Part D extra help low income subsidy (LIS) exceed either amount in item
(i) or (ii), the person's assets are no more than the LIS resource limit in United States Code,
title 42, section 1396d, subsection (p).
new text end
new text begin (b)new text end Reimbursement of the Medicare coinsurance and deductibles, when added to the
amount paid by Medicare, must not exceed the total rate the provider would have received
for the same service or services if the person were a medical assistance recipient with
Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until July 1 of each year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.06, subdivision 4, is amended to read:
Subd. 4.
Citizenship requirements.
(a) Eligibility for medical assistance is limited to
citizens of the United States, qualified noncitizens as defined in this subdivision, and other
persons residing lawfully in the United States. Citizens or nationals of the United States
must cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.
(b) "Qualified noncitizen" means a person who meets one of the following immigration
criteria:
(1) admitted for lawful permanent residence according to United States Code, title 8;
(2) admitted to the United States as a refugee according to United States Code, title 8,
section 1157;
(3) granted asylum according to United States Code, title 8, section 1158;
(4) granted withholding of deportation according to United States Code, title 8, section
1253(h);
(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);
(6) granted conditional entrant status according to United States Code, title 8, section
1153(a)(7);
(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
(8) is a child of a noncitizen determined to be a battered noncitizen by the United States
Attorney General according to the Illegal Immigration Reform and Immigrant Responsibility
Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
or
(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.
(c) All qualified noncitizens who were residing in the United States before August 22,
1996, who otherwise meet the eligibility requirements of this chapter, are eligible for medical
assistance with federal financial participation.
(d) Beginning December 1, 1996, qualified noncitizens who entered the United States
on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
chapter are eligible for medical assistance with federal participation for five years if they
meet one of the following criteria:
(1) refugees admitted to the United States according to United States Code, title 8, section
1157;
(2) persons granted asylum according to United States Code, title 8, section 1158;
(3) persons granted withholding of deportation according to United States Code, title 8,
section 1253(h);
(4) veterans of the United States armed forces with an honorable discharge for a reason
other than noncitizen status, their spouses and unmarried minor dependent children; or
(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.
Beginning July 1, 2010, children and pregnant women who are noncitizens described
in paragraph (b) or who are lawfully present in the United States as defined in Code of
Federal Regulations, title 8, section 103.12, and who otherwise meet eligibility requirements
of this chapter, are eligible for medical assistance with federal financial participation as
provided by the federal Children's Health Insurance Program Reauthorization Act of 2009,
Public Law 111-3.
(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter are
eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this subdivision,
a "nonimmigrant" is a person in one of the classes listed in United States Code, title 8,
section 1101(a)(15).
(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of this
chapter, if such care and services are necessary for the treatment of an emergency medical
condition.
(g) For purposes of this subdivision, the term "emergency medical condition" means a
medical condition that meets the requirements of United States Code, title 42, section
1396b(v).
(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment of
an emergency medical condition are limited to the following:
(i) services delivered in an emergency room or by an ambulance service licensed under
chapter 144E that are directly related to the treatment of an emergency medical condition;
(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and
(iii) follow-up services that are directly related to the original service provided to treat
the emergency medical condition and are covered by the global payment made to the
provider.
(2) Services for the treatment of emergency medical conditions do not include:
(i) services delivered in an emergency room or inpatient setting to treat a nonemergency
condition;
(ii) organ transplants, stem cell transplants, and related care;
(iii) services for routine prenatal care;
(iv) continuing care, including long-term care, nursing facility services, home health
care, adult day care, day training, or supportive living services;
(v) elective surgery;
(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as part
of an emergency room visit;
(vii) preventative health care and family planning services;
(viii) rehabilitation services;
(ix) physical, occupational, or speech therapy;
(x) transportation services;
(xi) case management;
(xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
(xiii) dental services;
(xiv) hospice care;
(xv) audiology services and hearing aids;
(xvi) podiatry services;
(xvii) chiropractic services;
(xviii) immunizations;
(xix) vision services and eyeglasses;
(xx) waiver services;
(xxi) individualized education programs; or
(xxii) chemical dependency treatment.
(i) Pregnant noncitizens who are ineligible for federally funded medical assistance
because of immigration status, are not covered by a group health plan or health insurance
coverage according to Code of Federal Regulations, title 42, section 457.310, and who
otherwise meet the eligibility requirements of this chapter, are eligible for medical assistance
through the period of pregnancy, including labor and delivery, and deleted text begin 60 daysdeleted text end new text begin 12 monthsnew text end
postpartumdeleted text begin , to the extent federal funds are available under title XXI of the Social Security
Act, and the state children's health insurance programdeleted text end .
(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation services
from a nonprofit center established to serve victims of torture and are otherwise ineligible
for medical assistance under this chapter are eligible for medical assistance without federal
financial participation. These individuals are eligible only for the period during which they
are receiving services from the center. Individuals eligible under this paragraph shall not
be required to participate in prepaid medical assistance. The nonprofit center referenced
under this paragraph may establish itself as a provider of mental health targeted case
management services through a county contract under section 256.0112, subdivision 6. If
the nonprofit center is unable to secure a contract with a lead county in its service area, then,
notwithstanding the requirements of section 256B.0625, subdivision 20, the commissioner
may negotiate a contract with the nonprofit center for provision of mental health targeted
case management services. When serving clients who are not the financial responsibility
of their contracted lead county, the nonprofit center must gain the concurrence of the county
of financial responsibility prior to providing mental health targeted case management services
for those clients.
(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
emergency medical conditions under paragraph (f) except where coverage is prohibited
under federal law for services under clauses (1) and (2):
(1) dialysis services provided in a hospital or freestanding dialysis facility;
(2) surgery and the administration of chemotherapy, radiation, and related services
necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission and
requires surgery, chemotherapy, or radiation treatment; and
(3) kidney transplant if the person has been diagnosed with end stage renal disease, is
currently receiving dialysis services, and is a potential candidate for a kidney transplant.
(l) Effective July 1, 2013, recipients of emergency medical assistance under this
subdivision are eligible for coverage of the elderly waiver services provided under chapter
256S, and coverage of rehabilitative services provided in a nursing facility. The age limit
for elderly waiver services does not apply. In order to qualify for coverage, a recipient of
emergency medical assistance is subject to the assessment and reassessment requirements
of section 256B.0911. Initial and continued enrollment under this paragraph is subject to
the limits of available funding.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256B.0625, subdivision 3c, is amended to read:
Subd. 3c.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end .
(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-memberdeleted text end new text begin 14-membernew text end Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end , which consists of deleted text begin 12deleted text end new text begin 13new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall advise the commissioner regardingnew text begin (1)new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programsdeleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision-making and health care benefit and coverage policies for
MHCP. The Health Services Advisory Council shall consider available evidence regarding
quality, safety, and cost-effectiveness when advising the commissionernew text end . The Health Services
deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end shall annually deleted text begin electdeleted text end new text begin selectnew text end a deleted text begin physiciandeleted text end chair from among its
membersdeleted text begin ,deleted text end who shall work directly with the commissioner's medical directordeleted text begin ,deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall alsodeleted text end new text begin Advisory
Council maynew text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.
(b) The commissioner shall establish a dental deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end to operate under
the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end . The dental deleted text begin subcommitteedeleted text end new text begin
subcouncilnew text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end shall advise the commissioner regarding:
(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;
(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;
(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;
(4) the development of dental delivery models; and
(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
deleted text begin
(c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end The Health Services deleted text begin Policy Committee shalldeleted text end new text begin Advisory Council maynew text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrolleesdeleted text end new text begin health care providers who serve MHCP recipientsnew text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committeedeleted text end new text begin monitoring
and trackingnew text end shall focus on services or specialties for which there is a high variation in
utilization new text begin or quality new text end across deleted text begin physiciansdeleted text end new text begin providersnew text end , or which are associated with high medical
costs. The commissioner, based upon the findings of the deleted text begin committeedeleted text end new text begin Health Services Advisory
Councilnew text end , deleted text begin shall regularlydeleted text end new text begin maynew text end notify deleted text begin physiciansdeleted text end new text begin providersnew text end whose practice patterns indicate
new text begin below average quality or new text end higher than average utilization or costs. Managed care and
county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make deleted text begin thisdeleted text end new text begin thesenew text end
data available to the deleted text begin committeedeleted text end new text begin Health Services Advisory Councilnew text end .
deleted text begin
(e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 3d, is amended to read:
Subd. 3d.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end members.
(a) The
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end consists of:
(1) deleted text begin sevendeleted text end new text begin sixnew text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, anddeleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistancedeleted text end new text begin MHCPnew text end recipients;
(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;
(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;
new text begin
(4) one voting member who is a health care or mental health professional licensed or
registered in the member's profession, actively engaged in the practice of the member's
profession in Minnesota, and actively engaged in the treatment of persons with mental
illness;
new text end
deleted text begin (4) one consumerdeleted text end new text begin (5) two consumersnew text end who shall serve as deleted text begin adeleted text end voting deleted text begin memberdeleted text end new text begin membersnew text end ; and
deleted text begin (5)deleted text end new text begin (6)new text end the commissioner's medical director who shall serve as a nonvoting member.
(b) Members of the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall not be
employed by the deleted text begin Department of Human Servicesdeleted text end new text begin state of Minnesotanew text end , except for the medical
director.new text begin A quorum shall comprise a simple majority of the voting members. Vacant seats
shall not count toward a quorum.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 3e, is amended to read:
Subd. 3e.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end terms and
compensation.
deleted text begin Committeedeleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committeedeleted text end new text begin councilnew text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end does not expire as provided in section 15.059, subdivision 6.
Sec. 23.
Minnesota Statutes 2020, section 256B.0625, subdivision 9, is amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers dental services.new text begin The commissioner
shall contract with a dental administrator for the administration of dental services. The
contract shall include the administration of dental services for persons enrolled in managed
care as described in section 256B.69.
new text end
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
(1) comprehensive exams, limited to once every five years;
(2) periodic exams, limited to one per year;
(3) limited exams;
(4) bitewing x-rays, limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
(7) prophylaxis, limited to one per year;
(8) application of fluoride varnish, limited to one per year;
(9) posterior fillings, all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited to root canals on the anterior and premolars only;
(12) removable prostheses, each dental arch limited to one every six years;
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
(14) palliative treatment and sedative fillings for relief of pain; deleted text begin and
deleted text end
(15) full-mouth debridement, limited to one every five yearsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
new text end
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
(1) periodontics, limited to periodontal scaling and root planing once every two years;
(2) general anesthesia; and
(3) full-mouth survey once every five years.
(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar for
children only;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
(f) The commissioner shall not require prior authorization for the services included in
paragraph (e), clauses (1) to (3)deleted text begin , and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (e), clauses
(1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except that the amendments
to paragraphs (a) and (f) are effective January 1, 2023.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0625, subdivision 13, is amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissionerdeleted text begin .deleted text end new text begin or the drug appears on the 90-day supply list
published by the commissioner. The 90-day supply list shall be published by the
commissioner on the department's website. The commissioner may add to, delete from, and
otherwise modify the 90-day supply list after providing public notice and the opportunity
for a 15-day public comment period. The 90-day supply list may include cost-effective
generic drugs and shall not include controlled substances.
new text end
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.new text begin
By March 1 of each year, each 340B covered entity and ambulatory pharmacy under common
ownership of the 340B covered entity must report to the commissioner its reimbursements
for the previous calendar year from each managed care and county-based purchasing plan,
or the pharmacy benefit manager contracted with the managed care or county-based
purchasing plan. The report must include:
new text end
new text begin
(1) the National Provider Identification (NPI) number for each 340B covered entity or
ambulatory pharmacy under common ownership of the 340B covered entity;
new text end
new text begin
(2) the name of each 340B covered entity;
new text end
new text begin
(3) the servicing address of each 340B covered entity;
new text end
new text begin
(4) the aggregate cost of drugs purchased during the prior calendar year through the
340B program;
new text end
new text begin
(5) the aggregate cost of drugs purchased during the prior calendar year outside of the
340B program;
new text end
new text begin
(6) the total reimbursement received by the 340B covered entity from all payers, including
uninsured patients, for all drugs during the prior calendar year; and
new text end
new text begin
(7) either: (i) the number of outpatient 340B pharmacy claims and reimbursement amounts
from each managed care and county-based purchasing plan, or pharmacy benefit manager
contracted with the managed care or county-based purchasing plan; or (ii) the number of
professional or facility 340B claim lines and reimbursement amounts during the prior
calendar year from each managed care and county-based purchasing plan.
new text end
new text begin
The commissioner shall submit a copy of the reports to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by April 1 of each year. Drugs acquired through the federal 340B Drug Pricing Program
and dispensed by a 340B covered entity or ambulatory pharmacy under common ownership
of the 340B covered entity are not eligible for coverage if the 340B covered entity or
ambulatory pharmacy under common ownership of the 340B covered entity fails to submit
a report to the commissioner containing the information required under clauses (1) to (7).
new text end
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
Sec. 25.
Minnesota Statutes 2020, section 256B.0625, subdivision 13c, is amended to
read:
Subd. 13c.
Formulary Committee.
The commissioner, after receiving recommendations
from professional medical associations and professional pharmacy associations, and consumer
groups shall designate a Formulary Committee to carry out duties as described in subdivisions
13 to 13g. The Formulary Committee shall be comprised of four licensed physicians actively
engaged in the practice of medicine in Minnesotanew text begin ,new text end one of whom must be actively engaged
in the treatment of persons with mental illness; at least three licensed pharmacists actively
engaged in the practice of pharmacy in Minnesota; and one consumer representative; the
remainder to be made up of health care professionals who are licensed in their field and
have recognized knowledge in the clinically appropriate prescribing, dispensing, and
monitoring of covered outpatient drugs. Members of the Formulary Committee shall not
be employed by the Department of Human Services, but the committee shall be staffed by
an employee of the department who shall serve as an ex officio, nonvoting member of the
committee. The department's medical director shall also serve as an ex officio, nonvoting
member for the committee. Committee members shall serve three-year terms and may be
reappointed by the commissioner. The Formulary Committee shall meet at least twice per
year. The commissioner may require more frequent Formulary Committee meetings as
needed. An honorarium of $100 per meeting and reimbursement for mileage shall be paid
to each committee member in attendance. deleted text begin The Formulary Committee expires June 30, 2022.deleted text end new text begin
Notwithstanding section 15.059, subdivision 6, the Formulary Committee does not expire.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.0625, subdivision 13d, is amended to
read:
Subd. 13d.
Drug formulary.
(a) The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the requirements of the Administrative
Procedure Act, but the Formulary Committee shall review and comment on the formulary
contents.
(b) The formulary shall not include:
(1) drugs, active pharmaceutical ingredients, or products for which there is no federal
funding;
(2) over-the-counter drugs, except as provided in subdivision 13;
deleted text begin
(3) drugs or active pharmaceutical ingredients used for weight loss, except that medically
necessary lipase inhibitors may be covered for a recipient with type II diabetes;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end drugs or active pharmaceutical ingredients when used for the treatment of
impotence or erectile dysfunction;
deleted text begin (5)deleted text end new text begin (4)new text end drugs or active pharmaceutical ingredients for which medical value has not been
established;
deleted text begin (6)deleted text end new text begin (5)new text end drugs from manufacturers who have not signed a rebate agreement with the
Department of Health and Human Services pursuant to section 1927 of title XIX of the
Social Security Act; and
deleted text begin (7)deleted text end new text begin (6)new text end medical cannabis as defined in section 152.22, subdivision 6.
(c) If a single-source drug used by at least two percent of the fee-for-service medical
assistance recipients is removed from the formulary due to the failure of the manufacturer
to sign a rebate agreement with the Department of Health and Human Services, the
commissioner shall notify prescribing practitioners within 30 days of receiving notification
from the Centers for Medicare and Medicaid Services (CMS) that a rebate agreement was
not signed.
Sec. 27.
Minnesota Statutes 2020, section 256B.0625, subdivision 13e, is amended to
read:
Subd. 13e.
Payment rates.
(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.48deleted text end new text begin $10.77new text end per deleted text begin bagdeleted text end new text begin claimnew text end . The professional dispensing fee for prescriptions filled
with over-the-counter drugs meeting the definition of covered outpatient drugs shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for dispensed quantities equal to or greater than the number of units contained
in the manufacturer's original package. The professional dispensing fee shall be prorated
based on the percentage of the package dispensed when the pharmacy dispenses a quantity
less than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for new text begin specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for new text end all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking members of the legislative committees with
jurisdiction over medical assistance pharmacy reimbursement.
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
Sec. 28.
Minnesota Statutes 2020, section 256B.0625, subdivision 17, is amended to read:
Subd. 17.
Transportation costs.
(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:
(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;
(2) ambulances, as defined in section 144E.001, subdivision 2;
(3) taxicabs that meet the requirements of this subdivision;
(4) public transit, as defined in section 174.22, subdivision 7; or
(5) not-for-hire vehicles, including volunteer drivers.
(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.
(d) An organization may be terminated, denied, or suspended from enrollment if:
(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and
(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.
(e) The administrative agency of nonemergency medical transportation must:
(1) adhere to the policies defined by the commissioner deleted text begin in consultation with the
Nonemergency Medical Transportation Advisory Committeedeleted text end ;
(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;new text begin and
new text end
(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by modedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.
deleted text end
deleted text begin
(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end The commissioner may use an order by the recipient's attending physician,
advanced practice registered nurse, or a medical or mental health professional to certify that
the recipient requires nonemergency medical transportation services. Nonemergency medical
transportation providers shall perform driver-assisted services for eligible individuals, when
appropriate. Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs, child seats,
or stretchers in the vehicle.
Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the deleted text begin local agencydeleted text end new text begin administratornew text end .
Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.
deleted text begin (h)deleted text end new text begin (g) new text end The administrative agency shall use the level of service process established by
the commissioner deleted text begin in consultation with the Nonemergency Medical Transportation Advisory
Committeedeleted text end to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.
deleted text begin (i)deleted text end new text begin (h)new text end The covered modes of transportation are:
(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;
(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;
(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;
(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;
(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;
(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and
(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.
deleted text begin
(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
deleted text end
deleted text begin (k)deleted text end new text begin (i)new text end The commissioner shall:
(1) deleted text begin in consultation with the Nonemergency Medical Transportation Advisory Committee,deleted text end
verify that the mode and use of nonemergency medical transportation is appropriate;
(2) verify that the client is going to an approved medical appointment; and
(3) investigate all complaints and appeals.
deleted text begin
(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
deleted text end
deleted text begin (m)deleted text end new text begin (j) new text end Payments for nonemergency medical transportation must be paid based on the
client's assessed mode under paragraph deleted text begin (h)deleted text end new text begin (g)new text end , not the type of vehicle used to provide the
service. deleted text begin The medical assistance reimbursement rates for nonemergency medical transportation
services that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:
deleted text end
deleted text begin
(1) $0.22 per mile for client reimbursement;
deleted text end
deleted text begin
(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;
deleted text end
deleted text begin
(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
deleted text end
deleted text begin
(4) $13 for the base rate and $1.30 per mile for assisted transport;
deleted text end
deleted text begin
(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
deleted text end
deleted text begin
(6) $75 for the base rate and $2.40 per mile for protected transport; and
deleted text end
deleted text begin
(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.
deleted text end
deleted text begin
(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:
deleted text end
deleted text begin
(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and
deleted text end
deleted text begin
(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).
deleted text end
deleted text begin
(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.
deleted text end
deleted text begin
(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.
deleted text end
deleted text begin (q)deleted text end new text begin (k)new text end The commissioner, when determining reimbursement rates for nonemergency
medical transportation deleted text begin under paragraphs (m) and (n)deleted text end , shall exempt all modes of transportation
listed under paragraph deleted text begin (i)deleted text end new text begin (h)new text end from Minnesota Rules, part 9505.0445, item R, subitem (2).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.0625, subdivision 17b, is amended to
read:
Subd. 17b.
Documentation required.
(a) As a condition for payment, nonemergency
medical transportation providers must document each occurrence of a service provided to
a recipient according to this subdivision. Providers must maintain odometer and other records
sufficient to distinguish individual trips with specific vehicles and drivers. The documentation
may be collected and maintained using electronic systems or software or in paper form but
must be made available and produced upon request. Program funds paid for transportation
that is not documented according to this subdivision shall be recovered by the new text begin nonemergency
medical transportation vendor or new text end department.
(b) A nonemergency medical transportation provider must compile transportation records
that meet the following requirements:
(1) the record must be in English and must be legible according to the standard of a
reasonable person;
(2) the recipient's name must be on each page of the record; and
(3) each entry in the record must document:
(i) the date on which the entry is made;
(ii) the date or dates the service is provided;
(iii) the printed last name, first name, and middle initial of the driver;
(iv) the signature of the driver attesting to the following: "I certify that I have accurately
reported in this record the trip miles I actually drove and the dates and times I actually drove
them. I understand that misreporting the miles driven and hours worked is fraud for which
I could face criminal prosecution or civil proceedings.";
(v) the signature of the recipient or authorized party attesting to the following: "I certify
that I received the reported transportation service.", or the signature of the provider of
medical services certifying that the recipient was delivered to the provider;
(vi) the address, or the description if the address is not available, of both the origin and
destination, and the mileage for the most direct route from the origin to the destination;
(vii) the mode of transportation in which the service is provided;
(viii) the license plate number of the vehicle used to transport the recipient;
(ix) whether the service was ambulatory or nonambulatory;
(x) the time of the pickup and the time of the drop-off with "a.m." and "p.m."
designations;
(xi) the name of the extra attendant when an extra attendant is used to provide special
transportation service; and
(xii) the electronic source documentation used to calculate driving directions and mileage.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.0625, subdivision 18, is amended to read:
Subd. 18.
deleted text begin Busdeleted text end new text begin Public transitnew text end or taxicab transportation.
new text begin (a) new text end To the extent authorized
by rule of the state agency, medical assistance covers the most appropriate and cost-effective
form of transportation incurred by any ambulatory eligible person for obtaining
nonemergency medical care.
new text begin
(b) The commissioner may provide a monthly public transit pass to recipients who are
well-served by public transit for the recipient's nonemergency medical transportation needs.
Any recipient who is eligible for one public transit trip for a medically necessary covered
service may select to receive a transit pass for that month. Recipients who do not have any
transportation needs for a medically necessary service in any given month or who have
received a transit pass for that month through another program administered by a county or
Tribe are not eligible for a transit pass that month. The commissioner shall not require
recipients to select a monthly transit pass if the recipient's transportation needs cannot be
served by public transit systems. Recipients who receive a monthly transit pass are not
eligible for other modes of transportation, unless an unexpected need arises that cannot be
accessed through public transit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.0625, subdivision 18b, is amended to
read:
Subd. 18b.
deleted text begin Broker dispatching prohibitiondeleted text end new text begin Administration of nonemergency medical
transportationnew text end .
deleted text begin
Except for establishing level of service process, the commissioner shall
not use a broker or coordinator for any purpose related to nonemergency medical
transportation services under subdivision 18.
deleted text end
new text begin
The commissioner shall contract either statewide
or regionally for the administration of the nonemergency medical transportation program
in compliance with the provisions of this chapter. The contract shall include the
administration of all covered modes under the nonemergency medical transportation benefit
for those enrolled in managed care as described in section 256B.69.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256B.0625, subdivision 30, is amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center (FQHC) that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. An FQHC that is already in operation shall submit
an initial report using actual costs and visits for the initial reporting period. Within 90 days
of the end of its reporting period, an FQHC shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred for
the period and the actual number of visits for services furnished during the period, and other
information required by the commissioner. FQHCs that file Medicare cost reports shall
provide the commissioner with a copy of the most recent Medicare cost report filed with
the Medicare program intermediary for the reporting year which support the costs claimed
on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation
as an essential community provider within six months of final adoption of rules by the
Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and
rural health clinics that have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will continue to be made according
to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural
health clinics that either do not apply within the time specified above or who have had
essential community provider status for three years, medical assistance payments for health
services provided by these entities shall be according to the same rates and conditions
applicable to the same service provided by health care providers that are not FQHCs or rural
health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural
health clinic to make application for an essential community provider designation in order
to have cost-based payments made according to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.
(g) Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).
(h) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
(i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner. the commissioner shall determine the most feasible method for paying claims
from the following options:
(1) FQHCs and rural health clinics submit claims directly to the commissioner for
payment, and the commissioner provides claims information for recipients enrolled in a
managed care or county-based purchasing plan to the plan, on a regular basis; or
(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed
care or county-based purchasing plan to the plan, and those claims are submitted by the
plan to the commissioner for payment to the clinic.
(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
(k) The commissioner shall seek a federal waiver, authorized under section 1115 of the
Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
(1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
(i) general social services and administrative costs;
(ii) retail pharmacy;
(iii) patient incentives, food, housing assistance, and utility assistance;
(iv) external lab and x-ray;
(v) navigation services;
(vi) health care taxes;
(vii) advertising, public relations, and marketing;
(viii) office entertainment costs, food, alcohol, and gifts;
(ix) contributions and donations;
(x) bad debts or losses on awards or contracts;
(xi) fines, penalties, damages, or other settlements;
(xii) fund-raising, investment management, and associated administrative costs;
(xiii) research and associated administrative costs;
(xiv) nonpaid workers;
(xv) lobbying;
(xvi) scholarships and student aid; and
(xvii) nonmedical assistance covered services;
(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
(5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;
(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing yearnew text begin . Years in which organizational
cost or claims volume is reduced or altered due to a pandemic, disease, or other public health
emergency shall not be used as part of a base year when the base year includes more than
one year. The commissioner may use the Medicare cost reports of a year unaffected by a
pandemic, disease, or other public health emergency, or previous two consecutive years,
inflated to the base year as established under item (iv)new text end ;
(iv) must be inflated to the base year using the inflation factor described in clause (6);
and
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
(6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;
(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;
(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;
(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);
(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
(12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rate;
(13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and
(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.
Sec. 33.
Minnesota Statutes 2020, section 256B.0625, subdivision 31, is amended to read:
Subd. 31.
Medical supplies and equipment.
(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.
(d) Durable medical equipment means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.
(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.
new text begin
(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or
(d), shall be considered durable medical equipment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256B.0625, subdivision 58, is amended to read:
Subd. 58.
Early and periodic screening, diagnosis, and treatment services.
new text begin (a) new text end Medical
assistance covers early and periodic screening, diagnosis, and treatment services (EPSDT).
new text begin In administering the EPSDT program, the commissioner shall, at a minimum:
new text end
new text begin
(1) provide information to children and families, using the most effective mode identified,
regarding:
new text end
new text begin
(i) the benefits of preventative health care visits;
new text end
new text begin
(ii) the services available as part of the EPSDT program; and
new text end
new text begin
(iii) assistance finding a provider, transportation, or interpreter services;
new text end
new text begin
(2) maintain an up-to-date periodicity schedule published in the department policy
manual, taking into consideration the most up-to-date community standard of care; and
new text end
new text begin
(3) maintain up-to-date policies for providers on the delivery of EPSDT services that
are in the provider manual on the department website.
new text end
new text begin
(b) The commissioner may contract for the administration of the outreach services as
required within the EPSDT program.
new text end
new text begin
(c) The commissioner may contract for the required EPSDT outreach services, including
but not limited to children enrolled or attributed to an integrated health partnership
demonstration project described in section 256B.0755. Integrated health partnerships that
choose to include the EPSDT outreach services within the integrated health partnership's
contracted responsibilities must receive compensation from the commissioner on a
per-member per-month basis for each included child. Integrated health partnerships must
accept responsibility for the effectiveness of outreach services it delivers. For children who
are not a part of the demonstration project, the commissioner may contract for the
administration of the outreach services.
new text end
new text begin (d) new text end The payment amount for a complete EPSDT screening shall not include charges for
health care services and products that are available at no cost to the provider and shall not
exceed the rate established per Minnesota Rules, part 9505.0445, item M, effective October
1, 2010.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except that paragraph (c)
is effective January 1, 2022.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 67. new text end
new text begin Enhanced asthma care services. new text end
new text begin
(a) Medical assistance covers enhanced
asthma care services and related products to be provided in the children's homes for children
with poorly controlled asthma. To be eligible for services and products under this subdivision,
a child must:
new text end
new text begin
(1) have poorly controlled asthma defined by having received health care for the child's
asthma from a hospital emergency department at least one time in the past year or have
been hospitalized for the treatment of asthma at least one time in the past year; and
new text end
new text begin
(2) receive a referral for services and products under this subdivision from a treating
health care provider.
new text end
new text begin
(b) Covered services include home visits provided by a registered environmental health
specialist or lead risk assessor currently credentialed by the Department of Health or a
healthy homes specialist credentialed by the Building Performance Institute.
new text end
new text begin
(c) Covered products include the following allergen-reducing products that are identified
as needed and recommended for the child by a registered environmental health specialist,
healthy homes specialist, lead risk assessor, certified asthma educator, public health nurse,
or other health care professional providing asthma care for the child, and proven to reduce
asthma triggers:
new text end
new text begin
(1) allergen encasements for mattresses, box springs, and pillows;
new text end
new text begin
(2) an allergen-rated vacuum cleaner, filters, and bags;
new text end
new text begin
(3) a dehumidifier and filters;
new text end
new text begin
(4) HEPA single-room air cleaners and filters;
new text end
new text begin
(5) integrated pest management, including traps and starter packages of food storage
containers;
new text end
new text begin
(6) a damp mopping system;
new text end
new text begin
(7) if the child does not have access to a bed, a waterproof hospital-grade mattress; and
new text end
new text begin
(8) for homeowners only, furnace filters.
new text end
new text begin
(d) The commissioner shall determine additional products that may be covered as new
best practices for asthma care are identified.
new text end
new text begin
(e) A home assessment is a home visit to identify asthma triggers in the home and to
provide education on trigger-reducing products. A child is limited to two home assessments
except that a child may receive an additional home assessment if the child moves to a new
home; if a new asthma trigger, including tobacco smoke, enters the home; or if the child's
health care provider identifies a new allergy for the child, including an allergy to mold,
pests, pets, or dust mites. The commissioner shall determine the frequency with which a
child may receive a product under paragraph (c) or (d) based on the reasonable expected
lifetime of the product.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting
by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription and $1 per generic drug prescription, subject
to a $12 per month maximum for prescription drug co-payments. No co-payments shall
apply to antipsychotic drugs when used for the treatment of mental illnessnew text begin . No co-payments
shall apply to medications when used for the prevention or treatment of the human
immunodeficiency virus (HIV)new text end ;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, subject to federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.0638, subdivision 3, is amended to read:
Subd. 3.
Opioid prescribing work group.
(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:
(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;
(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;
(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;
(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;
(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;
(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;
(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;
(8) one member who is a medical examiner for a Minnesota county;
(9) one member of the Health Services Policy Committee established under section
256B.0625, subdivisions 3c to 3e;
(10) one member who is a medical director of a health plan company doing business in
Minnesota;
(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; deleted text begin and
deleted text end
(12) one member representing Minnesota law enforcementdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) two consumer members who are Minnesota residents and who have used or are
using opioids to manage chronic pain.
new text end
(b) In addition, the work group shall include the following nonvoting members:
(1) the medical director for the medical assistance program;
(2) a member representing the Department of Human Services pharmacy unit; deleted text begin and
deleted text end
(3) the medical director for the Department of Labor and Industrydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) a member representing the Minnesota Department of Health.
new text end
(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.
Sec. 38.
Minnesota Statutes 2020, section 256B.0638, subdivision 5, is amended to read:
Subd. 5.
Program implementation.
(a) The commissioner shall implement the programs
within the Minnesota health care program to improve the health of and quality of care
provided to Minnesota health care program enrollees. The commissioner shall annually
collect and report tonew text begin provider groups the sentinel measures of data showing individualnew text end opioid
deleted text begin prescribers data showing the sentinel measures of theirdeleted text end new text begin prescribers'new text end opioid prescribing
patterns compared to their anonymized peers.new text begin Provider groups shall distribute data to their
affiliated, contracted, or employed opioid prescribers.
new text end
(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:
(1) components of the program described in subdivision 4, paragraph (a);
(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and
(3) appropriate use of the prescription monitoring program under section 152.126.
(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall take one or more of the following steps:
(1) monitor prescribing practices more frequently than annually;
(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or
(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.
(d) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.
Sec. 39.
Minnesota Statutes 2020, section 256B.0638, subdivision 6, is amended to read:
Subd. 6.
Data practices.
(a) Reports and data identifying an opioid prescriber are private
data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber
is subject to termination as a medical assistance provider under this section. Notwithstanding
this data classification, the commissioner shall share with all of the provider groups with
which an opioid prescriber is employednew text begin , contracted,new text end or affiliated, deleted text begin a report identifying an
opioid prescriber who is subject to quality improvement activitiesdeleted text end new text begin the datanew text end under subdivision
5, paragraphnew text begin (a),new text end (b)new text begin ,new text end or (c).
(b) Reports and data identifying a provider group are nonpublic data as defined under
section 13.02, subdivision 9, until the provider group is subject to termination as a medical
assistance provider under this section.
(c) Upon termination under this section, reports and data identifying an opioid prescriber
or provider group are public, except that any identifying information of Minnesota health
care program enrollees must be redacted by the commissioner.
Sec. 40.
Minnesota Statutes 2020, section 256B.0659, subdivision 13, is amended to read:
Subd. 13.
Qualified professional; qualifications.
(a) The qualified professional must
work for a personal care assistance provider agency, meet the definition of qualified
professional under section 256B.0625, subdivision 19c, deleted text begin and enroll with the department as
a qualified professional after clearingdeleted text end new text begin clearnew text end a background studynew text begin , and meet provider training
requirementsnew text end . Before a qualified professional provides services, the personal care assistance
provider agency must initiate a background study on the qualified professional under chapter
245C, and the personal care assistance provider agency must have received a notice from
the commissioner that the qualified professional:
(1) is not disqualified under section 245C.14; or
(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:
(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;
(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;
(3) review documentation of personal care assistance services provided;
(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and
(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.
(c) deleted text begin Effective July 1, 2011,deleted text end The qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.
Sec. 41.
Minnesota Statutes 2020, section 256B.196, subdivision 2, is amended to read:
Subd. 2.
Commissioner's duties.
(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.
(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.
(c) Beginning January 1, 2010, deleted text begin Hennepin County anddeleted text end Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
deleted text begin $12,000,000 per year from Hennepin County anddeleted text end $6,000,000 per year deleted text begin from Ramsey Countydeleted text end .
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to deleted text begin Hennepin County Medical Center ordeleted text end Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to deleted text begin Hennepin County Medical Center anddeleted text end
Regions Hospital by those plans. For the purposes of this paragraph, "the base amount"
means the total annual value of increased medical assistance capitation payments, including
the voluntary intergovernmental transfers, under this paragraph in calendar year 2017. For
managed care contracts beginning on or after January 1, 2018, the commissioner shall reduce
the total annual value of increased medical assistance capitation payments under this
paragraph by an amount equal to ten percent of the base amount, and by an additional ten
percent of the base amount for each subsequent contract year until December 31, 2025.
Upon the request of the commissioner, health plans shall submit individual-level cost data
for verification purposes. The commissioner may ratably reduce these payments on a pro
rata basis in order to satisfy federal requirements for actuarial soundness. If payments are
reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
increased medical assistance capitation payments under the intergovernmental transfer
described in this paragraph shall increase its medical assistance payments to deleted text begin Hennepin
County Medical Center anddeleted text end Regions Hospital by the same amount as the increased payments
received in the capitation payment described in this paragraph. This paragraph expires
January 1, 2026.
(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County, the
city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center, the city of St. Paul, and other participating governmental entities equal to
the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center, the city of St.
Paul, and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.
(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.
(f) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (e), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.
(g) The payments in paragraphs (a) to (e) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under subdivision 3.
(h) All of the data and funding transactions related to the payments in paragraphs (a) to
(e) shall be between the commissioner and the governmental entities.
(i) For purposes of this subdivision, billing professionals are limited to physicians, nurse
practitioners, nurse midwives, clinical nurse specialists, physician assistants,
anesthesiologists, certified registered nurse anesthetists, dentists, dental hygienists, and
dental therapists.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval
of both this section and Minnesota Statutes, section 256B.1973, whichever is later. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 42.
new text begin
[256B.1973] DIRECTED PAYMENT ARRANGEMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given them.
new text end
new text begin
(b) "Billing professionals" means physicians, nurse practitioners, nurse midwives, clinical
nurse specialists, physician assistants, anesthesiologists, and certified registered anesthetists,
and may include dentists, individually enrolled dental hygienists, and dental therapists.
new text end
new text begin
(c) "Health plan" means a managed care or county-based purchasing plan that is under
contract with the commissioner to deliver services to medical assistance enrollees under
section 256B.69.
new text end
new text begin
(d) "High medical assistance utilization" means a medical assistance utilization rate
equal to the standard established in section 256.969, subdivision 9, paragraph (d), clause
(6).
new text end
new text begin Subd. 2. new text end
new text begin Federal approval required. new text end
new text begin
Each directed payment arrangement under this
section is contingent on federal approval and must conform with the requirements for
permissible directed managed care organization expenditures under section 256B.6928,
subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Eligible providers. new text end
new text begin
Eligible providers under this section are nonstate government
teaching hospitals with high medical assistance utilization and a level 1 trauma center and
the hospital's affiliated billing professionals, ambulance services, and clinics.
new text end
new text begin Subd. 4. new text end
new text begin Voluntary intergovernmental transfers. new text end
new text begin
A nonstate governmental entity that
is eligible to perform intergovernmental transfers may make voluntary intergovernmental
transfers to the commissioner. The commissioner shall inform the nonstate governmental
entity of the intergovernmental transfers necessary to maximize the allowable directed
payments.
new text end
new text begin Subd. 5. new text end
new text begin Commissioner's duties; state-directed fee schedule requirement. new text end
new text begin
(a) For
each federally approved directed payment arrangement that is a state-directed fee schedule
requirement, the commissioner shall determine a uniform adjustment factor to be applied
to each claim submitted by an eligible provider to a health plan. The uniform adjustment
factor shall be determined using the average commercial payer rate or using another method
acceptable to the Centers for Medicare and Medicaid Services if the average commercial
payer rate is not approved, minus the amount necessary for the plan to satisfy tax liabilities
under sections 256.9657 and 297I.05 attributable to the directed payment arrangement. The
commissioner shall ensure that the application of the uniform adjustment factor maximizes
the allowable directed payments and does not result in payments exceeding federal limits,
and may use an annual settle-up process. The directed payment shall be specific to each
health plan and prospectively incorporated into capitation payments for that plan.
new text end
new text begin
(b) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner shall develop a plan for the initial
implementation of the state-directed fee schedule requirement to ensure that the eligible
provider receives the entire permissible value of the federally approved directed payment
arrangement. If federal approval of a directed payment arrangement under this subdivision
is retroactive, the commissioner shall make a onetime pro rata increase to the uniform
adjustment factor and the initial payments in order to include claims submitted between the
retroactive federal approval date and the period captured by the initial payments.
new text end
new text begin Subd. 6. new text end
new text begin Health plan duties; submission of claims. new text end
new text begin
In accordance with its contract,
each health plan shall submit to the commissioner payment information for each claim paid
to an eligible provider for services provided to a medical assistance enrollee.
new text end
new text begin Subd. 7. new text end
new text begin Health plan duties; directed payments. new text end
new text begin
In accordance with its contract, each
health plan shall make directed payments to the eligible provider in an amount equal to the
payment amounts the plan received from the commissioner.
new text end
new text begin Subd. 8. new text end
new text begin State quality goals. new text end
new text begin
The directed payment arrangement and state-directed fee
schedule requirement must align the state quality goals to Hennepin Healthcare medical
assistance patients, including unstably housed individuals, those with higher levels of social
and clinical risk, limited English proficiency (LEP) patients, adults with serious chronic
conditions, and individuals of color. The directed payment arrangement must maintain
quality and access to a full range of health care delivery mechanisms for these patients that
may include behavioral health, emergent care, preventive care, hospitalization, transportation,
interpreter services, and pharmaceutical services. The commissioner, in consultation with
Hennepin Healthcare, shall submit to the Centers for Medicare and Medicaid Services a
methodology to measure access to care and the achievement of state quality goals.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, unless the federal approval provides for an effective date that is before
the date the federal approval was issued, including a retroactive effective date, in which
case this section is effective retroactively from the federally approved effective date. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 43.
Minnesota Statutes 2020, section 256B.69, subdivision 6d, is amended to read:
Subd. 6d.
Prescription drugs.
The commissioner deleted text begin maydeleted text end new text begin shallnew text end exclude deleted text begin or modifydeleted text end coverage
for new text begin outpatient new text end prescription drugs new text begin dispensed by a pharmacy to a member eligible for medical
assistance under this chapter new text end from the prepaid managed care contracts entered into under
this section deleted text begin in order to increase savings to the state by collecting additional prescription
drug rebates. The contracts must maintain incentives for the managed care plan to manage
drug costs and utilization and may require that the managed care plans maintain an open
drug formulary. In order to manage drug costs and utilization, the contracts may authorize
the managed care plans to use preferred drug lists and prior authorization. This subdivision
is contingent on federal approval of the managed care contract changes and the collection
of additional prescription drug rebatesdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon completion of
the Medicaid Management Information System pharmacy module modernization project,
whichever is later. The commissioner shall notify the revisor of statutes when the project
is completed.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256B.69, is amended by adding a subdivision
to read:
new text begin Subd. 9f. new text end
new text begin Annual report on provider reimbursement rates. new text end
new text begin
(a) The commissioner,
by December 15 of each year, shall submit to the chairs and ranking minority members of
the legislative committees with jurisdiction over health care policy and finance a report on
managed care and county-based purchasing plan provider reimbursement rates. The report
must comply with sections 3.195 and 3.197.
new text end
new text begin
(b) The report must include, for each managed care and county-based purchasing plan,
the mean and median provider reimbursement rates by county for the calendar year preceding
the reporting year, for the five most common billing codes statewide across all plans, in
each of the following provider service categories:
new text end
new text begin
(1) physician services - prenatal and preventive;
new text end
new text begin
(2) physician services - nonprenatal and nonpreventive;
new text end
new text begin
(3) dental services;
new text end
new text begin
(4) inpatient hospital services;
new text end
new text begin
(5) outpatient hospital services; and
new text end
new text begin
(6) mental health services.
new text end
new text begin
(c) The commissioner shall also include in the report:
new text end
new text begin
(1) the mean and median reimbursement rates across all plans by county for the calendar
year preceding the reporting year for the billing codes and provider service categories
described in paragraph (b); and
new text end
new text begin
(2) the mean and median fee-for-service reimbursement rates by county for the calendar
year preceding the reporting year for the billing codes and provider service categories
described in paragraph (b).
new text end
Sec. 45.
Minnesota Statutes 2020, section 256B.69, is amended by adding a subdivision
to read:
new text begin Subd. 9g. new text end
new text begin
Annual report on prepaid health plan reimbursement to 340B covered
entities.
new text end
new text begin
(a) By March 1 of each year, each managed care and county-based purchasing plan
shall report to the commissioner its reimbursement to 340B covered entities for the previous
calendar year. The report must include:
new text end
new text begin
(1) the National Provider Identification (NPI) number for each 340B covered entity;
new text end
new text begin
(2) the name of each 340B covered entity;
new text end
new text begin
(3) the servicing address of each 340B covered entity; and
new text end
new text begin
(4) either: (i) the number of outpatient 340B pharmacy claims and reimbursement
amounts; or (ii) the number of professional or facility 340B claim lines and reimbursement
amounts.
new text end
new text begin
(b) The commissioner shall submit a copy of the reports to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by April 1 of each year.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256B.6928, subdivision 5, is amended to read:
Subd. 5.
Direction of managed care organization expenditures.
(a) The commissioner
shall not direct managed care organizations expenditures under the managed care contract,
except deleted text begin indeleted text end new text begin as permitted under Code of Federal Regulations, part 42, section 438.6(c). The
exception under this paragraph includesnew text end the following situations:
(1) implementation of a value-based purchasing model for provider reimbursement,
including pay-for-performance arrangements, bundled payments, or other service payments
intended to recognize value or outcomes over volume of services;
(2) participation in a multipayer or medical assistance-specific delivery system reform
or performance improvement initiative; or
(3) implementation of a minimum or maximum fee schedule, or a uniform dollar or
percentage increase for network providers that provide a particular service. The maximum
fee schedule must allow the managed care organization the ability to reasonably manage
risk and provide discretion in accomplishing the goals of the contract.
(b) Any managed care contract that directs managed care organization expenditures as
permitted under paragraph (a), clauses (1) to (3), must be developed in accordance with
Code of Federal Regulations, part 42, sections 438.4 and 438.5; comply with actuarial
soundness and generally accepted actuarial principles and practices; and have written
approval from the Centers for Medicare and Medicaid Services before implementation. To
obtain approval, the commissioner shall demonstrate in writing that the contract arrangement:
(1) is based on the utilization and delivery of services;
(2) directs expenditures equally, using the same terms of performance for a class of
providers providing service under the contract;
(3) is intended to advance at least one of the goals and objectives in the commissioner's
quality strategy;
(4) has an evaluation plan that measures the degree to which the arrangement advances
at least one of the goals in the commissioner's quality strategy;
(5) does not condition network provider participation on the network provider entering
into or adhering to an intergovernmental transfer agreement; and
(6) is not renewed automatically.
(c) For contract arrangements identified in paragraph (a), clauses (1) and (2), the
commissioner shall:
(1) make participation in the value-based purchasing model, special delivery system
reform, or performance improvement initiative available, using the same terms of
performance, to a class of providers providing services under the contract related to the
model, reform, or initiative; and
(2) use a common set of performance measures across all payers and providers.
(d) The commissioner shall not set the amount or frequency of the expenditures or recoup
from the managed care organization any unspent funds allocated for these arrangements.
Sec. 47.
Minnesota Statutes 2020, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) new text begin (1) new text end Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
new text begin
(2) Effective for services provided on or after January 1, 2023, the rate described in
clause (1) shall be increased for hospitals providing high levels of high-cost drugs or 340B
drugs. The rate adjustment shall be based on each hospital's share of the total reimbursement
for 340B drugs to all critical access hospitals, but shall not exceed three percentage points.
new text end
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.new text begin
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
new text end
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
Sec. 48.
Minnesota Statutes 2020, section 256B.76, subdivision 2, is amended to read:
Subd. 2.
Dental reimbursement.
(a) Effective for services rendered on or after October
1, 1992new text begin , through December 31, 2022new text end , the commissioner shall make payments for dental
services as follows:
(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and
(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.
(b) Beginning October 1, 1999new text begin , through December 31, 2022new text end , the payment for tooth
sealants and fluoride treatments shall be the lower of (1) submitted charge, or (2) 80 percent
of median 1997 charges.
(c) Effective for services rendered on or after January 1, 2000new text begin , through December 31,
2022new text end , payment rates for dental services shall be increased by three percent over the rates in
effect on December 31, 1999.
(d) Effective for services provided on or after January 1, 2002new text begin , through December 31,
2022new text end , payment for diagnostic examinations and dental x-rays provided to children under
age 21 shall be the lower of (1) the submitted charge, or (2) 85 percent of median 1999
charges.
(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.
(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.
(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.
(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).
deleted text begin
(i) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for dental services shall be reduced by three percent. This reduction does not
apply to state-operated dental clinics in paragraph (f).
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end Effective for services rendered on or after January 1, 2014new text begin , through December 31,
2022new text end , payment rates for dental services shall be increased by five percent from the rates in
effect on December 31, 2013. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2014, payments made to managed care plans and county-based
purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment
increase described in this paragraph.
deleted text begin
(k) Effective for services rendered on or after July 1, 2015, through December 31, 2016,
the commissioner shall increase payment rates for services furnished by dental providers
located outside of the seven-county metropolitan area by the maximum percentage possible
above the rates in effect on June 30, 2015, while remaining within the limits of funding
appropriated for this purpose. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2016, through December 31, 2016, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph. The commissioner shall require managed
care and county-based purchasing plans to pass on the full amount of the increase, in the
form of higher payment rates to dental providers located outside of the seven-county
metropolitan area.
deleted text end
deleted text begin (l)deleted text end new text begin (j)new text end Effective for services provided on or after January 1, 2017new text begin , through December 31,
2022new text end , the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph.
deleted text begin (m)deleted text end new text begin (k)new text end Effective for services provided on or after July 1, 2017new text begin , through December 31,
2022new text end , the commissioner shall increase payment rates by 23.8 percent for dental services
provided to enrollees under the age of 21. This rate increase does not apply to state-operated
dental clinics in paragraph (f), federally qualified health centers, rural health centers, or
Indian health centers. This rate increase does not apply to managed care plans and
county-based purchasing plans.
new text begin
(l) Effective for services provided on or after January 1, 2023, payment for dental services
shall be the lower of the submitted charge or 86 percent of the fifth percentile of 2018
submitted charges from claims paid by the commissioner. The commissioner shall increase
this payment amount by 20 percent for providers designated as critical access dental providers
under medical assistance and MinnesotaCare. The critical access dental provider payment
add-on shall be calculated to be specific to each individual clinic location within a larger
system. This paragraph does not apply to federally qualified health centers, rural health
centers, state-operated dental clinics, or Indian health centers.
new text end
new text begin
(m) Beginning January 1, 2026, and every four years thereafter, the commissioner shall
rebase payment rates for dental services to the first percentile of submitted charges for the
applicable base year using charge data from paid claims submitted by providers. The base
year used for each rebasing shall be the calendar year that is two years prior to the effective
date of the rebasing.
new text end
Sec. 49.
Minnesota Statutes 2020, section 256B.76, subdivision 4, is amended to read:
Subd. 4.
Critical access dental providers.
(a) The commissioner shall increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. For dental services rendered on or after July 1, 2016new text begin , through
December 31, 2022new text end , the commissioner shall increase reimbursement by 37.5 percent above
the reimbursement rate that would otherwise be paid to the critical access dental provider,
except as specified under paragraph (b). The commissioner shall pay the managed care
plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.
(b) For dental services rendered on or after July 1, 2016new text begin , through December 31, 2022new text end ,
by a dental clinic or dental group that meets the critical access dental provider designation
under paragraph (d), clause (4), and is owned and operated by a health maintenance
organization licensed under chapter 62D, the commissioner shall increase reimbursement
by 35 percent above the reimbursement rate that would otherwise be paid to the critical
access provider.
(c) Critical access dental payments made under paragraph (a) or (b) for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.
(d) The commissioner shall designate the following dentists and dental clinics as critical
access dental providers:
(1) nonprofit community clinics that:
(i) have nonprofit status in accordance with chapter 317A;
(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;
(iv) have professional staff familiar with the cultural background of the clinic's patients;
(v) charge for services on a sliding fee scale designed to provide assistance to low-income
patients based on current poverty income guidelines and family size;
(vi) do not restrict access or services because of a patient's financial limitations or public
assistance status; and
(vii) have free care available as needed;
(2) federally qualified health centers, rural health clinics, and public health clinics;
(3) hospital-based dental clinics owned and operated by a city, county, or former state
hospital as defined in section 62Q.19, subdivision 1, paragraph (a), clause (4);
(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;
(5) a dental clinic owned and operated by the University of Minnesota or the Minnesota
State Colleges and Universities system; and
(6) private practicing dentists if:
(i) the dentist's office is located within the seven-county metropolitan area and more
than 50 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare; or
(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare.
Sec. 50.
Minnesota Statutes 2020, section 256B.79, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given them.
(b) "Adverse outcomes" means maternal opiate addiction, other reportable prenatal
substance abuse, low birth weight, or preterm birth.
(c) "Qualified integrated perinatal care collaborative" or "collaborative" means a
combination of (1) members of community-based organizations that represent communities
within the identified targeted populations, and (2) local or tribally based service entities,
including health care, public health, social services, mental health, chemical dependency
treatment, and community-based providers, determined by the commissioner to meet the
criteria for the provision of integrated care and enhanced services for enrollees within
targeted populations.
(d) "Targeted populations" means pregnant medical assistance enrollees residing in
deleted text begin geographic areasdeleted text end new text begin communitiesnew text end identified by the commissioner as being at above-average
risk for adverse outcomes.
Sec. 51.
Minnesota Statutes 2020, section 256B.79, subdivision 3, is amended to read:
Subd. 3.
Grant awards.
The commissioner shall award grants to qualifying applicants
to support interdisciplinary, integrated perinatal care. Grant funds must be distributed through
a request for proposals process to a designated lead agency within an entity that has been
determined to be a qualified integrated perinatal care collaborative or within an entity in
the process of meeting the qualifications to become a qualified integrated perinatal care
collaborativedeleted text begin , and priority shall be given to qualified integrated perinatal care collaboratives
that received grants under this section prior to January 1, 2019deleted text end . Grant awards must be used
to support interdisciplinary, team-based needs assessments, planning, and implementation
of integrated care and enhanced services for targeted populations. In determining grant
award amounts, the commissioner shall consider the identified health and social risks linked
to adverse outcomes and attributed to enrollees within the identified targeted population.
Sec. 52.
Minnesota Statutes 2020, section 256L.01, subdivision 5, is amended to read:
Subd. 5.
Income.
"Income" has the meaning given for modified adjusted gross income,
as defined in Code of Federal Regulations, title 26, section 1.36B-1, and means a household's
deleted text begin current income, or if income fluctuates month to month, the income for the 12-month
eligibility perioddeleted text end new text begin projected annual income for the applicable tax yearnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 53.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 deleted text begin anddeleted text end new text begin ,new text end to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5new text begin , or to pre-exposure prophylaxis (PrEP) and postexposure
prophylaxis (PEP) medications when used for the prevention or treatment of the human
immunodeficiency virus (HIV)new text end .
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, subject to federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end
Sec. 54.
Minnesota Statutes 2020, section 256L.04, subdivision 7b, is amended to read:
Subd. 7b.
Annual income limits adjustment.
The commissioner shall adjust the income
limits under this section annually deleted text begin each July 1deleted text end new text begin on January 1new text end as deleted text begin described in section 256B.056,
subdivision 1cdeleted text end new text begin provided in Code of Federal Regulations, title 26, section 1.36B-1(h)new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 55.
Minnesota Statutes 2020, section 256L.05, subdivision 3a, is amended to read:
Subd. 3a.
Redetermination of eligibility.
(a) An enrollee's eligibility must be
redetermined on an annual basisdeleted text begin , in accordance with Code of Federal Regulations, title 42,
section 435.916 (a). The 12-month eligibility period begins the month of application.
Beginning July 1, 2017, the commissioner shall adjust the eligibility period for enrollees to
implement renewals throughout the year according to guidance from the Centers for Medicare
and Medicaid Servicesdeleted text end .new text begin The period of eligibility is the entire calendar year following the
year in which eligibility is redetermined. Eligibility redeterminations shall occur during the
open enrollment period for qualified health plans as specified in Code of Federal Regulations,
title 45, section 155.410(e)(3).
new text end
(b) Each new period of eligibility must take into account any changes in circumstances
that impact eligibility and premium amount. Coverage begins as provided in section 256L.06.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 56.
Minnesota Statutes 2020, section 256L.07, subdivision 2, is amended to read:
Subd. 2.
Must not have access to employer-subsidized minimum essential
coverage.
(a) To be eligible, a family or individual must not have access to subsidized health
coverage that is affordable and provides minimum value as defined in Code of Federal
Regulations, title 26, section 1.36B-2.
(b) new text begin Notwithstanding paragraph (a), an individual who has access through a spouse's or
parent's employer to subsidized health coverage that is deemed minimum essential coverage
under Code of Federal Regulations, title 26, section 1.36B-2, is eligible for MinnesotaCare
if the employee's portion of the annual premium for employee and dependent coverage
exceeds the required contribution percentage, as defined for premium tax credit eligibility
under United States Code, title 26, section 36B(c)(2)(C)(i)(II), as indexed according to item
(iv) of that section, of the individual's household income for the coverage year.
new text end
new text begin (c) new text end This subdivision does not apply to a family or individual who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 57.
Minnesota Statutes 2020, section 256L.11, subdivision 6a, is amended to read:
Subd. 6a.
Dental providers.
Effective for dental services provided to MinnesotaCare
enrollees on or after January 1, 2018new text begin , through December 31, 2022new text end , the commissioner shall
increase payment rates to dental providers by 54 percent. Payments made to prepaid health
plans under section 256L.12 shall reflect the payment increase described in this subdivision.
The prepaid health plans under contract with the commissioner shall provide payments to
dental providers that are at least equal to a rate that includes the payment rate specified in
this subdivision, and if applicable to the provider, the rates described under subdivision 7.
Sec. 58.
Minnesota Statutes 2020, section 256L.11, subdivision 7, is amended to read:
Subd. 7.
Critical access dental providers.
Effective for dental services provided to
MinnesotaCare enrollees on or after July 1, 2017new text begin , through December 31, 2022new text end , the
commissioner shall increase payment rates to dentists and dental clinics deemed by the
commissioner to be critical access providers under section 256B.76, subdivision 4, by 20
percent above the payment rate that would otherwise be paid to the provider. The
commissioner shall pay the prepaid health plans under contract with the commissioner
amounts sufficient to reflect this rate increase. The prepaid health plan must pass this rate
increase to providers who have been identified by the commissioner as critical access dental
providers under section 256B.76, subdivision 4.
Sec. 59.
Minnesota Statutes 2020, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
(c) Paragraph (b) does not apply to:
(1) children 20 years of age or younger; and
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
|
Federal Poverty Guideline Greater than or Equal to |
Less than |
Individual Premium Amount |
| 35% |
55% |
$4 |
| 55% |
80% |
$6 |
| 80% |
90% |
$8 |
| 90% |
100% |
$10 |
| 100% |
110% |
$12 |
| 110% |
120% |
$14 |
| 120% |
130% |
$15 |
| 130% |
140% |
$16 |
| 140% |
150% |
$25 |
| 150% |
160% |
$37 |
| 160% |
170% |
$44 |
| 170% |
180% |
$52 |
| 180% |
190% |
$61 |
| 190% |
200% |
$71 |
| 200% |
$80 |
new text begin
(e) Retroactive to January 1, 2021, the commissioner shall adjust the premium schedule
under paragraph (d) to ensure that MinnesotaCare premiums do not exceed the amount that
an individual would have been required to pay if the individual was enrolled in an applicable
benchmark plan in accordance with Code of Federal Regulations, title 42, section
600.505(a)(1).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 60.
Minnesota Statutes 2020, section 295.53, subdivision 1, is amended to read:
Subdivision 1.
Exclusions and exemptions.
(a) The following payments are excluded
from the gross revenues subject to the hospital, surgical center, or health care provider taxes
under sections 295.50 to 295.59:
(1) payments received by a health care provider or the wholly owned subsidiary of a
health care provider for care provided outside Minnesota;
(2) government payments received by the commissioner of human services for
state-operated services;
(3) payments received by a health care provider for hearing aids and related equipment
or prescription eyewear delivered outside of Minnesota; and
(4) payments received by an educational institution from student tuition, student activity
fees, health care service fees, government appropriations, donations, or grants, and for
services identified in and provided under an individualized education program as defined
in section 256B.0625 or Code of Federal Regulations, chapter 34, section 300.340(a). Fee
for service payments and payments for extended coverage are taxable.
(b) The following payments are exempted from the gross revenues subject to hospital,
surgical center, or health care provider taxes under sections 295.50 to 295.59:
(1) payments received for services provided under the Medicare program, including
payments received from the government and organizations governed by sections 1833,
1853, and 1876 of title XVIII of the federal Social Security Act, United States Code, title
42, section 1395; and enrollee deductibles, co-insurance, and co-payments, whether paid
by the Medicare enrollee, by Medicare supplemental coverage as described in section
62A.011, subdivision 3, clause (10), or by Medicaid payments under title XIX of the federal
Social Security Act. Payments for services not covered by Medicare are taxable;
(2) payments received for home health care services;
(3) payments received from hospitals or surgical centers for goods and services on which
liability for tax is imposed under section 295.52 or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(4) payments received from the health care providers for goods and services on which
liability for tax is imposed under this chapter or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(5) amounts paid for legend drugs to a wholesale drug distributor who is subject to tax
under section 295.52, subdivision 3, reduced by reimbursement received for legend drugs
otherwise exempt under this chapter;
(6) payments received from the chemical dependency fund under chapter 254B;
(7) payments received in the nature of charitable donations that are not designated for
providing patient services to a specific individual or group;
(8) payments received for providing patient services incurred through a formal program
of health care research conducted in conformity with federal regulations governing research
on human subjects. Payments received from patients or from other persons paying on behalf
of the patients are subject to tax;
(9) payments received from any governmental agency for services benefiting the public,
not including payments made by the government in its capacity as an employer or insurer
or payments made by the government for services provided under the MinnesotaCare
program or the medical assistance program governed by title XIX of the federal Social
Security Act, United States Code, title 42, sections 1396 to 1396v;
(10) payments received under the federal Employees Health Benefits Act, United States
Code, title 5, section 8909(f), as amended by the Omnibus Reconciliation Act of 1990.
Enrollee deductibles, co-insurance, and co-payments are subject to tax;
(11) payments received under the federal Tricare program, Code of Federal Regulations,
title 32, section 199.17(a)(7). Enrollee deductibles, co-insurance, and co-payments are
subject to tax; and
(12) supplemental deleted text begin ordeleted text end new text begin ,new text end enhancednew text begin , or uniform adjustment factornew text end payments authorized under
section 256B.196 deleted text begin ordeleted text end new text begin ,new text end 256B.197new text begin , or 256B.1973new text end .
(c) Payments received by wholesale drug distributors for legend drugs sold directly to
veterinarians or veterinary bulk purchasing organizations are excluded from the gross
revenues subject to the wholesale drug distributor tax under sections 295.50 to 295.59.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for taxable years beginning after December
31, 2021.
new text end
Sec. 61. new text begin COURT RULING ON AFFORDABLE CARE ACT.
new text end
new text begin
In the event the United States Supreme Court reverses, in whole or in part, Public Law
111-148, as amended by Public Law 111-152, the commissioner of human services shall
take all actions necessary to maintain the current policies of the medical assistance and
MinnesotaCare programs, including but not limited to pursuing federal funds, or if federal
funding is not available, operating programs with state funding for at least one year following
the date of the Supreme Court decision or until the conclusion of the next regular legislative
session, whichever is later. Nothing in this section prohibits the commissioner from making
changes necessary to comply with federal or state requirements for the medical assistance
or MinnesotaCare programs that were not affected by the Supreme Court decision.
new text end
Sec. 62. new text begin DELIVERY REFORM ANALYSIS REPORT.
new text end
new text begin
(a) The commissioner of human services shall present to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance,
by January 15, 2023, a report comparing service delivery and payment system models for
delivering services to Medical Assistance enrollees for whom income eligibility is determined
using the modified adjusted gross income methodology under Minnesota Statutes, section
256B.056, subdivision 1a, paragraph (b), clause (1), and MinnesotaCare enrollees eligible
under Minnesota Statutes, chapter 256L. The report must compare the current delivery
model with at least two alternative models. The alternative models must include a state-based
model in which the state holds the plan risk as the insurer and may contract with a third-party
administrator for claims processing and plan administration. The alternative models may
include but are not limited to:
new text end
new text begin
(1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end
new text begin
(2) delivering care under fee-for-service through a primary care case management system;
and
new text end
new text begin
(3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end
new text begin
(b) The report must include:
new text end
new text begin
(1) a description of how each model would address:
new text end
new text begin
(i) racial and other inequities in the delivery of health care and health care outcomes;
new text end
new text begin
(ii) geographic inequities in the delivery of health care;
new text end
new text begin
(iii) the provision of incentives for preventive care and other best practices;
new text end
new text begin
(iv) reimbursing providers for high-quality, value-based care at levels sufficient to sustain
or increase enrollee access to care; and
new text end
new text begin
(v) transparency and simplicity for enrollees, health care providers, and policymakers;
new text end
new text begin
(2) a comparison of the projected cost of each model; and
new text end
new text begin
(3) an implementation timeline for each model, that includes the earliest date by which
each model could be implemented if authorized during the 2023 legislative session, and a
discussion of barriers to implementation.
new text end
Sec. 63. new text begin DENTAL HOME DEMONSTRATION PROJECT.
new text end
new text begin
(a) The Dental Services Advisory Committee, in collaboration with stakeholders, shall
design a dental home demonstration project and present recommendations by February 1,
2022, to the commissioner and the chairs and ranking minority members of the legislative
committees with jurisdiction over health finance and policy.
new text end
new text begin
(b) The Dental Services Advisory Committee, at a minimum, shall engage with the
following stakeholders: the Minnesota Department of Health, the Minnesota Dental
Association, the Minnesota Dental Hygienists' Association, the University of Minnesota
School of Dentistry, dental programs operated by the Minnesota State Colleges and
Universities system, and representatives of each of the following dental provider types
serving medical assistance and MinnesotaCare enrollees:
new text end
new text begin
(1) private practice dental clinics for which medical assistance and MinnesotaCare
enrollees comprise more than 25 percent of the clinic's patient load;
new text end
new text begin
(2) private practice dental clinics for which medical assistance and MinnesotaCare
enrollees comprise 25 percent or less of the clinic's patient load;
new text end
new text begin
(3) nonprofit dental clinics with a primary focus on serving Indigenous communities
and other communities of color;
new text end
new text begin
(4) nonprofit dental clinics with a primary focus on providing eldercare;
new text end
new text begin
(5) nonprofit dental clinics with a primary focus on serving children;
new text end
new text begin
(6) nonprofit dental clinics providing services within the seven-county metropolitan
area;
new text end
new text begin
(7) nonprofit dental clinics providing services outside of the seven-county metropolitan
area; and
new text end
new text begin
(8) multispecialty hospital-based dental clinics.
new text end
new text begin
(c) The dental home demonstration project shall give incentives for qualified providers
that provide high-quality, patient-centered, comprehensive, and coordinated oral health
services. The demonstration project shall seek to increase the number of new dental providers
serving medical assistance and MinnesotaCare enrollees and increase the capacity of existing
providers. The demonstration project must test payment methods that establish value-based
incentives to:
new text end
new text begin
(1) increase the extent to which current dental providers serve medical assistance and
MinnesotaCare enrollees across their lifespan;
new text end
new text begin
(2) develop service models that create equity and reduce disparities in access to dental
services for high-risk and medically and socially complex enrollees;
new text end
new text begin
(3) advance alternative delivery models of care within community settings using
evidence-based approaches and innovative workforce teams; and
new text end
new text begin
(4) improve the quality of dental care by meeting dental home goals.
new text end
Sec. 64. new text begin DIRECTION TO COMMISSIONER; INCOME AND ASSET EXCLUSION
FOR ST. PAUL GUARANTEED INCOME DEMONSTRATION PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services unless specified
otherwise.
new text end
new text begin
(c) "Guaranteed income demonstration project" means a demonstration project in St.
Paul to evaluate how unconditional cash payments have a causal effect on income volatility,
financial well-being, and early childhood development in infants and toddlers.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner; income and asset exclusion. new text end
new text begin
(a) During the duration of the
guaranteed income demonstration project, the commissioner shall not count payments made
to families by the guaranteed income demonstration project as income or assets for purposes
of determining or redetermining eligibility for the following programs:
new text end
new text begin
(1) child care assistance programs under Minnesota Statutes, chapter 119B; and
new text end
new text begin
(2) the Minnesota family investment program, work benefit program, or diversionary
work program under Minnesota Statutes, chapter 256J.
new text end
new text begin
(b) During the duration of the guaranteed income demonstration project, the commissioner
shall not count payments made to families by the guaranteed income demonstration project
as income or assets for purposes of determining or redetermining eligibility for the following
programs:
new text end
new text begin
(1) medical assistance under Minnesota Statutes, chapter 256B; and
new text end
new text begin
(2) MinnesotaCare under Minnesota Statutes, chapter 256L.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
The city of St. Paul shall provide a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance by February 15, 2023, with information on the progress and outcomes of the
guaranteed income demonstration project under this section.
new text end
new text begin Subd. 4. new text end
new text begin Expiration. new text end
new text begin
This section expires June 30, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except for subdivision 2,
paragraph (b), which is effective July 1, 2021, or upon federal approval, whichever is later.
new text end
Sec. 65. new text begin EXPANSION OF OUTPATIENT DRUG CARVE OUT; PRESCRIPTION
DRUG PURCHASING PROGRAM.
new text end
new text begin
The commissioner of human services, in consultation with the commissioners of
commerce and health, shall assess the feasibility of, and develop recommendations for: (1)
expanding the outpatient prescription drug carve out under Minnesota Statutes, section
256B.69, subdivision 6d, to include MinnesotaCare enrollees; and (2) establishing a
prescription drug purchasing program to serve nonpublic program enrollees of health plan
companies. The recommendations must address the process and terms by which the
commissioner would contract with health plan companies to administer prescription drug
benefits for the companies' enrollees and develop and manage a formulary. The commissioner
shall present recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over commerce and health and human services policy and
finance by December 15, 2023.
new text end
Sec. 66. new text begin FEDERAL APPROVAL; EXTENSION OF POSTPARTUM COVERAGE.
new text end
new text begin
The commissioner of human services shall seek all federal waivers and approvals
necessary to extend medical assistance postpartum coverage, as provided in Minnesota
Statutes, section 256B.055, subdivision 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 67. new text begin PROPOSAL FOR A PUBLIC OPTION.
new text end
new text begin
(a) The commissioner of human services shall consult with the Centers for Medicare
and Medicaid Services, the Internal Revenue Service, and other relevant federal agencies
to develop a proposal for a public option program. The proposal may consider multiple
public option structures, at least one of which must be through expanded enrollment into
MinnesotaCare. Each option must:
new text end
new text begin
(1) allow individuals with incomes above the maximum income eligibility limit under
Minnesota Statutes, section 256L.04, subdivision 1 or 7, the option of purchasing coverage
through the public option;
new text end
new text begin
(2) allow undocumented noncitizens, and individuals with access to subsidized employer
health coverage who are subject to the family glitch, the option of purchasing through the
public option;
new text end
new text begin
(3) establish a small employer public option that allows employers with 50 or fewer
employees to offer the public option to the employer's employees and contribute to the
employees' premiums;
new text end
new text begin
(4) allow the state to:
new text end
new text begin
(i) receive the maximum pass through of federal dollars that would otherwise be used
to provide coverage for eligible public option enrollees if the enrollees were instead covered
through qualified health plans with premium tax credits, emergency medical assistance, or
other relevant programs; and
new text end
new text begin
(ii) continue to receive basic health program payments for eligible MinnesotaCare
enrollees; and
new text end
new text begin
(5) be administered in coordination with the existing MinnesotaCare program to maximize
efficiency and improve continuity of care, consistent with the requirements of Minnesota
Statutes, sections 256L.06, 256L.10, and 256L.11.
new text end
new text begin
(b) Each public option proposal must include:
new text end
new text begin
(1) a premium scale for public option enrollees that at least meets the Affordable Care
Act affordability standard for each income level;
new text end
new text begin
(2) an analysis of the impact of the public option on MNsure enrollment and the consumer
assistance program and, if necessary, a proposal to ensure that the public option has an
adequate enrollment infrastructure and consumer assistance capacity;
new text end
new text begin
(3) actuarial and financial analyses necessary to project program enrollment and costs;
and
new text end
new text begin
(4) an analysis of the cost of implementing the public option using current eligibility
and enrollment technology systems, and at the option of the commissioner, an analysis of
alternative eligibility and enrollment systems that may reduce initial and ongoing costs and
improve functionality and accessibility.
new text end
new text begin
(c) The commissioner shall incorporate into the design of the public option mechanisms
to ensure the long-term financial sustainability of MinnesotaCare and mitigate any adverse
financial impacts to MNsure. These mechanisms must minimize: (i) adverse selection; (ii)
state financial risk and expenditures; and (iii) potential impacts on premiums in the individual
and group insurance markets.
new text end
new text begin
(d) The commissioner shall present the proposal to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by December 15, 2021. The proposal must include recommendations on any legislative
changes necessary to implement the public option. Any implementation of the proposal that
requires a state financial contribution must be contingent on legislative approval.
new text end
Sec. 68. new text begin RESPONSE TO COVID-19 PUBLIC HEALTH EMERGENCY.
new text end
new text begin
(a) Notwithstanding Minnesota Statutes, section 256B.057, subdivision 9, 256L.06,
subdivision 3, or any other provision to the contrary, the commissioner shall not collect any
unpaid premium for a coverage month that occurred during the COVID-19 public health
emergency declared by the United States Secretary of Health and Human Services.
new text end
new text begin
(b) Notwithstanding any provision to the contrary, periodic data matching under
Minnesota Statutes, section 256B.0561, subdivision 2, may be suspended for up to six
months following the last day of the COVID-19 public health emergency declared by the
United States Secretary of Health and Human Services.
new text end
new text begin
(c) Notwithstanding any provision to the contrary, the requirement for the commissioner
of human services to issue an annual report on periodic data matching under Minnesota
Statutes, section 256B.0561, is suspended for one year following the last day of the
COVID-19 public health emergency declared by the United States Secretary of Health and
Human Services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
paragraph (a) related to MinnesotaCare premiums is effective upon federal approval. The
commissioner shall notify the revisor of statutes when federal approval is received.
new text end
Sec. 69. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes must change the term "Health Services Policy Committee" to
"Health Services Advisory Council" wherever the term appears in Minnesota Statutes and
may make any necessary changes to grammar or sentence structure to preserve the meaning
of the text.
new text end
Sec. 70. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Rules, parts 9505.0275; 9505.1693; 9505.1696, subparts 1, 2, 3, 4, 5, 6,
7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, and 22; 9505.1699; 9505.1701; 9505.1703;
9505.1706; 9505.1712; 9505.1715; 9505.1718; 9505.1724; 9505.1727; 9505.1730;
9505.1733; 9505.1736; 9505.1739; 9505.1742; 9505.1745; and 9505.1748,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, section 256B.0625, subdivisions 18c, 18d, 18e, and 18h,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective July 1, 2021, and paragraph (b) is
effective January 1, 2023.
new text end
ARTICLE 2
DEPARTMENT OF HUMAN SERVICES LICENSING AND BACKGROUND
STUDIES
Section 1.
Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Background study required. new text end
new text begin
(a) The board must initiate background studies
under section 245C.031 of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The board may initiate the background studies required by paragraph (a) using the
online NETStudy 2.0 system operated by the commissioner of human services.
new text end
new text begin
(c) The board shall not permit any individual to provide any service or function listed
in paragraph (a) until the board has received notification from the commissioner of human
services indicating that the individual:
new text end
new text begin
(1) is not disqualified under chapter 245C; or
new text end
new text begin
(2) is disqualified, but has received a set aside from the board of that disqualification
according to sections 245C.22 and 245C.23.
new text end
new text begin
(d) The board or its delegate shall review a reconsideration request of an individual in
paragraph (a), including granting a set aside, according to the procedures and criteria in
chapter 245C. The board shall notify the individual and the Department of Human Services
of the board's decision.
new text end
Sec. 2.
Minnesota Statutes 2020, section 122A.18, subdivision 8, is amended to read:
Subd. 8.
Background deleted text begin checksdeleted text end new text begin studiesnew text end .
(a) The Professional Educator Licensing and
Standards Board and the Board of School Administrators must deleted text begin obtain adeleted text end new text begin initiatenew text end criminal
history background deleted text begin check ondeleted text end new text begin studies ofnew text end all first-time deleted text begin teachingdeleted text end applicants for new text begin educator new text end licenses
under their jurisdiction. Applicants must include with their licensure applications:
(1) an executed criminal history consent form, including fingerprints; and
(2) payment to conduct the background deleted text begin checkdeleted text end new text begin studynew text end . The Professional Educator Licensing
and Standards Board must deposit payments received under this subdivision in an account
in the special revenue fund. Amounts in the account are annually appropriated to the
Professional Educator Licensing and Standards Board to pay for the costs of background
deleted text begin checksdeleted text end new text begin studiesnew text end on applicants for licensure.
(b) The background deleted text begin checkdeleted text end new text begin studynew text end for all first-time teaching applicants for licenses must
include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository. The superintendent of the Bureau of Criminal
Apprehension is authorized to exchange fingerprints with the Federal Bureau of Investigation
for purposes of the criminal history check. deleted text begin The superintendent shall recover the cost to the
bureau of a background check through the fee charged to the applicant under paragraph (a).
deleted text end
(c) The Professional Educator Licensing and Standards Board deleted text begin must contract withdeleted text end new text begin may
initiate criminal history background studies throughnew text end the commissioner of human services
new text begin according to section 245C.031 new text end to deleted text begin conduct background checks anddeleted text end obtain background deleted text begin checkdeleted text end
new text begin studynew text end data required under this chapter.
Sec. 3.
new text begin
[245.975] OMBUDSPERSON FOR FAMILY CHILD CARE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Appointment. new text end
new text begin
The governor shall appoint an ombudsperson in the
classified service to assist family child care providers with licensing, compliance, and other
issues facing family child care providers. The ombudsperson must be selected without regard
to the person's political affiliation.
new text end
new text begin Subd. 2. new text end
new text begin Duties. new text end
new text begin
(a) The ombudsperson's duties shall include:
new text end
new text begin
(1) advocating on behalf of a family child care provider to address all areas of concern
related to the provision of child care services, including licensing monitoring activities,
licensing actions, and other interactions with state and county licensing staff;
new text end
new text begin
(2) providing recommendations for family child care improvement or family child care
provider education;
new text end
new text begin
(3) operating a telephone line to answer questions, receive complaints, and discuss
agency actions when a family child care provider believes their rights or program may have
been adversely affected; and
new text end
new text begin
(4) assisting family child care license applicants with navigating the application process.
new text end
new text begin
(b) The ombudsperson must report annually by December 31 to the commissioner and
the chairs and ranking minority members of the legislative committees with jurisdiction
over child care on the services provided by the ombudsperson to child care providers,
including the number and locations of child care providers served, and the activities of the
ombudsperson in carrying out the duties under this section. The commissioner shall determine
the form of the report and may specify additional reporting requirements.
new text end
new text begin Subd. 3. new text end
new text begin Staff. new text end
new text begin
The ombudsperson may appoint and compensate out of available funds
a deputy, confidential secretary, and other employees in the unclassified service as authorized
by law. The ombudsperson and the full-time staff are members of the Minnesota State
Retirement Association. The ombudsperson may delegate to members of the staff any
authority or duties of the office except the duty to provide reports to the governor,
commissioner, or the legislature.
new text end
new text begin Subd. 4. new text end
new text begin Access to records. new text end
new text begin
(a) The ombudsperson or designee, excluding volunteers,
has access to data of a state agency necessary for the discharge of the ombudsperson's duties,
including records classified as confidential data on individuals or private data on individuals
under chapter 13 or any other law. The ombudsperson's data request must relate to a specific
case and is subject to section 13.03, subdivision 4. If the data concerns an individual, the
ombudsperson or designee shall first obtain the individual's consent. If the individual cannot
consent and has no parent or legal guardian, then access to the data is authorized by this
section.
new text end
new text begin
(b) The ombudsperson and designees must adhere to the Minnesota Government Data
Practices Act and must not disseminate any private or confidential data on individuals unless
specifically authorized by state, local, or federal law or pursuant to a court order.
new text end
new text begin
(c) The commissioner and county agency must provide the ombudsperson copies of all
fix-it tickets, correction orders, and licensing actions issued to family child care providers.
new text end
new text begin Subd. 5. new text end
new text begin Independence of action. new text end
new text begin
In carrying out the duties under this section, the
ombudsperson may act independently of the department to provide testimony to the
legislature, make periodic reports to the legislature, and address areas of concern to child
care providers.
new text end
new text begin Subd. 6. new text end
new text begin Civil actions. new text end
new text begin
The ombudsperson or designee is not civilly liable for any action
taken under this section if the action was taken in good faith, was within the scope of the
ombudsperson's authority, and did not constitute willful or reckless misconduct.
new text end
new text begin Subd. 7. new text end
new text begin Qualifications. new text end
new text begin
The ombudsperson must be a person who has knowledge and
experience concerning the provision of family child care. The ombudsperson must be
experienced in dealing with governmental entities, interpretation of laws and regulations,
investigations, record keeping, report writing, public speaking, and management. A person
is not eligible to serve as the ombudsperson while holding public office or while holding a
family child care license.
new text end
new text begin Subd. 8. new text end
new text begin Office support. new text end
new text begin
The commissioner shall provide the ombudsperson with the
necessary office space, supplies, equipment, and clerical support to effectively perform the
duties under this section.
new text end
new text begin Subd. 9. new text end
new text begin Posting. new text end
new text begin
(a) The commissioner shall post on the department's website the
mailing address, e-mail address, and telephone number for the office of the ombudsperson.
The commissioner shall provide family child care providers with the mailing address, e-mail
address, and telephone number of the office on the family child care licensing website and
upon request from a family child care applicant or provider. Counties must provide family
child care applicants and providers with the name, mailing address, e-mail address, and
telephone number of the office upon request.
new text end
new text begin
(b) The ombudsperson must approve all postings and notices required by the department
and counties under this subdivision.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.043, subdivision 3, is amended to read:
Subd. 3.
Change of ownership process.
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. deleted text begin A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
deleted text end
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
Sec. 5.
Minnesota Statutes 2020, section 245A.05, is amended to read:
245A.05 DENIAL OF APPLICATION.
(a) The commissioner may deny a license if an applicant or controlling individual:
(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;
(2) fails to comply with applicable laws or rules;
(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;
(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;
(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;
(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted;
(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g);
(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
(9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C; deleted text begin or
deleted text end
(10) is prohibited from holding a license according to section 245.095deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(11) for a family foster setting, has nondisqualifying background study information, as
described in section 245C.05, subdivision 4, that reflects on the individual's ability to safely
provide care to foster children.
new text end
(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail or personal service. The notice must state the reasons the
application was denied and must inform the applicant of the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The applicant may
appeal the denial by notifying the commissioner in writing by certified mail or personal
service. If mailed, the appeal must be postmarked and sent to the commissioner within 20
calendar days after the applicant received the notice of denial. If an appeal request is made
by personal service, it must be received by the commissioner within 20 calendar days after
the applicant received the notice of denial. Section 245A.08 applies to hearings held to
appeal the commissioner's denial of an application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.07, subdivision 1, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rulenew text begin , or who has nondisqualifying background
study information, as described in section 245C.05, subdivision 4, that reflects on the license
holder's ability to safely provide care to foster childrennew text end . When applying sanctions authorized
under this section, the commissioner shall consider the nature, chronicity, or severity of the
violation of law or rule and the effect of the violation on the health, safety, or rights of
persons served by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. If a license holder fails to comply with
applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license issued under this chapter is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.
(d) Failure to reapply or closure of a license issued under this chapter by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this section or section 245A.06 at the conclusion
of the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
$200 |
|
| greater than $10,000 but less than or equal to $25,000 |
$300 |
|
| greater than $25,000 but less than or equal to $50,000 |
$400 |
|
| greater than $50,000 but less than or equal to $100,000 |
$500 |
|
| greater than $100,000 but less than or equal to $150,000 |
$600 |
|
| greater than $150,000 but less than or equal to $200,000 |
$800 |
|
| greater than $200,000 but less than or equal to $250,000 |
$1,000 |
|
| greater than $250,000 but less than or equal to $300,000 |
$1,200 |
|
| greater than $300,000 but less than or equal to $350,000 |
$1,400 |
|
| greater than $350,000 but less than or equal to $400,000 |
$1,600 |
|
| greater than $400,000 but less than or equal to $450,000 |
$1,800 |
|
| greater than $450,000 but less than or equal to $500,000 |
$2,000 |
|
| greater than $500,000 but less than or equal to $600,000 |
$2,250 |
|
| greater than $600,000 but less than or equal to $700,000 |
$2,500 |
|
| greater than $700,000 but less than or equal to $800,000 |
$2,750 |
|
| greater than $800,000 but less than or equal to $900,000 |
$3,000 |
|
| greater than $900,000 but less than or equal to $1,000,000 |
$3,250 |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
$3,500 |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
$3,750 |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
$4,000 |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
$4,250 |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
$4,500 |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
$4,750 |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
$5,000 |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
$5,500 |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
$6,000 |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
$6,500 |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
$7,000 |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
$8,500 |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
$10,000 |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
$14,000 |
|
| greater than $15,000,000 |
$18,000 |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A deleted text begin chemical dependencydeleted text end new text begin detoxificationnew text end program licensed under Minnesota Rules,
parts 9530.6510 to 9530.6590, deleted text begin to provide detoxification servicesdeleted text end new text begin or a withdrawal management
program licensed under chapter 245Fnew text end shall pay an annual nonrefundable license fee based
on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
new text begin
A detoxification program that also operates a withdrawal management program at the same
location shall only pay one fee based upon the licensed capacity of the program with the
higher overall capacity.
new text end
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670,
to serve persons with mental illness shall pay an annual nonrefundable license fee based on
the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A mental health center or mental health clinic requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870, shall pay a certification fee of $1,550 per year. If the mental health center or
mental health clinic provides services at a primary location with satellite facilities, the
satellite facilities shall be certified with the primary location without an additional charge.
Sec. 8.
Minnesota Statutes 2020, section 245A.14, subdivision 4, is amended to read:
Subd. 4.
Special family deleted text begin daydeleted text end new text begin childnew text end care homes.
Nonresidential child care programs
serving 14 or fewer children that are conducted at a location other than the license holder's
own residence shall be licensed under this section and the rules governing family deleted text begin daydeleted text end new text begin childnew text end
care or group family deleted text begin daydeleted text end new text begin childnew text end care if:
(a) the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwelling that is located on a residential lot;
(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
(c) the license holder is a church or religious organization;
(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;
(2) the program meets a one to seven staff-to-child ratio during the variance period;
(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;
(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
(5) the program is in compliance with local zoning regulations;
(6) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code 2015,
Section 202, unless the rooms in which the children are cared for are located on a level of
exit discharge and each of these child care rooms has an exit door directly to the exterior,
then the applicable fire code is Group E occupancies, as provided in the Minnesota State
Fire Code 2015, Section 202; and
(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
(1) the program is in compliance with local zoning regulations;
(2) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code 2015,
Section 202;
(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."
(g) deleted text begin The commissioner may approve two or more licenses under paragraphs (a) to (f) to
be issued at the same location or under one contiguous roof, if each license holder is able
to demonstrate compliance with all applicable rules and laws. Each license holder must
operate the license holder's respective licensed program as a distinct program and within
the capacity, age, and ratio distributions of each license.deleted text end new text begin Notwithstanding Minnesota Rules,
part 9502.0335, subpart 12, the commissioner may issue up to four licenses to an organization
licensed under paragraphs (b), (c), or (e). Each license must have its own primary provider
of care as required under paragraph (i). Each license must operate as a distinct and separate
program in compliance with all applicable laws and regulations.
new text end
(h) deleted text begin The commissioner may grant variances to this section to allow a primary provider
of care, a not-for-profit organization, a church or religious organization, an employer, or a
community collaborative to be licensed to provide child care under paragraphs (e) and (f)
if the license holder meets the other requirements of the statute.deleted text end new text begin For licenses issued under
paragraphs (b), (c), (d), (e), or (f), the commissioner may approve up to four licenses at the
same location or under one contiguous roof if each license holder is able to demonstrate
compliance with all applicable rules and laws. Each licensed program must operate as a
distinct program and within the capacity, age, and ratio distributions of each license.
new text end
new text begin
(i) For a license issued under paragraphs (b), (c), or (e), the license holder must designate
a person to be the primary provider of care at the licensed location on a form and in a manner
prescribed by the commissioner. The license holder shall notify the commissioner in writing
before there is a change of the person designated to be the primary provider of care. The
primary provider of care:
new text end
new text begin
(1) must be the person who will be the provider of care at the program and present during
the hours of operation;
new text end
new text begin
(2) must operate the program in compliance with applicable laws and regulations under
chapter 245A and Minnesota Rules, chapter 9502;
new text end
new text begin
(3) is considered a child care background study subject as defined in section 245C.02,
subdivision 6a, and must comply with background study requirements in chapter 245C; and
new text end
new text begin
(4) must complete the training that is required of license holders in section 245A.50.
new text end
new text begin
(j) For any license issued under this subdivision, the license holder must ensure that any
other caregiver, substitute, or helper who assists in the care of children meets the training
requirements in section 245A.50 and background study requirements under chapter 245C.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.16, is amended by adding a subdivision to
read:
new text begin Subd. 9. new text end
new text begin Licensed family foster settings. new text end
new text begin
(a) Before recommending to grant a license,
deny a license under section 245A.05, or revoke a license under section 245A.07 for
nondisqualifying background study information received under section 245C.05, subdivision
4, paragraph (a), clause (3), for a licensed family foster setting, a county agency or private
agency that has been designated or licensed by the commissioner must review the following:
new text end
new text begin
(1) the type of offenses;
new text end
new text begin
(2) the number of offenses;
new text end
new text begin
(3) the nature of the offenses;
new text end
new text begin
(4) the age of the individual at the time of the offenses;
new text end
new text begin
(5) the length of time that has elapsed since the last offense;
new text end
new text begin
(6) the relationship of the offenses and the capacity to care for a child;
new text end
new text begin
(7) evidence of rehabilitation;
new text end
new text begin
(8) information or knowledge from community members regarding the individual's
capacity to provide foster care;
new text end
new text begin
(9) any available information regarding child maltreatment reports or child in need of
protection or services petitions, or related cases, in which the individual has been involved
or implicated, and documentation that the individual has remedied issues or conditions
identified in child protection or court records that are relevant to safely caring for a child;
new text end
new text begin
(10) a statement from the study subject;
new text end
new text begin
(11) a statement from the license holder; and
new text end
new text begin
(12) other aggravating and mitigating factors.
new text end
new text begin
(b) For purposes of this section, "evidence of rehabilitation" includes but is not limited
to the following:
new text end
new text begin
(1) maintaining a safe and stable residence;
new text end
new text begin
(2) continuous, regular, or stable employment;
new text end
new text begin
(3) successful participation in an education or job training program;
new text end
new text begin
(4) positive involvement with the community or extended family;
new text end
new text begin
(5) compliance with the terms and conditions of probation or parole following the
individual's most recent conviction;
new text end
new text begin
(6) if the individual has had a substance use disorder, successful completion of a substance
use disorder assessment, substance use disorder treatment, and recommended continuing
care, if applicable, demonstrated abstinence from controlled substances, as defined in section
152.01, subdivision 4, or the establishment of a sober network;
new text end
new text begin
(7) if the individual has had a mental illness or documented mental health issues,
demonstrated completion of a mental health evaluation, participation in therapy or other
recommended mental health treatment, or appropriate medication management, if applicable;
new text end
new text begin
(8) if the individual's offense or conduct involved domestic violence, demonstrated
completion of a domestic violence or anger management program, and the absence of any
orders for protection or harassment restraining orders against the individual since the previous
offense or conduct;
new text end
new text begin
(9) written letters of support from individuals of good repute, including but not limited
to employers, members of the clergy, probation or parole officers, volunteer supervisors,
or social services workers;
new text end
new text begin
(10) demonstrated remorse for convictions or conduct, or demonstrated positive behavior
changes; and
new text end
new text begin
(11) absence of convictions or arrests since the previous offense or conduct, including
any convictions that were expunged or pardoned.
new text end
new text begin
(c) An applicant for a family foster setting license must sign all releases of information
requested by the county or private licensing agency.
new text end
new text begin
(d) When licensing a relative for a family foster setting, the commissioner shall also
consider the importance of maintaining the child's relationship with relatives as an additional
significant factor in determining whether an application will be denied.
new text end
new text begin
(e) When recommending that the commissioner deny or revoke a license, the county or
private licensing agency must send a summary of the review completed according to
paragraph (a), on a form developed by the commissioner, to the commissioner and include
any recommendation for licensing action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 10.
Minnesota Statutes 2020, section 245A.50, subdivision 7, is amended to read:
Subd. 7.
Training requirements for family and group family child care.
new text begin (a) new text end For
purposes of family and group family child care, the license holder and each second adult
caregiver must complete 16 hours of ongoing training each year. Repeat of topical training
requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
requirement. Additional ongoing training subjects to meet the annual 16-hour training
requirement must be selected from the following areas:
(1) child development and learning training in understanding how a child develops
physically, cognitively, emotionally, and socially, and how a child learns as part of the
child's family, culture, and community;
(2) developmentally appropriate learning experiences, including training in creating
positive learning experiences, promoting cognitive development, promoting social and
emotional development, promoting physical development, promoting creative development;
and behavior guidance;
(3) relationships with families, including training in building a positive, respectful
relationship with the child's family;
(4) assessment, evaluation, and individualization, including training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality;
(5) historical and contemporary development of early childhood education, including
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs;
(6) professionalism, including training in knowledge, skills, and abilities that promote
ongoing professional development; and
(7) health, safety, and nutrition, including training in establishing healthy practices;
ensuring safety; and providing healthy nutrition.
new text begin
(b) A provider who is approved as a trainer through the Develop data system may count
up to two hours of training instruction toward the annual 16-hour training requirement in
paragraph (a). The provider may only count training instruction hours for the first instance
in which they deliver a particular content-specific training during each licensing year. Hours
counted as training instruction must be approved through the Develop data system with
attendance verified on the trainer's individual learning record and must be in Knowledge
and Competency Framework content area VII A (Establishing Healthy Practices) or B
(Ensuring Safety).
new text end
Sec. 11.
Minnesota Statutes 2020, section 245A.50, subdivision 9, is amended to read:
Subd. 9.
Supervising for safety; training requirement.
(a) Courses required by this
subdivision must include the following health and safety topics:
(1) preventing and controlling infectious diseases;
(2) administering medication;
(3) preventing and responding to allergies;
(4) ensuring building and physical premises safety;
(5) handling and storing biological contaminants;
(6) preventing and reporting child abuse and maltreatment; and
(7) emergency preparedness.
(b) Before initial licensure and before caring for a child, all family child care license
holders and each second adult caregiver shall complete and document the completion of
the six-hour Supervising for Safety for Family Child Care course developed by the
commissioner.
(c) The license holder must ensure and document that, before caring for a child, all
substitutes have completed the four-hour Basics of Licensed Family Child Care for
Substitutes course developed by the commissioner, which must include health and safety
topics as well as child development and learning.
(d) The family child care license holder and each second adult caregiver shall complete
and document:
(1) the annual completion of new text begin either:
new text end
new text begin (i) new text end a two-hour active supervision course developed by the commissioner;new text begin or
new text end
new text begin (ii) any courses in the ensuring safety competency area under the health, safety, and
nutrition standard of the Knowledge and Competency Framework that the commissioner
has identified as an active supervision training course;new text end and
(2) the completion at least once every five years of the two-hour courses Health and
Safety I and Health and Safety II. When the training is due for the first time or expires, it
must be taken no later than the day before the anniversary of the license holder's license
effective date. A license holder's or second adult caregiver's completion of either training
in a given year meets the annual active supervision training requirement in clause (1).
(e) At least once every three years, license holders must ensure and document that
substitutes have completed the four-hour Basics of Licensed Family Child Care for
Substitutes course. When the training expires, it must be retaken no later than the day before
the anniversary of the license holder's license effective date.
Sec. 12.
Minnesota Statutes 2020, section 245C.02, subdivision 4a, is amended to read:
Subd. 4a.
Authorized fingerprint collection vendor.
"Authorized fingerprint collection
vendor" means a qualified organization under a written contract with the commissioner to
provide services in accordance with section 245C.05, subdivision 5, paragraph (b).new text begin The
commissioner may retain the services of more than one authorized fingerprint collection
vendor.
new text end
Sec. 13.
Minnesota Statutes 2020, section 245C.02, subdivision 5, is amended to read:
Subd. 5.
Background study.
"Background study" meansnew text begin :
new text end
new text begin
(1) the collection and processing of a background study subject's fingerprints, including
the process of obtaining a background study subject's classifiable fingerprints and photograph
as required by section 245C.05, subdivision 5, paragraph (b); and
new text end
new text begin (2)new text end the review of records conducted by the commissioner to determine whether a subject
is disqualified from direct contact with persons served by a program and, where specifically
provided in statutes, whether a subject is disqualified from having access to persons served
by a program and from working in a children's residential facility or foster residence setting.
Sec. 14.
Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 5b. new text end
new text begin Alternative background study. new text end
new text begin
"Alternative background study" means:
new text end
new text begin
(1) the collection and processing of a background study subject's fingerprints, including
the process of obtaining a background study subject's classifiable fingerprints and photograph
as required by section 245C.05, subdivision 5, paragraph (b); and
new text end
new text begin
(2) a review of records conducted by the commissioner pursuant to section 245C.08 in
order to forward the background study investigating information to the entity that submitted
the alternative background study request under section 245C.031, subdivision 2. The
commissioner shall not make any eligibility determinations on background studies conducted
under section 245C.031.
new text end
Sec. 15.
Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 11c. new text end
new text begin Entity. new text end
new text begin
"Entity" means any program, organization, or agency initiating a
background study.
new text end
Sec. 16.
Minnesota Statutes 2020, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Results. new text end
new text begin
"Results" means a determination that a study subject is eligible,
disqualified, set aside, granted a variance, or that more time is needed to complete the
background study.
new text end
Sec. 17.
Minnesota Statutes 2020, section 245C.03, is amended to read:
245C.03 BACKGROUND STUDY; INDIVIDUALS TO BE STUDIED.
Subdivision 1.
Licensed programs.
(a) The commissioner shall conduct a background
study on:
(1) the person or persons applying for a license;
(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;
(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;
(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);
(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(7) all controlling individuals as defined in section 245A.02, subdivision 5a;
(8) notwithstanding the other requirements in this subdivision, child care background
study subjects as defined in section 245C.02, subdivision 6a; and
(9) notwithstanding clause (3), for children's residential facilities and foster residence
settings, any adult working in the facility, whether or not the individual will have direct
contact with persons served by the facility.
(b) For child foster care when the license holder resides in the home where foster care
services are provided, a short-term substitute caregiver providing direct contact services for
a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.
new text begin
(c) This subdivision applies to the following programs that must be licensed under
chapter 245A:
new text end
new text begin
(1) adult foster care;
new text end
new text begin
(2) child foster care;
new text end
new text begin
(3) children's residential facilities;
new text end
new text begin
(4) family child care;
new text end
new text begin
(5) licensed child care centers;
new text end
new text begin
(6) licensed home and community-based services under chapter 245D;
new text end
new text begin
(7) residential mental health programs for adults;
new text end
new text begin
(8) substance use disorder treatment programs under chapter 245G;
new text end
new text begin
(9) withdrawal management programs under chapter 245F;
new text end
new text begin
(10) programs that provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons;
new text end
new text begin
(11) adult day care centers;
new text end
new text begin
(12) family adult day services;
new text end
new text begin
(13) independent living assistance for youth;
new text end
new text begin
(14) detoxification programs;
new text end
new text begin
(15) community residential settings; and
new text end
new text begin
(16) intensive residential treatment services and residential crisis stabilization under
chapter 245I.
new text end
new text begin Subd. 1a. new text end
new text begin Procedure. new text end
new text begin
(a) Individuals and organizations that are required under this
section to have or initiate background studies shall comply with the requirements of this
chapter.
new text end
new text begin
(b) All studies conducted under this section shall be conducted according to sections
299C.60 to 299C.64. This requirement does not apply to subdivisions 1, paragraph (c),
clauses (2) to (5), and 6a.
new text end
Subd. 2.
Personal care provider organizations.
The commissioner shall conduct
background studies on any individual required under sections 256B.0651 to 256B.0654 and
256B.0659 to have a background study completed under this chapter.
Subd. 3.
Supplemental nursing services agencies.
The commissioner shall conduct all
background studies required under this chapter and initiated by supplemental nursing services
agencies registered under section 144A.71, subdivision 1.
new text begin Subd. 3a. new text end
new text begin Personal care assistance provider agency; background studies. new text end
new text begin
Personal
care assistance provider agencies enrolled to provide personal care assistance services under
the medical assistance program must meet the following requirements:
new text end
new text begin
(1) owners who have a five percent interest or more and all managing employees are
subject to a background study as provided in this chapter. This requirement applies to
currently enrolled personal care assistance provider agencies and agencies seeking enrollment
as a personal care assistance provider agency. "Managing employee" has the same meaning
as Code of Federal Regulations, title 42, section 455.101. An organization is barred from
enrollment if:
new text end
new text begin
(i) the organization has not initiated background studies of owners and managing
employees; or
new text end
new text begin
(ii) the organization has initiated background studies of owners and managing employees
and the commissioner has sent the organization a notice that an owner or managing employee
of the organization has been disqualified under section 245C.14, and the owner or managing
employee has not received a set aside of the disqualification under section 245C.22; and
new text end
new text begin
(2) a background study must be initiated and completed for all qualified professionals.
new text end
new text begin Subd. 3b. new text end
new text begin Exception to personal care assistant; requirements. new text end
new text begin
The personal care
assistant for a recipient may be allowed to enroll with a different personal care assistance
provider agency upon initiation of a new background study according to this chapter if:
new text end
new text begin
(1) the commissioner determines that a change in enrollment or affiliation of the personal
care assistant is needed in order to ensure continuity of services and protect the health and
safety of the recipient;
new text end
new text begin
(2) the chosen agency has been continuously enrolled as a personal care assistance
provider agency for at least two years;
new text end
new text begin
(3) the recipient chooses to transfer to the personal care assistance provider agency;
new text end
new text begin
(4) the personal care assistant has been continuously enrolled with the former personal
care assistance provider agency since the last background study was completed; and
new text end
new text begin
(5) the personal care assistant continues to meet requirements of section 256B.0659,
subdivision 11, notwithstanding paragraph (a), clause (3).
new text end
Subd. 4.
Personnel agencies; educational programs; professional services
agencies.
The commissioner also may conduct studies on individuals specified in subdivision
1, paragraph (a), clauses (3) and (4), when the studies are initiated by:
(1) personnel pool agencies;
(2) temporary personnel agencies;
(3) educational programs that train individuals by providing direct contact services in
licensed programs; and
(4) professional services agencies that are not licensed and which contract with licensed
programs to provide direct contact services or individuals who provide direct contact services.
Subd. 5.
Other state agencies.
The commissioner shall conduct background studies on
applicants and license holders under the jurisdiction of other state agencies who are required
in other statutory sections to initiate background studies under this chapter, including the
applicant's or license holder's employees, contractors, and volunteers when required under
other statutory sections.
new text begin Subd. 5a. new text end
new text begin
Facilities serving children or adults licensed or regulated by the
Department of Health.
new text end
new text begin
(a) The commissioner shall conduct background studies of:
new text end
new text begin
(1) individuals providing services who have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; assisted living facilities and assisted living
facilities with dementia care licensed under chapter 144G; and board and lodging
establishments that are registered to provide supportive or health supervision services under
section 157.17;
new text end
new text begin
(2) individuals specified in subdivision 2 who provide direct contact services in a nursing
home or a home care agency licensed under chapter 144A; an assisted living facility or
assisted living facility with dementia care licensed under chapter 144G; or a boarding care
home licensed under sections 144.50 to 144.58. If the individual undergoing a study resides
outside of Minnesota, the study must include a check for substantiated findings of
maltreatment of adults and children in the individual's state of residence when the state
makes the information available;
new text end
new text begin
(3) all other employees in assisted living facilities or assisted living facilities with
dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A,
and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual from positions allowing direct
contact with or access to patients or residents receiving services. "Access" means physical
access to a client or the client's personal property without continuous, direct supervision as
defined in section 245C.02, subdivision 8, when the employee's employment responsibilities
do not include providing direct contact services;
new text end
new text begin
(4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities; and
new text end
new text begin
(5) controlling persons of a supplemental nursing services agency, as defined by section
144A.70.
new text end
new text begin
(b) If a facility or program is licensed by the Department of Human Services and the
Department of Health and is subject to the background study provisions of this chapter, the
Department of Human Services is solely responsible for the background studies of individuals
in the jointly licensed program.
new text end
new text begin
(c) The commissioner of health shall review and make decisions regarding reconsideration
requests, including whether to grant variances, according to the procedures and criteria in
this chapter. The commissioner of health shall inform the requesting individual and the
Department of Human Services of the commissioner of health's decision regarding the
reconsideration. The commissioner of health's decision to grant or deny a reconsideration
of a disqualification is a final administrative agency action.
new text end
new text begin Subd. 5b. new text end
new text begin
Facilities serving children or youth licensed by the Department of
Corrections.
new text end
new text begin
(a) The commissioner shall conduct background studies of individuals working
in secure and nonsecure children's residential facilities, juvenile detention facilities, and
foster residence settings, whether or not the individual will have direct contact, as defined
under section 245C.02, subdivision 11, with persons served in the facilities or settings.
new text end
new text begin
(b) A clerk or administrator of any court, the Bureau of Criminal Apprehension, a
prosecuting attorney, a county sheriff, or a chief of a local police department shall assist in
conducting background studies by providing the commissioner of human services or the
commissioner's representative all criminal conviction data available from local and state
criminal history record repositories related to applicants, operators, all persons living in a
household, and all staff of any facility subject to background studies under this subdivision.
new text end
new text begin
(c) For the purpose of this subdivision, the term "secure and nonsecure residential facility
and detention facility" includes programs licensed or certified under section 241.021,
subdivision 2.
new text end
new text begin
(d) If an individual is disqualified, the Department of Human Services shall notify the
disqualified individual and the facility in which the disqualified individual provides services
of the disqualification and shall inform the disqualified individual of the right to request a
reconsideration of the disqualification by submitting the request to the Department of
Corrections.
new text end
new text begin
(e) The commissioner of corrections shall review and make decisions regarding
reconsideration requests, including whether to grant variances, according to the procedures
and criteria in this chapter. The commissioner of corrections shall inform the requesting
individual and the Department of Human Services of the commissioner of corrections'
decision regarding the reconsideration. The commissioner of corrections' decision to grant
or deny a reconsideration of a disqualification is the final administrative agency action.
new text end
Subd. 6.
Unlicensed home and community-based waiver providers of service to
seniors and individuals with disabilities.
new text begin (a) new text end The commissioner shall conduct background
studies deleted text begin ondeleted text end new text begin ofnew text end any individual deleted text begin required under section 256B.4912 to have a background study
completed under this chapterdeleted text end new text begin who provides direct contact, as defined in section 245C.02,
subdivision 11, for services specified in the federally approved home and community-based
waiver plans under section 256B.4912. The individual studied must meet the requirements
of this chapter prior to providing waiver services and as part of ongoing enrollment.
new text end
new text begin (b) The requirements in paragraph (a) apply to consumer-directed community supports
under section 256B.4911new text end .
Subd. 6a.
Legal nonlicensed and certified child care programs.
The commissioner
shall conduct background studies deleted text begin on an individualdeleted text end new text begin of the following individuals asnew text end required
deleted text begin underdeleted text end new text begin bynew text end sections 119B.125 and 245H.10 deleted text begin to complete a background study under this chapter.deleted text end new text begin :
new text end
new text begin
(1) every individual who applies for certification;
new text end
new text begin
(2) every member of a provider's household who is age 13 and older and lives in the
household where nonlicensed child care is provided; and
new text end
new text begin
(3) an individual who is at least ten years of age and under 13 years of age and lives in
the household where the nonlicensed child care will be provided when the county has
reasonable cause as defined under section 245C.02, subdivision 15.
new text end
Subd. 7.
Children's therapeutic services and supports providers.
The commissioner
shall conduct background studies deleted text begin according to this chapter when initiated by a children's
therapeutic services and supports providerdeleted text end new text begin of all direct service providers and volunteers for
children's therapeutic services and supports providersnew text end under section 256B.0943.
deleted text begin Subd. 8. deleted text end
deleted text begin Self-initiated background studies. deleted text end
deleted text begin
Upon implementation of NETStudy 2.0,
the commissioner shall conduct background studies according to this chapter when initiated
by an individual who is not on the master roster. A subject under this subdivision who is
not disqualified must be placed on the inactive roster.
deleted text end
Subd. 9.
Community first services and supports new text begin and financial management services
new text end organizations.
deleted text begin
The commissioner shall conduct background studies on any individual
required under section 256B.85 to have a background study completed under this chapter.
deleted text end
new text begin
Individuals affiliated with Community First Services and Supports (CFSS) agency-providers
and Financial Management Services (FMS) providers enrolled to provide CFSS services
under the medical assistance program must meet the following requirements:
new text end
new text begin
(1) owners who have a five percent interest or more and all managing employees are
subject to a background study under this chapter. This requirement applies to currently
enrolled providers and agencies seeking enrollment. "Managing employee" has the meaning
given in Code of Federal Regulations, title 42, section 455.101. An organization is barred
from enrollment if:
new text end
new text begin
(i) the organization has not initiated background studies of owners and managing
employees; or
new text end
new text begin
(ii) the organization has initiated background studies of owners and managing employees
and the commissioner has sent the organization a notice that an owner or managing employee
of the organization has been disqualified under section 245C.14 and the owner or managing
employee has not received a set aside of the disqualification under section 245C.22;
new text end
new text begin
(2) a background study must be initiated and completed for all staff who will have direct
contact with the participant to provide worker training and development; and
new text end
new text begin
(3) a background study must be initiated and completed for all support workers.
new text end
new text begin Subd. 9a. new text end
new text begin Exception to support worker requirements for continuity of services. new text end
new text begin
The
support worker for a participant may enroll with a different Community First Services and
Supports (CFSS) agency-provider or Financial Management Services (FMS) provider upon
initiation, rather than completion, of a new background study according to this chapter if:
new text end
new text begin
(1) the commissioner determines that the support worker's change in enrollment or
affiliation is necessary to ensure continuity of services and to protect the health and safety
of the participant;
new text end
new text begin
(2) the chosen agency-provider or FMS provider has been continuously enrolled as a
CFSS agency-provider or FMS provider for at least two years or since the inception of the
CFSS program, whichever is shorter;
new text end
new text begin
(3) the participant served by the support worker chooses to transfer to the CFSS
agency-provider or the FMS provider to which the support worker is transferring;
new text end
new text begin
(4) the support worker has been continuously enrolled with the former CFSS
agency-provider or FMS provider since the support worker's last background study was
completed; and
new text end
new text begin
(5) the support worker continues to meet the requirements of section 256B.85, subdivision
16, notwithstanding paragraph (a), clause (1).
new text end
Subd. 10.
Providers of group residential housing or supplementary services.
new text begin (a) new text end The
commissioner shall conduct background studies deleted text begin on any individual required under section
256I.04 to have a background study completed under this chapter.deleted text end new text begin of the following individuals
who provide services under section 256I.04:
new text end
new text begin
(1) controlling individuals as defined in section 245A.02;
new text end
new text begin
(2) managerial officials as defined in section 245A.02; and
new text end
new text begin
(3) all employees and volunteers of the establishment who have direct contact with
recipients or who have unsupervised access to recipients, recipients' personal property, or
recipients' private data.
new text end
new text begin
(b) The provider of housing support must comply with all requirements for entities
initiating background studies under this chapter.
new text end
new text begin
(c) A provider of housing support must demonstrate that all individuals who are required
to have a background study according to paragraph (a) have a notice stating that:
new text end
new text begin
(1) the individual is not disqualified under section 245C.14; or
new text end
new text begin
(2) the individual is disqualified and the individual has been issued a set aside of the
disqualification for the setting under section 245C.22.
new text end
deleted text begin Subd. 11. deleted text end
deleted text begin
Child protection workers or social services staff having responsibility for
child protective duties.
deleted text end
deleted text begin
(a) The commissioner must complete background studies, according
to paragraph (b) and section 245C.04, subdivision 10, when initiated by a county social
services agency or by a local welfare agency according to section 626.559, subdivision 1b.
deleted text end
deleted text begin
(b) For background studies completed by the commissioner under this subdivision, the
commissioner shall not make a disqualification decision, but shall provide the background
study information received to the county that initiated the study.
deleted text end
Subd. 12.
Providers of special transportation service.
new text begin (a) new text end The commissioner shall
conduct background studies deleted text begin on any individual required under section 174.30 to have a
background study completed under this chapter.deleted text end new text begin of the following individuals who provide
special transportation services under section 174.30:
new text end
new text begin
(1) each person with a direct or indirect ownership interest of five percent or higher in
a transportation service provider;
new text end
new text begin
(2) each controlling individual as defined under section 245A.02;
new text end
new text begin
(3) a managerial official as defined in section 245A.02;
new text end
new text begin
(4) each driver employed by the transportation service provider;
new text end
new text begin
(5) each individual employed by the transportation service provider to assist a passenger
during transport; and
new text end
new text begin
(6) each employee of the transportation service agency who provides administrative
support, including an employee who:
new text end
new text begin
(i) may have face-to-face contact with or access to passengers, passengers' personal
property, or passengers' private data;
new text end
new text begin
(ii) performs any scheduling or dispatching tasks; or
new text end
new text begin
(iii) performs any billing activities.
new text end
new text begin
(b) When a local or contracted agency is authorizing a ride under section 256B.0625,
subdivision 17, by a volunteer driver, and the agency authorizing the ride has a reason to
believe that the volunteer driver has a history that would disqualify the volunteer driver or
that may pose a risk to the health or safety of passengers, the agency may initiate a
background study that shall be completed according to this chapter using the commissioner
of human services' online NETStudy system, or by contacting the Department of Human
Services background study division for assistance. The agency that initiates the background
study under this paragraph shall be responsible for providing the volunteer driver with the
privacy notice required by section 245C.05, subdivision 2c, and with the payment for the
background study required by section 245C.10 before the background study is completed.
new text end
Subd. 13.
Providers of housing support services.
The commissioner shall conduct
background studies deleted text begin ondeleted text end new text begin ofnew text end any deleted text begin individualdeleted text end new text begin provider of housing support servicesnew text end required deleted text begin underdeleted text end new text begin
bynew text end section 256B.051 to have a background study completed under this chapter.
new text begin Subd. 14. new text end
new text begin Tribal nursing facilities. new text end
new text begin
For completed background studies to comply with
a Tribal organization's licensing requirements for individuals affiliated with a tribally licensed
nursing facility, the commissioner shall obtain state and national criminal history data.
new text end
new text begin Subd. 15. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall conduct background studies according to this chapter when initiated by
an early intensive developmental and behavioral intervention provider under section
256B.0949.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except subdivision 6,
paragraph (b), is effective upon federal approval and subdivision 15 is effective the day
following final enactment. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 18.
new text begin
[245C.031] BACKGROUND STUDY; ALTERNATIVE BACKGROUND
STUDIES.
new text end
new text begin Subdivision 1. new text end
new text begin Alternative background studies. new text end
new text begin
(a) The commissioner shall conduct
an alternative background study of individuals listed in this section.
new text end
new text begin
(b) Notwithstanding other sections of this chapter, all alternative background studies
except subdivision 12 shall be conducted according to this section and with section 299C.60
to 299C.64.
new text end
new text begin
(c) All terms in this section shall have the definitions provided in section 245C.02.
new text end
new text begin
(d) The entity that submits an alternative background study request under this section
shall submit the request to the commissioner according to section 245C.05.
new text end
new text begin
(e) The commissioner shall comply with the destruction requirements in section 245C.051.
new text end
new text begin
(f) Background studies conducted under this section are subject to the provisions of
section 245C.32.
new text end
new text begin
(g) The commissioner shall forward all information that the commissioner receives under
section 245C.08 to the entity that submitted the alternative background study request under
subdivision 2. The commissioner shall not make any eligibility determinations regarding
background studies conducted under this section.
new text end
new text begin Subd. 2. new text end
new text begin Access to information. new text end
new text begin
Each entity that submits an alternative background
study request shall enter into an agreement with the commissioner before submitting requests
for alternative background studies under this section. As a part of the agreement, the entity
must agree to comply with state and federal law.
new text end
new text begin Subd. 3. new text end
new text begin
Child protection workers or social services staff having responsibility for
child protective duties.
new text end
new text begin
The commissioner shall conduct an alternative background study
of any person who has responsibility for child protection duties when the background study
is initiated by a county social services agency or by a local welfare agency according to
section 260E.36, subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin
Applicants, licensees, and other occupations regulated by the commissioner
of health.
new text end
new text begin
The commissioner shall conduct an alternative background study, including a
check of state data, and a national criminal history records check of the following individuals.
For studies under this section, the following persons shall complete a consent form:
new text end
new text begin
(1) an applicant for initial licensure, temporary licensure, or relicensure after a lapse in
licensure as an audiologist or speech-language pathologist or an applicant for initial
certification as a hearing instrument dispenser who must submit to a background study
under section 144.0572.
new text end
new text begin
(2) an applicant for a renewal license or certificate as an audiologist, speech-language
pathologist, or hearing instrument dispenser who was licensed or obtained a certificate
before January 1, 2018.
new text end
new text begin Subd. 5. new text end
new text begin Guardians and conservators. new text end
new text begin
(a) The commissioner shall conduct an alternative
background study of:
new text end
new text begin
(1) every court-appointed guardian and conservator, unless a background study has been
completed of the person under this section within the previous five years. The alternative
background study shall be completed prior to the appointment of the guardian or conservator,
unless a court determines that it would be in the best interests of the ward or protected person
to appoint a guardian or conservator before the alternative background study can be
completed. If the court appoints the guardian or conservator while the alternative background
study is pending, the alternative background study must be completed as soon as reasonably
possible after the guardian or conservator's appointment and no later than 30 days after the
guardian or conservator's appointment; and
new text end
new text begin
(2) a guardian and a conservator once every five years after the guardian or conservator's
appointment if the person continues to serve as a guardian or conservator.
new text end
new text begin
(b) An alternative background study is not required if the guardian or conservator is:
new text end
new text begin
(1) a state agency or county;
new text end
new text begin
(2) a parent or guardian of a proposed ward or protected person who has a developmental
disability if the parent or guardian has raised the proposed ward or protected person in the
family home until the time that the petition is filed, unless counsel appointed for the proposed
ward or protected person under section 524.5-205, paragraph (d); 524.5-304, paragraph (b);
524.5-405, paragraph (a); or 524.5-406, paragraph (b), recommends a background study;
or
new text end
new text begin
(3) a bank with trust powers, a bank and trust company, or a trust company, organized
under the laws of any state or of the United States and regulated by the commissioner of
commerce or a federal regulator.
new text end
new text begin Subd. 6. new text end
new text begin Guardians and conservators; required checks. new text end
new text begin
(a) An alternative background
study for a guardian or conservator pursuant to subdivision 5 shall include:
new text end
new text begin
(1) criminal history data from the Bureau of Criminal Apprehension and other criminal
history data obtained by the commissioner of human services;
new text end
new text begin
(2) data regarding whether the person has been a perpetrator of substantiated maltreatment
of a vulnerable adult under section 626.557 or a minor under chapter 260E. If the subject
of the study has been the perpetrator of substantiated maltreatment of a vulnerable adult or
a minor, the commissioner must include a copy of the public portion of the investigation
memorandum under section 626.557, subdivision 12b, or the public portion of the
investigation memorandum under section 260E.30. The commissioner shall provide the
court with information from a review of information according to subdivision 7 if the study
subject provided information that the study subject has a current or prior affiliation with a
state licensing agency;
new text end
new text begin
(3) criminal history data from a national criminal history record check as defined in
section 245C.02, subdivision 13c; and
new text end
new text begin
(4) state licensing agency data if a search of the database or databases of the agencies
listed in subdivision 7 shows that the proposed guardian or conservator has held a
professional license directly related to the responsibilities of a professional fiduciary from
an agency listed in subdivision 7 that was conditioned, suspended, revoked, or canceled.
new text end
new text begin
(b) If the guardian or conservator is not an individual, the background study must be
completed of all individuals who are currently employed by the proposed guardian or
conservator who are responsible for exercising powers and duties under the guardianship
or conservatorship.
new text end
new text begin Subd. 7. new text end
new text begin Guardians and conservators; state licensing data. new text end
new text begin
(a) Within 25 working
days of receiving the request for an alternative background study of a guardian or conservator,
the commissioner shall provide the court with licensing agency data for licenses directly
related to the responsibilities of a guardian or conservator if the study subject has a current
or prior affiliation with the:
new text end
new text begin
(1) Lawyers Responsibility Board;
new text end
new text begin
(2) State Board of Accountancy;
new text end
new text begin
(3) Board of Social Work;
new text end
new text begin
(4) Board of Psychology;
new text end
new text begin
(5) Board or Nursing;
new text end
new text begin
(6) Board of Medical Practice;
new text end
new text begin
(7) Department of Education;
new text end
new text begin
(8) Department of Commerce;
new text end
new text begin
(9) Board of Chiropractic Examiners;
new text end
new text begin
(10) Board of Dentistry;
new text end
new text begin
(11) Board of Marriage and Family Therapy;
new text end
new text begin
(12) Department of Human Services;
new text end
new text begin
(13) Peace Officer Standards and Training (POST) Board; and
new text end
new text begin
(14) Professional Educator Licensing and Standards Board.
new text end
new text begin
(b) The commissioner and each of the agencies listed above, except for the Department
of Human Services, shall enter into a written agreement to provide the commissioner with
electronic access to the relevant licensing data and to provide the commissioner with a
quarterly list of new sanctions issued by the agency.
new text end
new text begin
(c) The commissioner shall provide to the court the electronically available data
maintained in the agency's database, including whether the proposed guardian or conservator
is or has been licensed by the agency and whether a disciplinary action or a sanction against
the individual's license, including a condition, suspension, revocation, or cancellation, is in
the licensing agency's database.
new text end
new text begin
(d) If the proposed guardian or conservator has resided in a state other than Minnesota
during the previous ten years, licensing agency data under this section shall also include
licensing agency data from any other state where the proposed guardian or conservator
reported to have resided during the previous ten years if the study subject has a current or
prior affiliation to the licensing agency. If the proposed guardian or conservator has or has
had a professional license in another state that is directly related to the responsibilities of a
guardian or conservator from one of the agencies listed under paragraph (a), state licensing
agency data shall also include data from the relevant licensing agency of the other state.
new text end
new text begin
(e) The commissioner is not required to repeat a search for Minnesota or out-of-state
licensing data on an individual if the commissioner has provided this information to the
court within the prior five years.
new text end
new text begin
(f) The commissioner shall review the information in paragraph (c) at least once every
four months to determine whether an individual who has been studied within the previous
five years:
new text end
new text begin
(1) has any new disciplinary action or sanction against the individual's license; or
new text end
new text begin
(2) did not disclose a prior or current affiliation with a Minnesota licensing agency.
new text end
new text begin
(g) If the commissioner's review in paragraph (f) identifies new information, the
commissioner shall provide any new information to the court.
new text end
new text begin Subd. 8. new text end
new text begin Guardians ad litem. new text end
new text begin
The commissioner shall conduct an alternative background
study of:
new text end
new text begin
(1) a guardian ad litem appointed under section 518.165 if a background study of the
guardian ad litem has not been completed within the past three years. The background study
of the guardian ad litem must be completed before the court appoints the guardian ad litem,
unless the court determines that it is in the best interests of the child to appoint the guardian
ad litem before a background study is completed by the commissioner.
new text end
new text begin
(2) a guardian ad litem once every three years after the guardian has been appointed, as
long as the individual continues to serve as a guardian ad litem.
new text end
new text begin Subd. 9. new text end
new text begin Guardians ad litem; required checks. new text end
new text begin
(a) An alternative background study
for a guardian ad litem under subdivision 8 must include:
new text end
new text begin
(1) criminal history data from the Bureau of Criminal Apprehension and other criminal
history data obtained by the commissioner of human services; and
new text end
new text begin
(2) data regarding whether the person has been a perpetrator of substantiated maltreatment
of a minor or a vulnerable adult. If the study subject has been determined by the Department
of Human Services or the Department of Health to be the perpetrator of substantiated
maltreatment of a minor or a vulnerable adult in a licensed facility, the response must include
a copy of the public portion of the investigation memorandum under section 260E.30 or the
public portion of the investigation memorandum under section 626.557, subdivision 12b.
When the background study shows that the subject has been determined by a county adult
protection or child protection agency to have been responsible for maltreatment, the court
shall be informed of the county, the date of the finding, and the nature of the maltreatment
that was substantiated.
new text end
new text begin
(b) For checks of records under paragraph (a), clauses (1) and (2), the commissioner
shall provide the records within 15 working days of receiving the request. The information
obtained under sections 245C.05 and 245C.08 from a national criminal history records
check shall be provided within three working days of the commissioner's receipt of the data.
new text end
new text begin
(c) Notwithstanding section 260E.30 or 626.557, subdivision 12b, if the commissioner
or county lead agency or lead investigative agency has information that a person of whom
a background study was previously completed under this section has been determined to
be a perpetrator of maltreatment of a minor or vulnerable adult, the commissioner or the
county may provide this information to the court that requested the background study.
new text end
new text begin Subd. 10. new text end
new text begin
First-time applicants for educator licenses with the Professional Educator
Licensing and Standards Board.
new text end
new text begin
The Professional Educator Licensing and Standards
Board shall make all eligibility determinations for alternative background studies conducted
under this section for the Professional Educator Licensing and Standards Board. The
commissioner may conduct an alternative background study of all first-time applicants for
educator licenses pursuant to section 122A.18, subdivision 8. The alternative background
study for all first-time applicants for educator licenses must include a review of information
from the Bureau of Criminal Apprehension, including criminal history data as defined in
section 13.87, and must also include a review of the national criminal records repository.
new text end
new text begin Subd. 11. new text end
new text begin
First-time applicants for administrator licenses with the Board of School
Administrators.
new text end
new text begin
The Board of School Administrators shall make all eligibility determinations
for alternative background studies conducted under this section for the Board of School
Administrators. The commissioner may conduct an alternative background study of all
first-time applicants for administrator licenses pursuant to section 122A.18, subdivision 8.
The alternative background study for all first-time applicants for administrator licenses must
include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository.
new text end
new text begin Subd. 12. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
(a) The commissioner shall conduct a
background study of any individual required under section 62V.05 to have a background
study completed under this chapter. Notwithstanding subdivision 1, paragraph (g), the
commissioner shall conduct a background study only based on Minnesota criminal records
of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The MNsure board of directors may initiate background studies required by paragraph
(a) using the online NETStudy 2.0 system operated by the commissioner.
new text end
new text begin
(c) The commissioner shall review information that the commissioner receives to
determine if the study subject has potentially disqualifying offenses. The commissioner
shall send a letter to the subject indicating any of the subject's potential disqualifications as
well as any relevant records. The commissioner shall send a copy of the letter indicating
any of the subject's potential disqualifications to the MNsure board.
new text end
new text begin
(d) The MNsure board or its delegate shall review a reconsideration request of an
individual in paragraph (a), including granting a set aside, according to the procedures and
criteria in chapter 245C. The board shall notify the individual and the Department of Human
Services of the board's decision.
new text end
Sec. 19.
Minnesota Statutes 2020, section 245C.05, subdivision 1, is amended to read:
Subdivision 1.
Individual studied.
(a) The individual who is the subject of the
background study must provide the applicant, license holder, or other entity under section
245C.04 with sufficient information to ensure an accurate study, including:
(1) the individual's first, middle, and last name and all other names by which the
individual has been known;
(2) current home address, city, and state of residence;
(3) current zip code;
(4) sex;
(5) date of birth;
(6) driver's license number or state identification number; and
(7) upon implementation of NETStudy 2.0, the home address, city, county, and state of
residence for the past five years.
(b) Every subject of a background study conducted or initiated by counties or private
agencies under this chapter must also provide the home address, city, county, and state of
residence for the past five years.
(c) Every subject of a background study related to private agency adoptions or related
to child foster care licensed through a private agency, who is 18 years of age or older, shall
also provide the commissioner a signed consent for the release of any information received
from national crime information databases to the private agency that initiated the background
study.
(d) The subject of a background study shall provide fingerprints and a photograph as
required in subdivision 5.
new text begin
(e) The subject of a background study shall submit a completed criminal and maltreatment
history records check consent form for applicable national and state level record checks.
new text end
Sec. 20.
Minnesota Statutes 2020, section 245C.05, subdivision 2, is amended to read:
Subd. 2.
Applicant, license holder, or other entity.
(a) The applicant, license holder,
or other deleted text begin entitiesdeleted text end new text begin entity initiating the background studynew text end as provided in this chapter shall verify
that the information collected under subdivision 1 about an individual who is the subject of
the background study is correct and must provide the information on forms or in a format
prescribed by the commissioner.
(b) The information collected under subdivision 1 about an individual who is the subject
of a completed background study may only be viewable by an entity that initiates a
subsequent background study on that individual under NETStudy 2.0 after the entity has
paid the applicable fee for the study and has provided the individual with the privacy notice
in subdivision 2c.
Sec. 21.
Minnesota Statutes 2020, section 245C.05, subdivision 2a, is amended to read:
Subd. 2a.
County or private agency.
For background studies related to child foster care
when the applicant or license holder resides in the home where child foster care services
are provided, county and private agencies new text begin initiating the background study new text end must collect the
information under subdivision 1 and forward it to the commissioner.
Sec. 22.
Minnesota Statutes 2020, section 245C.05, subdivision 2b, is amended to read:
Subd. 2b.
County agency to collect and forward information to commissioner.
(a)
For background studies related to all family adult day services and to adult foster care when
the adult foster care license holder resides in the adult foster care residence, the county
agency new text begin or private agency initiating the background study new text end must collect the information
required under subdivision 1 and forward it to the commissioner.
(b) Upon implementation of NETStudy 2.0, for background studies related to family
child care and legal nonlicensed child care authorized under chapter 119B, the county agency
new text begin initiating the background study new text end must collect the information required under subdivision 1
and provide the information to the commissioner.
Sec. 23.
Minnesota Statutes 2020, section 245C.05, subdivision 2c, is amended to read:
Subd. 2c.
Privacy notice to background study subject.
(a) Prior to initiating each
background study, the entity initiating the study must provide the commissioner's privacy
notice to the background study subject required under section 13.04, subdivision 2. The
notice must be available through the commissioner's electronic NETStudy and NETStudy
2.0 systems and shall include the information in paragraphs (b) and (c).
(b) The background study subject shall be informed that any previous background studies
that received a set-aside will be reviewed, and without further contact with the background
study subject, the commissioner may notify the agency that initiated the subsequent
background study:
(1) that the individual has a disqualification that has been set aside for the program or
agency that initiated the study;
(2) the reason for the disqualification; and
(3) that information about the decision to set aside the disqualification will be available
to the license holder upon request without the consent of the background study subject.
(c) The background study subject must also be informed that:
(1) the subject's fingerprints collected for purposes of completing the background study
under this chapter must not be retained by the Department of Public Safety, Bureau of
Criminal Apprehension, or by the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text end new text begin not retain background study
subjects' fingerprintsnew text end ;
(2) effective upon implementation of NETStudy 2.0, the subject's photographic image
will be retained by the commissioner, and if the subject has provided the subject's Social
Security number for purposes of the background study, the photographic image will be
available to prospective employers and agencies initiating background studies under this
chapter to verify the identity of the subject of the background study;
(3) the commissioner's authorized fingerprint collection vendornew text begin or vendorsnew text end shall, for
purposes of verifying the identity of the background study subject, be able to view the
identifying information entered into NETStudy 2.0 by the entity that initiated the background
study, but shall not retain the subject's fingerprints, photograph, or information from
NETStudy 2.0. The authorized fingerprint collection vendornew text begin or vendorsnew text end shall retain no more
than the subject's name and the date and time the subject's fingerprints were recorded and
sent, only as necessary for auditing and billing activities;
(4) the commissioner shall provide the subject notice, as required in section 245C.17,
subdivision 1, paragraph (a), when an entity initiates a background study on the individual;
(5) the subject may request in writing a report listing the entities that initiated a
background study on the individual as provided in section 245C.17, subdivision 1, paragraph
(b);
(6) the subject may request in writing that information used to complete the individual's
background study in NETStudy 2.0 be destroyed if the requirements of section 245C.051,
paragraph (a), are met; and
(7) notwithstanding clause (6), the commissioner shall destroy:
(i) the subject's photograph after a period of two years when the requirements of section
245C.051, paragraph (c), are met; and
(ii) any data collected on a subject under this chapter after a period of two years following
the individual's death as provided in section 245C.051, paragraph (d).
Sec. 24.
Minnesota Statutes 2020, section 245C.05, subdivision 2d, is amended to read:
Subd. 2d.
Fingerprint data notification.
The commissioner of human services shall
notify all background study subjects under this chapter that the Department of Human
Services, Department of Public Safety, and the Bureau of Criminal Apprehension do not
retain fingerprint data after a background study is completed, and that the Federal Bureau
of Investigation deleted text begin only retains the fingerprints of subjects who have a criminal historydeleted text end new text begin does
not retain background study subjects' fingerprintsnew text end .
Sec. 25.
Minnesota Statutes 2020, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study deleted text begin resultsdeleted text end new text begin information obtained under this section and section 245C.08new text end
to countiesnew text begin and private agenciesnew text end for background studies conducted by the commissioner for
child foster carenew text begin , including a summary of nondisqualifying results, except as prohibited by
lawnew text end ; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 26.
Minnesota Statutes 2020, section 245C.08, subdivision 3, is amended to read:
Subd. 3.
Arrest and investigative information.
(a) For any background study completed
under this section, if the commissioner has reasonable cause to believe the information is
pertinent to the disqualification of an individual, the commissioner also may review arrest
and investigative information from:
(1) the Bureau of Criminal Apprehension;
(2) the commissioners of health and human services;
(3) a county attorney;
(4) a county sheriff;
(5) a county agency;
(6) a local chief of police;
(7) other states;
(8) the courts;
(9) the Federal Bureau of Investigation;
(10) the National Criminal Records Repository; and
(11) criminal records from other states.
(b) Except when specifically required by law, the commissioner is not required to conduct
more than one review of a subject's records from the Federal Bureau of Investigation if a
review of the subject's criminal history with the Federal Bureau of Investigation has already
been completed by the commissioner and there has been no break in the subject's affiliation
with the entity that initiated the background study.
(c) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the data obtained is private data and cannot be shared with
deleted text begin county agencies,deleted text end private agenciesdeleted text begin ,deleted text end or prospective employers of the background study subject.
(d) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the license holder or entity that submitted the study is not
required to obtain a copy of the background study subject's disqualification letter under
section 245C.17, subdivision 3.
Sec. 27.
Minnesota Statutes 2020, section 245C.08, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Authorization. new text end
new text begin
The commissioner of human services shall be authorized to
receive information under this chapter.
new text end
Sec. 28.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Background study fees. new text end
new text begin
(a) The commissioner shall recover the cost of
background studies. Except as otherwise provided in subdivisions 1c and 1d, the fees
collected under this section shall be appropriated to the commissioner for the purpose of
conducting background studies under this chapter. Fees under this section are charges under
section 16A.1283, paragraph (b), clause (3).
new text end
new text begin
(b) Background study fees may include:
new text end
new text begin
(1) a fee to compensate the commissioner's authorized fingerprint collection vendor or
vendors for obtaining and processing a background study subject's classifiable fingerprints
and photograph pursuant to subdivision 1c; and
new text end
new text begin
(2) a separate fee under subdivision 1c to complete a review of background-study-related
records as authorized under this chapter.
new text end
new text begin
(c) Fees charged under paragraph (b) may be paid in whole or part when authorized by
law by a state agency or board; by state court administration; by a service provider, employer,
license holder, or other organization that initiates the background study; by the commissioner
or other organization with duly appropriated funds; by a background study subject; or by
some combination of these sources.
new text end
Sec. 29.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 1c. new text end
new text begin Fingerprint and photograph processing fees. new text end
new text begin
The commissioner shall enter
into a contract with a qualified vendor or vendors to obtain and process a background study
subject's classifiable fingerprints and photograph as required by section 245C.05. The
commissioner may, at their discretion, directly collect fees and reimburse the commissioner's
authorized fingerprint collection vendor for the vendor's services or require the vendor to
collect the fees. The authorized vendor is responsible for reimbursing the vendor's
subcontractors at a rate specified in the contract with the commissioner.
new text end
Sec. 30.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 1d. new text end
new text begin Background studies fee schedule. new text end
new text begin
(a) By March 1 each year, the commissioner
shall publish a schedule of fees sufficient to administer and conduct background studies
under this chapter. The published schedule of fees shall be effective on July 1 each year.
new text end
new text begin
(b) Fees shall be based on the actual costs of administering and conducting background
studies, including payments to external agencies, department indirect cost payments under
section 16A.127, processing fees, and costs related to due process.
new text end
new text begin
(c) The commissioner shall publish a notice of fees by posting fee amounts on the
department website. The notice shall specify the actual costs that comprise the fees including
the categories described in paragraph (b).
new text end
new text begin
(d) The published schedule of fees shall remain in effect from July 1 to June 30 each
year.
new text end
new text begin
(e) The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies, alternative background studies, and criminal
background checks.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021. The commissioner of human
services shall publish the initial fee schedule on the Department of Human Services website
on July 1, 2021, and the initial fee schedule is effective September 1, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 245C.10, subdivision 15, is amended to read:
Subd. 15.
Guardians and conservators.
The deleted text begin commissioner shall recover the cost of
conducting background studies for guardians and conservators under section 524.5-118
through a fee of no more than $110 per study. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.deleted text end new text begin fee
for conducting an alternative background study for appointment of a professional guardian
or conservator must be paid by the guardian or conservator. In other cases, the fee must be
paid as follows:
new text end
new text begin
(1) if the matter is proceeding in forma pauperis, the fee must be paid as an expense for
purposes of section 524.5-502, paragraph (a);
new text end
new text begin
(2) if there is an estate of the ward or protected person, the fee must be paid from the
estate; or
new text end
new text begin
(3) in the case of a guardianship or conservatorship of a person that is not proceeding
in forma pauperis, the fee must be paid by the guardian, conservator, or the court.
new text end
Sec. 32.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 15, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $20 per study charged to the enrolled
agency. The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin
Applicants, licensees, and other occupations regulated by commissioner
of health.
new text end
new text begin
The applicant or license holder is responsible for paying to the Department of
Human Services all fees associated with the preparation of the fingerprints, the criminal
records check consent form, and the criminal background check.
new text end
Sec. 34.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 19. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
The commissioner shall set fees to
recover the cost of background studies and criminal background checks initiated by MNsure
under sections 62V.05 and 245C.031. The fee amount shall be established through
interagency agreement between the commissioner and the board of MNsure or its designee.
The fees collected under this subdivision shall be deposited in the special revenue fund and
are appropriated to the commissioner for the purpose of conducting background studies and
criminal background checks.
new text end
Sec. 35.
Minnesota Statutes 2020, section 245C.13, subdivision 2, is amended to read:
Subd. 2.
Activities pending completion of background study.
The subject of a
background study may not perform any activity requiring a background study under
paragraph (c) until the commissioner has issued one of the notices under paragraph (a).
(a) Notices from the commissioner required prior to activity under paragraph (c) include:
(1) a notice of the study results under section 245C.17 stating that:
(i) the individual is not disqualified; or
(ii) more time is needed to complete the study but the individual is not required to be
removed from direct contact or access to people receiving services prior to completion of
the study as provided under section 245C.17, subdivision 1, paragraph (b) or (c). The notice
that more time is needed to complete the study must also indicate whether the individual is
required to be under continuous direct supervision prior to completion of the background
study. When more time is necessary to complete a background study of an individual
affiliated with a Title IV-E eligible children's residential facility or foster residence setting,
the individual may not work in the facility or setting regardless of whether or not the
individual is supervised;
(2) a notice that a disqualification has been set aside under section 245C.23; or
(3) a notice that a variance has been granted related to the individual under section
245C.30.
(b) For a background study affiliated with a licensed child care center or certified
license-exempt child care center, the notice sent under paragraph (a), clause (1), item (ii),
must require the individual to be under continuous direct supervision prior to completion
of the background study except as permitted in subdivision 3.
(c) Activities prohibited prior to receipt of notice under paragraph (a) include:
(1) being issued a license;
(2) living in the household where the licensed program will be provided;
(3) providing direct contact services to persons served by a program unless the subject
is under continuous direct supervision;
(4) having access to persons receiving services if the background study was completed
under section 144.057, subdivision 1, or 245C.03, subdivision 1, paragraph (a), clause (2),
(5), or (6), unless the subject is under continuous direct supervision;
(5) for licensed child care centers and certified license-exempt child care centers,
providing direct contact services to persons served by the program; deleted text begin or
deleted text end
(6) for children's residential facilities or foster residence settings, working in the facility
or settingdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) for background studies affiliated with a personal care provider organization, except
as provided in section 245C.03, subdivision 3b, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study of
the personal care assistant under this chapter and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
new text end
new text begin
(i) not disqualified under section 245C.14; or
new text end
new text begin
(ii) disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22.
new text end
Sec. 36.
Minnesota Statutes 2020, section 245C.14, subdivision 1, is amended to read:
Subdivision 1.
Disqualification from direct contact.
(a) The commissioner shall
disqualify an individual who is the subject of a background study from any position allowing
direct contact with persons receiving services from the license holder or entity identified in
section 245C.03, upon receipt of information showing, or when a background study
completed under this chapter shows any of the following:
(1) a conviction of, admission to, or Alford plea to one or more crimes listed in section
245C.15, regardless of whether the conviction or admission is a felony, gross misdemeanor,
or misdemeanor level crime;
(2) a preponderance of the evidence indicates the individual has committed an act or
acts that meet the definition of any of the crimes listed in section 245C.15, regardless of
whether the preponderance of the evidence is for a felony, gross misdemeanor, or
misdemeanor level crime; or
(3) an investigation results in an administrative determination listed under section
245C.15, subdivision 4, paragraph (b).
(b) No individual who is disqualified following a background study under section
245C.03, subdivisions 1 and 2, may be retained in a position involving direct contact with
persons served by a program or entity identified in section 245C.03, unless the commissioner
has provided written notice under section 245C.17 stating that:
(1) the individual may remain in direct contact during the period in which the individual
may request reconsideration as provided in section 245C.21, subdivision 2;
(2) the commissioner has set aside the individual's disqualification for that program or
entity identified in section 245C.03, as provided in section 245C.22, subdivision 4; or
(3) the license holder has been granted a variance for the disqualified individual under
section 245C.30.
new text begin
(c) Notwithstanding paragraph (a), for the purposes of a background study affiliated
with a licensed family foster setting, the commissioner shall disqualify an individual who
is the subject of a background study from any position allowing direct contact with persons
receiving services from the license holder or entity identified in section 245C.03, upon
receipt of information showing or when a background study completed under this chapter
shows reason for disqualification under section 245C.15, subdivision 4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 37.
Minnesota Statutes 2020, section 245C.14, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin
Disqualification from working in licensed child care centers or certified
license-exempt child care centers.
new text end
new text begin
(a) For a background study affiliated with a licensed
child care center or certified license-exempt child care center, if an individual is disqualified
from direct contact under subdivision 1, the commissioner must also disqualify the individual
from working in any position regardless of whether the individual would have direct contact
with or access to children served in the licensed child care center or certified license-exempt
child care center and from having access to a person receiving services from the center.
new text end
new text begin
(b) Notwithstanding any other requirement of this chapter, for a background study
affiliated with a licensed child care center or a certified license-exempt child care center, if
an individual is disqualified, the individual may not work in the child care center until the
commissioner has issued a notice stating that:
new text end
new text begin
(1) the individual is not disqualified;
new text end
new text begin
(2) a disqualification has been set aside under section 245C.23; or
new text end
new text begin
(3) a variance has been granted related to the individual under section 245C.30.
new text end
Sec. 38.
Minnesota Statutes 2020, section 245C.15, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Licensed family foster setting disqualifications. new text end
new text begin
(a) Notwithstanding
subdivisions 1 to 4, for a background study affiliated with a licensed family foster setting,
regardless of how much time has passed, an individual is disqualified under section 245C.14
if the individual committed an act that resulted in a felony-level conviction for sections:
609.185 (murder in the first degree); 609.19 (murder in the second degree); 609.195 (murder
in the third degree); 609.20 (manslaughter in the first degree); 609.205 (manslaughter in
the second degree); 609.2112 (criminal vehicular homicide); 609.221 (assault in the first
degree); 609.223, subdivision 2 (assault in the third degree, past pattern of child abuse);
609.223, subdivision 3 (assault in the third degree, victim under four); a felony offense
under sections 609.2242 and 609.2243 (domestic assault, spousal abuse, child abuse or
neglect, or a crime against children); 609.2247 (domestic assault by strangulation); 609.2325
(criminal abuse of a vulnerable adult resulting in the death of a vulnerable adult); 609.245
(aggravated robbery); 609.25 (kidnapping); 609.255 (false imprisonment); 609.2661 (murder
of an unborn child in the first degree); 609.2662 (murder of an unborn child in the second
degree); 609.2663 (murder of an unborn child in the third degree); 609.2664 (manslaughter
of an unborn child in the first degree); 609.2665 (manslaughter of an unborn child in the
second degree); 609.267 (assault of an unborn child in the first degree); 609.2671 (assault
of an unborn child in the second degree); 609.268 (injury or death of an unborn child in the
commission of a crime); 609.322, subdivision 1 (solicitation, inducement, and promotion
of prostitution; sex trafficking in the first degree); 609.324, subdivision 1 (other prohibited
acts; engaging in, hiring, or agreeing to hire minor to engage in prostitution); 609.342
(criminal sexual conduct in the first degree); 609.343 (criminal sexual conduct in the second
degree); 609.344 (criminal sexual conduct in the third degree); 609.345 (criminal sexual
conduct in the fourth degree); 609.3451 (criminal sexual conduct in the fifth degree);
609.3453 (criminal sexual predatory conduct); 609.352 (solicitation of children to engage
in sexual conduct); 609.377 (malicious punishment of a child); 609.378 (neglect or
endangerment of a child); 609.561 (arson in the first degree); 609.582, subdivision 1 (burglary
in the first degree); 609.746 (interference with privacy); 617.23 (indecent exposure); 617.246
(use of minors in sexual performance prohibited); or 617.247 (possession of pictorial
representations of minors).
new text end
new text begin
(b) Notwithstanding subdivisions 1 to 4, for the purposes of a background study affiliated
with a licensed family foster setting, an individual is disqualified under section 245C.14,
regardless of how much time has passed, if the individual:
new text end
new text begin
(1) committed an action under paragraph (d) that resulted in death or involved sexual
abuse, as defined in section 260E.03, subdivision 20;
new text end
new text begin
(2) committed an act that resulted in a gross misdemeanor-level conviction for section
609.3451 (criminal sexual conduct in the fifth degree);
new text end
new text begin
(3) committed an act against or involving a minor that resulted in a felony-level conviction
for: section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the
third degree); 609.2231 (assault in the fourth degree); or 609.224 (assault in the fifth degree);
or
new text end
new text begin
(4) committed an act that resulted in a misdemeanor or gross misdemeanor-level
conviction for section 617.293 (dissemination and display of harmful materials to minors).
new text end
new text begin
(c) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than 20
years have passed since the termination of the individual's parental rights under section
260C.301, subdivision 1, paragraph (b), or if the individual consented to a termination of
parental rights under section 260C.301, subdivision 1, paragraph (a), to settle a petition to
involuntarily terminate parental rights. An individual is disqualified under section 245C.14
if less than 20 years have passed since the termination of the individual's parental rights in
any other state or country, where the conditions for the individual's termination of parental
rights are substantially similar to the conditions in section 260C.301, subdivision 1, paragraph
(b).
new text end
new text begin
(d) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than five
years have passed since a felony-level violation for sections: 152.021 (controlled substance
crime in the first degree); 152.022 (controlled substance crime in the second degree); 152.023
(controlled substance crime in the third degree); 152.024 (controlled substance crime in the
fourth degree); 152.025 (controlled substance crime in the fifth degree); 152.0261 (importing
controlled substances across state borders); 152.0262, subdivision 1, paragraph (b)
(possession of substance with intent to manufacture methamphetamine); 152.027, subdivision
6, paragraph (c) (sale or possession of synthetic cannabinoids); 152.096 (conspiracies
prohibited); 152.097 (simulated controlled substances); 152.136 (anhydrous ammonia;
prohibited conduct; criminal penalties; civil liabilities); 152.137 (methamphetamine-related
crimes involving children or vulnerable adults); 169A.24 (felony first-degree driving while
impaired); 243.166 (violation of predatory offender registration requirements); 609.2113
(criminal vehicular operation; bodily harm); 609.2114 (criminal vehicular operation; unborn
child); 609.228 (great bodily harm caused by distribution of drugs); 609.2325 (criminal
abuse of a vulnerable adult not resulting in the death of a vulnerable adult); 609.233 (criminal
neglect); 609.235 (use of drugs to injure or facilitate a crime); 609.24 (simple robbery);
609.322, subdivision 1a (solicitation, inducement, and promotion of prostitution; sex
trafficking in the second degree); 609.498, subdivision 1 (tampering with a witness in the
first degree); 609.498, subdivision 1b (aggravated first-degree witness tampering); 609.562
(arson in the second degree); 609.563 (arson in the third degree); 609.582, subdivision 2
(burglary in the second degree); 609.66 (felony dangerous weapons); 609.687 (adulteration);
609.713 (terroristic threats); 609.749, subdivision 3, 4, or 5 (felony-level harassment or
stalking); 609.855, subdivision 5 (shooting at or in a public transit vehicle or facility); or
624.713 (certain people not to possess firearms).
new text end
new text begin
(e) Notwithstanding subdivisions 1 to 4, except as provided in paragraph (a), for a
background study affiliated with a licensed family child foster care license, an individual
is disqualified under section 245C.14 if less than five years have passed since:
new text end
new text begin
(1) a felony-level violation for an act not against or involving a minor that constitutes:
section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the third
degree); 609.2231 (assault in the fourth degree); or 609.224, subdivision 4 (assault in the
fifth degree);
new text end
new text begin
(2) a violation of an order for protection under section 518B.01, subdivision 14;
new text end
new text begin
(3) a determination or disposition of the individual's failure to make required reports
under section 260E.06 or 626.557, subdivision 3, for incidents in which the final disposition
under chapter 260E or section 626.557 was substantiated maltreatment and the maltreatment
was recurring or serious;
new text end
new text begin
(4) a determination or disposition of the individual's substantiated serious or recurring
maltreatment of a minor under chapter 260E, a vulnerable adult under section 626.557, or
serious or recurring maltreatment in any other state, the elements of which are substantially
similar to the elements of maltreatment under chapter 260E or section 626.557 and meet
the definition of serious maltreatment or recurring maltreatment;
new text end
new text begin
(5) a gross misdemeanor-level violation for sections: 609.224, subdivision 2 (assault in
the fifth degree); 609.2242 and 609.2243 (domestic assault); 609.233 (criminal neglect);
609.377 (malicious punishment of a child); 609.378 (neglect or endangerment of a child);
609.746 (interference with privacy); 609.749 (stalking); or 617.23 (indecent exposure); or
new text end
new text begin
(6) committing an act against or involving a minor that resulted in a misdemeanor-level
violation of section 609.224, subdivision 1 (assault in the fifth degree).
new text end
new text begin
(f) For purposes of this subdivision, the disqualification begins from:
new text end
new text begin
(1) the date of the alleged violation, if the individual was not convicted;
new text end
new text begin
(2) the date of conviction, if the individual was convicted of the violation but not
committed to the custody of the commissioner of corrections; or
new text end
new text begin
(3) the date of release from prison, if the individual was convicted of the violation and
committed to the custody of the commissioner of corrections.
new text end
new text begin
Notwithstanding clause (3), if the individual is subsequently reincarcerated for a violation
of the individual's supervised release, the disqualification begins from the date of release
from the subsequent incarceration.
new text end
new text begin
(g) An individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraphs (a) and (b), as each of these offenses is defined in Minnesota
Statutes, permanently disqualifies the individual under section 245C.14. An individual is
disqualified under section 245C.14 if less than five years have passed since the individual's
aiding and abetting, attempt, or conspiracy to commit any of the offenses listed in paragraphs
(d) and (e).
new text end
new text begin
(h) An individual's offense in any other state or country, where the elements of the
offense are substantially similar to any of the offenses listed in paragraphs (a) and (b),
permanently disqualifies the individual under section 245C.14. An individual is disqualified
under section 245C.14 if less than five years has passed since an offense in any other state
or country, the elements of which are substantially similar to the elements of any offense
listed in paragraphs (d) and (e).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 39.
Minnesota Statutes 2020, section 245C.16, subdivision 1, is amended to read:
Subdivision 1.
Determining immediate risk of harm.
(a) If the commissioner determines
that the individual studied has a disqualifying characteristic, the commissioner shall review
the information immediately available and make a determination as to the subject's immediate
risk of harm to persons served by the program where the individual studied will have direct
contact with, or access to, people receiving services.
(b) The commissioner shall consider all relevant information available, including the
following factors in determining the immediate risk of harm:
(1) the recency of the disqualifying characteristic;
(2) the recency of discharge from probation for the crimes;
(3) the number of disqualifying characteristics;
(4) the intrusiveness or violence of the disqualifying characteristic;
(5) the vulnerability of the victim involved in the disqualifying characteristic;
(6) the similarity of the victim to the persons served by the program where the individual
studied will have direct contact;
(7) whether the individual has a disqualification from a previous background study that
has not been set aside; deleted text begin and
deleted text end
(8) if the individual has a disqualification which may not be set aside because it is a
permanent bar under section 245C.24, subdivision 1, or the individual is a child care
background study subject who has a felony-level conviction for a drug-related offense in
the last five years, the commissioner may order the immediate removal of the individual
from any position allowing direct contact with, or access to, persons receiving services from
the program and from working in a children's residential facility or foster residence settingdeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(9) if the individual has a disqualification which may not be set aside because it is a
permanent bar under section 245C.24, subdivision 2, or the individual is a child care
background study subject who has a felony-level conviction for a drug-related offense during
the last five years, the commissioner may order the immediate removal of the individual
from any position allowing direct contact with or access to persons receiving services from
the center and from working in a licensed child care center or certified license-exempt child
care center.
new text end
(c) This section does not apply when the subject of a background study is regulated by
a health-related licensing board as defined in chapter 214, and the subject is determined to
be responsible for substantiated maltreatment under section 626.557 or chapter 260E.
(d) This section does not apply to a background study related to an initial application
for a child foster family setting license.
(e) Except for paragraph (f), this section does not apply to a background study that is
also subject to the requirements under section 256B.0659, subdivisions 11 and 13, for a
personal care assistant or a qualified professional as defined in section 256B.0659,
subdivision 1.
(f) If the commissioner has reason to believe, based on arrest information or an active
maltreatment investigation, that an individual poses an imminent risk of harm to persons
receiving services, the commissioner may order that the person be continuously supervised
or immediately removed pending the conclusion of the maltreatment investigation or criminal
proceedings.
Sec. 40.
Minnesota Statutes 2020, section 245C.16, subdivision 2, is amended to read:
Subd. 2.
Findings.
(a) After evaluating the information immediately available under
subdivision 1, the commissioner may have reason to believe one of the following:
(1) the individual poses an imminent risk of harm to persons served by the program
where the individual studied will have direct contact or access to persons served by the
program or where the individual studied will work;
(2) the individual poses a risk of harm requiring continuous, direct supervision while
providing direct contact services during the period in which the subject may request a
reconsideration; or
(3) the individual does not pose an imminent risk of harm or a risk of harm requiring
continuous, direct supervision while providing direct contact services during the period in
which the subject may request a reconsideration.
(b) After determining an individual's risk of harm under this section, the commissioner
must notify the subject of the background study and the applicant or license holder as
required under section 245C.17.
(c) For Title IV-E eligible children's residential facilities and foster residence settings,
the commissioner is prohibited from making the findings in paragraph (a), clause (2) or (3).
new text begin
(d) For licensed child care centers or certified license-exempt child care centers, the
commissioner is prohibited from making the findings in paragraph (a), clause (2) or (3).
new text end
Sec. 41.
Minnesota Statutes 2020, section 245C.17, subdivision 1, is amended to read:
Subdivision 1.
Time frame for notice of study results and auditing system access.
(a)
Within three working days after the commissioner's receipt of a request for a background
study submitted through the commissioner's NETStudy or NETStudy 2.0 system, the
commissioner shall notify the background study subject and the license holder or other
entity as provided in this chapter in writing or by electronic transmission of the results of
the study or that more time is needed to complete the study. The notice to the individual
shall include the identity of the entity that initiated the background study.
(b) Before being provided access to NETStudy 2.0, the license holder or other entity
under section 245C.04 shall sign an acknowledgment of responsibilities form developed
by the commissioner that includes identifying the sensitive background study information
person, who must be an employee of the license holder or entity. All queries to NETStudy
2.0 are electronically recorded and subject to audit by the commissioner. The electronic
record shall identify the specific user. A background study subject may request in writing
to the commissioner a report listing the entities that initiated a background study on the
individual.
(c) When the commissioner has completed a prior background study on an individual
that resulted in an order for immediate removal and more time is necessary to complete a
subsequent study, the notice that more time is needed that is issued under paragraph (a)
shall include an order for immediate removal of the individual from any position allowing
direct contact with or access to people receiving services and from working in a children's
residential facility deleted text begin ordeleted text end new text begin ,new text end foster residence settingnew text begin , child care center, or certified license-exempt
child care centernew text end pending completion of the background study.
Sec. 42.
Minnesota Statutes 2020, section 245C.17, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin
Disqualification notice to child care centers and certified license-exempt
child care centers.
new text end
new text begin
(a) For child care centers and certified license-exempt child care centers,
all notices under this section that order the license holder to immediately remove the
individual studied from any position allowing direct contact with, or access to a person
served by the center, must also order the license holder to immediately remove the individual
studied from working in any position regardless of whether the individual would have direct
contact with or access to children served in the center.
new text end
new text begin
(b) For child care centers and certified license-exempt child care centers, notices under
this section must not allow an individual to work in the center.
new text end
Sec. 43.
Minnesota Statutes 2020, section 245C.18, is amended to read:
245C.18 OBLIGATION TO REMOVE DISQUALIFIED INDIVIDUAL FROM
DIRECT CONTACT AND FROM WORKING IN A PROGRAM, FACILITY, deleted text begin ORdeleted text end
SETTINGnew text begin , OR CENTERnew text end .
(a) Upon receipt of notice from the commissioner, the license holder must remove a
disqualified individual from direct contact with persons served by the licensed program if:
(1) the individual does not request reconsideration under section 245C.21 within the
prescribed time;
(2) the individual submits a timely request for reconsideration, the commissioner does
not set aside the disqualification under section 245C.22, subdivision 4, and the individual
does not submit a timely request for a hearing under sections 245C.27 and 256.045, or
245C.28 and chapter 14; or
(3) the individual submits a timely request for a hearing under sections 245C.27 and
256.045, or 245C.28 and chapter 14, and the commissioner does not set aside or rescind the
disqualification under section 245A.08, subdivision 5, or 256.045.
(b) For children's residential facility and foster residence setting license holders, upon
receipt of notice from the commissioner under paragraph (a), the license holder must also
remove the disqualified individual from working in the program, facility, or setting and
from access to persons served by the licensed program.
(c) For Title IV-E eligible children's residential facility and foster residence setting
license holders, upon receipt of notice from the commissioner under paragraph (a), the
license holder must also remove the disqualified individual from working in the program
and from access to persons served by the program and must not allow the individual to work
in the facility or setting until the commissioner has issued a notice stating that:
(1) the individual is not disqualified;
(2) a disqualification has been set aside under section 245C.23; or
(3) a variance has been granted related to the individual under section 245C.30.
new text begin
(d) For licensed child care center and certified license-exempt child care center license
holders, upon receipt of notice from the commissioner under paragraph (a), the license
holder must remove the disqualified individual from working in any position regardless of
whether the individual would have direct contact with or access to children served in the
center and from having access to persons served by the center and must not allow the
individual to work in the center until the commissioner has issued a notice stating that:
new text end
new text begin
(1) the individual is not disqualified;
new text end
new text begin
(2) a disqualification has been set aside under section 245C.23; or
new text end
new text begin
(3) a variance has been granted related to the individual under section 245C.30.
new text end
Sec. 44.
Minnesota Statutes 2020, section 245C.24, subdivision 2, is amended to read:
Subd. 2.
Permanent bar to set aside a disqualification.
(a) Except as provided in
paragraphs (b) to deleted text begin (e)deleted text end new text begin (f)new text end , the commissioner may not set aside the disqualification of any
individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
1.
(b) For an individual in the chemical dependency or corrections field who was disqualified
for a crime or conduct listed under section 245C.15, subdivision 1, and whose disqualification
was set aside prior to July 1, 2005, the commissioner must consider granting a variance
pursuant to section 245C.30 for the license holder for a program dealing primarily with
adults. A request for reconsideration evaluated under this paragraph must include a letter
of recommendation from the license holder that was subject to the prior set-aside decision
addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that service.
(c) If an individual who requires a background study for nonemergency medical
transportation services under section 245C.03, subdivision 12, was disqualified for a crime
or conduct listed under section 245C.15, subdivision 1, and if more than 40 years have
passed since the discharge of the sentence imposed, the commissioner may consider granting
a set-aside pursuant to section 245C.22. A request for reconsideration evaluated under this
paragraph must include a letter of recommendation from the employer. This paragraph does
not apply to a person disqualified based on a violation of sections 243.166; 609.185 to
609.205; 609.25; 609.342 to 609.3453; 609.352; 617.23, subdivision 2, clause (1), or 3,
clause (1); 617.246; or 617.247.
(d) When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.
new text begin
(e) For an individual 18 years of age or older affiliated with a licensed family foster
setting, the commissioner must not set aside or grant a variance for the disqualification of
any individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
4a, paragraphs (a) and (b).
new text end
new text begin
(f) In connection with a family foster setting license, the commissioner may grant a
variance to the disqualification for an individual who is under 18 years of age at the time
the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 45.
Minnesota Statutes 2020, section 245C.24, subdivision 3, is amended to read:
Subd. 3.
Ten-year bar to set aside disqualification.
(a) The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if: (1) less than ten years has passed since
the discharge of the sentence imposed, if any, for the offense; or (2) when disqualified based
on a preponderance of evidence determination under section 245C.14, subdivision 1,
paragraph (a), clause (2), or an admission under section 245C.14, subdivision 1, paragraph
(a), clause (1), and less than ten years has passed since the individual committed the act or
admitted to committing the act, whichever is later; and (3) the individual has committed a
violation of any of the following offenses: sections 609.165 (felon ineligible to possess
firearm); criminal vehicular homicide or criminal vehicular operation causing death under
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.215 (aiding
suicide or aiding attempted suicide); felony violations under 609.223 or 609.2231 (assault
in the third or fourth degree); 609.229 (crimes committed for benefit of a gang); 609.713
(terroristic threats); 609.235 (use of drugs to injure or to facilitate crime); 609.24 (simple
robbery); 609.255 (false imprisonment); 609.562 (arson in the second degree); 609.71 (riot);
609.498, subdivision 1 or 1b (aggravated first-degree or first-degree tampering with a
witness); burglary in the first or second degree under 609.582 (burglary); 609.66 (dangerous
weapon); 609.665 (spring guns); 609.67 (machine guns and short-barreled shotguns);
609.749, subdivision 2 (gross misdemeanor harassment); 152.021 or 152.022 (controlled
substance crime in the first or second degree); 152.023, subdivision 1, clause (3) or (4) or
subdivision 2, clause (4) (controlled substance crime in the third degree); 152.024,
subdivision 1, clause (2), (3), or (4) (controlled substance crime in the fourth degree);
609.224, subdivision 2, paragraph (c) (fifth-degree assault by a caregiver against a vulnerable
adult); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of residents or
patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal neglect of a
vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult); 609.234 (failure
to report); 609.265 (abduction); 609.2664 to 609.2665 (manslaughter of an unborn child in
the first or second degree); 609.267 to 609.2672 (assault of an unborn child in the first,
second, or third degree); 609.268 (injury or death of an unborn child in the commission of
a crime); repeat offenses under 617.23 (indecent exposure); 617.293 (disseminating or
displaying harmful material to minors); a felony-level conviction involving alcohol or drug
use, a gross misdemeanor offense under 609.324, subdivision 1 (other prohibited acts); a
gross misdemeanor offense under 609.378 (neglect or endangerment of a child); a gross
misdemeanor offense under 609.377 (malicious punishment of a child); 609.72, subdivision
3 (disorderly conduct against a vulnerable adult); or 624.713 (certain persons not to possess
firearms); or Minnesota Statutes 2012, section 609.21.
(b) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the individual's aiding and abetting, attempt, or conspiracy to
commit any of the offenses listed in paragraph (a) as each of these offenses is defined in
Minnesota Statutes.
(c) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the discharge of the sentence imposed for an offense in any
other state or country, the elements of which are substantially similar to the elements of any
of the offenses listed in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 46.
Minnesota Statutes 2020, section 245C.24, subdivision 4, is amended to read:
Subd. 4.
Seven-year bar to set aside disqualification.
The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if within seven years preceding the study:
(1) the individual committed an act that constitutes maltreatment of a child under sections
260E.24, subdivisions 1, 2, and 3, and 260E.30, subdivisions 1, 2, and 4, and the maltreatment
resulted in substantial bodily harm as defined in section 609.02, subdivision 7a, or substantial
mental or emotional harm as supported by competent psychological or psychiatric evidence;
or
(2) the individual was determined under section 626.557 to be the perpetrator of a
substantiated incident of maltreatment of a vulnerable adult that resulted in substantial
bodily harm as defined in section 609.02, subdivision 7a, or substantial mental or emotional
harm as supported by competent psychological or psychiatric evidence.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 47.
Minnesota Statutes 2020, section 245C.24, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Five-year bar to set aside disqualification; family foster setting. new text end
new text begin
(a) The
commissioner shall not set aside or grant a variance for the disqualification of an individual
18 years of age or older in connection with a foster family setting license if within five years
preceding the study the individual is convicted of a felony in section 245C.15, subdivision
4a, paragraph (d).
new text end
new text begin
(b) In connection with a foster family setting license, the commissioner may set aside
or grant a variance to the disqualification for an individual who is under 18 years of age at
the time the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 48.
Minnesota Statutes 2020, section 245C.32, subdivision 1a, is amended to read:
Subd. 1a.
NETStudy 2.0 system.
(a) The commissioner shall design, develop, and test
the NETStudy 2.0 system and implement it no later than September 1, 2015.
(b) The NETStudy 2.0 system developed and implemented by the commissioner shall
incorporate and meet all applicable data security standards and policies required by the
Federal Bureau of Investigation (FBI), Department of Public Safety, Bureau of Criminal
Apprehension, and the Office of MN.IT Services. The system shall meet all required
standards for encryption of data at the database level as well as encryption of data that
travels electronically among agencies initiating background studies, the commissioner's
authorized fingerprint collection vendornew text begin or vendorsnew text end , the commissioner, the Bureau of Criminal
Apprehension, and in cases involving national criminal record checks, the FBI.
(c) The data system developed and implemented by the commissioner shall incorporate
a system of data security that allows the commissioner to control access to the data field
level by the commissioner's employees. The commissioner shall establish that employees
have access to the minimum amount of private data on any individual as is necessary to
perform their duties under this chapter.
(d) The commissioner shall oversee regular quality and compliance audits of the
authorized fingerprint collection vendornew text begin or vendorsnew text end .
Sec. 49.
Minnesota Statutes 2020, section 245F.04, subdivision 2, is amended to read:
Subd. 2.
Contents of application.
Prior to the issuance of a license, an applicant must
submit, on forms provided by the commissioner, documentation demonstrating the following:
(1) compliance with this section;
(2) compliance with applicable building, fire, and safety codes; health rules; zoning
ordinances; and other applicable rules and regulations or documentation that a waiver has
been granted. The granting of a waiver does not constitute modification of any requirement
of this section;new text begin and
new text end
deleted text begin
(3) completion of an assessment of need for a new or expanded program as required by
Minnesota Rules, part 9530.6800; and
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end insurance coverage, including bonding, sufficient to cover all patient funds,
property, and interests.
Sec. 50.
Minnesota Statutes 2020, section 245G.03, subdivision 2, is amended to read:
Subd. 2.
Application.
new text begin (a) new text end Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires.
new text begin
(b) At least 60 days prior to submitting an application for licensure under this chapter,
the applicant must notify the county human services director in writing of the applicant's
intent to open a new treatment program. The written notification must include, at a minimum:
new text end
new text begin
(1) a description of the proposed treatment program;
new text end
new text begin
(2) a description of the target population to be served by the treatment program; and
new text end
new text begin
(3) a copy of the program's abuse prevention plan, as required under section 245A.65,
subdivision 2.
new text end
new text begin
(c) The county human services director may submit a written statement to the
commissioner regarding the county's support of or opposition to the opening of the new
treatment program. The written statement must include documentation of the rationale for
the county's determination. The commissioner shall consider the county's written statement
when determining whether to issue a license for the treatment program. If the county does
not submit a written statement, the commissioner shall confirm with the county that the
county received the notification required by paragraph (b).
new text end
Sec. 51.
Minnesota Statutes 2020, section 256B.0949, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Background studies. new text end
new text begin
The requirements for background studies under this
section shall be met by an early intensive developmental and behavioral intervention services
agency through the commissioner's NETStudy system as provided under sections 245C.03,
subdivision 15, and 245C.10, subdivision 17.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 52.
Minnesota Statutes 2020, section 260C.215, subdivision 4, is amended to read:
Subd. 4.
Duties of commissioner.
The commissioner of human services shall:
(1) provide practice guidance to responsible social services agencies and licensed
child-placing agencies that reflect federal and state laws and policy direction on placement
of children;
(2) develop criteria for determining whether a prospective adoptive or foster family has
the ability to understand and validate the child's cultural background;
(3) provide a standardized training curriculum for adoption and foster care workers and
administrators who work with children. Training must address the following objectives:
(i) developing and maintaining sensitivity to all cultures;
(ii) assessing values and their cultural implications;
(iii) making individualized placement decisions that advance the best interests of a
particular child under section 260C.212, subdivision 2; and
(iv) issues related to cross-cultural placement;
(4) provide a training curriculum for all prospective adoptive and foster families that
prepares them to care for the needs of adoptive and foster children taking into consideration
the needs of children outlined in section 260C.212, subdivision 2, paragraph (b), and, as
necessary, preparation is continued after placement of the child and includes the knowledge
and skills related to reasonable and prudent parenting standards for the participation of the
child in age or developmentally appropriate activities, according to section 260C.212,
subdivision 14;
(5) develop and provide to responsible social services agencies and licensed child-placing
agencies a home study format to assess the capacities and needs of prospective adoptive
and foster families. The format must address problem-solving skills; parenting skills; evaluate
the degree to which the prospective family has the ability to understand and validate the
child's cultural background, and other issues needed to provide sufficient information for
agencies to make an individualized placement decision consistent with section 260C.212,
subdivision 2. For a study of a prospective foster parent, the format must also address the
capacity of the prospective foster parent to provide a safe, healthy, smoke-free home
environment. If a prospective adoptive parent has also been a foster parent, any update
necessary to a home study for the purpose of adoption may be completed by the licensing
authority responsible for the foster parent's license. If a prospective adoptive parent with
an approved adoptive home study also applies for a foster care license, the license application
may be made with the same agency which provided the adoptive home study; deleted text begin and
deleted text end
(6) consult with representatives reflecting diverse populations from the councils
established under sections 3.922 and 15.0145, and other state, local, and community
organizationsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) establish family foster setting licensing guidelines for county agencies and private
agencies designated or licensed by the commissioner to perform licensing functions and
activities under section 245A.04. Guidelines that the commissioner establishes under this
clause shall be considered directives of the commissioner under section 245A.16.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 53.
Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
new text begin Subd. 5. new text end
new text begin Waivers and modifications; extension for 180 days. new text end
new text begin
When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, waiver CV23: modifying background
study requirements, issued by the commissioner of human services pursuant to Executive
Orders 20-11 and 20-12, including any amendments to the modification issued before the
peacetime emergency expires, shall remain in effect for 180 days after the peacetime
emergency ends.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment or
retroactively from the date the peacetime emergency declared by the governor in response
to the COVID-19 outbreak ends, whichever is earlier.
new text end
Sec. 54. new text begin CHILD CARE CENTER REGULATION MODERNIZATION.
new text end
new text begin
(a) The commissioner of human services shall contract with an experienced and
independent organization or individual consultant to conduct the work outlined in this
section. If practicable, the commissioner must contract with the National Association for
Regulatory Administration.
new text end
new text begin
(b) The consultant must develop a proposal for revised licensing standards that includes
a risk-based model for monitoring compliance with child care center licensing standards,
grounded in national regulatory best practices. Violations in the new model must be weighted
to reflect the potential risk that the violations pose to children's health and safety, and
licensing sanctions must be tied to the potential risk. The proposed new model must protect
the health and safety of children in child care centers and be child-centered, family-friendly,
and fair to providers.
new text end
new text begin
(c) The consultant shall develop and implement a stakeholder engagement process that
solicits input from parents, licensed child care centers, staff of the Department of Human
Services, and experts in child development about appropriate licensing standards, appropriate
tiers for violations of the standards based on the potential risk of harm that each violation
poses, and appropriate licensing sanctions for each tier.
new text end
new text begin
(d) The consultant shall solicit input from parents, licensed child care centers, and staff
of the Department of Human Services about which child care centers should be eligible for
abbreviated inspections that predict compliance with other licensing standards for licensed
child care centers using key indicators previously identified by an empirically based statistical
methodology developed by the National Association for Regulatory Administration and the
Research Institute for Key Indicators.
new text end
new text begin
(e) No later than February 1, 2024, the commissioner shall submit a report and proposed
legislation required to implement the new licensing model to the chairs and ranking minority
members of the legislative committees with jurisdiction over child care regulation.
new text end
Sec. 55. new text begin CHILD FOSTER CARE LICENSING GUIDELINES.
new text end
new text begin
By July 1, 2023, the commissioner of human services shall, in consultation with
stakeholders with expertise in child protection and children's behavioral health, develop
family foster setting licensing guidelines for county agencies and private agencies that
perform licensing functions. Stakeholders include but are not limited to child advocates,
representatives from community organizations, representatives of the state ethnic councils,
the ombudsperson for families, family foster setting providers, youth who have experienced
family foster setting placements, county child protection staff, and representatives of county
and private licensing agencies.
new text end
Sec. 56. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE ONE-STOP ASSISTANCE NETWORK.
new text end
new text begin
By January 1, 2022, the commissioner of human services shall, in consultation with
county agencies, providers, and other relevant stakeholders, develop a proposal to create,
advertise, and implement a one-stop regional assistance network comprised of individuals
who have experience starting a licensed family or group family child care program or
technical expertise regarding the applicable licensing statutes and procedures, in order to
assist individuals with matters relating to starting or sustaining a licensed family or group
family child care program. The proposal shall include an estimated timeline for
implementation of the assistance network, an estimated budget of the cost of the assistance
network, and any necessary legislative proposals to implement the assistance network. The
proposal shall also include a plan to raise awareness and distribute contact information for
the assistance network to all licensed family or group family child care providers.
new text end
Sec. 57. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
RECOMMENDED FAMILY CHILD CARE ORIENTATION TRAINING.
new text end
new text begin
(a) By July 1, 2022, the commissioner of human services shall develop, in consultation
with licensed family child care providers and representatives from counties, recommended
orientation training for family child care license applicants to ensure that all family child
care license applicants have access to information about Minnesota Statutes, chapters 245A
and 245C, and Minnesota Rules, chapter 9502.
new text end
new text begin
(b) The orientation training is voluntary and completion of the orientation is not required
to receive or maintain a family child care license.
new text end
Sec. 58. new text begin FAMILY CHILD CARE REGULATION MODERNIZATION.
new text end
new text begin
(a) The commissioner of human services shall contract with an experienced and
independent organization or individual consultant to conduct the work outlined in this
section. If practicable, the commissioner must contract with the National Association for
Regulatory Administration.
new text end
new text begin
(b) The consultant must develop a proposal for updated family child care licensing
standards and solicit input from stakeholders as described in paragraph (d).
new text end
new text begin
(c) The consultant must develop a proposal for a risk-based model for monitoring
compliance with family child care licensing standards, grounded in national regulatory best
practices. Violations in the new model must be weighted to reflect the potential risk they
pose to children's health and safety, and licensing sanctions must be tied to the potential
risk. The proposed new model must protect the health and safety of children in family child
care programs and be child-centered, family-friendly, and fair to providers.
new text end
new text begin
(d) The consultant shall develop and implement a stakeholder engagement process that
solicits input from parents, licensed family child care providers, county licensors, staff of
the Department of Human Services, and experts in child development about licensing
standards, tiers for violations of the standards based on the potential risk of harm that each
violation poses, and licensing sanctions for each tier.
new text end
new text begin
(e) The consultant shall solicit input from parents, licensed family child care providers,
county licensors, and staff of the Department of Human Services about which family child
care providers should be eligible for abbreviated inspections that predict compliance with
other licensing standards for licensed family child care providers using key indicators
previously identified by an empirically based statistical methodology developed by the
National Association for Regulatory Administration and the Research Institute for Key
Indicators.
new text end
new text begin
(f) No later than February 1, 2024, the commissioner shall submit a report and proposed
legislation required to implement the new licensing model and the new licensing standards
to the chairs and ranking minority members of the legislative committees with jurisdiction
over child care regulation.
new text end
Sec. 59. new text begin FAMILY CHILD CARE TRAINING ADVISORY COMMITTEE.
new text end
new text begin Subdivision 1. new text end
new text begin Formation; duties. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee shall advise the commissioner of human services on the training requirements
for licensed family and group family child care providers. Beginning January 1, 2022, the
advisory committee shall meet at least twice per year. The advisory committee shall annually
elect a chair from among its members who shall establish the agenda for each meeting. The
commissioner or commissioner's designee shall attend all advisory committee meetings.
new text end
new text begin
(b) The Family Child Care Training Advisory Committee shall advise and make
recommendations to the commissioner of human services and the contractors working on
the family child care licensing modernization project on:
new text end
new text begin
(1) updates to the rules and statutes governing family child care training, including
technical updates to facilitate providers' understanding of training requirements;
new text end
new text begin
(2) difficulties facing family child care providers in completing training requirements,
including proposed solutions to provider difficulties; and
new text end
new text begin
(3) other ideas for improving access to and quality of training for family child care
providers.
new text end
new text begin
(c) The Family Child Care Training Advisory Committee shall expire December 1, 2025.
new text end
new text begin Subd. 2. new text end
new text begin Advisory committee members. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee consists of:
new text end
new text begin
(1) four members representing family child care providers from greater Minnesota,
including two appointed by the speaker of the house and two appointed by the senate majority
leader;
new text end
new text begin
(2) two members representing family child care providers from the seven-county
metropolitan area as defined in Minnesota Statutes, section 473.121, subdivision 2, including
one appointed by the speaker of the house and one appointed by the senate majority leader;
new text end
new text begin
(3) one member appointed by the Minnesota Association of Child Care Professionals;
new text end
new text begin
(4) one member appointed by the Minnesota Child Care Provider Information Network;
new text end
new text begin
(5) two members appointed by the Association of Minnesota Child Care Licensors,
including one from greater Minnesota and one from the seven-county metropolitan area, as
defined in Minnesota Statutes, section 473.121, subdivision 2; and
new text end
new text begin
(6) five members with experience in child development, instructional design, and training
delivery, with:
new text end
new text begin
(i) one member appointed by Child Care Aware of Minnesota;
new text end
new text begin
(ii) one member appointed by the Minnesota Initiative Foundations;
new text end
new text begin
(iii) one member appointed by the Center for Inclusive Child Care;
new text end
new text begin
(iv) one member appointed by the Greater Minnesota Partnership; and
new text end
new text begin
(v) one member appointed by Achieve, the Minnesota Center for Professional
Development.
new text end
new text begin
(b) Advisory committee members shall not be employed by the Department of Human
Services. Advisory committee members shall receive no compensation for their participation
in the advisory committee.
new text end
new text begin
(c) Advisory committee members must include representatives of diverse cultural
communities.
new text end
new text begin
(d) Advisory committee members shall serve two-year terms. Initial appointments to
the advisory committee must be made by December 1, 2021. Subsequent appointments to
the advisory committee must be made by December 1 of the year in which the member's
term expires.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner report. new text end
new text begin
The commissioner of human services shall report
annually by November 1 to the chairs and ranking minority members of the legislative
committees with jurisdiction over early care and education programs on any recommendations
from the Family Child Care Training Advisory Committee.
new text end
Sec. 60. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber Minnesota Statutes, section 245C.02, so that the
subdivisions are alphabetical. The revisor shall correct any cross-references that arise as a
result of the renumbering.
new text end
Sec. 61. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 245C.10, subdivisions 2, 2a, 3, 4, 5, 6, 7, 8, 9, 9a,
10, 11, 12, 13, 14, and 16,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9530.6800; and 9530.6810,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (b) is effective the day following final enactment.
new text end
ARTICLE 3
HEALTH DEPARTMENT
Section 1.
Minnesota Statutes 2020, section 62J.495, subdivision 1, is amended to read:
Subdivision 1.
Implementation.
The commissioner of health, in consultation with the
e-Health Advisory Committee, shall develop uniform standards to be used for the
interoperable electronic health records system for sharing and synchronizing patient data
across systems. The standards must be compatible with federal efforts. The uniform standards
must be developed by January 1, 2009, and updated on an ongoing basis. deleted text begin The commissioner
shall include an update on standards development as part of an annual report to the legislature.deleted text end
Individual health care providers in private practice with no other providers and health care
providers that do not accept reimbursement from a group purchaser, as defined in section
62J.03, subdivision 6, are excluded from the requirements of this section.
Sec. 2.
Minnesota Statutes 2020, section 62J.495, subdivision 2, is amended to read:
Subd. 2.
E-Health Advisory Committee.
(a) The commissioner shall establish an
e-Health Advisory Committee governed by section 15.059 to advise the commissioner on
the following matters:
(1) assessment of the adoption and effective use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;
(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for clinical data exchange, clinical support programs, patient privacy requirements, and
maintenance of the security and confidentiality of individual patient data;
(3) recommendations for encouraging use of innovative health care applications using
information technology and systems to improve patient care and reduce the cost of care,
including applications relating to disease management and personal health management
that enable remote monitoring of patients' conditions, especially those with chronic
conditions; and
(4) other related issues as requested by the commissioner.
(b) The members of the e-Health Advisory Committee shall include the commissioners,
or commissioners' designees, of health, human services, administration, and commerce and
additional members to be appointed by the commissioner to include persons representing
Minnesota's local public health agencies, licensed hospitals and other licensed facilities and
providers, private purchasers, the medical and nursing professions, health insurers and health
plans, the state quality improvement organization, academic and research institutions,
consumer advisory organizations with an interest and expertise in health information
technology, and other stakeholders as identified by the commissioner to fulfill the
requirements of section 3013, paragraph (g), of the HITECH Act.
(c) deleted text begin The commissioner shall prepare and issue an annual report not later than January 30
of each year outlining progress to date in implementing a statewide health information
infrastructure and recommending action on policy and necessary resources to continue the
promotion of adoption and effective use of health information technology.
deleted text end
deleted text begin (d)deleted text end This subdivision expires June 30, deleted text begin 2021deleted text end new text begin 2031new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62J.495, subdivision 3, is amended to read:
Subd. 3.
Interoperable electronic health record requirements.
(a) Hospitals and health
care providers must meet the following criteria when implementing an interoperable
electronic health records system within their hospital system or clinical practice setting.
(b) The electronic health record must be a qualified electronic health record.
(c) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and health
care providers if a certified electronic health record product for the provider's particular
practice setting is available. This criterion shall be considered met if a hospital or health
care provider is using an electronic health records system that has been certified within the
last three years, even if a more current version of the system has been certified within the
three-year period.
(d) The electronic health record must meet the standards established according to section
3004 of the HITECH Act as applicable.
(e) The electronic health record must have the ability to generate information on clinical
quality measures and other measures reported under sections 4101, 4102, and 4201 of the
HITECH Act.
(f) The electronic health record system must be connected to a state-certified health
information organization either directly or through a connection facilitated by a deleted text begin state-certifieddeleted text end
health data intermediary as defined in section 62J.498.
(g) A health care provider who is a prescriber or dispenser of legend drugs must have
an electronic health record system that meets the requirements of section 62J.497.
Sec. 4.
Minnesota Statutes 2020, section 62J.495, subdivision 4, is amended to read:
Subd. 4.
Coordination with national HIT activities.
(a) The commissioner, in
consultation with the e-Health Advisory Committee, shall update the statewide
implementation plan required under subdivision 2 and released June 2008, to be consistent
with the updated federal deleted text begin HIT Strategic Plan released by the Office of the National Coordinator
in accordance with section 3001 of the HITECH Act. The statewide plan shall meet the
requirements for a plan required under section 3013 of the HITECH Actdeleted text end new text begin plansnew text end .
(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
work to ensure coordination between state, regional, and national efforts to support and
accelerate efforts to effectively use health information technology to improve the quality
and coordination of health care and the continuity of patient care among health care providers,
to reduce medical errors, to improve population health, to reduce health disparities, and to
reduce chronic disease. The commissioner's coordination efforts shall include but not be
limited to:
deleted text begin
(1) assisting in the development and support of health information technology regional
extension centers established under section 3012(c) of the HITECH Act to provide technical
assistance and disseminate best practices;
deleted text end
deleted text begin
(2) providing supplemental information to the best practices gathered by regional centers
to ensure that the information is relayed in a meaningful way to the Minnesota health care
community;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end providing financial and technical support to Minnesota health care providers to
encourage implementation of admission, discharge and transfer alerts, and care summary
document exchange transactions and to evaluate the impact of health information technology
on cost and quality of care. Communications about available financial and technical support
shall include clear information about the interoperable health record requirements in
subdivision 1, including a separate statement in bold-face type clarifying the exceptions to
those requirements;
deleted text begin (4)deleted text end new text begin (2)new text end providing educational resources and technical assistance to health care providers
and patients related to state and national privacy, security, and consent laws governing
clinical health information, including the requirements in sections 144.291 to 144.298. In
carrying out these activities, the commissioner's technical assistance does not constitute
legal advice;
deleted text begin (5)deleted text end new text begin (3)new text end assessing Minnesota's legal, financial, and regulatory framework for health
information exchange, including the requirements in sections 144.291 to 144.298, and
making recommendations for modifications that would strengthen the ability of Minnesota
health care providers to securely exchange data in compliance with patient preferences and
in a way that is efficient and financially sustainable; and
deleted text begin (6)deleted text end new text begin (4)new text end seeking public input on both patient impact and costs associated with requirements
related to patient consent for release of health records for the purposes of treatment, payment,
and health care operations, as required in section 144.293, subdivision 2. The commissioner
shall provide a report to the legislature on the findings of this public input process no later
than February 1, 2017.
(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
monitor national activity related to health information technology and shall coordinate
statewide input on policy development. The commissioner shall coordinate statewide
responses to proposed federal health information technology regulations in order to ensure
that the needs of the Minnesota health care community are adequately and efficiently
addressed in the proposed regulations. The commissioner's responses may include, but are
not limited to:
(1) reviewing and evaluating any standard, implementation specification, or certification
criteria proposed by the national HIT standards deleted text begin committeedeleted text end new text begin committeesnew text end ;
(2) reviewing and evaluating policy proposed by deleted text begin thedeleted text end national HIT policy deleted text begin committeedeleted text end new text begin
committeesnew text end relating to the implementation of a nationwide health information technology
infrastructure;new text begin and
new text end
(3) deleted text begin monitoring and responding to activity related to the development of quality measures
and other measures as required by section 4101 of the HITECH Act. Any response related
to quality measures shall consider and address the quality efforts required under chapter
62U; and
deleted text end
deleted text begin (4)deleted text end monitoring and responding to national activity related to privacy, security, and data
stewardship of electronic health information and individually identifiable health information.
(d) To the extent that the state is either required or allowed to apply, or designate an
entity to apply for or carry out activities and programs deleted text begin under section 3013 of the HITECH
Actdeleted text end , the commissioner of health, in consultation with the e-Health Advisory Committee
and the commissioner of human services, shall be the lead applicant or sole designating
authority. The commissioner shall make such designations consistent with the goals and
objectives of sections 62J.495 to 62J.497 and 62J.50 to 62J.61.
(e) The commissioner of human services shall apply for funding necessary to administer
the incentive payments to providers authorized under title IV of the American Recovery
and Reinvestment Act.
deleted text begin
(f) The commissioner shall include in the report to the legislature information on the
activities of this subdivision and provide recommendations on any relevant policy changes
that should be considered in Minnesota.
deleted text end
Sec. 5.
Minnesota Statutes 2020, section 62J.497, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given.
deleted text begin
(b) "Backward compatible" means that the newer version of a data transmission standard
deleted text end
deleted text begin
would retain, at a minimum, the full functionality of the versions previously adopted, and
deleted text end
deleted text begin
would permit the successful completion of the applicable transactions with entities that
deleted text end
deleted text begin
continue to use the older versions.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.
deleted text begin (d)deleted text end new text begin (c)new text end "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.
deleted text begin (e)deleted text end new text begin (d)new text end "Electronic media" has the meaning given under Code of Federal Regulations,
title 45, part 160.103.
deleted text begin (f)deleted text end new text begin (e)new text end "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.
deleted text begin (g)deleted text end new text begin (f)new text end "Electronic prescription drug program" means a program that provides for
e-prescribing.
deleted text begin (h)deleted text end new text begin (g)new text end "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
deleted text begin (i)deleted text end new text begin (h)new text end "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
deleted text begin (j)deleted text end new text begin (i)new text end "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.
deleted text begin (k)deleted text end new text begin (j)new text end "NCPDP" means the National Council for Prescription Drug Programs, Inc.
deleted text begin (l)deleted text end new text begin (k)new text end "NCPDP Formulary and Benefits Standard" means thenew text begin most recent version of thenew text end
National Council for Prescription Drug Programs Formulary and Benefits Standarddeleted text begin ,
Implementation Guide, Version 1, Release 0, October 2005deleted text end new text begin or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare
Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act and regulations
adopted under it. The standards shall be implemented according to the Centers for Medicare
and Medicaid Services schedule for compliancenew text end .
deleted text begin (m)deleted text end new text begin (l)new text end "NCPDP SCRIPT Standard" means thenew text begin most recent version of thenew text end National
Council for Prescription Drug Programs deleted text begin Prescriber/Pharmacist Interfacedeleted text end SCRIPT Standard,
deleted text begin Implementation Guide Version 8, Release 1 (Version 8.1), October 2005,deleted text end or the most recent
standard adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
regulations adopted under it. The standards shall be implemented according to the Centers
for Medicare and Medicaid Services schedule for compliance. deleted text begin Subsequently released versions
of the NCPDP SCRIPT Standard may be used, provided that the new version of the standard
is backward compatible to the current version adopted by the Centers for Medicare and
Medicaid Services.
deleted text end
deleted text begin (n)deleted text end new text begin (m)new text end "Pharmacy" has the meaning given in section 151.01, subdivision 2.
deleted text begin (o)deleted text end new text begin (n)new text end "Prescriber" means a licensed health care practitioner, other than a veterinarian,
as defined in section 151.01, subdivision 23.
deleted text begin (p)deleted text end new text begin (o)new text end "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
deleted text begin (q)deleted text end new text begin (p)new text end "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.
Sec. 6.
Minnesota Statutes 2020, section 62J.497, subdivision 3, is amended to read:
Subd. 3.
Standards for electronic prescribing.
(a) Prescribers and dispensers must use
the NCPDP SCRIPT Standard for the communication of a prescription or prescription-related
information. deleted text begin The NCPDP SCRIPT Standard shall be used to conduct the following
transactions:
deleted text end
deleted text begin
(1) get message transaction;
deleted text end
deleted text begin
(2) status response transaction;
deleted text end
deleted text begin
(3) error response transaction;
deleted text end
deleted text begin
(4) new prescription transaction;
deleted text end
deleted text begin
(5) prescription change request transaction;
deleted text end
deleted text begin
(6) prescription change response transaction;
deleted text end
deleted text begin
(7) refill prescription request transaction;
deleted text end
deleted text begin
(8) refill prescription response transaction;
deleted text end
deleted text begin
(9) verification transaction;
deleted text end
deleted text begin
(10) password change transaction;
deleted text end
deleted text begin
(11) cancel prescription request transaction; and
deleted text end
deleted text begin
(12) cancel prescription response transaction.
deleted text end
(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP SCRIPT
Standard for communicating and transmitting medication history information.
(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and benefit
information.
(d) Providers, group purchasers, prescribers, and dispensers must use the national provider
identifier to identify a health care provider in e-prescribing or prescription-related transactions
when a health care provider's identifier is required.
(e) Providers, group purchasers, prescribers, and dispensers must communicate eligibility
information and conduct health care eligibility benefit inquiry and response transactions
according to the requirements of section 62J.536.
Sec. 7.
Minnesota Statutes 2020, section 62J.498, is amended to read:
62J.498 HEALTH INFORMATION EXCHANGE.
Subdivision 1.
Definitions.
(a) The following definitions apply to sections 62J.498 to
62J.4982:
(b) "Clinical data repository" means a real time database that consolidates data from a
variety of clinical sources to present a unified view of a single patient and is used by a
deleted text begin state-certifieddeleted text end health information exchange service provider to enable health information
exchange among health care providers that are not related health care entities as defined in
section 144.291, subdivision 2, paragraph (k). This does not include clinical data that are
submitted to the commissioner for public health purposes required or permitted by law,
including any rules adopted by the commissioner.
(c) "Clinical transaction" means any meaningful use transaction or other health
information exchange transaction that is not covered by section 62J.536.
(d) "Commissioner" means the commissioner of health.
(e) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.
(f) "Health data intermediary" means an entity that provides the technical capabilities
or related products and services to enable health information exchange among health care
providers that are not related health care entities as defined in section 144.291, subdivision
2, paragraph (k). This includes but is not limited to health information service providers
(HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries
as defined in section 62J.495.
(g) "Health information exchange" means the electronic transmission of health-related
information between organizations according to nationally recognized standards.
(h) "Health information exchange service provider" means a health data intermediary
or health information organization.
(i) "Health information organization" means an organization that oversees, governs, and
facilitates health information exchange among health care providers that are not related
health care entities as defined in section 144.291, subdivision 2, paragraph (k), to improve
coordination of patient care and the efficiency of health care delivery.
deleted text begin
(j) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act as defined in section 62J.495.
deleted text end
deleted text begin (k)deleted text end new text begin (j)new text end "Major participating entity" means:
(1) a participating entity that receives compensation for services that is greater than 30
percent of the health information organization's gross annual revenues from the health
information exchange service provider;
(2) a participating entity providing administrative, financial, or management services to
the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and
(3) a participating entity that nominates or appoints 30 percent or more of the board of
directors or equivalent governing body of the health information organization.
deleted text begin (l)deleted text end new text begin (k)new text end "Master patient index" means an electronic database that holds unique identifiers
of patients registered at a care facility and is used by a deleted text begin state-certifieddeleted text end health information
exchange service provider to enable health information exchange among health care providers
that are not related health care entities as defined in section 144.291, subdivision 2, paragraph
(k). This does not include data that are submitted to the commissioner for public health
purposes required or permitted by law, including any rules adopted by the commissioner.
deleted text begin
(m) "Meaningful use" means use of certified electronic health record technology to
improve quality, safety, and efficiency and reduce health disparities; engage patients and
families; improve care coordination and population and public health; and maintain privacy
and security of patient health information as established by the Centers for Medicare and
Medicaid Services and the Minnesota Department of Human Services pursuant to sections
4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin
(n) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin (o)deleted text end new text begin (l)new text end "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization deleted text begin or health
data intermediarydeleted text end has contracts or other agreements for the provision of health information
exchange services:
(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;
(2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;
(3) a group, professional corporation, or other organization that provides the services of
individuals or entities identified in clause (2), including but not limited to a medical clinic,
a medical group, a home health care agency, an urgent care center, and an emergent care
center;
(4) a health plan as defined in section 62A.011, subdivision 3; and
(5) a state agency as defined in section 13.02, subdivision 17.
deleted text begin (p)deleted text end new text begin (m)new text end "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of clinical transactions.
deleted text begin
(q) "State-certified health data intermediary" means a health data intermediary that has
been issued a certificate of authority to operate in Minnesota.
deleted text end
deleted text begin (r)deleted text end new text begin (n)new text end "State-certified health information organization" means a health information
organization that has been issued a certificate of authority to operate in Minnesota.
Subd. 2.
Health information exchange oversight.
(a) The commissioner shall protect
the public interest on matters pertaining to health information exchange. The commissioner
shall:
(1) review and act on applications from deleted text begin health data intermediaries anddeleted text end health information
organizations for certificates of authority to operate in Minnesota;
new text begin
(2) require information to be provided as needed from health information exchange
service providers in order to meet requirements established under sections 62J.498 to
62J.4982;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;
deleted text begin (3)deleted text end new text begin (4)new text end respond to public complaints related to health information exchange services;
deleted text begin (4)deleted text end new text begin (5)new text end take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;
deleted text begin (5)deleted text end new text begin (6)new text end provide a biennial report on the status of health information exchange services
that includes but is not limited to:
(i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;
(ii) recommendations on enforcement actions to ensure that health information exchange
service providers act in the public interest without causing disruption in health information
exchange services;
(iii) recommendations on updates to criteria for obtaining certificates of authority under
this section; and
(iv) recommendations on standard operating procedures for health information exchange,
including but not limited to the management of consumer preferences; and
deleted text begin (6)deleted text end new text begin (7)new text end other duties necessary to protect the public interest.
(b) As part of the application review process for certification under paragraph (a), prior
to issuing a certificate of authority, the commissioner shall:
(1) make all portions of the application classified as public data available to the public
for at least ten days while an application is under consideration. At the request of the
commissioner, the applicant shall participate in a public hearing by presenting an overview
of their application and responding to questions from interested parties; and
(2) consult with hospitals, physicians, and other providers prior to issuing a certificate
of authority.
(c) When the commissioner is actively considering a suspension or revocation of a
certificate of authority as described in section 62J.4982, subdivision 3, all investigatory data
that are collected, created, or maintained related to the suspension or revocation are classified
as confidential data on individuals and as protected nonpublic data in the case of data not
on individuals.
(d) The commissioner may disclose data classified as protected nonpublic or confidential
under paragraph (c) if disclosing the data will protect the health or safety of patients.
(e) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified as
public data.
Sec. 8.
Minnesota Statutes 2020, section 62J.4981, is amended to read:
62J.4981 CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.
Subdivision 1.
Authority to require organizations to apply.
The commissioner shall
require deleted text begin a health data intermediary ordeleted text end a health information organization to apply for a
certificate of authority under this section. An applicant may continue to operate until the
commissioner acts on the application. If the application is denied, the applicant is considered
a health information exchange service provider whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).
deleted text begin Subd. 2. deleted text end
deleted text begin Certificate of authority for health data intermediaries. deleted text end
deleted text begin
(a) A health data
intermediary must be certified by the state and comply with requirements established in this
section.
deleted text end
deleted text begin
(b) Notwithstanding any law to the contrary, any corporation organized to do so may
apply to the commissioner for a certificate of authority to establish and operate as a health
data intermediary in compliance with this section. No person shall establish or operate a
health data intermediary in this state, nor sell or offer to sell, or solicit offers to purchase
or receive advance or periodic consideration in conjunction with a health data intermediary
contract unless the organization has a certificate of authority or has an application under
active consideration under this section.
deleted text end
deleted text begin
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
deleted text end
deleted text begin
(1) hold reciprocal agreements with at least one state-certified health information
organization to access patient data, and for the transmission and receipt of clinical
transactions. Reciprocal agreements must meet the requirements established in subdivision
5; and
deleted text end
deleted text begin
(2) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability between state-certified health information
organizations and state-certified health data intermediaries.
deleted text end
Subd. 3.
Certificate of authority for health information organizations.
(a) A health
information organization must obtain a certificate of authority from the commissioner and
demonstrate compliance with the criteria in paragraph (c).
(b) Notwithstanding any law to the contrary, an organization may apply for a certificate
of authority to establish and operate a health information organization under this section.
No person shall establish or operate a health information organization in this state, nor sell
or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in
conjunction with a health information organization or health information contract unless
the organization has a certificate of authority under this section.
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
(1) the entity is a legally established organization;
(2) appropriate insurance, including liability insurance, for the operation of the health
information organization is in place and sufficient to protect the interest of the public and
participating entities;
(3) strategic and operational plans address governance, technical infrastructure, legal
and policy issues, finance, and business operations in regard to how the organization will
expand to support providers in achieving health information exchange goals over time;
(4) the entity addresses the parameters to be used with participating entities and other
health information exchange service providers for clinical transactions, compliance with
Minnesota law, and interstate health information exchange trust agreements;
(5) the entity's board of directors or equivalent governing body is composed of members
that broadly represent the health information organization's participating entities and
consumers;
(6) the entity maintains a professional staff responsible to the board of directors or
equivalent governing body with the capacity to ensure accountability to the organization's
mission;
(7) the organization is compliant with national certification and accreditation programs
designated by the commissioner;
(8) the entity maintains the capability to query for patient information based on national
standards. The query capability may utilize a master patient index, clinical data repository,
or record locator service as defined in section 144.291, subdivision 2, paragraph (j). The
entity must be compliant with the requirements of section 144.293, subdivision 8, when
conducting clinical transactions;
(9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;
(10) the organization demonstrates compliance with all privacy and security requirements
required by state and federal law; and
(11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's financials
on an annual basis.
(d) Health information organizations that have obtained a certificate of authority must:
(1) meet the requirements established for connecting to the National eHealth Exchange;
(2) annually submit strategic and operational plans for review by the commissioner that
address:
(i) progress in achieving objectives included in previously submitted strategic and
operational plans across the following domains: business and technical operations, technical
infrastructure, legal and policy issues, finance, and organizational governance;
(ii) plans for ensuring the necessary capacity to support clinical transactions;
(iii) approach for attaining financial sustainability, including public and private financing
strategies, and rate structures;
(iv) rates of adoption, utilization, and transaction volume, and mechanisms to support
health information exchange; and
(v) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;
(3) enter into reciprocal agreements with all other state-certified health information
organizations deleted text begin and state-certified health data intermediariesdeleted text end to enable access to patient data,
and for the transmission and receipt of clinical transactions. Reciprocal agreements must
meet the requirements in subdivision 5;
(4) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability deleted text begin between state-certified health information
organizations and state-certified health data intermediariesdeleted text end ; and
(5) comply with additional requirements for the certification or recertification of health
information organizations that may be established by the commissioner.
Subd. 4.
Application for certificate of authority for health information deleted text begin exchange
service providersdeleted text end new text begin organizationsnew text end .
(a) Each application for a certificate of authority shall
be in a form prescribed by the commissioner and verified by an officer or authorized
representative of the applicant. Each application shall include the following in addition to
information described in the criteria in deleted text begin subdivisions 2 anddeleted text end new text begin subdivisionnew text end 3:
(1) deleted text begin for health information organizations only,deleted text end a copy of the basic organizational document,
if any, of the applicant and of each major participating entity, such as the articles of
incorporation, or other applicable documents, and all amendments to it;
(2) deleted text begin for health information organizations only,deleted text end a list of the names, addresses, and official
positions of the following:
(i) all members of the board of directors or equivalent governing body, and the principal
officers and, if applicable, shareholders of the applicant organization; and
(ii) all members of the board of directors or equivalent governing body, and the principal
officers of each major participating entity and, if applicable, each shareholder beneficially
owning more than ten percent of any voting stock of the major participating entity;
(3) deleted text begin for health information organizations only,deleted text end the name and address of each participating
entity and the agreed-upon duration of each contract or agreement if applicable;
(4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end . Contractual
provisions shall be consistent with the purposes of this section, in regard to the services to
be performed under the standard agreement or contract, the manner in which payment for
services is determined, the nature and extent of responsibilities to be retained by the health
information organization, and contractual termination provisions;
(5) a statement generally describing the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end , its health information exchange contracts, facilities, and personnel, including
a statement describing the manner in which the applicant proposes to provide participants
with comprehensive health information exchange services;
(6) a statement reasonably describing the geographic area or areas to be served and the
type or types of participants to be served;
(7) a description of the complaint procedures to be used as required under this section;
(8) a description of the mechanism by which participating entities will have an opportunity
to participate in matters of policy and operation;
(9) a copy of any pertinent agreements between the health information organization and
insurers, including liability insurers, demonstrating coverage is in place;
(10) a copy of the conflict of interest policy that applies to all members of the board of
directors or equivalent governing body and the principal officers of the health information
organization; and
(11) other information as the commissioner may reasonably require to be provided.
(b) Within 45 days after the receipt of the application for a certificate of authority, the
commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.
(c) Within 90 days after the receipt of a complete application for a certificate of authority,
the commissioner shall issue a certificate of authority to the applicant if the commissioner
determines that the applicant meets the minimum criteria requirements of deleted text begin subdivision 2 for
health data intermediaries ordeleted text end subdivision 3 deleted text begin for health information organizationsdeleted text end . If the
commissioner determines that the applicant is not qualified, the commissioner shall notify
the applicant and specify the reasons for disqualification.
(d) Upon being granted a certificate of authority to operate as a state-certified health
information organization deleted text begin or state-certified health data intermediarydeleted text end , the organization must
operate in compliance with the provisions of this section. Noncompliance may result in the
imposition of a fine or the suspension or revocation of the certificate of authority according
to section 62J.4982.
Subd. 5.
Reciprocal agreements between health information deleted text begin exchange entitiesdeleted text end new text begin
organizationsnew text end .
(a) Reciprocal agreements between two health information organizations
deleted text begin or between a health information organization and a health data intermediarydeleted text end must include
a fair and equitable model for charges between the entities that:
(1) does not impede the secure transmission of clinical transactions;
(2) does not charge a fee for the exchange of deleted text begin meaningful usedeleted text end transactions transmitted
according to nationally recognized standards where no additional value-added service is
rendered to the sending or receiving health information organization deleted text begin or health data
intermediarydeleted text end either directly or on behalf of the client;
(3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and
(4) prevents health care stakeholders from being charged multiple times for the same
service.
(b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.
(c) Reciprocal agreements are subject to review and approval by the commissioner.
(d) Nothing in this section precludes a state-certified health information organization deleted text begin or
state-certified health data intermediarydeleted text end from entering into contractual agreements for the
provision of value-added services deleted text begin beyond meaningful use transactionsdeleted text end .
Sec. 9.
Minnesota Statutes 2020, section 62J.4982, is amended to read:
62J.4982 ENFORCEMENT AUTHORITY; COMPLIANCE.
Subdivision 1.
Penalties and enforcement.
(a) The commissioner may, for any violation
of statute or rule applicable to a health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end ,
levy an administrative penalty in an amount up to $25,000 for each violation. In determining
the level of an administrative penalty, the commissioner shall consider the following factors:
(1) the number of participating entities affected by the violation;
(2) the effect of the violation on participating entities' access to health information
exchange services;
(3) if only one participating entity is affected, the effect of the violation on the patients
of that entity;
(4) whether the violation is an isolated incident or part of a pattern of violations;
(5) the economic benefits derived by the health information organization deleted text begin or a health data
intermediarydeleted text end by virtue of the violation;
(6) whether the violation hindered or facilitated an individual's ability to obtain health
care;
(7) whether the violation was intentional;
(8) whether the violation was beyond the direct control of the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end ;
(9) any history of prior compliance with the provisions of this section, including
violations;
(10) whether and to what extent the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end attempted to correct previous violations;
(11) how the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end responded to
technical assistance from the commissioner provided in the context of a compliance effort;
and
(12) the financial condition of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end whether the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end had financial difficulties that affected its ability to comply or whether
the imposition of an administrative monetary penalty would jeopardize the ability of the
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end to continue to deliver health
information exchange services.
The commissioner shall give reasonable notice in writing to the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end of the intent to levy the penalty and the reasons for
it. A health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may have 15 days within
which to contest whether the facts found constitute a violation of sections 62J.4981 and
62J.4982, according to the contested case and judicial review provisions of sections 14.57
to 14.69.
(b) If the commissioner has reason to believe that a violation of section 62J.4981 or
62J.4982 has occurred or is likely, the commissioner may confer with the persons involved
before commencing action under subdivision 2. The commissioner may notify the health
information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end and the representatives, or other persons
who appear to be involved in the suspected violation, to arrange a voluntary conference
with the alleged violators or their authorized representatives. The purpose of the conference
is to attempt to learn the facts about the suspected violation and, if it appears that a violation
has occurred or is threatened, to find a way to correct or prevent it. The conference is not
governed by any formal procedural requirements, and may be conducted as the commissioner
considers appropriate.
(c) The commissioner may issue an order directing a health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end or a representative of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to cease and desist from engaging in any act or practice in violation of sections
62J.4981 and 62J.4982.
(d) Within 20 days after service of the order to cease and desist, a health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may contest whether the facts found constitute a
violation of sections 62J.4981 and 62J.4982 according to the contested case and judicial
review provisions of sections 14.57 to 14.69.
(e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or other
appropriate relief in Ramsey County District Court.
Subd. 2.
Suspension or revocation of certificates of authority.
(a) The commissioner
may suspend or revoke a certificate of authority issued to a deleted text begin health data intermediary ordeleted text end
health information organization under section 62J.4981 if the commissioner finds that:
(1) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is operating
significantly in contravention of its basic organizational document, or in a manner contrary
to that described in and reasonably inferred from any other information submitted under
section 62J.4981, unless amendments to the submissions have been filed with and approved
by the commissioner;
(2) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;
(3) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is no longer financially
solvent or may not reasonably be expected to meet its obligations to participating entities;
(4) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has failed to implement
the complaint system in a manner designed to reasonably resolve valid complaints;
(5) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end , or any person acting
with its sanction, has advertised or merchandised its services in an untrue, misleading,
deceptive, or unfair manner;
(6) the continued operation of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end would be hazardous to its participating entities or the patients served by the
participating entities; or
(7) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has otherwise failed
to substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.
(b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.
(c) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is suspended, the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end
shall not, during the period of suspension, enroll any additional participating entities, and
shall not engage in any advertising or solicitation.
(d) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is revoked, the organization shall proceed, immediately following the effective
date of the order of revocation, to wind up its affairs, and shall conduct no further business
except as necessary to the orderly conclusion of the affairs of the organization. The
organization shall engage in no further advertising or solicitation. The commissioner may,
by written order, permit further operation of the organization as the commissioner finds to
be in the best interest of participating entities, to the end that participating entities will be
given the greatest practical opportunity to access continuing health information exchange
services.
Subd. 3.
Denial, suspension, and revocation; administrative procedures.
(a) When
the commissioner has cause to believe that grounds for the denial, suspension, or revocation
of a certificate of authority exist, the commissioner shall notify the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end in writing stating the grounds for denial, suspension,
or revocation and setting a time within 20 days for a hearing on the matter.
(b) After a hearing before the commissioner at which the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to appear at the hearing, the commissioner shall take action as deemed necessary
and shall issue written findings and mail them to the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end .
(c) If suspension, revocation, or administrative penalty is proposed according to this
section, the commissioner must deliver, or send by certified mail with return receipt
requested, to the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end written notice
of the commissioner's intent to impose a penalty. This notice of proposed determination
must include:
(1) a reference to the statutory basis for the penalty;
(2) a description of the findings of fact regarding the violations with respect to which
the penalty is proposed;
(3) the nature and amount of the proposed penalty;
(4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;
(5) instructions for responding to the notice, including a statement of the health
information deleted text begin exchange service provider'sdeleted text end new text begin organization'snew text end right to a contested case proceeding
and a statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and
(6) the address to which the contested case proceeding request must be sent.
Subd. 4.
Coordination.
The commissioner shall, to the extent possible, seek the advice
of the Minnesota e-Health Advisory Committee, in the review and update of criteria for the
certification and recertification of health information deleted text begin exchange service providersdeleted text end new text begin
organizationsnew text end when implementing sections 62J.498 to 62J.4982.
Subd. 5.
Fees and monetary penalties.
(a) The commissioner shall assess fees on every
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end subject to sections 62J.4981 and
62J.4982 as follows:
(1) filing an application for certificate of authority to operate as a health information
organization, $7,000;new text begin and
new text end
(2) deleted text begin filing an application for certificate of authority to operate as a health data intermediary,
$7,000;
deleted text end
deleted text begin (3)deleted text end annual health information organization certificate fee, $7,000deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) annual health data intermediary certificate fee, $7,000.
deleted text end
(b) Fees collected under this section shall be deposited in the state treasury and credited
to the state government special revenue fund.
(c) Administrative monetary penalties imposed under this subdivision shall be credited
to an account in the special revenue fund and are appropriated to the commissioner for the
purposes of sections 62J.498 to 62J.4982.
Sec. 10.
Minnesota Statutes 2020, section 62J.63, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Establishment; administrationdeleted text end new text begin Support for state health care
purchasing and performance measurementnew text end .
The commissioner of health shall deleted text begin establish
and administer the Center for Health Care Purchasing Improvement as an administrative
unit within the Department of Health. The Center for Health Care Purchasing Improvement
shalldeleted text end support the state in its efforts to be a more prudent and efficient purchaser of quality
health care servicesdeleted text begin . The center shalldeleted text end new text begin ,new text end aid the state in developing and using more common
strategies and approaches for health care performance measurement and health care
purchasingdeleted text begin . The common strategies and approaches shalldeleted text end new text begin ,new text end promote greater transparency of
health care costs and qualitydeleted text begin ,deleted text end and greater accountability for health care results and
improvementdeleted text begin . The center shall alsodeleted text end new text begin , andnew text end identify barriers to more efficient, effective, quality
health care and options for overcoming the barriers.
Sec. 11.
Minnesota Statutes 2020, section 62J.63, subdivision 2, is amended to read:
Subd. 2.
deleted text begin Staffing;deleted text end Duties; scope.
deleted text begin (a)deleted text end The commissioner of health may deleted text begin appoint a director,
and up to three additional senior-level staff or codirectors, and other staff as needed who
are under the direction of the commissioner. The staff of the center are in the unclassified
service.deleted text end new text begin :
new text end
deleted text begin
(b) With the authorization of the commissioner of health, and in consultation or
interagency agreement with the appropriate commissioners of state agencies, the director,
or codirectors, may:
deleted text end
deleted text begin
(1) initiate projects to develop plan designs for state health care purchasing;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end require reports or surveys to evaluate the performance of current health care
purchasingnew text begin or administrative simplificationnew text end strategies;
deleted text begin (3)deleted text end new text begin (2)new text end calculate fiscal impacts, including net savings and return on investment, of health
care purchasing strategies and initiatives;
deleted text begin
(4) conduct policy audits of state programs to measure conformity to state statute or
other purchasing initiatives or objectives;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end support the Administrative Uniformity Committee under deleted text begin sectiondeleted text end new text begin sectionsnew text end 62J.50
new text begin and 62J.536 new text end and other relevant groups or activities to advance agreement on health care
administrative process streamlining;
deleted text begin
(6) consult with the Health Economics Unit of the Department of Health regarding
reports and assessments of the health care marketplace;
deleted text end
deleted text begin
(7) consult with the Department of Commerce regarding health care regulatory issues
and legislative initiatives;
deleted text end
deleted text begin
(8) work with appropriate Department of Human Services staff and the Centers for
Medicare and Medicaid Services to address federal requirements and conformity issues for
health care purchasing;
deleted text end
deleted text begin
(9) assist the Minnesota Comprehensive Health Association in health care purchasing
strategies;
deleted text end
deleted text begin
(10) convene medical directors of agencies engaged in health care purchasing for advice,
collaboration, and exploring possible synergies;
deleted text end
deleted text begin (11)deleted text end new text begin (4)new text end contact and participate with other relevant health care task forces, study activities,
and similar efforts with regard to health care performance measurement and
performance-based purchasing; and
deleted text begin (12)deleted text end new text begin (5)new text end assist in seeking external funding through appropriate grants or other funding
opportunities and may administer grants and externally funded projects.
Sec. 12.
new text begin
[62J.826] MEDICAL PRACTICES; CURRENT STANDARD CHARGES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "Chargemaster" means the list of all individual items and services maintained by a
medical practice for which the medical practice has established a charge.
new text end
new text begin
(c) "Diagnostic laboratory testing" means a service charged using a CPT code within
the CPT code range of 80047 to 89398.
new text end
new text begin
(d) "Diagnostic radiology service" means a service charged using a CPT code within
the CPT code range of 70010 to 7999 and includes the provision of x-rays, computed
tomography scans, positron emission tomography scans, magnetic resonance imaging scans,
and mammographies.
new text end
new text begin
(e) "Hospital" means an acute care institution licensed under sections 144.50 to 144.58,
but does not include a health care institution conducted for those who rely primarily upon
treatment by prayer or spiritual means in accordance with the creed or tenets of any church
or denomination.
new text end
new text begin
(f) "Medical practice" means a business that:
new text end
new text begin
(1) earns revenue by providing medical care to the public;
new text end
new text begin
(2) issues payment claims to health plan companies and other payers; and
new text end
new text begin
(3) may be identified by its federal tax identification number.
new text end
new text begin
(g) "Outpatient surgical center" means a health care facility other than a hospital offering
elective outpatient surgery under a license issued under sections 144.50 to 144.58.
new text end
new text begin Subd. 2. new text end
new text begin Requirement; current standard charges. new text end
new text begin
The following medical practices
must make available to the public a list of the medical practice's current standard charges,
as reflected in the medical practice's chargemaster, for all items and services provided by
the medical practice:
new text end
new text begin
(1) hospitals;
new text end
new text begin
(2) outpatient surgical centers; and
new text end
new text begin
(3) any other medical practice that has revenue of greater than $50,000,000 per year and
that derives the majority of the medical practice's revenue by providing one or more of the
following services:
new text end
new text begin
(i) diagnostic radiology services;
new text end
new text begin
(ii) diagnostic laboratory testing;
new text end
new text begin
(iii) orthopedic surgical procedures, including joint arthroplasty procedures within the
CPT code range of 26990 to 27899;
new text end
new text begin
(iv) ophthalmologic surgical procedures, including cataract surgery coded using CPT
code 66982 or 66984, or refractive correction surgery to improve visual acuity;
new text end
new text begin
(v) anesthesia services commonly provided as an ancillary to services provided at a
hospital, outpatient surgical center, or medical practice that provides orthopedic surgical
procedures or ophthalmologic surgical procedures; or
new text end
new text begin
(vi) oncology services, including radiation oncology treatments within the CPT code
range of 77261 to 77799 and drug infusions.
new text end
new text begin Subd. 3. new text end
new text begin Required file format and data attributes. new text end
new text begin
(a) A medical practice required to
post the medical practice's current standard charges must post the following data attributes
in the listed order:
new text end
new text begin
(1) federal tax identification number for the medical practice;
new text end
new text begin
(2) name of the medical practice, defined as the provider name that the medical practice
enters on the CMS claim form 1500 or a successor form when the medical practice submits
health care claims to a payer organization;
new text end
new text begin
(3) internal chargemaster record identification, defined as the internal record identifier
for this chargemaster line item in the medical practice's billing system;
new text end
new text begin
(4) service billing code system, defined as a code signifying the HIPAA-compliant
billing code system from which the service billing code was drawn;
new text end
new text begin
(5) service billing code, defined as a specific billing code drawn from the service billing
code system denoted by the value in the service billing code type field;
new text end
new text begin
(6) service description, defined as the shortest, nonabbreviated official description
associated with the service billing code in the applicable service billing code system;
new text end
new text begin
(7) revenue code, defined as the National Uniform Billing Committee revenue code
denoting the patient's location within the medical practice where the patient will receive the
item or service subject to this charge. This value is required only if the charge amount is
dependent on the location within the medical practice where the item or service is provided;
new text end
new text begin
(8) revenue code description, defined as the description provided by the National Uniform
Billing Committee for the revenue code. This value is required only if the charge amount
is dependent on the location within the medical practice where the item or service is provided;
new text end
new text begin
(9) national drug code, defined as the national drug code for a drug that is administered
as part of the service subject to this charge. This field is required only when the charge
amount is dependent on which, if any, drug is being administered as part of this service;
new text end
new text begin
(10) national drug code description, defined as the official description associated with
the national drug code for a drug that is administered as part of the service subject to this
charge. This field is required only when the charge amount is dependent on which, if any,
drug is being administered as part of this service;
new text end
new text begin
(11) inpatient gross charge, defined as the charge for an individual item or service that
is reflected on a hospital's chargemaster, absent any discounts as defined in Code of Federal
Regulations, title 45, section 180.20, for an item or service provided on an inpatient basis;
new text end
new text begin
(12) outpatient gross charge, defined as the charge for an individual item or service that
is reflected on a chargemaster, absent any discounts as defined in Code of Federal
Regulations, title 45, section 180.20, for an item or service provided on an outpatient basis;
new text end
new text begin
(13) inpatient discounted cash price, defined as the charge that applies to an individual
who pays cash or a cash equivalent for an item or service being reported under this section
and provided on an inpatient basis;
new text end
new text begin
(14) outpatient discounted cash price, defined as the charge that applies to an individual
who pays cash or a cash equivalent for an item or service being reported under this section
and provided on an outpatient basis;
new text end
new text begin
(15) charge unit, defined as the unit cost basis for the charge;
new text end
new text begin
(16) effective date of the charge; and
new text end
new text begin
(17) payer-specific negotiated charges, as defined in Code of Federal Regulations, title
45, section 180.20. There must be a separate field for each payer's rate and the payers must
be listed in alphabetical order.
new text end
new text begin
(b) The data attributes specified in paragraph (a) must be posted in the form of a
comma-separated values file, with all text values quoted and all leading and trailing white
spaces trimmed before and after data attribute values.
new text end
new text begin
(c) The data attributes specified in paragraph (a) must be posted on a web page labeled
"Cost of Care at [Name of Medical Practice]" which members of the public can access via
a direct, clearly labeled link on the medical practice's main billing web page, and which is
searchable by entering the words "cost of care at [name of medical practice]" into an Internet
search engine. The consumer-friendly list of standard charges for a limited set of shoppable
services required under Code of Federal Regulations, title 45, section 180.60, must be
presented on the same web page.
new text end
new text begin
(d) The file must be named according to the following convention:
<ein>_<hospital-name>_standardcharges.csv as required by Code of Federal Regulations,
title 45, section 180.50.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 62U.04, subdivision 4, is amended to read:
Subd. 4.
Encounter data.
(a) deleted text begin Beginning July 1, 2009, and every six months thereafter,deleted text end
All health plan companies and third-party administrators shall submit encounter datanew text begin on a
monthly basisnew text end to a private entity designated by the commissioner of health. The data shall
be submitted in a form and manner specified by the commissioner subject to the following
requirements:
(1) the data must be de-identified data as described under the Code of Federal Regulations,
title 45, section 164.514;
(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care home and, for claims incurred on or after
January 1, 2019, data deemed necessary by the commissioner to uniquely identify claims
in the individual health insurance market; and
(3) except for the identifier described in clause (2), the data must not include information
that is not included in a health care claim or equivalent encounter information transaction
that is required under section 62J.536.
(b) The commissioner or the commissioner's designee shall only use the data submitted
under paragraph (a) to carry out the commissioner's responsibilities in this section, including
supplying the data to providers so they can verify their results of the peer grouping process
consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
and adopted by the commissioner and, if necessary, submit comments to the commissioner
or initiate an appeal.
(c) Data on providers collected under this subdivision are private data on individuals or
nonpublic data, as defined in section 13.02. new text begin Notwithstanding the data classifications in this
paragraph, data on providers collected under this subdivision may be released or published
as authorized in subdivision 11. new text end Notwithstanding the definition of summary data in section
13.02, subdivision 19, summary data prepared under this subdivision may be derived from
nonpublic data. The commissioner or the commissioner's designee shall establish procedures
and safeguards to protect the integrity and confidentiality of any data that it maintains.
(d) The commissioner or the commissioner's designee shall not publish analyses or
reports that identify, or could potentially identify, individual patients.
(e) The commissioner shall compile summary information on the data submitted under
this subdivision. The commissioner shall work with its vendors to assess the data submitted
in terms of compliance with the data submission requirements and the completeness of the
data submitted by comparing the data with summary information compiled by the
commissioner and with established and emerging data quality standards to ensure data
quality.
Sec. 14.
Minnesota Statutes 2020, section 62U.04, subdivision 5, is amended to read:
Subd. 5.
Pricing data.
(a) Beginning July 1, 2009, and annually on January 1 thereafter,
all health plan companies and third-party administrators shall submit data on their contracted
prices with health care providers to a private entity designated by the commissioner of health
for the purposes of performing the analyses required under this subdivision. The data shall
be submitted in the form and manner specified by the commissioner of health.
(b) The commissioner or the commissioner's designee shall only use the data submitted
under this subdivision to carry out the commissioner's responsibilities under this section,
including supplying the data to providers so they can verify their results of the peer grouping
process consistent with the recommendations developed pursuant to subdivision 3c, paragraph
(d), and adopted by the commissioner and, if necessary, submit comments to the
commissioner or initiate an appeal.
(c) Data collected under this subdivision are nonpublic data as defined in section 13.02.
new text begin Notwithstanding the data classification in this paragraph, data collected under this subdivision
may be released or published as authorized in subdivision 11. new text end Notwithstanding the definition
of summary data in section 13.02, subdivision 19, summary data prepared under this section
may be derived from nonpublic data. The commissioner shall establish procedures and
safeguards to protect the integrity and confidentiality of any data that it maintains.
Sec. 15.
Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patientsdeleted text begin ,deleted text end new text begin ornew text end payersdeleted text begin , or providersdeleted text end new text begin but that may identify the
rendering or billing hospital, clinic, or medical practicenew text end ;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) deleted text begin so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerneddeleted text end .new text begin
The data published under this paragraph may identify hospitals, clinics, and medical practices
so long as no individual health professionals are identified and the commissioner finds the
data to be accurate, valid, and suitable for publication for such use.
new text end
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 16.
Minnesota Statutes 2020, section 103H.201, subdivision 1, is amended to read:
Subdivision 1.
Procedure.
(a) If groundwater quality monitoring results show that there
is a degradation of groundwater, the commissioner of health may promulgate health risk
limits under subdivision 2 for substances degrading the groundwater.
(b) Health risk limits shall be determined by two methods depending on their toxicological
end point.
(c) For systemic toxicants that are not carcinogens, the adopted health risk limits shall
be derived using United States Environmental Protection Agency risk assessment methods
using a reference dose, a drinking water equivalent, and a relative source contribution factor.
(d) For toxicants that are known or probable carcinogens, the adopted health risk limits
shall be derived from a quantitative estimate of the chemical's carcinogenic potency published
by the United States Environmental Protection Agency deleted text begin anddeleted text end new text begin ornew text end determined by the
commissioner to have undergone thorough scientific review.
Sec. 17.
new text begin
[144.066] DISTRIBUTION OF COVID-19 VACCINES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section
and sections 144.0661 to 144.0663.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "COVID-19 vaccine" means a vaccine against severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2).
new text end
new text begin
(d) "Department" means the Department of Health.
new text end
new text begin
(e) "Disproportionately impacted community" means a community or population that
has been disproportionately and negatively impacted by the COVID-19 pandemic.
new text end
new text begin
(f) "Local health department" has the meaning given in section 145A.02, subdivision
8b.
new text end
new text begin
(g) "Mobile vaccination vehicle" means a vehicle-mounted unit that is either motorized
or trailered, that is readily movable without disassembling, and at which vaccines are
provided in more than one geographic location.
new text end
new text begin Subd. 2. new text end
new text begin Distribution. new text end
new text begin
The commissioner shall establish and maintain partnerships or
agreements with local health departments; local health care providers, including community
health centers and primary care providers; and local pharmacies to administer COVID-19
vaccines throughout the state. COVID-19 vaccines may also be administered via mobile
vaccination vehicles authorized under section 144.0662.
new text end
new text begin Subd. 3. new text end
new text begin Second dose or booster. new text end
new text begin
For all COVID-19 vaccines for which a second dose
or booster is required, during the first vaccine appointment the registered vaccine provider
should be directed by the department during the vaccine provider registration process to
assist vaccine recipients with scheduling an appointment for the second dose or booster.
This assistance may be provided during the observation period following vaccine
administration.
new text end
new text begin Subd. 4. new text end
new text begin Nondiscrimination. new text end
new text begin
Nothing in sections 144.066 to 144.0663 shall be construed
to allow or require the denial of any benefit or opportunity on the basis of race, color, creed,
marital status, status with regard to public assistance, disability, genetic information, sexual
orientation, age, religion, national origin, sex, or membership in a local human rights
commission.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
new text begin
[144.0661] EQUITABLE COVID-19 VACCINE DISTRIBUTION.
new text end
new text begin Subdivision 1. new text end
new text begin COVID-19 vaccination equity and outreach. new text end
new text begin
The commissioner shall
establish positions to continue the department's COVID-19 vaccination equity and outreach
activities and to plan and implement actions and programs to overcome disparities in
COVID-19 vaccination rates that are rooted in historic and current racism; biases based on
ethnicity, income, primary language, immigration status, or disability; geography; or
transportation access, language access, or Internet access. This work shall be managed by
a director who shall serve in a leadership role in the department's COVID-19 response.
new text end
new text begin Subd. 2. new text end
new text begin
Vaccine education and outreach campaign; direct delivery of
information.
new text end
new text begin
(a) The commissioner shall administer a COVID-19 vaccine education and
outreach campaign that engages in direct delivery of information to members of
disproportionately impacted communities. In this campaign, the commissioner shall contract
with community-based organizations including community faith-based organizations, tribal
governments, local health departments, and local health care providers, including community
health centers and primary care providers, to deliver the following information in a culturally
relevant and linguistically appropriate manner:
new text end
new text begin
(1) medically and scientifically accurate information on the safety, efficacy, science,
and benefits of vaccines generally and COVID-19 vaccines in particular;
new text end
new text begin
(2) information on how members of disproportionately impacted communities may
obtain a COVID-19 vaccine including, if applicable, obtaining a vaccine from a mobile
vaccination vehicle; and
new text end
new text begin
(3) measures to prevent transmission of COVID-19, including adequate indoor ventilation,
wearing face coverings, and physical distancing from individuals outside the household.
new text end
new text begin
(b) This information must be delivered directly by methods that include phone calls,
text messages, physically distanced door-to-door and street canvassing, and digital
event-based communication involving live and interactive messengers. For purposes of this
subdivision, direct delivery shall not include delivery by television, radio, newspaper, or
other forms of mass media.
new text end
new text begin Subd. 3. new text end
new text begin Vaccine education and outreach campaign; mass media. new text end
new text begin
The commissioner
shall administer a mass media campaign to provide COVID-19 vaccine education and
outreach to members of disproportionately impacted communities. In this campaign, the
commissioner shall contract with media vendors to provide the following information to
members of disproportionately impacted communities in a manner that is culturally relevant
and linguistically appropriate:
new text end
new text begin
(1) medically and scientifically accurate information on the safety, efficacy, science,
and benefits of COVID-19 vaccines; and
new text end
new text begin
(2) information on how members of disproportionately impacted communities may
obtain a COVID-19 vaccine.
new text end
new text begin Subd. 4. new text end
new text begin Community assistance. new text end
new text begin
The commissioner shall administer a program to help
members of disproportionately impacted communities arrange for and prepare to obtain a
COVID-19 vaccine and to support transportation-limited members of these communities
with transportation to vaccination appointments or otherwise arrange for vaccine providers
to reach members of these communities.
new text end
new text begin Subd. 5. new text end
new text begin Equitable distribution of COVID-19 vaccines. new text end
new text begin
The commissioner shall
establish a set of metrics to measure the equitable distribution of COVID-19 vaccines in
the state, and shall set and periodically update goals for COVID-19 vaccine distribution in
the state that are focused on equity.
new text end
new text begin Subd. 6. new text end
new text begin Expiration of programs. new text end
new text begin
The vaccine education and outreach programs in
subdivisions 2 and 3 and the community assistance program in subdivision 4 shall operate
until a sufficient percentage of individuals in each county or census tract have received the
full series of COVID-19 vaccines to protect individuals in each county or census tract from
COVID-19.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
new text begin
[144.0662] MOBILE VACCINATION PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Administration. new text end
new text begin
The commissioner, in partnership with local health
departments and the regional health care coalitions, shall administer a mobile vaccination
program in which mobile vaccination vehicles are deployed to communities around the state
to provide COVID-19 vaccines to individuals. The commissioner shall deploy mobile
vaccination vehicles to communities to improve access to vaccines based on factors that
include but are not limited to vulnerability, likelihood of exposure, limits to transportation
access, rate of vaccine uptake, and limited access to vaccines or barriers to obtaining vaccines.
new text end
new text begin Subd. 2. new text end
new text begin Eligibility. new text end
new text begin
Notwithstanding the phases and priorities of the state's COVID-19
allocation and prioritization plan or guidance, all individuals in a community to which a
mobile vaccination vehicle is deployed shall be eligible to receive COVID-19 vaccines from
the vehicle.
new text end
new text begin Subd. 3. new text end
new text begin Staffing. new text end
new text begin
Each mobile vaccination vehicle must be staffed in accordance with
Centers for Disease Control and Prevention guidelines and may be staffed with additional
support staff based on needs determined by local request. Additional support staff may
include but are not limited to community partners and translators.
new text end
new text begin Subd. 4. new text end
new text begin Second doses. new text end
new text begin
For vaccine recipients who receive a first dose of a COVID-19
vaccine from a mobile vaccination vehicle, vehicle staff shall provide assistance in scheduling
an appointment with a mobile vaccination vehicle or with another vaccine provider for any
needed second dose or booster. The commissioner shall, to the extent possible, deploy
mobile vaccination vehicles in a manner that allows vaccine recipients to receive second
doses or boosters from a mobile vaccination vehicle.
new text end
new text begin Subd. 5. new text end
new text begin Expiration. new text end
new text begin
The commissioner shall administer the mobile vaccination vehicle
program until a sufficient percentage of individuals in each county or census tract have
received the full series of COVID-19 vaccines to protect individuals in each county or
census tract from the spread of COVID-19.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
new text begin
[144.0663] COVID-19 VACCINATION PLAN AND DATA; REPORTS.
new text end
new text begin Subdivision 1. new text end
new text begin COVID-19 vaccination plan; implementation protocols. new text end
new text begin
The
commissioner shall:
new text end
new text begin
(1) publish the set of metrics and goals for equitable COVID-19 vaccine distribution
established by the commissioner under section 144.0661, subdivision 5; and
new text end
new text begin
(2) publish implementation protocols to address the disparities in COVID-19 vaccination
rates in certain communities and ensure that members of disproportionately impacted
communities are given adequate access to COVID-19 vaccines.
new text end
new text begin Subd. 2. new text end
new text begin Data on COVID-19 vaccines. new text end
new text begin
On at least a weekly basis, the commissioner
shall publish on the department website:
new text end
new text begin
(1) data measuring compliance with the set of metrics and goals for equitable COVID-19
vaccine distribution established by the commissioner under section 144.0661, subdivision
5; and
new text end
new text begin
(2) summary data on individuals who have received one or two doses of a COVID-19
vaccine, broken out by race, gender, ethnicity, age within an age range, and zip code.
new text end
new text begin Subd. 3. new text end
new text begin Quarterly reports. new text end
new text begin
On a quarterly basis while funds are available, the
commissioner shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over finance, ways and means, and health care:
new text end
new text begin
(1) funds distributed to local health departments for COVID-19 activities and the sources
of the funds; and
new text end
new text begin
(2) funds expended to implement sections 144.066 to 144.0663.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21.
Minnesota Statutes 2020, section 144.0724, subdivision 1, is amended to read:
Subdivision 1.
Resident reimbursement case mix classifications.
The commissioner
of health shall establish resident reimbursementnew text begin case mixnew text end classifications based upon the
assessments of residents of nursing homes and boarding care homes conducted under this
section and according to section 256R.17.
Sec. 22.
Minnesota Statutes 2020, section 144.0724, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given.
(a) "Assessment reference date" or "ARD" means the specific end point for look-back
periods in the MDS assessment process. This look-back period is also called the observation
or assessment period.
(b) "Case mix index" means the weighting factors assigned to the RUG-IV classifications.
(c) "Index maximization" means classifying a resident who could be assigned to more
than one category, to the category with the highest case mix index.
(d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,
and functional status elements, that include common definitions and coding categories
specified by the Centers for Medicare and Medicaid Services and designated by the
deleted text begin Minnesotadeleted text end Department of Health.
(e) "Representative" means a person who is the resident's guardian or conservator, the
person authorized to pay the nursing home expenses of the resident, a representative of the
Office of Ombudsman for Long-Term Care whose assistance has been requested, or any
other individual designated by the resident.
(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
facility's residents according to their clinical and functional status identified in data supplied
by the facility's Minimum Data Set.
(g) "Activities of daily living" deleted text begin means grooming,deleted text end new text begin includes personal hygiene,new text end dressing,
bathing, transferring,new text begin bednew text end mobility, deleted text begin positioning,deleted text end new text begin locomotion,new text end eating, and toileting.
(h) "Nursing facility level of care determination" means the assessment process that
results in a determination of a resident's or prospective resident's need for nursing facility
level of care as established in subdivision 11 for purposes of medical assistance payment
of long-term care services for:
(1) nursing facility services under section 256B.434 or chapter 256R;
(2) elderly waiver services under chapter 256S;
(3) CADI and BI waiver services under section 256B.49; and
(4) state payment of alternative care services under section 256B.0913.
Sec. 23.
Minnesota Statutes 2020, section 144.0724, subdivision 3a, is amended to read:
Subd. 3a.
Resident reimbursementnew text begin case mixnew text end classifications beginning January 1,
2012.
(a) Beginning January 1, 2012, resident reimbursementnew text begin case mixnew text end classifications shall
be based on the Minimum Data Set, version 3.0 assessment instrument, or its successor
version mandated by the Centers for Medicare and Medicaid Services that nursing facilities
are required to complete for all residents. The commissioner of health shall establish resident
classifications according to the RUG-IV, 48 group, resource utilization groups. Resident
classification must be established based on the individual items on the Minimum Data Set,
which must be completed according to the Long Term Care Facility Resident Assessment
Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare
and Medicaid Services.
(b) Each resident must be classified based on the information from the Minimum Data
Set according to general categories deleted text begin as defined in the Case Mix Classification Manual for
Nursing Facilitiesdeleted text end issued by the Minnesota Department of Health.
Sec. 24.
Minnesota Statutes 2020, section 144.0724, subdivision 5, is amended to read:
Subd. 5.
Short stays.
(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or lessdeleted text begin .deleted text end new text begin , unless the
resident is admitted and discharged from the facility on the same day, in which case the
admission assessment is not required. When an admission assessment is not submitted, the
case mix classification shall be the rate with a case mix index of 1.0.
new text end
(b) Notwithstanding the admission assessment requirements of paragraph (a), a facility
may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents
who stay 14 days or less in lieu of submitting an admission assessment. Facilities shall make
this election annually.
(c) Nursing facilities must elect one of the options described in paragraphs (a) and (b)
by reporting to the commissioner of health, as prescribed by the commissioner. The election
is effective on July 1 each year.
Sec. 25.
Minnesota Statutes 2020, section 144.0724, subdivision 7, is amended to read:
Subd. 7.
Notice of resident reimbursementnew text begin case mixnew text end classification.
(a) The
commissioner of health shall provide to a nursing facility a notice for each resident of the
deleted text begin reimbursementdeleted text end classification established under subdivision 1. The notice must inform the
resident of thenew text begin case mixnew text end classification deleted text begin that wasdeleted text end assigned, the opportunity to review the
documentation supporting the classification, the opportunity to obtain clarification from the
commissioner, and the opportunity to request a reconsideration of the classification and the
address and telephone number of the Office of Ombudsman for Long-Term Care. The
commissioner must transmit the notice of resident classification by electronic means to the
nursing facility. deleted text begin Adeleted text end new text begin Thenew text end nursing facility is responsible for the distribution of the notice to
each residentdeleted text begin , to the person responsible for the payment of the resident's nursing home
expenses, or to another person designated by the residentdeleted text end new text begin or the resident's representativenew text end .
This notice must be distributed within three deleted text begin workingdeleted text end new text begin businessnew text end days after the facility's receipt
deleted text begin of the electronic file of notice of case mix classifications from the commissioner of healthdeleted text end .
(b) If a facility submits a deleted text begin modification to the most recent assessment used to establish
a case mix classification conducted under subdivision 3 that resultsdeleted text end new text begin modifying assessment
resultingnew text end in a change innew text begin thenew text end case mix classification, the facility deleted text begin shall givedeleted text end new text begin must provide anew text end
written notice to the resident or the resident's representative deleted text begin aboutdeleted text end new text begin regardingnew text end the itemnew text begin or
itemsnew text end that deleted text begin wasdeleted text end new text begin werenew text end modified and the reason for the deleted text begin modificationdeleted text end new text begin modificationsnew text end . The notice
deleted text begin of modified assessment maydeleted text end new text begin mustnew text end be provided deleted text begin at the same time that the resident or resident's
representative is provided the resident's modified notice of classificationdeleted text end new text begin within three business
days after distribution of the resident case mix classification noticenew text end .
Sec. 26.
Minnesota Statutes 2020, section 144.0724, subdivision 8, is amended to read:
Subd. 8.
Request for reconsideration of resident classifications.
(a) The resident, or
resident's representative, or the nursing facility or boarding care home may request that the
commissioner of health reconsider the assigned reimbursementnew text begin case mixnew text end classificationnew text begin and
any item or items changed during the audit processnew text end . The request for reconsideration must
be submitted in writing to the commissioner deleted text begin within 30 days of the day the resident or the
resident's representative receives the resident classification noticedeleted text end new text begin of healthnew text end .
new text begin
(b) For reconsideration requests initiated by the resident or the resident's representative:
new text end
new text begin (1) The resident or the resident's representative must submit in writing a reconsideration
request to the facility administrator within 30 days of receipt of the resident classification
notice.new text end Thenew text begin writtennew text end request deleted text begin for reconsiderationdeleted text end must include the deleted text begin name of the resident, the
name and address of the facility in which the resident resides, thedeleted text end reasons for the
reconsiderationdeleted text begin , and documentation supporting thedeleted text end request. deleted text begin The documentation accompanying
the reconsideration request is limited to a copy of the MDS that determined the classification
and other documents that would support or change the MDS findings.
deleted text end
new text begin
(2) Within three business days of receiving the reconsideration request, the nursing
facility must submit to the commissioner of health a completed reconsideration request
form, a copy of the resident's or resident's representative's written request, and all supporting
documentation used to complete the assessment being considered. If the facility fails to
provide the required information, the reconsideration will be completed with the information
submitted and the facility cannot make further reconsideration requests on this classification.
new text end
deleted text begin (b)deleted text end new text begin (3)new text end Uponnew text begin writtennew text end requestnew text begin and within three business daysnew text end , the nursing facility must
give the resident or the resident's representative a copy of the assessment deleted text begin formdeleted text end new text begin being
reconsiderednew text end and deleted text begin the otherdeleted text end new text begin all supportingnew text end documentation deleted text begin that was given to the commissioner
of healthdeleted text end new text begin usednew text end to deleted text begin supportdeleted text end new text begin completenew text end the assessment deleted text begin findingsdeleted text end . deleted text begin The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information.deleted text end Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the deleted text begin materialdeleted text end new text begin required documentsnew text end within this time, it is subject to the issuance of
a correction order and penalty assessment under sections 144.653 and 144A.10.
Notwithstanding those sections, any correction order issued under this subdivision must
require that the nursing facility immediately comply with the request for informationnew text begin ,new text end and
deleted text begin thatdeleted text end as of the date of the issuance of the correction order, the facility shall forfeit to the state
a $100 fine for the first day of noncompliance, and an increase in the $100 fine by $50
increments for each day the noncompliance continues.
(c) deleted text begin in addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
deleted text end deleted text begin classification notices were distributed to the resident or the resident's representative; and
(iii)deleted text end new text begin For reconsideration requests initiated by the facility:
new text end
new text begin
(1) The facility is required to inform the resident or the resident's representative in writing
that a reconsideration of the resident's case mix classification is being requested. The notice
must inform the resident or the resident's representative:
new text end
new text begin
(i) of the date and reason for the reconsideration request;
new text end
new text begin
(ii) of the potential for a classification and subsequent rate change;
new text end
new text begin
(iii) of the extent of the potential rate change;
new text end
new text begin
(iv) that copies of the request and supporting documentation are available for review;
and
new text end
new text begin
(v) that the resident or the resident's representative has the right to request a
reconsideration.
new text end
new text begin (2) Within 30 days of receipt of the audit exit report or resident classification notice, the
facility must submit to the commissioner of health a completed reconsideration request
form, all supporting documentation used to complete the assessment being reconsidered,
andnew text end a copy of deleted text begin adeleted text end new text begin thenew text end notice deleted text begin sent todeleted text end new text begin informingnew text end the resident or deleted text begin todeleted text end the resident's representativedeleted text begin .
This notice must inform the resident or the resident's representativedeleted text end that a reconsideration
of the resident's classification is being requesteddeleted text begin , the reason for the request, that the resident's
rate will change if the request is approved by the commissioner, the extent of the change,
that copies of the facility's request and supporting documentation are available for review,
and that the resident also has the right to request a reconsiderationdeleted text end .
new text begin (3)new text end If the facility fails to provide the required information deleted text begin listed in item (iii) with the
reconsideration request, the commissioner may request that the facility provide the
information within 14 calendar days.deleted text end new text begin ,new text end the reconsideration request deleted text begin mustdeleted text end new text begin maynew text end be denied deleted text begin if the
information is then not provided,deleted text end and the facility may not make further reconsideration
requests on deleted text begin that specific reimbursementdeleted text end new text begin thisnew text end classification.
(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissionernew text begin of healthnew text end under paragraphs (a) deleted text begin and
(b)deleted text end new text begin to (c)new text end . If necessary for evaluating the reconsideration request, the commissioner may
conduct on-site reviews. Within 15 deleted text begin workingdeleted text end new text begin businessnew text end days of receiving the request for
reconsideration, the commissioner shall affirm or modify the original resident classification.
The original classification must be modified if the commissioner determines that the
assessment resulting in the classification did not accurately reflect characteristics of the
resident at the time of the assessment. deleted text begin The resident and the nursing facility or boarding care
home shall be notified within five working days after the decision is made.deleted text end new text begin The commissioner
must transmit the reconsideration classification notice by electronic means to the nursing
facility. The nursing facility is responsible for the distribution of the notice to the resident
or the resident's representative. The notice must be distributed by the nursing facility within
three business days after receipt.new text end A decision by the commissioner under this subdivision is
the final administrative decision of the agency for the party requesting reconsideration.
(e) The deleted text begin residentdeleted text end new text begin case mixnew text end classification established by the commissioner shall be the
classification deleted text begin thatdeleted text end new text begin whichnew text end applies to the resident while the request for reconsideration is
pending. If a request for reconsideration applies to an assessment used to determine nursing
facility level of care under subdivision 4, paragraph (c), the resident shall continue to be
eligible for nursing facility level of care while the request for reconsideration is pending.
(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.
Sec. 27.
Minnesota Statutes 2020, section 144.0724, subdivision 9, is amended to read:
Subd. 9.
Audit authority.
(a) The commissioner shall audit the accuracy of resident
assessments performed under section 256R.17 through any of the following: desk audits;
on-site review of residents and their records; and interviews with staff, residents, or residents'
families. The commissioner shall reclassify a resident if the commissioner determines that
the resident was incorrectly classified.
(b) The commissioner is authorized to conduct on-site audits on an unannounced basis.
(c) A facility must grant the commissioner access to examine the medical records relating
to the resident assessments selected for audit under this subdivision. The commissioner may
also observe and speak to facility staff and residents.
(d) The commissioner shall consider documentation under the time frames for coding
items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment
Instrument User's Manual published by the Centers for Medicare and Medicaid Services.
(e) The commissioner shall develop an audit selection procedure that includes the
following factors:
(1) Each facility shall be audited annually. If a facility has two successive audits in which
the percentage of change is five percent or less and the facility has not been the subject of
a special audit in the past 36 months, the facility may be audited biannually. A stratified
sample of 15 percent, with a minimum of ten assessments, of the most current assessments
shall be selected for audit. If more than 20 percent of the RUG-IV classifications are changed
as a result of the audit, the audit shall be expanded to a second 15 percent sample, with a
minimum of ten assessments. If the total change between the first and second samples is
35 percent or greater, the commissioner may expand the audit to all of the remaining
assessments.
(2) If a facility qualifies for an expanded audit, the commissioner may audit the facility
again within six months. If a facility has two expanded audits within a 24-month period,
that facility will be audited at least every six months for the next 18 months.
(3) The commissioner may conduct special audits if the commissioner determines that
circumstances exist that could alter or affect the validity of case mix classifications of
residents. These circumstances include, but are not limited to, the following:
(i) frequent changes in the administration or management of the facility;
(ii) an unusually high percentage of residents in a specific case mix classification;
(iii) a high frequency in the number of reconsideration requests received from a facility;
(iv) frequent adjustments of case mix classifications as the result of reconsiderations or
audits;
(v) a criminal indictment alleging provider fraud;
(vi) other similar factors that relate to a facility's ability to conduct accurate assessments;
(vii) an atypical pattern of scoring minimum data set items;
(viii) nonsubmission of assessments;
(ix) late submission of assessments; or
(x) a previous history of audit changes of 35 percent or greater.
(f) deleted text begin Within 15 working days of completing the audit process, the commissioner shall
make available electronically the results of the audit to the facility. If the results of the audit
reflect a change in the resident's case mix classification, a case mix classification notice
will be made available electronically to the facility, using the procedure in subdivision 7,
paragraph (a). The notice must contain the resident's classification and a statement informing
the resident, the resident's authorized representative, and the facility of their right to review
the commissioner's documents supporting the classification and to request a reconsideration
of the classification. This notice must also include the address and telephone number of the
Office of Ombudsman for Long-Term Care.deleted text end new text begin If the audit results in a case mix classification
change, the commissioner must transmit the audit classification notice by electronic means
to the nursing facility within 15 business days of completing an audit. The nursing facility
is responsible for distribution of the notice to each resident or the resident's representative.
This notice must be distributed by the nursing facility within three business days after
receipt. The notice must inform the resident of the case mix classification assigned, the
opportunity to review the documentation supporting the classification, the opportunity to
obtain clarification from the commissioner, the opportunity to request a reconsideration of
the classification, and the address and telephone number of the Office of Ombudsman for
Long-Term Care.
new text end
Sec. 28.
Minnesota Statutes 2020, section 144.0724, subdivision 12, is amended to read:
Subd. 12.
Appeal of nursing facility level of care determination.
(a) A resident or
prospective resident whose level of care determination results in a denial of long-term care
services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
paragraph (h), clause (9).
(b) The commissioner of human services shall ensure that notice of changes in eligibility
due to a nursing facility level of care determination is provided to each affected recipient
or the recipient's guardian at least 30 days before the effective date of the change. The notice
shall include the following information:
(1) how to obtain further information on the changes;
(2) how to receive assistance in obtaining other services;
(3) a list of community resources; and
(4) appeal rights.
deleted text begin
A recipient who meets the criteria in section 256B.0922, subdivision 2, paragraph (a), clauses
(1) and (2), may request continued services pending appeal within the time period allowed
to request an appeal under section 256.045, subdivision 3, paragraph (i). This paragraph is
in effect for appeals filed between January 1, 2015, and December 31, 2016.
deleted text end
Sec. 29.
Minnesota Statutes 2020, section 144.1205, subdivision 2, is amended to read:
Subd. 2.
new text begin Initial and new text end annual fee.
new text begin
(a) A licensee must pay an initial fee that is equivalent
to the annual fee upon issuance of the initial license.
new text end
new text begin (b) new text end A licensee must pay an annual fee at least 60 days before the anniversary date of the
issuance of the license. The annual fee is as follows:
| TYPE |
deleted text begin ANNUALdeleted text end new text begin LICENSEnew text end FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$19,920
deleted text end
new text begin
$25,896 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
19,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
19,920 deleted text end |
||
|
new text begin
Academic broad scope - type A, B, or C (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Academic broad scope - type A, B, or C (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| Medical broad scope - type A |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Medical broad scope- type A (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Medical broad scope- type A (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$4,784 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (4-8 locations) new text end |
new text begin
$5,740 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (9 or more locations) new text end |
new text begin
$6,697 new text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
3,680 deleted text end |
||
| Teletherapy |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Gamma knife |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Veterinary medicine |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| In vitro testing lab |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Nuclear pharmacy |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Nuclear pharmacy (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Radiopharmaceutical processing and distribution (10 CFR 32.72) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Medical sealed sources - processing and distribution (10 CFR 32.74) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Well logging - sealed sources |
deleted text begin
3,760
deleted text end
new text begin
$4,888 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
2,000 deleted text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (4-8 locations) new text end |
new text begin
$3,120 new text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (9 or more locations) new text end |
new text begin
$3,640 new text end |
||
| X-ray fluorescent analyzer |
deleted text begin
1,520
deleted text end
new text begin
$1,976 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
2,000 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
2,000 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin broad scope new text end |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Bnew text begin or C broad scope new text end |
deleted text begin
17,600
deleted text end
new text begin
$22,880 new text end |
||
|
deleted text begin
Broad scope Manufacturing and distribution - type C deleted text end |
deleted text begin
17,600 deleted text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (4-8 locations) new text end |
new text begin
$27,456 new text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (9 or more locations) new text end |
new text begin
$32,032 new text end |
||
| Manufacturing and distribution - other |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
|
new text begin
Manufacturing and distribution - other (4-8 locations) new text end |
new text begin
$8,236 new text end |
||
|
new text begin
Manufacturing and distribution - other (9 or more locations) new text end |
new text begin
$9,609 new text end |
||
| Nuclear laundry |
deleted text begin
18,640
deleted text end
new text begin
$24,232 new text end |
||
| Decontamination services |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Leak test services only |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
2,000 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
6,000
deleted text end
new text begin
$7,800 new text end |
||
| Waste disposal |
deleted text begin
8,320
deleted text end
new text begin
$10,816 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
1,760
deleted text end
new text begin
$2,288 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
1,120
deleted text end
new text begin
$1,456 new text end |
||
| Industrial radiography - fixednew text begin or temporarynew text end location |
deleted text begin
9,840
deleted text end
new text begin
$12,792 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
9,840 deleted text end |
||
|
new text begin
Industrial radiography - fixed or temporary location (5 or more locations) new text end |
new text begin
$16,629 new text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
2,880
deleted text end
new text begin
$3,744 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
5,360
deleted text end
new text begin
$6,968 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
2,880 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
9,520
deleted text end
new text begin
$12,376 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (4-8 locations) new text end |
new text begin
$14,851 new text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (9 or more locations) new text end |
new text begin
$17,326 new text end |
||
| Research and development - other |
deleted text begin
4,480
deleted text end
new text begin
$5,824 new text end |
||
| Storage - no operations |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Source material - shielding |
deleted text begin
584
deleted text end
new text begin
$759 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$500 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 30.
Minnesota Statutes 2020, section 144.1205, subdivision 4, is amended to read:
Subd. 4.
new text begin Initial and renewal new text end application fee.
A licensee must pay an new text begin initial and a
renewal new text end application fee deleted text begin as follows:deleted text end new text begin according to this subdivision.
new text end
| TYPE |
APPLICATION FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$ 5,920
deleted text end
new text begin
$6,808 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Medical broad scope - type A |
deleted text begin
3,920
deleted text end
new text begin
$4,508 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$1,748 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
1,520 deleted text end |
||
| Teletherapy |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Gamma knife |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Veterinary medicine |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| In vitro testing lab |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Nuclear pharmacy |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Well logging - sealed sources |
deleted text begin
1,600
deleted text end
new text begin
$1,840 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
960 deleted text end |
||
| X-ray fluorescent analyzer |
deleted text begin
584
deleted text end
new text begin
$671 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
960 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
960 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin , B, and C broad scope new text end |
deleted text begin
5,920
deleted text end
new text begin
$6,854 new text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Manufacturing and distribution - other |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Nuclear laundry |
deleted text begin
10,080
deleted text end
new text begin
$11,592 new text end |
||
| Decontamination services |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Leak test services only |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
960 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
2,240
deleted text end
new text begin
$2,576 new text end |
||
| Waste disposal |
deleted text begin
1,520
deleted text end
new text begin
$1,748 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
880
deleted text end
new text begin
$1,012 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
520
deleted text end
new text begin
$598 new text end |
||
| Industrial radiography - fixed new text begin or temporary new text end location |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
2,640 deleted text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
1,440
deleted text end
new text begin
$1,656 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
2,960
deleted text end
new text begin
$3,404 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
1,440 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
4,960
deleted text end
new text begin
$5,704 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
| Research and development - other |
deleted text begin
2,400
deleted text end
new text begin
$2,760 new text end |
||
| Storage - no operations |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Source material - shielding |
deleted text begin
136
deleted text end
new text begin
$156 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
4,100
deleted text end
new text begin
$4,715 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$345 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
0 deleted text end |
||
|
deleted text begin
Industrial radiographer certification deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 31.
Minnesota Statutes 2020, section 144.1205, subdivision 8, is amended to read:
Subd. 8.
Reciprocity fee.
A licensee submitting an application for reciprocal recognition
of a materials license issued by another agreement state or the United States Nuclear
Regulatory Commission for a period of 180 days or less during a calendar year must pay
deleted text begin $1,200deleted text end new text begin $2,400new text end . For a period of 181 days or more, the licensee must obtain a license under
subdivision 4.
Sec. 32.
Minnesota Statutes 2020, section 144.1205, subdivision 9, is amended to read:
Subd. 9.
Fees for license amendments.
A licensee must pay a fee of deleted text begin $300deleted text end new text begin $600new text end to
amend a license as follows:
(1) to amend a license requiring review including, but not limited to, addition of isotopes,
procedure changes, new authorized users, or a new radiation safety officer; deleted text begin anddeleted text end new text begin or
new text end
(2) to amend a license requiring review and a site visit including, but not limited to,
facility move or addition of processes.
Sec. 33.
Minnesota Statutes 2020, section 144.1205, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Fees for general license registrations. new text end
new text begin
A person required to register generally
licensed devices according to Minnesota Rules, part 4731.3215, must pay an annual
registration fee of $450.
new text end
Sec. 34.
Minnesota Statutes 2020, section 144.125, subdivision 1, is amended to read:
Subdivision 1.
Duty to perform testing.
(a) It is the duty of (1) the administrative officer
or other person in charge of each institution caring for infants 28 days or less of age, (2) the
person required in pursuance of the provisions of section 144.215, to register the birth of a
child, or (3) the nurse midwife or midwife in attendance at the birth, to arrange to have
administered to every infant or child in its care tests for heritable and congenital disorders
according to subdivision 2 and rules prescribed by the state commissioner of health.
(b) Testing, recording of test results, reporting of test results, and follow-up of infants
with heritable congenital disorders, including hearing loss detected through the early hearing
detection and intervention program in section 144.966, shall be performed at the times and
in the manner prescribed by the commissioner of health.
(c) The fee to support the newborn screening program, including tests administered
under this section and section 144.966, shall be deleted text begin $135deleted text end new text begin $177new text end per specimen. This fee amount
shall be deposited in the state treasury and credited to the state government special revenue
fund.
(d) The fee to offset the cost of the support services provided under section 144.966,
subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
and credited to the general fund.
Sec. 35.
new text begin
[144.1461] DIGNITY IN PREGNANCY AND CHILDBIRTH.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This section may be cited as the "Dignity in Pregnancy and
Childbirth Act."
new text end
new text begin Subd. 2. new text end
new text begin Continuing education requirement. new text end
new text begin
(a) Hospitals with obstetric care and birth
centers must provide continuing education on anti-racism training and implicit bias. The
continuing education must be evidence-based and must include at a minimum the following
criteria:
new text end
new text begin
(1) education aimed at identifying personal, interpersonal, institutional, structural, and
cultural barriers to inclusion;
new text end
new text begin
(2) identifying and implementing corrective measures to promote anti-racism practices
and decrease implicit bias at the interpersonal and institutional levels, including the
institution's ongoing policies and practices;
new text end
new text begin
(3) providing information on the ongoing effects of historical and contemporary exclusion
and oppression of Black and Indigenous communities with the greatest health disparities
related to maternal and infant mortality and morbidity;
new text end
new text begin
(4) providing information and discussion of health disparities in the perinatal health care
field including how systemic racism and implicit bias have different impacts on health
outcomes for different racial and ethnic communities; and
new text end
new text begin
(5) soliciting perspectives of diverse, local constituency groups and experts on racial,
identity, cultural, and provider-community relationship issues.
new text end
new text begin
(b) In addition to the initial continuing educational requirement in paragraph (a), hospitals
with obstetric care and birth centers must provide an annual refresher course that reflects
current trends on race, culture, identity, and anti-racism principles and institutional implicit
bias.
new text end
new text begin
(c) Hospitals with obstetric care and birth centers must develop continuing education
materials on anti-racism and implicit bias that must be provided and updated annually for
direct care employees and contractors who routinely care for patients who are pregnant or
postpartum.
new text end
new text begin
(d) Hospitals with obstetric care and birth centers shall coordinate with health-related
licensing boards to obtain continuing education credits for the trainings and materials
required in this section. The commissioner of health shall monitor compliance with this
section. Initial training for the continuing education requirements in this subdivision must
be completed by December 31, 2022. The commissioner may inspect the training records
or require reports on the continuing education materials in this section from hospitals with
obstetric care and birth centers.
new text end
new text begin
(e) A facility described in paragraph (d) must provide a certificate of training completion
to another facility or a training attendee upon request. A facility may accept the training
certificate from another facility for a health care provider that works in more than one
facility.
new text end
new text begin Subd. 3. new text end
new text begin Midwife and doula care. new text end
new text begin
In order to improve maternal and infant health and
to improve birth outcomes in groups with the most significant disparities, including Black
communities, Indigenous communities, and other communities of color; rural communities;
and people with low incomes, the commissioner of health, in partnership with patient groups
and culturally based community organizations, shall:
new text end
new text begin
(1) develop procedures and services to increase the availability of midwife and doula
services to groups with the most significant disparities in maternal and infant morbidity and
mortality;
new text end
new text begin
(2) propose changes to midwife licensure to allow midwives with nationally recognized
credentials to practice to the full scope of their competencies and education;
new text end
new text begin
(3) promote racial, ethnic, and language diversity in the midwife and doula workforce
that better aligns with the childbearing populations in groups with the most significant
disparities in maternal and infant morbidity and mortality; and
new text end
new text begin
(4) ensure that midwife and doula training and licensure are culturally responsive to the
specific needs of groups with the most significant disparities in maternal and infant morbidity
and mortality, including training on providing trauma-informed care and training on maternal
mood disorders, intimate partner violence, and implicit bias and anti-racism.
new text end
Sec. 36.
Minnesota Statutes 2020, section 144.1481, subdivision 1, is amended to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 15-memberdeleted text end new text begin 16-membernew text end Rural Health Advisory Committee. The committee shall consist
of the following members, all of whom must reside outside the seven-county metropolitan
area, as defined in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) new text begin a dentist licensed under chapter 150A;
new text end
new text begin (8) new text end a midlevel practitioner;
deleted text begin (8)deleted text end new text begin (9)new text end a registered nurse or licensed practical nurse;
deleted text begin (9)deleted text end new text begin (10)new text end a licensed health care professional from an occupation not otherwise represented
on the committee;
deleted text begin (10)deleted text end new text begin (11)new text end a representative of an institution of higher education located outside the
seven-county metropolitan area that provides training for rural health care providers; and
deleted text begin (11)deleted text end new text begin (12)new text end three consumers, at least one of whom must be an advocate for persons who
are mentally ill or developmentally disabled.
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 37.
Minnesota Statutes 2020, section 144.1501, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
(b) "Advanced dental therapist" means an individual who is licensed as a dental therapist
under section 150A.06, and who is certified as an advanced dental therapist under section
150A.106.
new text begin
(c) "Alcohol and drug counselor" means an individual who is licensed as an alcohol and
drug counselor under chapter 148F.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.
deleted text begin (d)deleted text end new text begin (e)new text end "Dentist" means an individual who is licensed to practice dentistry.
deleted text begin (e)deleted text end new text begin (f)new text end "Designated rural area" means a statutory and home rule charter city or township
that is outside the seven-county metropolitan area as defined in section 473.121, subdivision
2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.
deleted text begin (f)deleted text end new text begin (g)new text end "Emergency circumstances" means those conditions that make it impossible for
the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.
deleted text begin (g)deleted text end new text begin (h)new text end "Mental health professional" means an individual providing clinical services in
the treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.
deleted text begin (h)deleted text end new text begin (i)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (i)deleted text end new text begin (j)new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse anesthetist,
advanced clinical nurse specialist, or physician assistant.
deleted text begin (j)deleted text end new text begin (k)new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.
deleted text begin (k)deleted text end new text begin (l)new text end "Nurse-midwife" means a registered nurse who has graduated from a program of
study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (l)deleted text end new text begin (m)new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.
deleted text begin (m)deleted text end new text begin (n)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (n)deleted text end new text begin (o)new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (o)deleted text end new text begin (p)new text end "Physician assistant" means a person licensed under chapter 147A.
deleted text begin (p)deleted text end new text begin (q)new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.
deleted text begin (q)deleted text end new text begin (r)new text end "Qualified educational loan" means a government, commercial, or foundation
loan for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
deleted text begin (r)deleted text end new text begin (s)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 38.
Minnesota Statutes 2020, section 144.1501, subdivision 2, is amended to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents deleted text begin anddeleted text end new text begin ,new text end mental health professionalsnew text begin , and alcohol and drug
counselorsnew text end agreeing to practice in designated rural areas or underserved urban communities
or specializing in the area of pediatric psychiatry;
(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;
(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; a hospital if the hospital owns and operates
a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse
is in the nursing home; a housing with services establishment as defined in section 144D.01,
subdivision 4; or for a home care provider as defined in section 144A.43, subdivision 4; or
agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a
postsecondary program at the undergraduate level or the equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;
(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas; and
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303.
(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.
Sec. 39.
Minnesota Statutes 2020, section 144.1501, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program, an
individual must:
(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, new text begin alcohol and drug counselor, new text end pharmacist, public health nurse, midlevel
practitioner, registered nurse, or a licensed practical nurse. The commissioner may also
consider applications submitted by graduates in eligible professions who are licensed and
in practice; and
(2) submit an application to the commissioner of health.
(b) An applicant selected to participate must sign a contract to agree to serve a minimum
three-year full-time service obligation according to subdivision 2, which shall begin no later
than March 31 following completion of required training, with the exception of a nurse,
who must agree to serve a minimum two-year full-time service obligation according to
subdivision 2, which shall begin no later than March 31 following completion of required
training.
Sec. 40.
Minnesota Statutes 2020, section 144.1911, subdivision 6, is amended to read:
Subd. 6.
International medical graduate primary care residency grant program
and revolving account.
(a) The commissioner shall award grants to support primary care
residency positions designated for Minnesota immigrant physicians who are willing to serve
in rural or underserved areas of the state. No grant shall exceed $150,000 per residency
position per year. Eligible primary care residency grant recipients include accredited family
medicine, new text begin general surgery, new text end internal medicine, obstetrics and gynecology, psychiatry, and
pediatric residency programs. Eligible primary care residency programs shall apply to the
commissioner. Applications must include the number of anticipated residents to be funded
using grant funds and a budget. Notwithstanding any law to the contrary, funds awarded to
grantees in a grant agreement do not lapse until the grant agreement expires. Before any
funds are distributed, a grant recipient shall provide the commissioner with the following:
(1) a copy of the signed contract between the primary care residency program and the
participating international medical graduate;
(2) certification that the participating international medical graduate has lived in
Minnesota for at least two years and is certified by the Educational Commission on Foreign
Medical Graduates. Residency programs may also require that participating international
medical graduates hold a Minnesota certificate of clinical readiness for residency, once the
certificates become available; and
(3) verification that the participating international medical graduate has executed a
participant agreement pursuant to paragraph (b).
(b) Upon acceptance by a participating residency program, international medical graduates
shall enter into an agreement with the commissioner to provide primary care for at least
five years in a rural or underserved area of Minnesota after graduating from the residency
program and make payments to the revolving international medical graduate residency
account for five years beginning in their second year of postresidency employment.
Participants shall pay $15,000 or ten percent of their annual compensation each year,
whichever is less.
(c) A revolving international medical graduate residency account is established as an
account in the special revenue fund in the state treasury. The commissioner of management
and budget shall credit to the account appropriations, payments, and transfers to the account.
Earnings, such as interest, dividends, and any other earnings arising from fund assets, must
be credited to the account. Funds in the account are appropriated annually to the
commissioner to award grants and administer the grant program established in paragraph
(a). Notwithstanding any law to the contrary, any funds deposited in the account do not
expire. The commissioner may accept contributions to the account from private sector
entities subject to the following provisions:
(1) the contributing entity may not specify the recipient or recipients of any grant issued
under this subdivision;
(2) the commissioner shall make public the identity of any private contributor to the
account, as well as the amount of the contribution provided; and
(3) a contributing entity may not specify that the recipient or recipients of any funds use
specific products or services, nor may the contributing entity imply that a contribution is
an endorsement of any specific product or service.
Sec. 41.
Minnesota Statutes 2020, section 144.212, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Homeless youth. new text end
new text begin
"Homeless youth" has the meaning given in section 256K.45,
subdivision 1a.
new text end
Sec. 42.
Minnesota Statutes 2020, section 144.225, subdivision 2, is amended to read:
Subd. 2.
Data about births.
(a) Except as otherwise provided in this subdivision, data
pertaining to the birth of a child to a woman who was not married to the child's father when
the child was conceived nor when the child was born, including the original record of birth
and the certified vital record, are confidential data. At the time of the birth of a child to a
woman who was not married to the child's father when the child was conceived nor when
the child was born, the mother may designate demographic data pertaining to the birth as
public. Notwithstanding the designation of the data as confidential, it may be disclosed:
(1) to a parent or guardian of the child;
(2) to the child when the child is 16 years of age or oldernew text begin , except as provided in clause
(3)new text end ;
new text begin
(3) to the child if the child is a homeless youth;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end under paragraph (b), (e), deleted text begin ordeleted text end (f)new text begin , or (g)new text end ; or
deleted text begin (4)deleted text end new text begin (5)new text end pursuant to a court order. For purposes of this section, a subpoena does not
constitute a court order.
(b) Unless the child is adopted, data pertaining to the birth of a child that are not accessible
to the public become public data if 100 years have elapsed since the birth of the child who
is the subject of the data, or as provided under section 13.10, whichever occurs first.
(c) If a child is adopted, data pertaining to the child's birth are governed by the provisions
relating to adoption records, including sections 13.10, subdivision 5; 144.218, subdivision
1; 144.2252; and 259.89.
(d) The name and address of a mother under paragraph (a) and the child's date of birth
may be disclosed to the county social services, tribal health department, or public health
member of a family services collaborative for purposes of providing services under section
124D.23.
(e) The commissioner of human services shall have access to birth records for:
(1) the purposes of administering medical assistance and the MinnesotaCare program;
(2) child support enforcement purposes; and
(3) other public health purposes as determined by the commissioner of health.
(f) Tribal child support programs shall have access to birth records for child support
enforcement purposes.
new text begin
(g) An entity administering a children's savings program that starts at birth shall have
access to birth records for the purpose of opening an account in the program for the child
as a beneficiary. For purposes of this paragraph, "children's savings program" means a
long-term savings or investment program that helps children and their families build savings
for the future.
new text end
Sec. 43.
Minnesota Statutes 2020, section 144.225, subdivision 7, is amended to read:
Subd. 7.
Certified birth or death record.
(a) The state registrar or local issuance office
shall issue a certified birth or death record or a statement of no vital record found to an
individual upon the individual's proper completion of an attestation provided by the
commissioner andnew text begin , except as provided in section 144.2255,new text end payment of the required fee:
(1) to a person who deleted text begin has a tangible interest in the requested vital record. A person who
has a tangible interestdeleted text end is:
(i) the subject of the vital record;
(ii) a child of the subject;
(iii) the spouse of the subject;
(iv) a parent of the subject;
(v) the grandparent or grandchild of the subject;
(vi) if the requested record is a death record, a sibling of the subject;
deleted text begin
(vii) the party responsible for filing the vital record;
deleted text end
deleted text begin (viii)deleted text end new text begin (vii)new text end the legal custodian, guardian or conservator, or health care agent of the subject;
deleted text begin (ix)deleted text end new text begin (viii)new text end a personal representative, by sworn affidavit of the fact that the certified copy
is required for administration of the estate;
deleted text begin (x)deleted text end new text begin (ix)new text end a successor of the subject, as defined in section 524.1-201, if the subject is
deceased, by sworn affidavit of the fact that the certified copy is required for administration
of the estate;
deleted text begin (xi)deleted text end new text begin (x)new text end if the requested record is a death record, a trustee of a trust by sworn affidavit
of the fact that the certified copy is needed for the proper administration of the trust;
deleted text begin (xii)deleted text end new text begin (xi)new text end a person or entity who demonstrates that a certified vital record is necessary
for the determination or protection of a personal or property right, pursuant to rules adopted
by the commissioner; or
deleted text begin (xiii)deleted text end new text begin (xii)new text end an adoption agency in order to complete confidential postadoption searches
as required by section 259.83;
(2) to any local, state, tribal, or federal governmental agency upon request if the certified
vital record is necessary for the governmental agency to perform its authorized duties;
(3) to an attorney new text begin representing the subject of the vital record or another person listed in
clause (1), new text end upon evidence of the attorney's license;
(4) pursuant to a court order issued by a court of competent jurisdiction. For purposes
of this section, a subpoena does not constitute a court order; or
(5) to a representative authorized by a person under clauses (1) to (4).
(b) The state registrar or local issuance office shall also issue a certified death record to
an individual described in paragraph (a), clause (1), items (ii) to deleted text begin (viii)deleted text end new text begin (xi)new text end , if, on behalf of
the individual, a licensed mortician furnishes the registrar with a properly completed
attestation in the form provided by the commissioner within 180 days of the time of death
of the subject of the death record. This paragraph is not subject to the requirements specified
in Minnesota Rules, part 4601.2600, subpart 5, item B.
Sec. 44.
new text begin
[144.2255] CERTIFIED BIRTH RECORD FOR HOMELESS YOUTH.
new text end
new text begin Subdivision 1. new text end
new text begin Application; certified birth record. new text end
new text begin
A subject of a birth record who is
a homeless youth in Minnesota or another state may apply to the state registrar or a local
issuance office for a certified birth record according to this section. The state registrar or
local issuance office shall issue a certified birth record or statement of no vital record found
to a subject of a birth record who submits:
new text end
new text begin
(1) a completed application signed by the subject of the birth record;
new text end
new text begin
(2) a statement that the subject of the birth record is a homeless youth, signed by the
subject of the birth record; and
new text end
new text begin
(3) one of the following:
new text end
new text begin
(i) a document of identity listed in Minnesota Rules, part 4601.2600, subpart 8, or, at
the discretion of the state registrar or local issuance office, Minnesota Rules, part 4601.2600,
subpart 9;
new text end
new text begin
(ii) a statement that complies with Minnesota Rules, part 4601.2600, subparts 6 and 7;
or
new text end
new text begin
(iii) a statement verifying that the subject of the birth record is a homeless youth that
complies with the requirements in subdivision 2 and is from an employee of a human services
agency that receives public funding to provide services to homeless youth, runaway youth,
youth with mental illness, or youth with substance use disorders; a school staff person who
provides services to homeless youth; or a school social worker.
new text end
new text begin Subd. 2. new text end
new text begin Statement verifying subject is a homeless youth. new text end
new text begin
A statement verifying that
a subject of a birth record is a homeless youth must include:
new text end
new text begin
(1) the following information regarding the individual providing the statement: first
name, middle name, if any, and last name; home or business address; telephone number, if
any; and e-mail address, if any;
new text end
new text begin
(2) the first name, middle name, if any, and last name of the subject of the birth record;
and
new text end
new text begin
(3) a statement specifying the relationship of the individual providing the statement to
the subject of the birth record and verifying that the subject of the birth record is a homeless
youth.
new text end
new text begin
The individual providing the statement must also provide a copy of the individual's
employment identification.
new text end
new text begin Subd. 3. new text end
new text begin Expiration; reissuance. new text end
new text begin
If a subject of a birth record obtains a certified birth
record under this section using the statement specified in subdivision 1, clause (3), item
(iii), the certified birth record issued shall expire six months after the date of issuance. Upon
expiration of the certified birth record, the subject of the birth record may surrender the
expired birth record to the state registrar or a local issuance office and obtain another birth
record. Each certified birth record obtained under this subdivision shall expire six months
after the date of issuance. If the subject of the birth record does not surrender the expired
birth record, the subject may apply for a certified birth record using the process in subdivision
1.
new text end
new text begin Subd. 4. new text end
new text begin Fees waived. new text end
new text begin
The state registrar or local issuance office shall not charge any
fee for issuance of a certified birth record or statement of no vital record found under this
section.
new text end
new text begin Subd. 5. new text end
new text begin Data practices. new text end
new text begin
Data listed under subdivision 1, clauses (2) and (3), item (iii),
are private data on individuals.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment for
applications for and the issuance of certified birth records on or after January 1, 2022.
new text end
Sec. 45.
Minnesota Statutes 2020, section 144.226, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Transaction fees. new text end
new text begin
The state registrar may charge and permit agents to charge
a convenience fee and a transaction fee for electronic transactions and transactions by
telephone or Internet, as well as the fees established under subdivisions 1 to 4. The
convenience fee may not exceed three percent of the cost of the charges for payment. The
state registrar may permit agents to charge and retain a transaction fee as payment agreed
upon under contract. When an electronic convenience fee or transaction fee is charged, the
agent charging the fee is required to post information on their web page informing individuals
of the fee. The information must be near the point of payment, clearly visible, include the
amount of the fee, and state: "This contracted agent is allowed by state law to charge a
convenience fee and transaction fee for this electronic transaction."
new text end
Sec. 46.
Minnesota Statutes 2020, section 144.226, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Birth record fees waived for homeless youth. new text end
new text begin
A subject of a birth record who
is a homeless youth shall not be charged any of the fees specified in this section for a certified
birth record or statement of no vital record found under section 144.2255.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment for
applications for and the issuance of certified birth records on or after January 1, 2022.
new text end
Sec. 47.
Minnesota Statutes 2020, section 144.55, subdivision 4, is amended to read:
Subd. 4.
Routine inspections; presumption.
Any hospital surveyed and accredited
under the standards of the hospital accreditation program of an approved accrediting
organization that submits to the commissioner within a reasonable time copies of (a) its
currently valid accreditation certificate and accreditation letter, together with accompanying
recommendations and comments and (b) any further recommendations, progress reports
and correspondence directly related to the accreditation is presumed to comply with
application requirements of subdivision 1 and the standards requirements of subdivision 3
and no further routine inspections or accreditation information shall be required by the
commissioner to determine compliance. Notwithstanding the provisions of sections 144.54
and 144.653, subdivisions 2 and 4, hospitals shall be inspected only as provided in this
section. The provisions of section 144.653 relating to the assessment and collection of fines
shall not apply to any hospital. The commissioner of health shall annually conduct, with
notice, validation inspections of a selected sample of the number of hospitals accredited by
an approved accrediting organization, not to exceed ten percent of accredited hospitals, for
the purpose of determining compliance with the provisions of subdivision 3. If a validation
survey discloses a failure to comply with subdivision 3, the provisions of section 144.653
relating to correction orders, reinspections, and notices of noncompliance shall apply. The
commissioner shall also conduct any inspection necessary to determine whether hospital
construction, addition, or remodeling projects comply with standards for construction
promulgated in rules pursuant to subdivision 3. new text begin The commissioner shall also conduct any
inspections necessary to determine whether a hospital or hospital corporate system continues
to satisfy the conditions on which a hospital construction moratorium exception was granted
under section 144.551. new text end Pursuant to section 144.653, the commissioner shall inspect any
hospital that does not have a currently valid hospital accreditation certificate from an
approved accrediting organization. Nothing in this subdivision shall be construed to limit
the investigative powers of the Office of Health Facility Complaints as established in sections
144A.51 to 144A.54.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 48.
Minnesota Statutes 2020, section 144.55, subdivision 6, is amended to read:
Subd. 6.
Suspension, revocation, and refusal to renew.
(a) The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the following grounds:
(1) violation of any of the provisions of sections 144.50 to 144.56 or the rules or standards
issued pursuant thereto, or Minnesota Rules, chapters 4650 and 4675;
(2) permitting, aiding, or abetting the commission of any illegal act in the institution;
(3) conduct or practices detrimental to the welfare of the patient; or
(4) obtaining or attempting to obtain a license by fraud or misrepresentation; or
(5) with respect to hospitals and outpatient surgical centers, if the commissioner
determines that there is a pattern of conduct that one or more physicians or advanced practice
registered nurses who have a "financial or economic interest," as defined in section 144.6521,
subdivision 3, in the hospital or outpatient surgical center, have not provided the notice and
disclosure of the financial or economic interest required by section 144.6521.
(b) The commissioner shall not renew a license for a boarding care bed in a resident
room with more than four beds.
new text begin
(c) The commissioner shall not renew licenses for hospital beds issued to a hospital or
hospital corporate system pursuant to a hospital construction moratorium exception under
section 144.551 if the commissioner determines the hospital or hospital corporate system
is not satisfying the conditions on which the exception was granted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment for
license renewals occurring on or after that date.
new text end
Sec. 49.
Minnesota Statutes 2020, section 144.551, subdivision 1, is amended to read:
Subdivision 1.
Restricted construction or modification.
(a) The following construction
or modification may not be commenced:
(1) any erection, building, alteration, reconstruction, modernization, improvement,
extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
to another, or otherwise results in an increase or redistribution of hospital beds within the
state; and
(2) the establishment of a new hospital.
(b) This section does not apply to:
(1) construction or relocation within a county by a hospital, clinic, or other health care
facility that is a national referral center engaged in substantial programs of patient care,
medical research, and medical education meeting state and national needs that receives more
than 40 percent of its patients from outside the state of Minnesota;
(2) a project for construction or modification for which a health care facility held an
approved certificate of need on May 1, 1984, regardless of the date of expiration of the
certificate;
(3) a project for which a certificate of need was denied before July 1, 1990, if a timely
appeal results in an order reversing the denial;
(4) a project exempted from certificate of need requirements by Laws 1981, chapter 200,
section 2;
(5) a project involving consolidation of pediatric specialty hospital services within the
Minneapolis-St. Paul metropolitan area that would not result in a net increase in the number
of pediatric specialty hospital beds among the hospitals being consolidated;
(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds to
an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
the number of hospital beds. Upon completion of the reconstruction, the licenses of both
hospitals must be reinstated at the capacity that existed on each site before the relocation;
(7) the relocation or redistribution of hospital beds within a hospital building or
identifiable complex of buildings provided the relocation or redistribution does not result
in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds from
one physical site or complex to another; or (iii) redistribution of hospital beds within the
state or a region of the state;
(8) relocation or redistribution of hospital beds within a hospital corporate system that
involves the transfer of beds from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the capacity of the closed facility is
transferred; (ii) the capacity of the site or complex to which the beds are transferred does
not increase by more than 50 percent; (iii) the beds are not transferred outside of a federal
health systems agency boundary in place on July 1, 1983; deleted text begin anddeleted text end (iv) the relocation or
redistribution does not involve the construction of a new hospital buildingnew text begin ; and (v) the
transferred beds are used first to replace within the hospital corporate system the total number
of beds previously used in the closed facility site or complex for mental health services and
substance use disorder services. Only after the hospital corporate system has fulfilled the
requirements of this item may the remainder of the available capacity of the closed facility
site or complex be transferred for any other purposenew text end ;
(9) a construction project involving up to 35 new beds in a psychiatric hospital in Rice
County that primarily serves adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;
(10) a project to replace a hospital or hospitals with a combined licensed capacity of
130 beds or less if: (i) the new hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement hospital, either at the time of
construction of the initial building or as the result of future expansion, will not exceed 70
licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;
(11) the relocation of licensed hospital beds from an existing state facility operated by
the commissioner of human services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one regional treatment center site
to another; or from one building or site to a new or existing building or site on the same
campus;
(12) the construction or relocation of hospital beds operated by a hospital having a
statutory obligation to provide hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;
(13) a construction project involving the addition of up to 31 new beds in an existing
nonfederal hospital in Beltrami County;
(14) a construction project involving the addition of up to eight new beds in an existing
nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
(15) a construction project involving the addition of 20 new hospital beds in an existing
hospital in Carver County serving the southwest suburban metropolitan area;
(16) a project for the construction or relocation of up to 20 hospital beds for the operation
of up to two psychiatric facilities or units for children provided that the operation of the
facilities or units have received the approval of the commissioner of human services;
(17) a project involving the addition of 14 new hospital beds to be used for rehabilitation
services in an existing hospital in Itasca County;
(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin County
that closed 20 rehabilitation beds in 2002, provided that the beds are used only for
rehabilitation in the hospital's current rehabilitation building. If the beds are used for another
purpose or moved to another location, the hospital's licensed capacity is reduced by 20 beds;
(19) a critical access hospital established under section 144.1483, clause (9), and section
1820 of the federal Social Security Act, United States Code, title 42, section 1395i-4, that
delicensed beds since enactment of the Balanced Budget Act of 1997, Public Law 105-33,
to the extent that the critical access hospital does not seek to exceed the maximum number
of beds permitted such hospital under federal law;
(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
(i) the project, including each hospital or health system that will own or control the entity
that will hold the new hospital license, is approved by a resolution of the Maple Grove City
Council as of March 1, 2006;
(ii) the entity that will hold the new hospital license will be owned or controlled by one
or more not-for-profit hospitals or health systems that have previously submitted a plan or
plans for a project in Maple Grove as required under section 144.552, and the plan or plans
have been found to be in the public interest by the commissioner of health as of April 1,
2005;
(iii) the new hospital's initial inpatient services must include, but are not limited to,
medical and surgical services, obstetrical and gynecological services, intensive care services,
orthopedic services, pediatric services, noninvasive cardiac diagnostics, behavioral health
services, and emergency room services;
(iv) the new hospital:
(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold the
new hospital license;
(B) will provide uncompensated care;
(C) will provide mental health services, including inpatient beds;
(D) will be a site for workforce development for a broad spectrum of health-care-related
occupations and have a commitment to providing clinical training programs for physicians
and other health care providers;
(E) will demonstrate a commitment to quality care and patient safety;
(F) will have an electronic medical records system, including physician order entry;
(G) will provide a broad range of senior services;
(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to enhance
the continuity of care for emergency medical patients; and
(I) will be completed by December 31, 2009, unless delayed by circumstances beyond
the control of the entity holding the new hospital license; and
(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;
(21) a project approved under section 144.553;
(22) a project for the construction of a hospital with up to 25 beds in Cass County within
a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's license holder
is approved by the Cass County Board;
(23) a project for an acute care hospital in Fergus Falls that will increase the bed capacity
from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 and closing
a separately licensed 13-bed skilled nursing facility;
(24) notwithstanding section 144.552, a project for the construction and expansion of a
specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for patients
who are under 21 years of age on the date of admission. The commissioner conducted a
public interest review of the mental health needs of Minnesota and the Twin Cities
metropolitan area in 2008. No further public interest review shall be conducted for the
construction or expansion project under this clause;
(25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if the
commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete;
(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;
(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and
(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review;
(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission; deleted text begin or
deleted text end
(28) a project to add 55 licensed beds in an existing safety net, level I trauma center
hospital in Ramsey County as designated under section 383A.91, subdivision 5, of which
15 beds are to be used for inpatient mental health and 40 are to be used for other services.
In addition, five unlicensed observation mental health beds shall be addeddeleted text begin .deleted text end new text begin ;
new text end
new text begin
(29) notwithstanding section 144.552, a project to add 45 licensed beds in an existing
safety net, level I trauma center hospital in Ramsey County as designated under section
383A.91, subdivision 5. The commissioner conducted a public interest review of the
construction and expansion of this hospital in 2018. No further public interest review shall
be conducted for the project under this clause; or
new text end
new text begin
(30) the addition of licensed beds in a hospital or hospital corporate system to primarily
provide mental health services or substance use disorder services. In order to add beds under
this clause, a hospital must have an emergency department and must not be a hospital that
solely provides treatment to adults for mental illnesses or substance use disorders. Beds
added under this clause must be available to serve medical assistance and MinnesotaCare
enrollees. Notwithstanding section 144.552, public interest review shall not be required for
an addition of beds under this clause.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
(a) Paragraph (b), clause (29), is effective the day following final
enactment, contingent upon:
new text end
new text begin
(1) the addition of the 15 inpatient mental health beds specified in paragraph (b), clause
(28), to the Ramsey County level I trauma center's bed capacity;
new text end
new text begin
(2) five of the 45 additional beds authorized in paragraph (b), clause (29), being
designated for use for inpatient mental health and added to the hospital's bed capacity before
the remaining 40 beds authorized under that clause are added; and
new text end
new text begin
(3) the Ramsey County level I trauma center's agreement to not participate in the Revenue
Recapture Act under Minnesota Statutes, chapter 270, and Minnesota Statutes, section
270C.41.
new text end
new text begin
(b) The amendment to paragraph (b), clause (8), and paragraph (b), clause (30), are
effective the day following final enactment.
new text end
Sec. 50.
Minnesota Statutes 2020, section 144.551, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Monitoring. new text end
new text begin
The commissioner shall monitor the implementation of exceptions
under this section. Each hospital or hospital corporate system granted an exception under
this section shall submit to the commissioner each year a report on how the hospital or
hospital corporate system continues to satisfy the conditions on which the exception was
granted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51.
Minnesota Statutes 2020, section 144.555, is amended to read:
144.555 deleted text begin HOSPITALdeleted text end new text begin FACILITY OR CAMPUSnew text end CLOSINGSnew text begin , RELOCATING
SERVICES, OR CEASING TO OFFER CERTAIN SERVICESnew text end ; PATIENT
RELOCATIONS.
Subdivision 1.
Notice of closing or curtailing deleted text begin servicedeleted text end new text begin operations; facilities other than
hospitalsnew text end .
If a facility licensed under sections 144.50 to 144.56new text begin , other than a hospital,new text end
voluntarily plans to cease operations or to curtail operations to the extent that patients or
residents must be relocated, the controlling persons of the facility must notify the
commissioner of health at least 90 days before the scheduled cessation or curtailment. The
commissioner shall cooperate with the controlling persons and advise them about relocating
the patients or residents.
new text begin Subd. 1a. new text end
new text begin
Notice of closing, curtailing operations, relocating services, or ceasing to
offer certain services; hospitals.
new text end
new text begin
(a) The controlling persons of a hospital licensed under
sections 144.50 to 144.56 or a hospital campus must notify the commissioner of health at
least nine months before a scheduled action if the hospital or hospital campus voluntarily
plans to:
new text end
new text begin
(1) cease operations;
new text end
new text begin
(2) curtail operations to the extent that patients must be relocated;
new text end
new text begin
(3) relocate the provision of health services to another hospital or another hospital
campus; or
new text end
new text begin
(4) cease offering maternity care and newborn care services, intensive care unit services,
inpatient mental health services, or inpatient substance use disorder treatment services.
new text end
new text begin
(b) The commissioner shall cooperate with the controlling persons and advise them
about relocating the patients. The controlling persons of the hospital or hospital campus
must comply with section 144.556.
new text end
new text begin Subd. 1b. new text end
new text begin Public hearing. new text end
new text begin
Upon receiving notice under subdivision 1a, the commissioner
shall conduct a public hearing on the scheduled cessation of operations, curtailment of
operations, relocation of health services, or cessation in offering health services. The
commissioner must provide adequate public notice of the hearing in a time and manner
determined by the commissioner. The public hearing must be held in the community where
the hospital or hospital campus is located at least six months before the scheduled cessation
or curtailment of operations, relocation of health services, or cessation in offering health
services. The controlling persons of the hospital or hospital campus must participate in the
public hearing. The public hearing must include:
new text end
new text begin
(1) an explanation by the controlling persons of the reasons for ceasing or curtailing
operations, relocating health services, or ceasing to offer any of the listed health services;
new text end
new text begin
(2) a description of the actions that controlling persons will take to ensure that residents
in the hospital's or campus's service area have continued access to the health services being
eliminated, curtailed, or relocated;
new text end
new text begin
(3) an opportunity for public testimony on the scheduled cessation or curtailment of
operations, relocation of health services, or cessation in offering any of the listed health
services, and on the hospital's or campus's plan to ensure continued access to those health
services being eliminated, curtailed, or relocated; and
new text end
new text begin
(4) an opportunity for the controlling persons to respond to questions from interested
persons.
new text end
Subd. 2.
Penalty.
Failure to notify the commissioner under subdivision 1 new text begin or 1a or failure
to participate in a public hearing under subdivision 1b new text end may result in issuance of a correction
order under section 144.653, subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 52.
new text begin
[144.556] RIGHT OF FIRST REFUSAL FOR HOSPITAL OR HOSPITAL
CAMPUS.
new text end
new text begin Subdivision 1. new text end
new text begin
Prerequisite before sale, conveyance, or ceasing operations of hospital
or hospital campus.
new text end
new text begin
The controlling persons of a hospital licensed under sections 144.50
to 144.56 shall not sell or convey the hospital or a campus of the hospital, offer to sell or
convey the hospital or hospital campus, or voluntarily cease operations of the hospital or
hospital campus unless the controlling persons have first made a good faith offer to sell or
convey the hospital or hospital campus to the home rule charter or statutory city, county,
town, or hospital district in which the hospital or hospital campus is located.
new text end
new text begin Subd. 2. new text end
new text begin Offer. new text end
new text begin
The offer to sell or convey the hospital or hospital campus must be at a
price that does not exceed the current fair market value of the hospital or hospital campus.
A party to whom an offer is made under subdivision 1 must accept or decline the offer
within 60 days after receipt. If the party fails to respond within 60 days after receipt, the
offer is deemed declined.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 53.
Minnesota Statutes 2020, section 144.9501, subdivision 17, is amended to read:
Subd. 17.
Lead hazard reduction.
"Lead hazard reduction" means abatement or interim
controls undertaken to make a residence, child care facility, school, deleted text begin ordeleted text end playgroundnew text begin , or other
location where lead hazards are identifiednew text end lead-safe by complying with the lead standards
and methods adopted under section 144.9508.
Sec. 54.
Minnesota Statutes 2020, section 144.9502, subdivision 3, is amended to read:
Subd. 3.
Reports of blood lead analysis required.
(a) Every hospital, medical clinic,
medical laboratory, other facility, or individual performing blood lead analysis shall report
the results after the analysis of each specimen analyzed, for both capillary and venous
specimens, and epidemiologic information required in this section to the commissioner of
health, within the time frames set forth in clauses (1) and (2):
(1) within two working days by telephone, fax, or electronic transmissionnew text begin as prescribed
by the commissionernew text end , with written or electronic confirmation within one monthnew text begin as prescribed
by the commissionernew text end , for a venous blood lead level equal to or greater than 15 micrograms
of lead per deciliter of whole blood; or
(2) within one month in writing or by electronic transmissionnew text begin as prescribed by the
commissionernew text end , for any capillary result or for a venous blood lead level less than 15
micrograms of lead per deciliter of whole blood.
(b) If a blood lead analysis is performed outside of Minnesota and the facility performing
the analysis does not report the blood lead analysis results and epidemiological information
required in this section to the commissioner, the provider who collected the blood specimen
must satisfy the reporting requirements of this section. For purposes of this section, "provider"
has the meaning given in section 62D.02, subdivision 9.
(c) The commissioner shall coordinate with hospitals, medical clinics, medical
laboratories, and other facilities performing blood lead analysis to develop a universal
reporting form and mechanism.
Sec. 55.
Minnesota Statutes 2020, section 144.9504, subdivision 2, is amended to read:
Subd. 2.
Lead risk assessment.
(a) new text begin Notwithstanding section 144.9501, subdivision 6a,
for purposes of this subdivision, "child" means an individual under 18 years of age.
new text end
new text begin (b) new text end An assessing agency shall conduct a lead risk assessment of a residencenew text begin , residential
or commercial child care facility, playground, school, or other location where lead hazards
are suspectednew text end according to the venous blood lead level and time frame set forth in clauses
(1) to (4) for purposes of secondary prevention:
(1) within 48 hours of a child or pregnant female in the residencenew text begin , residential or
commercial child care facility, playground, school, or other location where lead hazards are
suspectednew text end being identified to the agency as having a venous blood lead level equal to or
greater than 60 micrograms of lead per deciliter of whole blood;
(2) within five working days of a child or pregnant female in the residencenew text begin , residential
or commercial child care facility, playground, school, or other location where lead hazards
are suspectednew text end being identified to the agency as having a venous blood lead level equal to
or greater than 45 micrograms of lead per deciliter of whole blood;
deleted text begin
(3) within ten working days of a child in the residence being identified to the agency as
having a venous blood lead level equal to or greater than 15 micrograms of lead per deciliter
of whole blood; or
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end within ten working days of a new text begin child or new text end pregnant female in the residencenew text begin , residential
or commercial child care facility, playground, school, or other location where lead hazards
are suspectednew text end being identified to the agency as having a venous blood lead level equal to
or greater than ten micrograms of lead per deciliter of whole blooddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(4) within 20 working days of a child or pregnant female in the residence, residential or
commercial child care facility, playground, school, or other location where lead hazards are
suspected being identified to the agency as having a venous blood lead level equal to or
greater than five micrograms per deciliter of whole blood.
new text end
new text begin
An assessing agency may refer investigations at sites other than the child's or pregnant
female's residence to the commissioner.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end Within the limits of available local, state, and federal appropriations, an assessing
agency may also conduct a lead risk assessment for children with any elevated blood lead
level.
deleted text begin (c)deleted text end new text begin (d)new text end In a building with two or more dwelling units, an assessing agency shall assess
the individual unit in which the conditions of this section are met and shall inspect all
common areas accessible to a child. If a child visits one or more other sites such as another
residence, or a residential or commercial child care facility, playground, or school, the
assessing agency shall also inspect the other sites. The assessing agency shall have one
additional day added to the time frame set forth in this subdivision to complete the lead risk
assessment for each additional site.
deleted text begin (d)deleted text end new text begin (e)new text end Within the limits of appropriations, the assessing agency shall identify the known
addresses for the previous 12 months of the child or pregnant female with venous blood
lead levels of at least 15 micrograms per deciliter for the child or at least ten micrograms
per deciliter for the pregnant female; notify the property owners, landlords, and tenants at
those addresses that an elevated blood lead level was found in a person who resided at the
property; and give them primary prevention information. Within the limits of appropriations,
the assessing agency may perform a risk assessment and issue corrective orders in the
properties, if it is likely that the previous address contributed to the child's or pregnant
female's blood lead level. The assessing agency shall provide the notice required by this
subdivision without identifying the child or pregnant female with the elevated blood lead
level. The assessing agency is not required to obtain the consent of the child's parent or
guardian or the consent of the pregnant female for purposes of this subdivision. This
information shall be classified as private data on individuals as defined under section 13.02,
subdivision 12.
deleted text begin (e)deleted text end new text begin (f)new text end The assessing agency shall conduct the lead risk assessment according to rules
adopted by the commissioner under section 144.9508. An assessing agency shall have lead
risk assessments performed by lead risk assessors licensed by the commissioner according
to rules adopted under section 144.9508. If a property owner refuses to allow a lead risk
assessment, the assessing agency shall begin legal proceedings to gain entry to the property
and the time frame for conducting a lead risk assessment set forth in this subdivision no
longer applies. A lead risk assessor or assessing agency may observe the performance of
lead hazard reduction in progress and shall enforce the provisions of this section under
section 144.9509. Deteriorated painted surfaces, bare soil, and dust must be tested with
appropriate analytical equipment to determine the lead content, except that deteriorated
painted surfaces or bare soil need not be tested if the property owner agrees to engage in
lead hazard reduction on those surfaces. The lead content of drinking water must be measured
if another probable source of lead exposure is not identified. Within a standard metropolitan
statistical area, an assessing agency may order lead hazard reduction of bare soil without
measuring the lead content of the bare soil if the property is in a census tract in which soil
sampling has been performed according to rules established by the commissioner and at
least 25 percent of the soil samples contain lead concentrations above the standard in section
144.9508.
deleted text begin (f)deleted text end new text begin (g)new text end Each assessing agency shall establish an administrative appeal procedure which
allows a property owner to contest the nature and conditions of any lead order issued by
the assessing agency. Assessing agencies must consider appeals that propose lower cost
methods that make the residence lead safe. The commissioner shall use the authority and
appeal procedure granted under sections 144.989 to 144.993.
deleted text begin (g)deleted text end new text begin (h)new text end Sections 144.9501 to 144.9512 neither authorize nor prohibit an assessing agency
from charging a property owner for the cost of a lead risk assessment.
Sec. 56.
Minnesota Statutes 2020, section 144.9504, subdivision 5, is amended to read:
Subd. 5.
Lead orders.
(a) An assessing agency, after conducting a lead risk assessment,
shall order a property owner to perform lead hazard reduction on all lead sources that exceed
a standard adopted according to section 144.9508. If lead risk assessments and lead orders
are conducted at times when weather or soil conditions do not permit the lead risk assessment
or lead hazard reduction, external surfaces and soil lead shall be assessed, and lead orders
complied with, if necessary, at the first opportunity that weather and soil conditions allow.
new text begin
(b) If, after conducting a lead risk assessment, an assessing agency determines that the
property owner's lead hazard originated from another source location, the assessing agency
may order the responsible person of the source location to:
new text end
new text begin
(1) perform lead hazard reduction at the site where the assessing agency conducted the
lead risk assessment; and
new text end
new text begin
(2) remediate the conditions at the source location that allowed the lead hazard, pollutant,
or contaminant to migrate from the source location.
new text end
new text begin
(c) For purposes of this subdivision, "pollutant or contaminant" has the meaning given
in section 115B.02, subdivision 13, and "responsible person" has the meaning given in
section 115B.03.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end If the paint standard under section 144.9508 is violated, but the paint is intact,
the assessing agency shall not order the paint to be removed unless the intact paint is a
known source of actual lead exposure to a specific person. Before the assessing agency may
order the intact paint to be removed, a reasonable effort must be made to protect the child
and preserve the intact paint by the use of guards or other protective devices and methods.
deleted text begin (c)deleted text end new text begin (e)new text end Whenever windows and doors or other components covered with deteriorated
lead-based paint have sound substrate or are not rotting, those components should be repaired,
sent out for stripping or planed down to remove deteriorated lead-based paint, or covered
with protective guards instead of being replaced, provided that such an activity is the least
cost method. However, a property owner who has been ordered to perform lead hazard
reduction may choose any method to address deteriorated lead-based paint on windows,
doors, or other components, provided that the method is approved in rules adopted under
section 144.9508 and that it is appropriate to the specific property.
deleted text begin (d)deleted text end new text begin (f)new text end Lead orders must require that any source of damage, such as leaking roofs,
plumbing, and windows, be repaired or replaced, as needed, to prevent damage to
lead-containing interior surfaces.
deleted text begin (e)deleted text end new text begin (g)new text end The assessing agency is not required to pay for lead hazard reduction. The
assessing agency shall enforce the lead orders issued to a property owner under this section.
Sec. 57.
Minnesota Statutes 2020, section 144G.08, subdivision 7, as amended by Laws
2020, Seventh Special Session chapter 1, article 6, section 5, is amended to read:
Subd. 7.
Assisted living facility.
"Assisted living facility" means deleted text begin a facility thatdeleted text end new text begin an
establishment where an operating person or legal entity, either directly or through contract,
business relationship, or common ownership with another person or entity,new text end provides sleeping
accommodations and assisted living services to one or more adultsnew text begin in the facilitynew text end . Assisted
living facility includes assisted living facility with dementia care, and does not include:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D or 245G;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) a private home in which the residents are related by kinship, law, or affinity with the
provider of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593;
(9) a setting offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011;
deleted text begin (14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b);deleted text end or
deleted text begin (15)deleted text end new text begin (14)new text end any establishment that exclusively or primarily serves as a shelter or temporary
shelter for victims of domestic or any other form of violence.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 58.
Minnesota Statutes 2020, section 144G.54, subdivision 3, is amended to read:
Subd. 3.
Appeals process.
(a) The Office of Administrative Hearings must conduct an
expedited hearing new text begin using the procedures in Minnesota Rules, parts 1400.8505 to 1400.8612,
new text end as soon as practicable under this section, but in no event later than 14 calendar days after
the office receives the request, unless the parties agree otherwise or the chief administrative
law judge deems the timing to be unreasonable, given the complexity of the issues presented.
(b) The hearing must be held at the facility where the resident lives, unless holding the
hearing at that location is impractical, the parties agree to hold the hearing at a different
location, or the chief administrative law judge grants a party's request to appear at another
location or by telephone or interactive video.
(c) The hearing is not a formal contested case proceedingnew text begin conducted according to the
procedures in Minnesota Rules, parts 1400.5010 to 1400.8400new text end , except when determined
necessary by the chief administrative law judge.
(d) Parties may but are not required to be represented by counsel. The appearance of a
party without counsel does not constitute the unauthorized practice of law.
(e) The hearing shall be limited to the amount of time necessary for the participants to
expeditiously present the facts about the proposed termination. The administrative law judge
shall issue a recommendation to the commissioner as soon as practicable, but in no event
later than ten business days after the hearing.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 59.
Minnesota Statutes 2020, section 144G.84, is amended to read:
144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA.
(a) In addition to the minimum services required in section 144G.41, an assisted living
facility with dementia care must also provide the following services:
(1) assistance with activities of daily living that address the needs of each resident with
dementia due to cognitive or physical limitations. These services must meet or be in addition
to the requirements in the licensing rules for the facility. Services must be provided in a
person-centered manner that promotes resident choice, dignity, and sustains the resident's
abilities;
(2) nonpharmacological practices that are person-centered and evidence-informed;
(3) services to prepare and educate persons living with dementia and their legal and
designated representatives about transitions in care and ensuring complete, timely
communication between, across, and within settings; and
(4) services that provide residents with choices for meaningful engagement with other
facility residents and the broader community.
(b) Each resident must be evaluated for activities according to the licensing rules of the
facility. In addition, the evaluation must address the following:
(1) past and current interests;
(2) current abilities and skills;
(3) emotional and social needs and patterns;
(4) physical abilities and limitations;
(5) adaptations necessary for the resident to participate; and
(6) identification of activities for behavioral interventions.
(c) An individualized activity plan must be developed for each resident based on their
activity evaluation. The plan must reflect the resident's activity preferences and needs.
(d) A selection of daily structured and non-structured activities must be provided and
included on the resident's activity service or care plan as appropriate. Daily activity options
based on resident evaluation may include but are not limited to:
(1) occupation or chore related tasks;
(2) scheduled and planned events such as entertainment or outings;
(3) spontaneous activities for enjoyment or those that may help defuse a behavior;
(4) one-to-one activities that encourage positive relationships between residents and
staff such as telling a life story, reminiscing, or playing music;
(5) spiritual, creative, and intellectual activities;
(6) sensory stimulation activities;
(7) physical activities that enhance or maintain a resident's ability to ambulate or move;
and
(8) new text begin a resident's individualized activity plan for regular new text end outdoor deleted text begin activitiesdeleted text end new text begin activitynew text end .
(e) Behavioral symptoms that negatively impact the resident and others in the assisted
living facility with dementia care must be evaluated and included on the service or care
plan. The staff must initiate and coordinate outside consultation or acute care when indicated.
(f) Support must be offered to family and other significant relationships on a regularly
scheduled basis but not less than quarterly.
(g) deleted text begin Access to secured outdoor space and walkways that allow residents to enter and
return without staff assistance must be provided.deleted text end new text begin Existing housing with services
establishments registered under chapter 144D prior to August 1, 2021, that obtain an assisted
living facility license must provide residents with regular access to outdoor space. A licensee
with new construction on or after August 1, 2021, or a new licensee that was not previously
registered under chapter 144D prior to August 1, 2021, must provide regular access to
secured outdoor space on the premises of the facility. A resident's access to outdoor space
must be in accordance with the resident's documented care plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 60.
new text begin
[145.87] HOME VISITING FOR PREGNANT WOMEN AND FAMILIES
WITH YOUNG CHILDREN.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section
and have the meanings given them.
new text end
new text begin
(b) "Evidence-based home visiting program" means a program that:
new text end
new text begin
(1) is based on a clear, consistent program or model that is research-based and grounded
in relevant, empirically based knowledge;
new text end
new text begin
(2) is linked to program-determined outcomes and is associated with a national
organization, institution of higher education, or national or state public health institute;
new text end
new text begin
(3) has comprehensive home visitation standards that ensure high-quality service delivery
and continuous quality improvement;
new text end
new text begin
(4) has demonstrated significant, sustained positive outcomes; and
new text end
new text begin
(5) either:
new text end
new text begin
(i) has been evaluated using rigorous randomized controlled research designs and the
evaluation results have been published in a peer-reviewed journal; or
new text end
new text begin
(ii) is based on quasi-experimental research using two or more separate, comparable
client samples.
new text end
new text begin
(c) "Evidence-informed home visiting program" means a program that:
new text end
new text begin
(1) has data or evidence demonstrating effectiveness at achieving positive outcomes for
pregnant women and young children; and
new text end
new text begin
(2) either:
new text end
new text begin
(i) has an active evaluation of the program; or
new text end
new text begin
(ii) has a plan and timeline for an active evaluation of the program to be conducted.
new text end
new text begin
(d) "Health equity" means every individual has a fair opportunity to attain the individual's
full health potential and no individual is disadvantaged from achieving this potential.
new text end
new text begin
(e) "Promising practice home visiting program" means a program that has shown
improvement toward achieving positive outcomes for pregnant women or young children.
new text end
new text begin Subd. 2. new text end
new text begin Grants for home visiting programs. new text end
new text begin
(a) The commissioner of health shall
award grants to community health boards, nonprofit organizations, and tribal nations to start
up or expand voluntary home visiting programs serving pregnant women and families with
young children. Home visiting programs supported under this section shall provide voluntary
home visits by early childhood professionals or health professionals, including but not
limited to nurses, social workers, early childhood educators, and trained paraprofessionals.
Grant money shall be used to:
new text end
new text begin
(1) establish or expand evidence-based, evidence-informed, or promising practice home
visiting programs that address health equity and utilize community-driven health strategies;
new text end
new text begin
(2) serve families with young children or pregnant women who have high needs or are
high-risk, including but not limited to a family with low income, a parent or pregnant woman
with a mental illness or a substance use disorder, or a parent or pregnant woman experiencing
housing instability or domestic abuse; and
new text end
new text begin
(3) improve program outcomes in two or more of the following areas:
new text end
new text begin
(i) maternal and newborn health;
new text end
new text begin
(ii) school readiness and achievement;
new text end
new text begin
(iii) family economic self-sufficiency;
new text end
new text begin
(iv) coordination and referral for other community resources and supports;
new text end
new text begin
(v) reduction in child injuries, abuse, or neglect; or
new text end
new text begin
(vi) reduction in crime or domestic violence.
new text end
new text begin
(b) Grants awarded to evidence-informed and promising practice home visiting programs
must include money to evaluate program outcomes for up to four of the areas listed in
paragraph (a), clause (3).
new text end
new text begin Subd. 3. new text end
new text begin Grant prioritization. new text end
new text begin
(a) In awarding grants, the commissioner shall give
priority to community health boards, nonprofit organizations, and tribal nations seeking to
expand home visiting services with community or regional partnerships.
new text end
new text begin
(b) The commissioner shall allocate at least 75 percent of the grant money awarded each
grant cycle to evidence-based home visiting programs that address health equity and up to
25 percent of the grant money awarded each grant cycle to evidence-informed or promising
practice home visiting programs that address health equity and utilize community-driven
health strategies.
new text end
new text begin Subd. 4. new text end
new text begin Administrative costs. new text end
new text begin
The commissioner may use up to seven percent of the
annual appropriation under this section to provide training and technical assistance and to
administer and evaluate the program. The commissioner may contract for training,
capacity-building support for grantees or potential grantees, technical assistance, and
evaluation support.
new text end
new text begin Subd. 5. new text end
new text begin Use of state general fund appropriations. new text end
new text begin
Appropriations dedicated to
establishing or expanding evidence-based home visiting programs shall, for grants awarded
on or after July 1, 2021, be awarded according to this section. This section shall not govern
grant awards of federal funds for home visiting programs and shall not govern grant awards
using state general fund appropriations dedicated to establishing or expanding nurse-family
partnership home visiting programs.
new text end
Sec. 61.
Minnesota Statutes 2020, section 145.893, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Vouchersdeleted text end new text begin Food benefitsnew text end .
An eligible individual shall receive deleted text begin vouchersdeleted text end new text begin
food benefitsnew text end for the purchase of specified nutritional supplements in type and quantity
approved by the commissioner. Alternate forms of delivery may be developed by the
commissioner in appropriate cases.
Sec. 62.
Minnesota Statutes 2020, section 145.894, is amended to read:
145.894 STATE COMMISSIONER OF HEALTH; DUTIES, RESPONSIBILITIES.
The commissioner of health shall:
(1) develop a comprehensive state plan for the delivery of nutritional supplements to
pregnant and lactating women, infants, and children;
(2) contract with existing local public or private nonprofit organizations for the
administration of the nutritional supplement program;
(3) develop and implement a public education program promoting the provisions of
sections 145.891 to 145.897, and provide for the delivery of individual and family nutrition
education and counseling at project sites. The education programs must include a campaign
to promote breast feeding;
(4) develop in cooperation with other agencies and vendors a uniform state deleted text begin voucherdeleted text end new text begin food
benefitnew text end system for the delivery of nutritional supplements;
(5) authorize local health agencies to issue deleted text begin vouchers bimonthlydeleted text end new text begin food benefits trimonthlynew text end
to some or all eligible individuals served by the agency, provided the agency demonstrates
that the federal minimum requirements for providing nutrition education will continue to
be met and that the quality of nutrition education and health services provided by the agency
will not be adversely impacted;
(6) investigate and implement a system to reduce the cost of nutritional supplements
and maintain ongoing negotiations with nonparticipating manufacturers and suppliers to
maximize cost savings;
(7) develop, analyze, and evaluate the health aspects of the nutritional supplement
program and establish nutritional guidelines for the program;
(8) apply for, administer, and annually expend at least 99 percent of available federal
or private funds;
(9) aggressively market services to eligible individuals by conducting ongoing outreach
activities and by coordinating with and providing marketing materials and technical assistance
to local human services and community service agencies and nonprofit service providers;
(10) determine, on July 1 of each year, the number of pregnant women participating in
each special supplemental food program for women, infants, and children (WIC) deleted text begin and, in
1986, 1987, and 1988, at the commissioner's discretion, designate a different food program
deliverer if the current deliverer fails to increase the participation of pregnant women in the
program by at least ten percent over the previous year's participation ratedeleted text end ;
(11) promulgate all rules necessary to carry out the provisions of sections 145.891 to
145.897; and
(12) ensure that any state appropriation to supplement the federal program is spent
consistent with federal requirements.
Sec. 63.
Minnesota Statutes 2020, section 145.897, is amended to read:
145.897 deleted text begin VOUCHERSdeleted text end new text begin FOOD BENEFITSnew text end .
deleted text begin Vouchersdeleted text end new text begin Food benefitsnew text end issued pursuant to sections 145.891 to 145.897 shall be only
for the purchase of those foods determined by the deleted text begin commissionerdeleted text end new text begin United States Department
of Agriculturenew text end to be desirable nutritional supplements for pregnant and lactating women,
infants and children. deleted text begin These foods shall include, but not be limited to, iron fortified infant
formula, vegetable or fruit juices, cereal, milk, cheese, and eggs.
deleted text end
Sec. 64.
Minnesota Statutes 2020, section 145.899, is amended to read:
145.899 WIC deleted text begin VOUCHERSdeleted text end new text begin FOOD BENEFITSnew text end FOR ORGANICS.
deleted text begin Vouchersdeleted text end new text begin Food benefitsnew text end for the special supplemental nutrition program for women,
infants, and children (WIC) may be used to purchase cost-neutral organic WIC allowable
food. The commissioner of health shall regularly evaluate the list of WIC allowable food
in accordance with federal requirements and shall add to the list any organic WIC allowable
foods determined to be cost-neutral.
Sec. 65.
Minnesota Statutes 2020, section 145.901, subdivision 2, is amended to read:
Subd. 2.
Access to data.
(a) The commissioner of health has access to medical data as
defined in section 13.384, subdivision 1, paragraph (b), medical examiner data as defined
in section 13.83, subdivision 1, and health records created, maintained, or stored by providers
deleted text begin as defined in section 144.291, subdivision 2, paragraph (i),deleted text end without the consent of the subject
of the data, and without the consent of the parent, spouse, other guardian, or legal
representative of the subject of the data, when the subject of the data is a woman who died
during a pregnancy or within 12 months of a fetal death, a live birth, or other termination
of a pregnancy.
The commissioner has access only to medical data and health records related to deaths
that occur on or after July 1, 2000new text begin , including the names of the providers, clinics, or other
health services such as family home visiting programs; the women, infants, and children
(WIC) program; prescription monitoring programs; and behavioral health services, where
care was received before, during, or related to the pregnancy or death. The commissioner
has access to records maintained by a medical examiner, a coroner, or hospitals or to hospital
discharge data, for the purpose of providing the name and location of any pre-pregnancy,
prenatal, or other care received by the subject of the data up to one year after the end of the
pregnancynew text end .
(b) The provider or responsible authority that creates, maintains, or stores the data shall
furnish the data upon the request of the commissioner. The provider or responsible authority
may charge a fee for providing the data, not to exceed the actual cost of retrieving and
duplicating the data.
(c) The commissioner shall make a good faith reasonable effort to notify the parent,
spouse, other guardian, or legal representative of the subject of the data before collecting
data on the subject. For purposes of this paragraph, "reasonable effort" means one notice
is sent by certified mail to the last known address of the parent, spouse, guardian, or legal
representative informing the recipient of the data collection and offering a public health
nurse support visit if desired.
(d) The commissioner does not have access to coroner or medical examiner data that
are part of an active investigation as described in section 13.83.
new text begin
(e) The commissioner may request and receive from a coroner or medical examiner the
name of the health care provider that provided prenatal, postpartum, or other health services
to the subject of the data.
new text end
new text begin
(f) The commissioner may access Department of Human Services data to identify sources
of care and services to assist with the evaluation of welfare systems, including housing, to
reduce preventable maternal deaths.
new text end
new text begin
(g) The commissioner may request and receive law enforcement reports or incident
reports related to the subject of the data.
new text end
Sec. 66.
Minnesota Statutes 2020, section 145.901, subdivision 4, is amended to read:
Subd. 4.
Classification of data.
(a) Data provided to the commissioner from source
records under subdivision 2, including identifying information on individual providers, data
subjects, or their children, and data derived by the commissioner under subdivision 3 for
the purpose of carrying out maternal death studies, are classified as confidential data on
individuals or confidential data on decedents, as defined in sections 13.02, subdivision 3,
and 13.10, subdivision 1, paragraph (a).
(b) Information classified under paragraph (a) shall not be subject to discovery or
introduction into evidence in any administrative, civil, or criminal proceeding. Such
information otherwise available from an original source shall not be immune from discovery
or barred from introduction into evidence merely because it was utilized by the commissioner
in carrying out maternal death studies.
(c) Summary data on maternal death studies created by the commissioner, which does
not identify individual data subjects or individual providers, shall be public in accordance
with section 13.05, subdivision 7.
new text begin
(d) Data provided by the commissioner of human services to the commissioner of health
under this section retain the same classification the data held when retained by the
commissioner of human services, as required under section 13.03, subdivision 4, paragraph
(c).
new text end
Sec. 67.
Minnesota Statutes 2020, section 152.01, subdivision 23, is amended to read:
Subd. 23.
Analog.
(a) Except as provided in paragraph (b), "analog" means a substance,
the chemical structure of which is substantially similar to the chemical structure of a
controlled substance in Schedule I or II:
(1) that has a stimulant, depressant, or hallucinogenic effect on the central nervous system
that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic
effect on the central nervous system of a controlled substance in Schedule I or II; or
(2) with respect to a particular person, if the person represents or intends that the substance
have a stimulant, depressant, or hallucinogenic effect on the central nervous system that is
substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect
on the central nervous system of a controlled substance in Schedule I or II.
(b) "Analog" does not include:
(1) a controlled substance;
(2) any substance for which there is an approved new drug application under the Federal
Food, Drug, and Cosmetic Act; deleted text begin or
deleted text end
(3) with respect to a particular person, any substance, if an exemption is in effect for
investigational use, for that person, as provided by United States Code, title 21, section 355,
and the person is registered as a controlled substance researcher as required under section
152.12, subdivision 3, to the extent conduct with respect to the substance is pursuant to the
exemption and registrationnew text begin ; or
new text end
new text begin (4) marijuana or tetrahydrocannabinols naturally contained in a plant of the genus
cannabis or in the resinous extractives of the plantnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, and applies to crimes
committed on or after that date.
new text end
Sec. 68.
Minnesota Statutes 2020, section 152.02, subdivision 2, is amended to read:
Subd. 2.
Schedule I.
(a) Schedule I consists of the substances listed in this subdivision.
(b) Opiates. Unless specifically excepted or unless listed in another schedule, any of the
following substances, including their analogs, isomers, esters, ethers, salts, and salts of
isomers, esters, and ethers, whenever the existence of the analogs, isomers, esters, ethers,
and salts is possible:
(1) acetylmethadol;
(2) allylprodine;
(3) alphacetylmethadol (except levo-alphacetylmethadol, also known as levomethadyl
acetate);
(4) alphameprodine;
(5) alphamethadol;
(6) alpha-methylfentanyl benzethidine;
(7) betacetylmethadol;
(8) betameprodine;
(9) betamethadol;
(10) betaprodine;
(11) clonitazene;
(12) dextromoramide;
(13) diampromide;
(14) diethyliambutene;
(15) difenoxin;
(16) dimenoxadol;
(17) dimepheptanol;
(18) dimethyliambutene;
(19) dioxaphetyl butyrate;
(20) dipipanone;
(21) ethylmethylthiambutene;
(22) etonitazene;
(23) etoxeridine;
(24) furethidine;
(25) hydroxypethidine;
(26) ketobemidone;
(27) levomoramide;
(28) levophenacylmorphan;
(29) 3-methylfentanyl;
(30) acetyl-alpha-methylfentanyl;
(31) alpha-methylthiofentanyl;
(32) benzylfentanyl beta-hydroxyfentanyl;
(33) beta-hydroxy-3-methylfentanyl;
(34) 3-methylthiofentanyl;
(35) thenylfentanyl;
(36) thiofentanyl;
(37) para-fluorofentanyl;
(38) morpheridine;
(39) 1-methyl-4-phenyl-4-propionoxypiperidine;
(40) noracymethadol;
(41) norlevorphanol;
(42) normethadone;
(43) norpipanone;
(44) 1-(2-phenylethyl)-4-phenyl-4-acetoxypiperidine (PEPAP);
(45) phenadoxone;
(46) phenampromide;
(47) phenomorphan;
(48) phenoperidine;
(49) piritramide;
(50) proheptazine;
(51) properidine;
(52) propiram;
(53) racemoramide;
(54) tilidine;
(55) trimeperidine;
(56) N-(1-Phenethylpiperidin-4-yl)-N-phenylacetamide (acetyl fentanyl);
(57) 3,4-dichloro-N-[(1R,2R)-2-(dimethylamino)cyclohexyl]-N-
methylbenzamide(U47700);
(58) N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]furan-2-carboxamide(furanylfentanyl);
(59) 4-(4-bromophenyl)-4-dimethylamino-1-phenethylcyclohexanol (bromadol);
(60) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopropanecarboxamide (Cyclopropryl
fentanyl);
(61) N-(1-phenethylpiperidin-4-yl)-N-phenylbutanamide) (butyryl fentanyl);
(62) 1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) (MT-45);
(63) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopentanecarboxamide (cyclopentyl
fentanyl);
(64) N-(1-phenethylpiperidin-4-yl)-N-phenylisobutyramide (isobutyryl fentanyl);
(65) N-(1-phenethylpiperidin-4-yl)-N-phenylpentanamide (valeryl fentanyl);
(66) N-(4-chlorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide
(para-chloroisobutyryl fentanyl);
(67) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)butyramide (para-fluorobutyryl
fentanyl);
(68) N-(4-methoxyphenyl)-N-(1-phenethylpiperidin-4-yl)butyramide
(para-methoxybutyryl fentanyl);
(69) N-(2-fluorophenyl)-2-methoxy-N-(1-phenethylpiperidin-4-yl)acetamide (ocfentanil);
(70) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide (4-fluoroisobutyryl
fentanyl or para-fluoroisobutyryl fentanyl);
(71) N-(1-phenethylpiperidin-4-yl)-N-phenylacrylamide (acryl fentanyl or
acryloylfentanyl);
(72) 2-methoxy-N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide (methoxyacetyl
fentanyl);
(73) N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)propionamide (ortho-fluorofentanyl
or 2-fluorofentanyl);
(74) N-(1-phenethylpiperidin-4-yl)-N-phenyltetrahydrofuran-2-carboxamide
(tetrahydrofuranyl fentanyl); and
(75) Fentanyl-related substances, their isomers, esters, ethers, salts and salts of isomers,
esters and ethers, meaning any substance not otherwise listed under another federal
Administration Controlled Substance Code Number or not otherwise listed in this section,
and for which no exemption or approval is in effect under section 505 of the Federal Food,
Drug, and Cosmetic Act, United States Code , title 21, section 355, that is structurally related
to fentanyl by one or more of the following modifications:
(i) replacement of the phenyl portion of the phenethyl group by any monocycle, whether
or not further substituted in or on the monocycle;
(ii) substitution in or on the phenethyl group with alkyl, alkenyl, alkoxyl, hydroxyl, halo,
haloalkyl, amino, or nitro groups;
(iii) substitution in or on the piperidine ring with alkyl, alkenyl, alkoxyl, ester, ether,
hydroxyl, halo, haloalkyl, amino, or nitro groups;
(iv) replacement of the aniline ring with any aromatic monocycle whether or not further
substituted in or on the aromatic monocycle; or
(v) replacement of the N-propionyl group by another acyl group.
(c) Opium derivatives. Any of the following substances, their analogs, salts, isomers,
and salts of isomers, unless specifically excepted or unless listed in another schedule,
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) acetorphine;
(2) acetyldihydrocodeine;
(3) benzylmorphine;
(4) codeine methylbromide;
(5) codeine-n-oxide;
(6) cyprenorphine;
(7) desomorphine;
(8) dihydromorphine;
(9) drotebanol;
(10) etorphine;
(11) heroin;
(12) hydromorphinol;
(13) methyldesorphine;
(14) methyldihydromorphine;
(15) morphine methylbromide;
(16) morphine methylsulfonate;
(17) morphine-n-oxide;
(18) myrophine;
(19) nicocodeine;
(20) nicomorphine;
(21) normorphine;
(22) pholcodine; and
(23) thebacon.
(d) Hallucinogens. Any material, compound, mixture or preparation which contains any
quantity of the following substances, their analogs, salts, isomers (whether optical, positional,
or geometric), and salts of isomers, unless specifically excepted or unless listed in another
schedule, whenever the existence of the analogs, salts, isomers, and salts of isomers is
possible:
(1) methylenedioxy amphetamine;
(2) methylenedioxymethamphetamine;
(3) methylenedioxy-N-ethylamphetamine (MDEA);
(4) n-hydroxy-methylenedioxyamphetamine;
(5) 4-bromo-2,5-dimethoxyamphetamine (DOB);
(6) 2,5-dimethoxyamphetamine (2,5-DMA);
(7) 4-methoxyamphetamine;
(8) 5-methoxy-3, 4-methylenedioxyamphetamine;
(9) alpha-ethyltryptamine;
(10) bufotenine;
(11) diethyltryptamine;
(12) dimethyltryptamine;
(13) 3,4,5-trimethoxyamphetamine;
(14) 4-methyl-2, 5-dimethoxyamphetamine (DOM);
(15) ibogaine;
(16) lysergic acid diethylamide (LSD);
(17) mescaline;
(18) parahexyl;
(19) N-ethyl-3-piperidyl benzilate;
(20) N-methyl-3-piperidyl benzilate;
(21) psilocybin;
(22) psilocyn;
(23) tenocyclidine (TPCP or TCP);
(24) N-ethyl-1-phenyl-cyclohexylamine (PCE);
(25) 1-(1-phenylcyclohexyl) pyrrolidine (PCPy);
(26) 1-[1-(2-thienyl)cyclohexyl]-pyrrolidine (TCPy);
(27) 4-chloro-2,5-dimethoxyamphetamine (DOC);
(28) 4-ethyl-2,5-dimethoxyamphetamine (DOET);
(29) 4-iodo-2,5-dimethoxyamphetamine (DOI);
(30) 4-bromo-2,5-dimethoxyphenethylamine (2C-B);
(31) 4-chloro-2,5-dimethoxyphenethylamine (2C-C);
(32) 4-methyl-2,5-dimethoxyphenethylamine (2C-D);
(33) 4-ethyl-2,5-dimethoxyphenethylamine (2C-E);
(34) 4-iodo-2,5-dimethoxyphenethylamine (2C-I);
(35) 4-propyl-2,5-dimethoxyphenethylamine (2C-P);
(36) 4-isopropylthio-2,5-dimethoxyphenethylamine (2C-T-4);
(37) 4-propylthio-2,5-dimethoxyphenethylamine (2C-T-7);
(38) 2-(8-bromo-2,3,6,7-tetrahydrofuro [2,3-f][1]benzofuran-4-yl)ethanamine
(2-CB-FLY);
(39) bromo-benzodifuranyl-isopropylamine (Bromo-DragonFLY);
(40) alpha-methyltryptamine (AMT);
(41) N,N-diisopropyltryptamine (DiPT);
(42) 4-acetoxy-N,N-dimethyltryptamine (4-AcO-DMT);
(43) 4-acetoxy-N,N-diethyltryptamine (4-AcO-DET);
(44) 4-hydroxy-N-methyl-N-propyltryptamine (4-HO-MPT);
(45) 4-hydroxy-N,N-dipropyltryptamine (4-HO-DPT);
(46) 4-hydroxy-N,N-diallyltryptamine (4-HO-DALT);
(47) 4-hydroxy-N,N-diisopropyltryptamine (4-HO-DiPT);
(48) 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DiPT);
(49) 5-methoxy-α-methyltryptamine (5-MeO-AMT);
(50) 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT);
(51) 5-methylthio-N,N-dimethyltryptamine (5-MeS-DMT);
(52) 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT);
(53) 5-methoxy-α-ethyltryptamine (5-MeO-AET);
(54) 5-methoxy-N,N-dipropyltryptamine (5-MeO-DPT);
(55) 5-methoxy-N,N-diethyltryptamine (5-MeO-DET);
(56) 5-methoxy-N,N-diallyltryptamine (5-MeO-DALT);
(57) methoxetamine (MXE);
(58) 5-iodo-2-aminoindane (5-IAI);
(59) 5,6-methylenedioxy-2-aminoindane (MDAI);
(60) 2-(4-bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25B-NBOMe);
(61) 2-(4-chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25C-NBOMe);
(62) 2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25I-NBOMe);
(63) 2-(2,5-Dimethoxyphenyl)ethanamine (2C-H);
(64) 2-(4-Ethylthio-2,5-dimethoxyphenyl)ethanamine (2C-T-2);
(65) N,N-Dipropyltryptamine (DPT);
(66) 3-[1-(Piperidin-1-yl)cyclohexyl]phenol (3-HO-PCP);
(67) N-ethyl-1-(3-methoxyphenyl)cyclohexanamine (3-MeO-PCE);
(68) 4-[1-(3-methoxyphenyl)cyclohexyl]morpholine (3-MeO-PCMo);
(69) 1-[1-(4-methoxyphenyl)cyclohexyl]-piperidine (methoxydine, 4-MeO-PCP);
(70) 2-(2-Chlorophenyl)-2-(ethylamino)cyclohexan-1-one (N-Ethylnorketamine,
ethketamine, NENK);
(71) methylenedioxy-N,N-dimethylamphetamine (MDDMA);
(72) 3-(2-Ethyl(methyl)aminoethyl)-1H-indol-4-yl (4-AcO-MET); and
(73) 2-Phenyl-2-(methylamino)cyclohexanone (deschloroketamine).
(e) Peyote. All parts of the plant presently classified botanically as Lophophora williamsii
Lemaire, whether growing or not, the seeds thereof, any extract from any part of the plant,
and every compound, manufacture, salts, derivative, mixture, or preparation of the plant,
its seeds or extracts. The listing of peyote as a controlled substance in Schedule I does not
apply to the nondrug use of peyote in bona fide religious ceremonies of the American Indian
Church, and members of the American Indian Church are exempt from registration. Any
person who manufactures peyote for or distributes peyote to the American Indian Church,
however, is required to obtain federal registration annually and to comply with all other
requirements of law.
(f) Central nervous system depressants. Unless specifically excepted or unless listed in
another schedule, any material compound, mixture, or preparation which contains any
quantity of the following substances, their analogs, salts, isomers, and salts of isomers
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) mecloqualone;
(2) methaqualone;
(3) gamma-hydroxybutyric acid (GHB), including its esters and ethers;
(4) flunitrazepam;
(5) 2-(2-Methoxyphenyl)-2-(methylamino)cyclohexanone (2-MeO-2-deschloroketamine,
methoxyketamine);
(6) tianeptine;
(7) clonazolam;
(8) etizolam;
(9) flubromazolam; and
(10) flubromazepam.
(g) Stimulants. Unless specifically excepted or unless listed in another schedule, any
material compound, mixture, or preparation which contains any quantity of the following
substances, their analogs, salts, isomers, and salts of isomers whenever the existence of the
analogs, salts, isomers, and salts of isomers is possible:
(1) aminorex;
(2) cathinone;
(3) fenethylline;
(4) methcathinone;
(5) methylaminorex;
(6) N,N-dimethylamphetamine;
(7) N-benzylpiperazine (BZP);
(8) methylmethcathinone (mephedrone);
(9) 3,4-methylenedioxy-N-methylcathinone (methylone);
(10) methoxymethcathinone (methedrone);
(11) methylenedioxypyrovalerone (MDPV);
(12) 3-fluoro-N-methylcathinone (3-FMC);
(13) methylethcathinone (MEC);
(14) 1-benzofuran-6-ylpropan-2-amine (6-APB);
(15) dimethylmethcathinone (DMMC);
(16) fluoroamphetamine;
(17) fluoromethamphetamine;
(18) α-methylaminobutyrophenone (MABP or buphedrone);
(19) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)butan-1-one (butylone);
(20) 2-(methylamino)-1-(4-methylphenyl)butan-1-one (4-MEMABP or BZ-6378);
(21) 1-(naphthalen-2-yl)-2-(pyrrolidin-1-yl) pentan-1-one (naphthylpyrovalerone or
naphyrone);
(22) (alpha-pyrrolidinopentiophenone (alpha-PVP);
(23) (RS)-1-(4-methylphenyl)-2-(1-pyrrolidinyl)-1-hexanone (4-Me-PHP or MPHP);
(24) 2-(1-pyrrolidinyl)-hexanophenone (Alpha-PHP);
(25) 4-methyl-N-ethylcathinone (4-MEC);
(26) 4-methyl-alpha-pyrrolidinopropiophenone (4-MePPP);
(27) 2-(methylamino)-1-phenylpentan-1-one (pentedrone);
(28) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)pentan-1-one (pentylone);
(29) 4-fluoro-N-methylcathinone (4-FMC);
(30) 3,4-methylenedioxy-N-ethylcathinone (ethylone);
(31) alpha-pyrrolidinobutiophenone (α-PBP);
(32) 5-(2-Aminopropyl)-2,3-dihydrobenzofuran (5-APDB);
(33) 1-phenyl-2-(1-pyrrolidinyl)-1-heptanone (PV8);
(34) 6-(2-Aminopropyl)-2,3-dihydrobenzofuran (6-APDB);
(35) 4-methyl-alpha-ethylaminopentiophenone (4-MEAPP);
(36) 4'-chloro-alpha-pyrrolidinopropiophenone (4'-chloro-PPP);
(37) 1-(1,3-Benzodioxol-5-yl)-2-(dimethylamino)butan-1-one (dibutylone, bk-DMBDB);
(38) 1-(3-chlorophenyl) piperazine (meta-chlorophenylpiperazine or mCPP);
(39) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)-pentan-1-one (N-ethylpentylone, ephylone);
and
(40) any other substance, except bupropion or compounds listed under a different
schedule, that is structurally derived from 2-aminopropan-1-one by substitution at the
1-position with either phenyl, naphthyl, or thiophene ring systems, whether or not the
compound is further modified in any of the following ways:
(i) by substitution in the ring system to any extent with alkyl, alkylenedioxy, alkoxy,
haloalkyl, hydroxyl, or halide substituents, whether or not further substituted in the ring
system by one or more other univalent substituents;
(ii) by substitution at the 3-position with an acyclic alkyl substituent;
(iii) by substitution at the 2-amino nitrogen atom with alkyl, dialkyl, benzyl, or
methoxybenzyl groups; or
(iv) by inclusion of the 2-amino nitrogen atom in a cyclic structure.
(h) deleted text begin Marijuana,deleted text end new text begin Syntheticnew text end tetrahydrocannabinolsdeleted text begin ,deleted text end and synthetic cannabinoids. Unless
specifically excepted or unless listed in another schedule, any deleted text begin natural ordeleted text end synthetic material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
deleted text begin
(1) marijuana;
deleted text end
deleted text begin (2)deleted text end new text begin (1) syntheticnew text end tetrahydrocannabinols deleted text begin naturally contained in a plant of the genus
Cannabis,deleted text end new text begin that are thenew text end synthetic equivalents of the substances contained in the cannabis
plant or in the resinous extractives of the plant, or synthetic substances with similar chemical
structure and pharmacological activity to those substances contained in the plant or resinous
extract, including, but not limited to, 1 cis or trans tetrahydrocannabinol, 6 cis or trans
tetrahydrocannabinol, and 3,4 cis or trans tetrahydrocannabinol;
deleted text begin (3)deleted text end new text begin (2)new text end synthetic cannabinoids, including the following substances:
(i) Naphthoylindoles, which are any compounds containing a 3-(1-napthoyl)indole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group, whether or not further substituted in the indole ring to any
extent and whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(1-naphthoyl)indole (JWH-018 and AM-678);
(B) 1-Butyl-3-(1-naphthoyl)indole (JWH-073);
(C) 1-Pentyl-3-(4-methoxy-1-naphthoyl)indole (JWH-081);
(D) 1-[2-(4-morpholinyl)ethyl]-3-(1-naphthoyl)indole (JWH-200);
(E) 1-Propyl-2-methyl-3-(1-naphthoyl)indole (JWH-015);
(F) 1-Hexyl-3-(1-naphthoyl)indole (JWH-019);
(G) 1-Pentyl-3-(4-methyl-1-naphthoyl)indole (JWH-122);
(H) 1-Pentyl-3-(4-ethyl-1-naphthoyl)indole (JWH-210);
(I) 1-Pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398);
(J) 1-(5-fluoropentyl)-3-(1-naphthoyl)indole (AM-2201).
(ii) Napthylmethylindoles, which are any compounds containing a
1H-indol-3-yl-(1-naphthyl)methane structure with substitution at the nitrogen atom of the
indole ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group, whether or not further
substituted in the indole ring to any extent and whether or not substituted in the naphthyl
ring to any extent. Examples of naphthylmethylindoles include, but are not limited to:
(A) 1-Pentyl-1H-indol-3-yl-(1-naphthyl)methane (JWH-175);
(B) 1-Pentyl-1H-indol-3-yl-(4-methyl-1-naphthyl)methane (JWH-184).
(iii) Naphthoylpyrroles, which are any compounds containing a 3-(1-naphthoyl)pyrrole
structure with substitution at the nitrogen atom of the pyrrole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the pyrrole ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylpyrroles include, but are not limited to,
(5-(2-fluorophenyl)-1-pentylpyrrol-3-yl)-naphthalen-1-ylmethanone (JWH-307).
(iv) Naphthylmethylindenes, which are any compounds containing a naphthylideneindene
structure with substitution at the 3-position of the indene ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indene ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthylemethylindenes include, but are not limited to,
E-1-[1-(1-naphthalenylmethylene)-1H-inden-3-yl]pentane (JWH-176).
(v) Phenylacetylindoles, which are any compounds containing a 3-phenylacetylindole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent, whether or not substituted in the phenyl ring to any extent. Examples of
phenylacetylindoles include, but are not limited to:
(A) 1-(2-cyclohexylethyl)-3-(2-methoxyphenylacetyl)indole (RCS-8);
(B) 1-pentyl-3-(2-methoxyphenylacetyl)indole (JWH-250);
(C) 1-pentyl-3-(2-methylphenylacetyl)indole (JWH-251);
(D) 1-pentyl-3-(2-chlorophenylacetyl)indole (JWH-203).
(vi) Cyclohexylphenols, which are compounds containing a
2-(3-hydroxycyclohexyl)phenol structure with substitution at the 5-position of the phenolic
ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group whether or not substituted
in the cyclohexyl ring to any extent. Examples of cyclohexylphenols include, but are not
limited to:
(A) 5-(1,1-dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (CP 47,497);
(B) 5-(1,1-dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol
(Cannabicyclohexanol or CP 47,497 C8 homologue);
(C) 5-(1,1-dimethylheptyl)-2-[(1R,2R)-5-hydroxy-2-(3-hydroxypropyl)cyclohexyl]
-phenol (CP 55,940).
(vii) Benzoylindoles, which are any compounds containing a 3-(benzoyl)indole structure
with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent and whether or not substituted in the phenyl ring to any extent. Examples of
benzoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(4-methoxybenzoyl)indole (RCS-4);
(B) 1-(5-fluoropentyl)-3-(2-iodobenzoyl)indole (AM-694);
(C) (4-methoxyphenyl-[2-methyl-1-(2-(4-morpholinyl)ethyl)indol-3-yl]methanone (WIN
48,098 or Pravadoline).
(viii) Others specifically named:
(A) (6aR,10aR)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (HU-210);
(B) (6aS,10aS)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (Dexanabinol or HU-211);
(C) 2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]
-1,4-benzoxazin-6-yl-1-naphthalenylmethanone (WIN 55,212-2);
(D) (1-pentylindol-3-yl)-(2,2,3,3-tetramethylcyclopropyl)methanone (UR-144);
(E) (1-(5-fluoropentyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone
(XLR-11);
(F) 1-pentyl-N-tricyclo[3.3.1.13,7]dec-1-yl-1H-indazole-3-carboxamide
(AKB-48(APINACA));
(G) N-((3s,5s,7s)-adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide
(5-Fluoro-AKB-48);
(H) 1-pentyl-8-quinolinyl ester-1H-indole-3-carboxylic acid (PB-22);
(I) 8-quinolinyl ester-1-(5-fluoropentyl)-1H-indole-3-carboxylic acid (5-Fluoro PB-22);
(J) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-pentyl-1H-indazole- 3-carboxamide
(AB-PINACA);
(K) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-[(4-fluorophenyl)methyl]-
1H-indazole-3-carboxamide (AB-FUBINACA);
(L) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-
indazole-3-carboxamide(AB-CHMINACA);
(M) (S)-methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3- methylbutanoate
(5-fluoro-AMB);
(N) [1-(5-fluoropentyl)-1H-indazol-3-yl](naphthalen-1-yl) methanone (THJ-2201);
(O) (1-(5-fluoropentyl)-1H-benzo[d]imidazol-2-yl)(naphthalen-1-yl)methanone)
(FUBIMINA);
(P) (7-methoxy-1-(2-morpholinoethyl)-N-((1S,2S,4R)-1,3,3-trimethylbicyclo
[2.2.1]heptan-2-yl)-1H-indole-3-carboxamide (MN-25 or UR-12);
(Q) (S)-N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide (5-fluoro-ABICA);
(R) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide;
(S) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indazole-3-carboxamide;
(T) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido) -3,3-dimethylbutanoate;
(U) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1(cyclohexylmethyl)-1
H-indazole-3-carboxamide (MAB-CHMINACA);
(V) N-(1-Amino-3,3-dimethyl-1-oxo-2-butanyl)-1-pentyl-1H-indazole-3-carboxamide
(ADB-PINACA);
(W) methyl (1-(4-fluorobenzyl)-1H-indazole-3-carbonyl)-L-valinate (FUB-AMB);
(X) N-[(1S)-2-amino-2-oxo-1-(phenylmethyl)ethyl]-1-(cyclohexylmethyl)-1H-Indazole-
3-carboxamide. (APP-CHMINACA);
(Y) quinolin-8-yl 1-(4-fluorobenzyl)-1H-indole-3-carboxylate (FUB-PB-22); and
(Z) methyl N-[1-(cyclohexylmethyl)-1H-indole-3-carbonyl]valinate (MMB-CHMICA).
(ix) Additional substances specifically named:
(A) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1
H-pyrrolo[2,3-B]pyridine-3-carboxamide (5F-CUMYL-P7AICA);
(B) 1-(4-cyanobutyl)-N-(2- phenylpropan-2-yl)-1 H-indazole-3-carboxamide
(4-CN-Cumyl-Butinaca);
(C) naphthalen-1-yl-1-(5-fluoropentyl)-1-H-indole-3-carboxylate (NM2201; CBL2201);
(D) N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1
H-indazole-3-carboxamide (5F-ABPINACA);
(E) methyl-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
(MDMB CHMICA);
(F) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate
(5F-ADB; 5F-MDMB-PINACA); and
(G) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)
1H-indazole-3-carboxamide (ADB-FUBINACA).
(i) A controlled substance analog, to the extent that it is implicitly or explicitly intended
for human consumption.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, and applies to crimes
committed on or after that date.
new text end
Sec. 69.
Minnesota Statutes 2020, section 152.02, subdivision 3, is amended to read:
Subd. 3.
Schedule II.
(a) Schedule II consists of the substances listed in this subdivision.
(b) Unless specifically excepted or unless listed in another schedule, any of the following
substances whether produced directly or indirectly by extraction from substances of vegetable
origin or independently by means of chemical synthesis, or by a combination of extraction
and chemical synthesis:
(1) Opium and opiate, and any salt, compound, derivative, or preparation of opium or
opiate.
(i) Excluding:
(A) apomorphine;
(B) thebaine-derived butorphanol;
(C) dextrophan;
(D) nalbuphine;
(E) nalmefene;
(F) naloxegol;
(G) naloxone;
(H) naltrexone; and
(I) their respective salts;
(ii) but including the following:
(A) opium, in all forms and extracts;
(B) codeine;
(C) dihydroetorphine;
(D) ethylmorphine;
(E) etorphine hydrochloride;
(F) hydrocodone;
(G) hydromorphone;
(H) metopon;
(I) morphine;
(J) oxycodone;
(K) oxymorphone;
(L) thebaine;
(M) oripavine;
(2) any salt, compound, derivative, or preparation thereof which is chemically equivalent
or identical with any of the substances referred to in clause (1), except that these substances
shall not include the isoquinoline alkaloids of opium;
(3) opium poppy and poppy straw;
(4) coca leaves and any salt, cocaine compound, derivative, or preparation of coca leaves
(including cocaine and ecgonine and their salts, isomers, derivatives, and salts of isomers
and derivatives), and any salt, compound, derivative, or preparation thereof which is
chemically equivalent or identical with any of these substances, except that the substances
shall not include decocainized coca leaves or extraction of coca leaves, which extractions
do not contain cocaine or ecgonine;
(5) concentrate of poppy straw (the crude extract of poppy straw in either liquid, solid,
or powder form which contains the phenanthrene alkaloids of the opium poppy).
(c) Any of the following opiates, including their isomers, esters, ethers, salts, and salts
of isomers, esters and ethers, unless specifically excepted, or unless listed in another schedule,
whenever the existence of such isomers, esters, ethers and salts is possible within the specific
chemical designation:
(1) alfentanil;
(2) alphaprodine;
(3) anileridine;
(4) bezitramide;
(5) bulk dextropropoxyphene (nondosage forms);
(6) carfentanil;
(7) dihydrocodeine;
(8) dihydromorphinone;
(9) diphenoxylate;
(10) fentanyl;
(11) isomethadone;
(12) levo-alpha-acetylmethadol (LAAM);
(13) levomethorphan;
(14) levorphanol;
(15) metazocine;
(16) methadone;
(17) methadone - intermediate, 4-cyano-2-dimethylamino-4, 4-diphenylbutane;
(18) moramide - intermediate, 2-methyl-3-morpholino-1, 1-diphenyl-propane-carboxylic
acid;
(19) pethidine;
(20) pethidine - intermediate - a, 4-cyano-1-methyl-4-phenylpiperidine;
(21) pethidine - intermediate - b, ethyl-4-phenylpiperidine-4-carboxylate;
(22) pethidine - intermediate - c, 1-methyl-4-phenylpiperidine-4-carboxylic acid;
(23) phenazocine;
(24) piminodine;
(25) racemethorphan;
(26) racemorphan;
(27) remifentanil;
(28) sufentanil;
(29) tapentadol;
(30) 4-Anilino-N-phenethylpiperidine.
(d) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a stimulant effect on the central nervous system:
(1) amphetamine, its salts, optical isomers, and salts of its optical isomers;
(2) methamphetamine, its salts, isomers, and salts of its isomers;
(3) phenmetrazine and its salts;
(4) methylphenidate;
(5) lisdexamfetamine.
(e) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a depressant effect on the central nervous system, including its salts, isomers, and
salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible
within the specific chemical designation:
(1) amobarbital;
(2) glutethimide;
(3) secobarbital;
(4) pentobarbital;
(5) phencyclidine;
(6) phencyclidine immediate precursors:
(i) 1-phenylcyclohexylamine;
(ii) 1-piperidinocyclohexanecarbonitrile;
(7) phenylacetone.
(f) new text begin Cannabis and new text end cannabinoids:
(1) nabilone;
new text begin
(2) unless specifically excepted or unless listed in another schedule, any natural material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
new text end
new text begin
(i) marijuana; and
new text end
new text begin
(ii) tetrahydrocannabinols naturally contained in a plant of the genus cannabis or in the
resinous extractives of the plant; and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in an oral
solution in a drug product approved for marketing by the United States Food and Drug
Administration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, and applies to crimes
committed on or after that date.
new text end
Sec. 70.
Minnesota Statutes 2020, section 152.11, subdivision 1a, is amended to read:
Subd. 1a.
Prescription requirements for Schedule II controlled substances.
new text begin Except
as allowed under section 152.29, new text end no person may dispense a controlled substance included
in Schedule II of section 152.02 without a prescription issued by a doctor of medicine, a
doctor of osteopathic medicine licensed to practice medicine, a doctor of dental surgery, a
doctor of dental medicine, a doctor of podiatry, or a doctor of veterinary medicine, lawfully
licensed to prescribe in this state or by a practitioner licensed to prescribe controlled
substances by the state in which the prescription is issued, and having a current federal Drug
Enforcement Administration registration number. The prescription must either be printed
or written in ink and contain the handwritten signature of the prescriber or be transmitted
electronically or by facsimile as permitted under subdivision 1. Provided that in emergency
situations, as authorized by federal law, such drug may be dispensed upon oral prescription
reduced promptly to writing and filed by the pharmacist. Such prescriptions shall be retained
in conformity with section 152.101. No prescription for a Schedule II substance may be
refilled.
Sec. 71.
Minnesota Statutes 2020, section 152.11, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 72.
Minnesota Statutes 2020, section 152.12, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 73.
Minnesota Statutes 2020, section 152.125, subdivision 3, is amended to read:
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician's treatment of an individual for chemical dependency resulting from the
use of controlled substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to an individual whom the physician knows to be using the controlled
substances for nontherapeutic purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of an individual having intractable
pain; deleted text begin or
deleted text end
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain reliefnew text begin ; or
new text end
new text begin (5) the administration of medical cannabis under sections 152.22 to 152.37new text end .
Sec. 74.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 5c. new text end
new text begin Hemp processor. new text end
new text begin
"Hemp processor" means a person or business licensed by
the commissioner of agriculture under chapter 18K to convert raw hemp into a product.
new text end
Sec. 75.
Minnesota Statutes 2020, section 152.22, subdivision 6, is amended to read:
Subd. 6.
Medical cannabis.
(a) "Medical cannabis" means any species of the genus
cannabis plant, or any mixture or preparation of them, including whole plant extracts and
resins, and is delivered in the form of:
(1) liquid, including, but not limited to, oil;
(2) pill;
(3) vaporized delivery method with use of liquid or oil deleted text begin but which does not require the
use of dried leaves or plant form; ordeleted text end new text begin ;
new text end
new text begin
(4) combustion with use of dried raw cannabis; or
new text end
deleted text begin (4)deleted text end new text begin (5)new text end any other methoddeleted text begin , excluding smoking,deleted text end approved by the commissioner.
(b) This definition includes any part of the genus cannabis plant prior to being processed
into a form allowed under paragraph (a), that is possessed by a person while that person is
engaged in employment duties necessary to carry out a requirement under sections 152.22
to 152.37 for a registered manufacturer or a laboratory under contract with a registered
manufacturer. This definition also includes any hemp acquired by a manufacturer by a hemp
grower as permitted under section 152.29, subdivision 1, paragraph (b).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the earlier of (1) March 1, 2022, or (2)
a date, as determined by the commissioner of health, by which (i) the rules adopted or
amended under Minnesota Statutes, section 152.26, paragraph (b), are in effect and (ii) the
independent laboratories under contract with the manufacturers have the necessary procedures
and equipment in place to perform the required testing of dried raw cannabis. If this section
is effective before March 1, 2022, the commissioner shall provide notice of that effective
date to the public.
new text end
Sec. 76.
Minnesota Statutes 2020, section 152.22, subdivision 11, is amended to read:
Subd. 11.
Registered designated caregiver.
"Registered designated caregiver" means
a person who:
(1) is at least 18 years old;
(2) does not have a conviction for a disqualifying felony offense;
(3) has been approved by the commissioner to assist a patient who deleted text begin has been identified
by a health care practitioner as developmentally or physically disabled and thereforedeleted text end requires
assistance in administering medical cannabis or obtaining medical cannabis from a
distribution facility deleted text begin due to the disabilitydeleted text end ; and
(4) is authorized by the commissioner to assist the patient with the use of medical
cannabis.
Sec. 77.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 13a. new text end
new text begin Tribal medical cannabis program. new text end
new text begin
"Tribal medical cannabis program"
means a medical cannabis program operated by a federally recognized Indian Tribe located
within the state that has been recognized by the commissioner of health in accordance with
section 152.25, subdivision 5.
new text end
Sec. 78.
Minnesota Statutes 2020, section 152.23, is amended to read:
152.23 LIMITATIONS.
(a) Nothing in sections 152.22 to 152.37 permits any person to engage in and does not
prevent the imposition of any civil, criminal, or other penalties for:
(1) undertaking any task under the influence of medical cannabis that would constitute
negligence or professional malpractice;
(2) possessing or engaging in the use of medical cannabis:
(i) on a school bus or van;
(ii) on the grounds of any preschool or primary or secondary school;
(iii) in any correctional facility; or
(iv) on the grounds of any child care facility or home day care;
(3) vaporizing new text begin or combusting new text end medical cannabis pursuant to section 152.22, subdivision
6:
(i) on any form of public transportation;
(ii) where the vapor would be inhaled by a nonpatient minor childnew text begin or where the smoke
would be inhaled by a minor childnew text end ; or
(iii) in any public place, including any indoor or outdoor area used by or open to the
general public or a place of employment as defined under section 144.413, subdivision 1b;
and
(4) operating, navigating, or being in actual physical control of any motor vehicle,
aircraft, train, or motorboat, or working on transportation property, equipment, or facilities
while under the influence of medical cannabis.
(b) Nothing in sections 152.22 to 152.37 require the medical assistance and
MinnesotaCare programs to reimburse an enrollee or a provider for costs associated with
the medical use of cannabis. Medical assistance and MinnesotaCare shall continue to provide
coverage for all services related to treatment of an enrollee's qualifying medical condition
if the service is covered under chapter 256B or 256L.
Sec. 79.
Minnesota Statutes 2020, section 152.25, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Tribal medical cannabis programs. new text end
new text begin
Upon the request of an Indian Tribe
operating a Tribal medical cannabis program, the commissioner shall determine if the
standards for the Tribal medical cannabis program meet or exceed the standards required
under sections 152.22 to 152.37 in terms of qualifying for the medical cannabis program,
allowable forms of medical cannabis, production and distribution requirements, product
safety and testing, and security measures. If the commissioner determines that the Tribal
medical cannabis program meets or exceeds the standards in sections 152.22 to 152.37, the
commissioner shall recognize the Tribal medical cannabis program and shall post the Tribal
medical cannabis programs that have been recognized by the commissioner on the
Department of Health's website.
new text end
Sec. 80.
Minnesota Statutes 2020, section 152.26, is amended to read:
152.26 RULEMAKING.
new text begin (a) new text end The commissioner may adopt rules to implement sections 152.22 to 152.37. Rules
for which notice is published in the State Register before January 1, 2015, may be adopted
using the process in section 14.389.
new text begin
(b) The commissioner may adopt or amend rules, using the procedure in section 14.386,
paragraph (a), to implement the addition of dried raw cannabis as an allowable form of
medical cannabis under section 152.22, subdivision 6, paragraph (a), clause (4). Section
14.386, paragraph (b), does not apply to these rules.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 81.
Minnesota Statutes 2020, section 152.27, subdivision 3, is amended to read:
Subd. 3.
Patient application.
(a) The commissioner shall develop a patient application
for enrollment into the registry program. The application shall be available to the patient
and given to health care practitioners in the state who are eligible to serve as health care
practitioners. The application must include:
(1) the name, mailing address, and date of birth of the patient;
(2) the name, mailing address, and telephone number of the patient's health care
practitioner;
(3) the name, mailing address, and date of birth of the patient's designated caregiver, if
any, or the patient's parent, legal guardian, or spouse if the parent, legal guardian, or spouse
will be acting as a caregiver;
(4) a copy of the certification from the patient's health care practitioner that is dated
within 90 days prior to submitting the application deleted text begin whichdeleted text end new text begin thatnew text end certifies that the patient has
been diagnosed with a qualifying medical condition deleted text begin and, if applicable, that, in the health
care practitioner's medical opinion, the patient is developmentally or physically disabled
and, as a result of that disability, the patient requires assistance in administering medical
cannabis or obtaining medical cannabis from a distribution facilitydeleted text end ; and
(5) all other signed affidavits and enrollment forms required by the commissioner under
sections 152.22 to 152.37, including, but not limited to, the disclosure form required under
paragraph (c).
(b) The commissioner shall require a patient to resubmit a copy of the certification from
the patient's health care practitioner on a yearly basis and shall require that the recertification
be dated within 90 days of submission.
(c) The commissioner shall develop a disclosure form and require, as a condition of
enrollment, all patients to sign a copy of the disclosure. The disclosure must include:
(1) a statement that, notwithstanding any law to the contrary, the commissioner, or an
employee of any state agency, may not be held civilly or criminally liable for any injury,
loss of property, personal injury, or death caused by any act or omission while acting within
the scope of office or employment under sections 152.22 to 152.37; and
(2) the patient's acknowledgment that enrollment in the patient registry program is
conditional on the patient's agreement to meet all of the requirements of sections 152.22 to
152.37.
Sec. 82.
Minnesota Statutes 2020, section 152.27, subdivision 4, is amended to read:
Subd. 4.
Registered designated caregiver.
(a) The commissioner shall register a
designated caregiver for a patient if deleted text begin the patient's health care practitioner has certified that
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability,deleted text end the patient requires assistance in administering
medical cannabis or obtaining medical cannabis from a distribution facility and the caregiver
has agreed, in writing, to be the patient's designated caregiver. As a condition of registration
as a designated caregiver, the commissioner shall require the person to:
(1) be at least 18 years of age;
(2) agree to only possess the patient's medical cannabis for purposes of assisting the
patient; and
(3) agree that if the application is approved, the person will not be a registered designated
caregiver for more than deleted text begin one patient, unless thedeleted text end new text begin six registered patients at one time.new text end Patients
new text begin who new text end reside in the same residencenew text begin shall count as one patientnew text end .
(b) The commissioner shall conduct a criminal background check on the designated
caregiver prior to registration to ensure that the person does not have a conviction for a
disqualifying felony offense. Any cost of the background check shall be paid by the person
seeking registration as a designated caregiver. A designated caregiver must have the criminal
background check renewed every two years.
(c) Nothing in sections 152.22 to 152.37 shall be construed to prevent a person registered
as a designated caregiver from also being enrolled in the registry program as a patient and
possessing and using medical cannabis as a patient.
Sec. 83.
Minnesota Statutes 2020, section 152.27, subdivision 6, is amended to read:
Subd. 6.
Patient enrollment.
(a) After receipt of a patient's application, application fees,
and signed disclosure, the commissioner shall enroll the patient in the registry program and
issue the patient and patient's registered designated caregiver or parent, legal guardian, or
spouse, if applicable, a registry verification. The commissioner shall approve or deny a
patient's application for participation in the registry program within 30 days after the
commissioner receives the patient's application and application fee. deleted text begin The commissioner may
approve applications up to 60 days after the receipt of a patient's application and application
fees until January 1, 2016.deleted text end A patient's enrollment in the registry program shall only be
denied if the patient:
(1) does not have certification from a health care practitioner that the patient has been
diagnosed with a qualifying medical condition;
(2) has not signed and returned the disclosure form required under subdivision 3,
paragraph (c), to the commissioner;
(3) does not provide the information required;new text begin or
new text end
deleted text begin
(4) has previously been removed from the registry program for violations of section
152.30 or 152.33; or
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end provides false information.
(b) The commissioner shall give written notice to a patient of the reason for denying
enrollment in the registry program.
(c) Denial of enrollment into the registry program is considered a final decision of the
commissioner and is subject to judicial review under the Administrative Procedure Act
pursuant to chapter 14.
(d) A patient's enrollment in the registry program may only be revoked upon the death
of the patient or if a patient violates a requirement under section 152.30 or 152.33.new text begin If a
patient's enrollment in the registry program has been revoked due to a violation of section
152.30 or 152.33, the patient may reapply for enrollment 12 months from the date the
patient's enrollment was revoked. The commissioner shall process the application in
accordance with this section.
new text end
(e) The commissioner shall develop a registry verification to provide to the patient, the
health care practitioner identified in the patient's application, and to the manufacturer. The
registry verification shall include:
(1) the patient's name and date of birth;
(2) the patient registry number assigned to the patient; and
(3) the name and date of birth of the patient's registered designated caregiver, if any, or
the name of the patient's parent, legal guardian, or spouse if the parent, legal guardian, or
spouse will be acting as a caregiver.
new text begin
(f) The commissioner shall not deny a patient's application for participation in the registry
program or revoke a patient's enrollment in the registry program solely because the patient
is also enrolled in a Tribal medical cannabis program.
new text end
Sec. 84.
Minnesota Statutes 2020, section 152.28, subdivision 1, is amended to read:
Subdivision 1.
Health care practitioner duties.
(a) Prior to a patient's enrollment in
the registry program, a health care practitioner shall:
(1) determine, in the health care practitioner's medical judgment, whether a patient suffers
from a qualifying medical condition, and, if so determined, provide the patient with a
certification of that diagnosis;
(2) deleted text begin determine whether a patient is developmentally or physically disabled and, as a result
of that disability, the patient requires assistance in administering medical cannabis or
obtaining medical cannabis from a distribution facility, and, if so determined, include that
determination on the patient's certification of diagnosis;
deleted text end
deleted text begin (3)deleted text end advise patients, registered designated caregivers, and parents, legal guardians, or
spouses who are acting as caregivers of the existence of any nonprofit patient support groups
or organizations;
deleted text begin (4)deleted text end new text begin (3)new text end provide explanatory information from the commissioner to patients with qualifying
medical conditions, including disclosure to all patients about the experimental nature of
therapeutic use of medical cannabis; the possible risks, benefits, and side effects of the
proposed treatment; the application and other materials from the commissioner; and provide
patients with the Tennessen warning as required by section 13.04, subdivision 2; and
deleted text begin (5)deleted text end new text begin (4)new text end agree to continue treatment of the patient's qualifying medical condition and
report medical findings to the commissioner.
(b) Upon notification from the commissioner of the patient's enrollment in the registry
program, the health care practitioner shall:
(1) participate in the patient registry reporting system under the guidance and supervision
of the commissioner;
(2) report health records of the patient throughout the ongoing treatment of the patient
to the commissioner in a manner determined by the commissioner and in accordance with
subdivision 2;
(3) determine, on a yearly basis, if the patient continues to suffer from a qualifying
medical condition and, if so, issue the patient a new certification of that diagnosis; and
(4) otherwise comply with all requirements developed by the commissioner.
(c) A health care practitioner may conduct a patient assessment to issue a recertification
as required under paragraph (b), clause (3), via telemedicine as defined under section
62A.671, subdivision 9.
(d) Nothing in this section requires a health care practitioner to participate in the registry
program.
Sec. 85.
Minnesota Statutes 2020, section 152.29, subdivision 1, is amended to read:
Subdivision 1.
Manufacturer; requirements.
(a) A manufacturer may operate eight
distribution facilities, which may include the manufacturer's single location for cultivation,
harvesting, manufacturing, packaging, and processing but is not required to include that
location. The commissioner shall designate the geographical service areas to be served by
each manufacturer based on geographical need throughout the state to improve patient
access. A manufacturer shall not have more than two distribution facilities in each
geographical service area assigned to the manufacturer by the commissioner. A manufacturer
shall operate only one location where all cultivation, harvesting, manufacturing, packaging,
and processing of medical cannabis shall be conducted. This location may be one of the
manufacturer's distribution facility sites. The additional distribution facilities may dispense
medical cannabis and medical cannabis products but may not contain any medical cannabis
in a form other than those forms allowed under section 152.22, subdivision 6, and the
manufacturer shall not conduct any cultivation, harvesting, manufacturing, packaging, or
processing at the other distribution facility sites. Any distribution facility operated by the
manufacturer is subject to all of the requirements applying to the manufacturer under sections
152.22 to 152.37, including, but not limited to, security and distribution requirements.
(b) A manufacturer may acquire hemp grown in this state from a hemp growernew text begin , and may
acquire hemp products produced by a hemp processornew text end . A manufacturer may manufacture
or process hemp new text begin and hemp products new text end into an allowable form of medical cannabis under
section 152.22, subdivision 6. Hemp new text begin and hemp products new text end acquired by a manufacturer under
this paragraph deleted text begin isdeleted text end new text begin arenew text end subject to the same quality control program, security and testing
requirements, and other requirements that apply to medical cannabis under sections 152.22
to 152.37 and Minnesota Rules, chapter 4770.
(c) A medical cannabis manufacturer shall contract with a laboratory approved by the
commissioner, subject to any additional requirements set by the commissioner, for purposes
of testing medical cannabis manufactured or hemp new text begin or hemp products new text end acquired by the medical
cannabis manufacturer as to content, contamination, and consistency to verify the medical
cannabis meets the requirements of section 152.22, subdivision 6. The cost of laboratory
testing shall be paid by the manufacturer.
(d) The operating documents of a manufacturer must include:
(1) procedures for the oversight of the manufacturer and procedures to ensure accurate
record keeping;
(2) procedures for the implementation of appropriate security measures to deter and
prevent the theft of medical cannabis and unauthorized entrance into areas containing medical
cannabis; and
(3) procedures for the delivery and transportation of hemp between hemp growers and
manufacturersnew text begin and for the delivery and transportation of hemp products between hemp
processors and manufacturersnew text end .
(e) A manufacturer shall implement security requirements, including requirements for
the delivery and transportation of hempnew text begin and hemp productsnew text end , protection of each location by
a fully operational security alarm system, facility access controls, perimeter intrusion
detection systems, and a personnel identification system.
(f) A manufacturer shall not share office space with, refer patients to a health care
practitioner, or have any financial relationship with a health care practitioner.
(g) A manufacturer shall not permit any person to consume medical cannabis on the
property of the manufacturer.
(h) A manufacturer is subject to reasonable inspection by the commissioner.
(i) For purposes of sections 152.22 to 152.37, a medical cannabis manufacturer is not
subject to the Board of Pharmacy licensure or regulatory requirements under chapter 151.
(j) A medical cannabis manufacturer may not employ any person who is under 21 years
of age or who has been convicted of a disqualifying felony offense. An employee of a
medical cannabis manufacturer must submit a completed criminal history records check
consent form, a full set of classifiable fingerprints, and the required fees for submission to
the Bureau of Criminal Apprehension before an employee may begin working with the
manufacturer. The bureau must conduct a Minnesota criminal history records check and
the superintendent is authorized to exchange the fingerprints with the Federal Bureau of
Investigation to obtain the applicant's national criminal history record information. The
bureau shall return the results of the Minnesota and federal criminal history records checks
to the commissioner.
(k) A manufacturer may not operate in any location, whether for distribution or
cultivation, harvesting, manufacturing, packaging, or processing, within 1,000 feet of a
public or private school existing before the date of the manufacturer's registration with the
commissioner.
(l) A manufacturer shall comply with reasonable restrictions set by the commissioner
relating to signage, marketing, display, and advertising of medical cannabis.
(m) Before a manufacturer acquires hemp from a hemp growernew text begin or hemp products from
a hemp processornew text end , the manufacturer must verify that the hemp grower new text begin or hemp processor
new text end has a valid license issued by the commissioner of agriculture under chapter 18K.
(n) Until a state-centralized, seed-to-sale system is implemented that can track a specific
medical cannabis plant from cultivation through testing and point of sale, the commissioner
shall conduct at least one unannounced inspection per year of each manufacturer that includes
inspection of:
(1) business operations;
(2) physical locations of the manufacturer's manufacturing facility and distribution
facilities;
(3) financial information and inventory documentation, including laboratory testing
results; and
(4) physical and electronic security alarm systems.
Sec. 86.
Minnesota Statutes 2020, section 152.29, subdivision 3, is amended to read:
Subd. 3.
Manufacturer; distribution.
(a) A manufacturer shall require that employees
licensed as pharmacists pursuant to chapter 151 be the only employees to give final approval
for the distribution of medical cannabis to a patient. A manufacturer may transport medical
cannabis or medical cannabis products that have been cultivated, harvested, manufactured,
packaged, and processed by that manufacturer to another registered manufacturer for the
other manufacturer to distribute.
(b) A manufacturer may distribute medical cannabis products, whether or not the products
have been manufactured by that manufacturer.
(c) Prior to distribution of any medical cannabis, the manufacturer shall:
(1) verify that the manufacturer has received the registry verification from the
commissioner for that individual patient;
(2) verify that the person requesting the distribution of medical cannabis is the patient,
the patient's registered designated caregiver, or the patient's parent, legal guardian, or spouse
listed in the registry verification using the procedures described in section 152.11, subdivision
2d;
(3) assign a tracking number to any medical cannabis distributed from the manufacturer;
(4) ensure that any employee of the manufacturer licensed as a pharmacist pursuant to
chapter 151 has consulted with the patient to determine the proper dosage for the individual
patient after reviewing the ranges of chemical compositions of the medical cannabis and
the ranges of proper dosages reported by the commissioner. For purposes of this clause, a
consultation may be conducted remotely deleted text begin using adeleted text end new text begin by securenew text end videoconferencenew text begin , telephone, or
other remote meansnew text end , so long as the employee providing the consultation is able to confirm
the identity of the patientdeleted text begin , the consultation occurs while the patient is at a distribution facility,deleted text end
and the consultation adheres to patient privacy requirements that apply to health care services
delivered through telemedicinenew text begin . A pharmacist consultation under this clause is not required
when a manufacturer is distributing medical cannabis to a patient according to a
patient-specific dosage plan established with that manufacturer and is not modifying the
dosage or product being distributed under that plan and the medical cannabis is distributed
by a pharmacy techniciannew text end ;
(5) properly package medical cannabis in compliance with the United States Poison
Prevention Packing Act regarding child-resistant packaging and exemptions for packaging
for elderly patients, and label distributed medical cannabis with a list of all active ingredients
and individually identifying information, including:
(i) the patient's name and date of birth;
(ii) the name and date of birth of the patient's registered designated caregiver or, if listed
on the registry verification, the name of the patient's parent or legal guardian, if applicable;
(iii) the patient's registry identification number;
(iv) the chemical composition of the medical cannabis; and
(v) the dosage; and
(6) ensure that the medical cannabis distributed contains a maximum of a 90-day supply
of the dosage determined for that patient.
(d) A manufacturer shall require any employee of the manufacturer who is transporting
medical cannabis or medical cannabis products to a distribution facility or to another
registered manufacturer to carry identification showing that the person is an employee of
the manufacturer.
new text begin
(e) A manufacturer shall distribute medical cannabis in dried raw cannabis form only
to a patient age 21 or older, or to the registered designated caregiver, parent, legal guardian,
or spouse of a patient age 21 or older.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (e) is effective the earlier of (1) March 1, 2022, or (2)
a date, as determined by the commissioner of health, by which (i) the rules adopted or
amended under Minnesota Statutes, section 152.26, paragraph (b), are in effect and (ii) the
independent laboratories under contract with the manufacturers have the necessary procedures
and equipment in place to perform the required testing of dried raw cannabis. If this section
is effective before March 1, 2022, the commissioner shall provide notice of that effective
date to the public.
new text end
Sec. 87.
Minnesota Statutes 2020, section 152.29, is amended by adding a subdivision to
read:
new text begin Subd. 3b. new text end
new text begin Distribution to recipient in a motor vehicle. new text end
new text begin
A manufacturer may distribute
medical cannabis to a patient, registered designated caregiver, or parent, legal guardian, or
spouse of a patient who is at the distribution facility but remains in a motor vehicle, provided:
new text end
new text begin
(1) distribution facility staff receive payment and distribute medical cannabis in a
designated zone that is as close as feasible to the front door of the distribution facility;
new text end
new text begin
(2) the manufacturer ensures that the receipt of payment and distribution of medical
cannabis are visually recorded by a closed-circuit television surveillance camera at the
distribution facility and provides any other necessary security safeguards;
new text end
new text begin
(3) the manufacturer does not store medical cannabis outside a restricted access area at
the distribution facility, and distribution facility staff transport medical cannabis from a
restricted access area at the distribution facility to the designated zone for distribution only
after confirming that the patient, designated caregiver, or parent, guardian, or spouse has
arrived in the designated zone;
new text end
new text begin
(4) the payment and distribution of medical cannabis take place only after a pharmacist
consultation takes place, if required under subdivision 3, paragraph (c), clause (4);
new text end
new text begin
(5) immediately following distribution of medical cannabis, distribution facility staff
enter the transaction in the state medical cannabis registry information technology database;
and
new text end
new text begin
(6) immediately following distribution of medical cannabis, distribution facility staff
take the payment received into the distribution facility.
new text end
Sec. 88.
Minnesota Statutes 2020, section 152.29, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin Disposal of medical cannabis plant root balls. new text end
new text begin
Notwithstanding Minnesota
Rules, part 4770.1200, subpart 2, item C, a manufacturer is not required to grind root balls
of medical cannabis plants or incorporate them with a greater quantity of nonconsumable
solid waste before transporting root balls to another location for disposal. For purposes of
this subdivision, "root ball" means a compact mass of roots formed by a plant and any
attached growing medium.
new text end
Sec. 89.
Minnesota Statutes 2020, section 152.31, is amended to read:
152.31 DATA PRACTICES.
(a) Government data in patient files maintained by the commissioner and the health care
practitioner, and data submitted to or by a medical cannabis manufacturer, are private data
on individuals, as defined in section 13.02, subdivision 12, or nonpublic data, as defined in
section 13.02, subdivision 9, but may be used for purposes of complying with chapter 13
and complying with a request from the legislative auditor or the state auditor in the
performance of official duties. The provisions of section 13.05, subdivision 11, apply to a
registration agreement entered between the commissioner and a medical cannabis
manufacturer under section 152.25.
(b) Not public data maintained by the commissioner may not be used for any purpose
not provided for in sections 152.22 to 152.37, and may not be combined or linked in any
manner with any other list, dataset, or database.
(c) The commissioner may execute data sharing arrangements with the commissioner
of agriculture to verify licensing, inspection, and compliance information related to hemp
growers new text begin and hemp processors new text end under chapter 18K.
Sec. 90.
Minnesota Statutes 2020, section 152.32, subdivision 3, is amended to read:
Subd. 3.
Discrimination prohibited.
(a) No school or landlord may refuse to enroll or
lease to and may not otherwise penalize a person solely for the person's status as a patient
enrolled in the registry program under sections 152.22 to 152.37, unless failing to do so
would violate federal law or regulations or cause the school or landlord to lose a monetary
or licensing-related benefit under federal law or regulations.
(b) For the purposes of medical care, including organ transplants, a registry program
enrollee's use of medical cannabis under sections 152.22 to 152.37 is considered the
equivalent of the authorized use of any other medication used at the discretion of a physician
or advanced practice registered nurse and does not constitute the use of an illicit substance
or otherwise disqualify a patient from needed medical care.
(c) Unless a failure to do so would violate federal law or regulations or cause an employer
to lose a monetary or licensing-related benefit under federal law or regulations, an employer
may not discriminate against a person in hiring, termination, or any term or condition of
employment, or otherwise penalize a person, if the discrimination is based upon either of
the following:
(1) the person's status as a patient enrolled in the registry program under sections 152.22
to 152.37; or
(2) a patient's positive drug test for cannabis components or metabolites, unless the
patient used, possessed, or was impaired by medical cannabis on the premises of the place
of employment or during the hours of employment.
(d) An employee who is required to undergo employer drug testing pursuant to section
181.953 may present verification of enrollment in the patient registry as part of the employee's
explanation under section 181.953, subdivision 6.
(e) A person shall not be denied custody of a minor child or visitation rights or parenting
time with a minor child solely based on the person's status as a patient enrolled in the registry
program under sections 152.22 to 152.37. There shall be no presumption of neglect or child
endangerment for conduct allowed under sections 152.22 to 152.37, unless the person's
behavior is such that it creates an unreasonable danger to the safety of the minor as
established by clear and convincing evidence.
new text begin
(f) This subdivision applies to any person enrolled in a Tribal medical cannabis program
to the same extent as if the person was enrolled in the registry program under sections 152.22
to 152.37.
new text end
Sec. 91.
Minnesota Statutes 2020, section 171.07, is amended by adding a subdivision to
read:
new text begin Subd. 3b. new text end
new text begin Identification card for homeless youth. new text end
new text begin
(a) A homeless youth, as defined in
section 256K.45, subdivision 1a, who meets the requirements of this subdivision may obtain
a noncompliant identification card, notwithstanding section 171.06, subdivision 3.
new text end
new text begin
(b) An applicant under this subdivision must:
new text end
new text begin
(1) provide the applicant's full name, date of birth, and sex;
new text end
new text begin
(2) provide the applicant's height in feet and inches, weight in pounds, and eye color;
new text end
new text begin
(3) submit a certified copy of a birth certificate issued by a government bureau of vital
statistics or equivalent agency in the applicant's state of birth, which must bear the raised
or authorized seal of the issuing government entity; and
new text end
new text begin
(4) submit a statement verifying that the applicant is a homeless youth who resides in
Minnesota that is signed by:
new text end
new text begin
(i) an employee of a human services agency receiving public funding to provide services
to homeless youth, runaway youth, youth with mental illness, or youth with substance use
disorders; or
new text end
new text begin
(ii) staff at a school who provide services to homeless youth or a school social worker.
new text end
new text begin
(c) For a noncompliant identification card under this subdivision:
new text end
new text begin
(1) the commissioner must not impose a fee, surcharge, or filing fee under section 171.06,
subdivision 2; and
new text end
new text begin
(2) a driver's license agent must not impose a filing fee under section 171.061, subdivision
4.
new text end
new text begin
(d) Minnesota Rules, parts 7410.0400 and 7410.0410, or successor rules, do not apply
for an identification card under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment for
application and issuance of Minnesota identification cards on and after January 1, 2022.
new text end
Sec. 92.
Minnesota Statutes 2020, section 256.98, subdivision 1, is amended to read:
Subdivision 1.
Wrongfully obtaining assistance.
new text begin (a) new text end A person who commits any of the
following acts or omissions with intent to defeat the purposes of sections 145.891 to 145.897,
the MFIP program formerly codified in sections 256.031 to 256.0361, the AFDC program
formerly codified in sections 256.72 to 256.871, chapter 256B, 256D, 256I, 256J, 256K, or
256L, child care assistance programs, and emergency assistance programs under section
256D.06, is guilty of theft and shall be sentenced under section 609.52, subdivision 3, clauses
(1) to (5):
(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a
willfully false statement or representation, by intentional concealment of any material fact,
or by impersonation or other fraudulent device, assistance or the continued receipt of
assistance, to include child care assistance or deleted text begin vouchersdeleted text end new text begin food benefitsnew text end produced according
to sections 145.891 to 145.897 and MinnesotaCare services according to sections 256.9365,
256.94, and 256L.01 to 256L.15, to which the person is not entitled or assistance greater
than that to which the person is entitled;
(2) knowingly aids or abets in buying or in any way disposing of the property of a
recipient or applicant of assistance without the consent of the county agency; or
(3) obtains or attempts to obtain, alone or in collusion with others, the receipt of payments
to which the individual is not entitled as a provider of subsidized child care, or by furnishing
or concurring in a willfully false claim for child care assistance.
new text begin (b) new text end The continued receipt of assistance to which the person is not entitled or greater than
that to which the person is entitled as a result of any of the acts, failure to act, or concealment
described in this subdivision shall be deemed to be continuing offenses from the date that
the first act or failure to act occurred.
Sec. 93.
Minnesota Statutes 2020, section 256B.0625, subdivision 52, is amended to read:
Subd. 52.
Lead risk assessments.
(a) Effective October 1, 2007, or six months after
federal approval, whichever is later, medical assistance covers lead risk assessments provided
by a lead risk assessor who is licensed by the commissioner of health under section 144.9505
and employed by an assessing agency as defined in section 144.9501. Medical assistance
covers a onetime on-site investigation of a recipient's home or primary residence to determine
the existence of lead so long as the recipient is under the age of 21 and has a venous blood
lead level specified in section 144.9504, subdivision 2, paragraph deleted text begin (a)deleted text end new text begin (b)new text end .
(b) Medical assistance reimbursement covers the lead risk assessor's time to complete
the following activities:
(1) gathering samples;
(2) interviewing family members;
(3) gathering data, including meter readings; and
(4) providing a report with the results of the investigation and options for reducing
lead-based paint hazards.
Medical assistance coverage of lead risk assessment does not include testing of
environmental substances such as water, paint, or soil or any other laboratory services.
Medical assistance coverage of lead risk assessments is not included in the capitated services
for children enrolled in health plans through the prepaid medical assistance program and
the MinnesotaCare program.
(c) Payment for lead risk assessment must be cost-based and must meet the criteria for
federal financial participation under the Medicaid program. The rate must be based on
allowable expenditures from cost information gathered. Under section 144.9507, subdivision
5, federal medical assistance funds may not replace existing funding for lead-related activities.
The nonfederal share of costs for services provided under this subdivision must be from
state or local funds and is the responsibility of the agency providing the risk assessment.
When the risk assessment is conducted by the commissioner of health, the state share must
be from appropriations to the commissioner of health for this purpose. Eligible expenditures
for the nonfederal share of costs may not be made from federal funds or funds used to match
other federal funds. Any federal disallowances are the responsibility of the agency providing
risk assessment services.
Sec. 94.
Minnesota Statutes 2020, section 326.71, subdivision 4, is amended to read:
Subd. 4.
Asbestos-related work.
"Asbestos-related work" means the enclosure, removal,
or encapsulation of asbestos-containing material in a quantity that meets or exceeds 260
linear feet of friable asbestos-containing material on pipes, 160 square feet of friable
asbestos-containing material on other facility components, or, if linear feet or square feet
cannot be measured, a total of 35 cubic feet of friable asbestos-containing material on or
off all facility components in one facility. In the case of single or multifamily residences,
"asbestos-related work" also means the enclosure, removal, or encapsulation of greater than
ten but less than 260 linear feet of friable asbestos-containing material on pipes, greater
than six but less than 160 square feet of friable asbestos-containing material on other facility
components, or, if linear feet or square feet cannot be measured, greater than one cubic foot
but less than 35 cubic feet of friable asbestos-containing material on or off all facility
components in one facility. deleted text begin This provision excludes asbestos-containing floor tiles and
sheeting, roofing materials, siding, and all ceilings with asbestos-containing material in
single family residences and buildings with no more than four dwelling units.deleted text end
Asbestos-related work includes asbestos abatement area preparation; enclosure, removal,
or encapsulation operations; and an air quality monitoring specified in rule to assure that
the abatement and adjacent areas are not contaminated with asbestos fibers during the project
and after completion.
For purposes of this subdivision, the quantity of deleted text begin asbestos containingdeleted text end new text begin asbestos-containingnew text end
material applies separately for every project.
Sec. 95.
Minnesota Statutes 2020, section 326.75, subdivision 1, is amended to read:
Subdivision 1.
Licensing fee.
A person required to be licensed under section 326.72
shall, before receipt of the license and before causing asbestos-related work to be performed,
pay the commissioner an annual license fee of deleted text begin $100deleted text end new text begin $105new text end .
Sec. 96.
Minnesota Statutes 2020, section 326.75, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
An individual required to be certified new text begin as an asbestos worker
or asbestos site supervisor new text end under section 326.73, subdivision 1, shall pay the commissioner
a certification fee of deleted text begin $50deleted text end new text begin $52.50new text end before the issuance of the certificate. deleted text begin The commissioner
may establish by rule fees required before the issuance ofdeleted text end new text begin An individual required to be
certified as annew text end asbestos inspector, asbestos management planner, and asbestos project
designer deleted text begin certificates requireddeleted text end under section 326.73, subdivisions 2, 3, and 4new text begin , shall pay the
commissioner a certification fee of $105 before the issuance of the certificatenew text end .
Sec. 97.
Minnesota Statutes 2020, section 326.75, subdivision 3, is amended to read:
Subd. 3.
Permit fee.
Five calendar days before beginning asbestos-related work, a person
shall pay a project permit fee to the commissioner equal to deleted text begin onedeleted text end new text begin twonew text end percent of the total costs
of the asbestos-related work. For asbestos-related work performed in single or multifamily
residences, of greater than ten but less than 260 linear feet of asbestos-containing material
on pipes, or greater than six but less than 160 square feet of asbestos-containing material
on other facility components, a person shall pay a project permit fee of $35 to the
commissioner.
Sec. 98.
Laws 2020, Seventh Special Session chapter 1, article 6, section 12, subdivision
4, is amended to read:
Subd. 4.
Housing with services establishment registration; conversion to an assisted
living facility license.
(a) Housing with services establishments registered under chapter
144D, providing home care services according to chapter 144A to at least one resident, and
intending to provide assisted living services on or after August 1, 2021, must submit an
application for an assisted living facility license in accordance with section 144G.12 no
later than June 1, 2021. The commissioner shall consider the application in accordance with
section deleted text begin 144G.16deleted text end new text begin 144G.15new text end .
(b) Notwithstanding the housing with services contract requirements identified in section
144D.04, any existing housing with services establishment registered under chapter 144D
that does not intend to convert its registration to an assisted living facility license under this
chapter must provide written notice to its residents at least 60 days before the expiration of
its registration, or no later than May 31, 2021, whichever is earlier. The notice must:
(1) state that the housing with services establishment does not intend to convert to an
assisted living facility;
(2) include the date when the housing with services establishment will no longer provide
housing with services;
(3) include the name, e-mail address, and phone number of the individual associated
with the housing with services establishment that the recipient of home care services may
contact to discuss the notice;
(4) include the contact information consisting of the phone number, e-mail address,
mailing address, and website for the Office of Ombudsman for Long-Term Care and the
Office of Ombudsman for Mental Health and Developmental Disabilities; and
(5) for residents who receive home and community-based waiver services under section
256B.49 and chapter 256S, also be provided to the resident's case manager at the same time
that it is provided to the resident.
(c) A housing with services registrant that obtains an assisted living facility license, but
does so under a different business name as a result of reincorporation, and continues to
provide services to the recipient, is not subject to the 60-day notice required under paragraph
(b). However, the provider must otherwise provide notice to the recipient as required under
sections 144D.04 and 144D.045, as applicable, and section 144D.09.
(d) All registered housing with services establishments providing assisted living under
sections 144G.01 to 144G.07 prior to August 1, 2021, must have an assisted living facility
license under this chapter.
(e) Effective August 1, 2021, any housing with services establishment registered under
chapter 144D that has not converted its registration to an assisted living facility license
under this chapter is prohibited from providing assisted living services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from December 17, 2020.
new text end
Sec. 99. new text begin ADDITIONAL MEMBER TO COVID-19 VACCINE ALLOCATION
ADVISORY GROUP.
new text end
new text begin
The commissioner of health shall appoint an individual who is an expert on vaccine
disinformation to the state COVID-19 Vaccine Allocation Advisory Group no later than
.......
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 100. new text begin REVIEW OF COVID-19 MEASURES.
new text end
new text begin Subdivision 1. new text end
new text begin Review. new text end
new text begin
The commissioner may contract with an independent third-party
entity that includes epidemiologists to conduct a review of measures to prevent and control
the spread of COVID-19.
new text end
new text begin Subd. 2. new text end
new text begin Costs. new text end
new text begin
If this review is performed, the commissioner may contract for the
performance of this review using existing resources, including federal funds that are available
for or that may be used for this purpose.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
No later than 30 days after completion of the review, the commissioner
may provide a report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health policy and data practices and the Legislative
Commission on Data Practices and Personal Data. Results of the review shall be public
data. The report shall de-identify any information used in the report. The report may be
submitted as required under Minnesota Statutes, section 3.195. Findings from the review
may be used to help develop strategies for improving COVID-19 prevention and control
measures.
new text end
Sec. 101. new text begin FEDERAL SCHEDULE I EXEMPTION APPLICATION FOR MEDICAL
USE OF CANNABIS.
new text end
new text begin
By September 1, 2021, the commissioner of health shall apply to the Drug Enforcement
Administration's Office of Diversion Control for an exception under Code of Federal
Regulations, title 21, section 1307.03, and request formal written acknowledgment that the
listing of marijuana, marijuana extract, and tetrahydrocannabinols as controlled substances
in federal Schedule I does not apply to the protected activities in Minnesota Statutes, section
152.32, subdivision 2, pursuant to the medical cannabis program established under Minnesota
Statutes, sections 152.22 to 152.37. The application shall include the presumption in
Minnesota Statutes, section 152.32, subdivision 1.
new text end
Sec. 102. new text begin LEGISLATIVE AUDITOR EXAMINATION OF PATIENT DISCHARGES
FROM HOSPITALS TO NURSING HOMES.
new text end
new text begin Subdivision 1. new text end
new text begin Topic to consider for evaluation. new text end
new text begin
(a) The Legislative Audit Commission
shall consider as a topic for evaluation by the legislative auditor during the next evaluation
cycle, an examination of patient discharges from hospitals to nursing homes during the
COVID-19 pandemic. If the Legislative Audit Commission chooses this topic for evaluation
according to Minnesota Statutes, section 3.97, subdivision 3a, the legislative auditor shall
review and analyze at least the following:
new text end
new text begin
(1) the number of patients discharged from hospitals to nursing homes during the
COVID-19 pandemic;
new text end
new text begin
(2) the effects of these patient discharges on the discharged patients and nursing home
residents, including the effect on the numbers of positive COVID-19 cases of nursing home
residents and employees whose cases may be traced to discharged patients and on the number
of hospitalizations and deaths of nursing home residents due to COVID-19 whose cases
may be traced to discharged patients;
new text end
new text begin
(3) whether these patient discharges occurred in compliance with federal and state agency
rules or guidance in effect when the discharges took place, including rules or guidance on
testing patients for COVID-19 prior to and following discharge, quarantine following
discharge of patients with an unknown COVID-19 infection status at discharge, isolation
following discharge of patients infected with COVID-19, and other COVID-19 infection
control measures;
new text end
new text begin
(4) for patient discharges that did not comply with federal and state agency rules or
guidance, the effect of failing to comply with such rules or guidance, including the effect
on the health of patients discharged to nursing homes and on the health of residents of
nursing homes to which patients were discharged; and
new text end
new text begin
(5) the impact of these patient discharges on reimbursement received by hospitals and
nursing homes for care provided to these patients.
new text end
new text begin
(b) If chosen for evaluation, the legislative auditor shall conduct this examination using
existing resources, including federal funds that are available for or that may be used for this
purpose.
new text end
new text begin Subd. 2. new text end
new text begin Cooperation. new text end
new text begin
If this evaluation is conducted, the commissioner of health, the
commissioner of human services, hospitals, and nursing homes must cooperate with this
examination and must provide the legislative auditor with access to data and records
necessary to perform this examination.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
By January 15, 2022, the legislative auditor shall submit a written
report on this evaluation according to Minnesota Statutes, section 3.974, if this evaluation
is conducted.
new text end
Sec. 103. new text begin MENTAL HEALTH CULTURAL COMMUNITY CONTINUING
EDUCATION GRANT PROGRAM.
new text end
new text begin
The commissioner of health shall develop a grant program, in consultation with the
relevant mental health licensing boards, to provide for the continuing education necessary
for social workers, marriage and family therapists, psychologists, and professional clinical
counselors who are members of communities of color or underrepresented communities,
as defined in Minnesota Statutes, section 148E.010, subdivision 20, and who work for
community mental health providers, to become supervisors for individuals pursuing licensure
in mental health professions.
new text end
Sec. 104. new text begin RECOMMENDATIONS; EXPANDED ACCESS TO DATA FROM
ALL-PAYER CLAIMS DATABASE.
new text end
new text begin
The commissioner of health shall develop recommendations to expand access to data
in the all-payer claims database under Minnesota Statutes, section 62U.04, to additional
outside entities for public health or research purposes. In the recommendations, the
commissioner must address an application process for outside entities to access the data,
how the department will exercise ongoing oversight over data use by outside entities,
purposes for which the data may be used by outside entities, establishment of a data access
committee to advise the department on selecting outside entities that may access the data,
and steps outside entities must take to protect data held by those entities from unauthorized
use. Following development of these recommendations, an outside entity that accesses data
in compliance with these recommendations may publish results that identify hospitals,
clinics, and medical practices so long as no individual health professionals are identified
and the commissioner finds the data to be accurate, valid, and suitable for publication for
such use. The commissioner shall submit these recommendations by December 15, 2021,
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health policy and civil law.
new text end
Sec. 105. new text begin SKIN LIGHTENING PRODUCTS PUBLIC AWARENESS AND
EDUCATION GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of health shall develop a
grant program for the purpose of increasing public awareness and education on the health
dangers associated with using skin lightening creams and products that contain mercury
that are manufactured in other countries and brought into this country and sold illegally
online or in stores.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants through a request
for proposal process to community-based, nonprofit organizations that serve ethnic
communities and that focus on public health outreach to Black, Indigenous, and people of
color communities on the issue of skin lightening products and chemical exposure from
these products. Priority in awarding grants shall be given to organizations that have
historically provided services to ethnic communities on the skin lightening and chemical
exposure issue for the past three years.
new text end
new text begin Subd. 3. new text end
new text begin Grant allocation. new text end
new text begin
(a) Grantees must use the funds to conduct public awareness
and education activities that are culturally specific and community-based and focus on:
new text end
new text begin
(1) the dangers of exposure to mercury through dermal absorption, inhalation,
hand-to-mouth contact, and through contact with individuals who have used these skin
lightening products;
new text end
new text begin
(2) the signs and symptoms of mercury poisoning;
new text end
new text begin
(3) the health effects of mercury poisoning, including the permanent effects on the central
nervous system and kidneys;
new text end
new text begin
(4) the dangers of using these products or being exposed to these products during
pregnancy and breastfeeding to the mother and to the infant;
new text end
new text begin
(5) knowing how to identify products that contain mercury; and
new text end
new text begin
(6) proper disposal of the product if the product contains mercury.
new text end
new text begin
(b) The grant application must include:
new text end
new text begin
(1) a description of the purpose or project for which the grant funds will be used;
new text end
new text begin
(2) a description of the objectives, a work plan, and a timeline for implementation; and
new text end
new text begin
(3) the community or group the grant proposes to focus on.
new text end
Sec. 106. new text begin TRAUMA-INFORMED GUN VIOLENCE REDUCTION; PILOT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Pilot program. new text end
new text begin
(a) The commissioner of health shall establish a pilot
program to aid in the reduction of trauma resulting from gun violence and address the root
causes of gun violence by making the following resources available to professionals and
organizations in health care, public health, mental health, social service, law enforcement,
and victim advocacy and other professionals who are most likely to encounter individuals
who have been victims, witnesses, or perpetrators of gun violence occurring in a community,
or in a domestic or other setting:
new text end
new text begin
(1) training on recognizing trauma as both a result and a cause of gun violence;
new text end
new text begin
(2) developing skills to address the effects of trauma on individuals and family members;
new text end
new text begin
(3) investments in community-based organizations to enable high-quality, targeted
services to individuals in need. This may include resources for additional training, hiring
of specialized staff needed to address trauma-related issues, management information
systems to facilitate data collection, and expansion of existing programming;
new text end
new text begin
(4) replication and expansion of effective community-based gun violence prevention
initiatives, such as Project Life, the Minneapolis Group Violence Intervention initiative, to
connect at-risk individuals to mental health services, job readiness programs, and employment
opportunities; and
new text end
new text begin
(5) education campaigns and outreach materials to educate communities, organizations,
and the public about the relationship between trauma and gun violence.
new text end
new text begin
(b) The pilot program shall address the traumatic effects of gun violence exposure using
a holistic treatment modality.
new text end
new text begin Subd. 2. new text end
new text begin Program guidelines and protocols. new text end
new text begin
(a) The commissioner, with advice from
an advisory panel knowledgeable about gun violence and its traumatic impact, shall develop
protocols and program guidelines that address resources and training to be used by
professionals who encounter individuals who have perpetrated or been impacted by gun
violence. Educational, training, and outreach material must be culturally appropriate for the
community and provided in multiple languages for those with limited English language
proficiency. The materials developed must address necessary responses by local, state, and
other governmental entities tasked with addressing gun violence. The protocols must include
a method of informing affected communities and local governments representing those
communities on effective strategies to target community, domestic, and other forms of gun
violence.
new text end
new text begin
(b) The commissioner may enter into contractual agreements with community-based
organizations or experts in the field to perform any of the activities under this section.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
By November 15, 2021, the commissioner shall submit a report on the
progress of the pilot program to the chairs and ranking minority members of the committees
with jurisdiction over health and public safety.
new text end
Sec. 107. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall amend the section headnote for Minnesota Statutes, section
62J.63, to read "HEALTH CARE PURCHASING AND PERFORMANCE
MEASUREMENT."
new text end
Sec. 108. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 62J.63, subdivision 3; 144.0721, subdivision 1;
144.0722; 144.0724, subdivision 10; and 144.693,
new text end
new text begin
are repealed.
new text end
ARTICLE 4
HEALTH-RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2020, section 148.90, subdivision 2, is amended to read:
Subd. 2.
Members.
(a) The members of the board shall:
(1) be appointed by the governor;
(2) be residents of the state;
(3) serve for not more than two consecutive terms;
(4) designate the officers of the board; and
(5) administer oaths pertaining to the business of the board.
(b) A public member of the board shall represent the public interest and shall not:
(1) be a psychologist or have engaged in the practice of psychology;
(2) be an applicant or former applicant for licensure;
(3) be a member of another health profession and be licensed by a health-related licensing
board as defined under section 214.01, subdivision 2; the commissioner of health; or licensed,
certified, or registered by another jurisdiction;
(4) be a member of a household that includes a psychologist; or
(5) have conflicts of interest or the appearance of conflicts with duties as a board member.
new text begin
(c) At the time of their appointments, at least two members of the board must reside
outside of the seven-county metropolitan area.
new text end
new text begin
(d) At the time of their appointments, at least two members of the board must be members
of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 2.
Minnesota Statutes 2020, section 148.911, is amended to read:
148.911 CONTINUING EDUCATION.
new text begin (a) new text end Upon application for license renewal, a licensee shall provide the board with
satisfactory evidence that the licensee has completed continuing education requirements
established by the board. Continuing education programs shall be approved under section
148.905, subdivision 1, clause (10). The board shall establish by rule the number of
continuing education training hours required each year and may specify subject or skills
areas that the licensee shall address.
new text begin
(b) At least four of the required continuing education hours must be on increasing the
knowledge, understanding, self-awareness, and practice skills to competently address the
psychological needs of individuals from diverse socioeconomic and cultural backgrounds.
Topics include but are not limited to:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression;
new text end
new text begin
(4) understanding cultural humility; and
new text end
new text begin
(5) understanding human diversity, meaning individual client differences that are
associated with the client's cultural group, including race, ethnicity, national origin, religious
affiliation, language, age, gender, gender identity, physical and mental capabilities, sexual
orientation, and socioeconomic status.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 3.
Minnesota Statutes 2020, section 148B.30, subdivision 1, is amended to read:
Subdivision 1.
Creation.
new text begin (a) new text end There is created a Board of Marriage and Family Therapy
that consists of seven members appointed by the governor. Four members shall be licensed,
practicing marriage and family therapists, each of whom shall for at least five years
immediately preceding appointment, have been actively engaged as a marriage and family
therapist, rendering professional services in marriage and family therapy. One member shall
be engaged in the professional teaching and research of marriage and family therapy. Two
members shall be representatives of the general public who have no direct affiliation with
the practice of marriage and family therapy. All members shall have been a resident of the
state two years preceding their appointment. Of the first board members appointed, three
shall continue in office for two years, two members for three years, and two members,
including the chair, for terms of four years respectively. Their successors shall be appointed
for terms of four years each, except that a person chosen to fill a vacancy shall be appointed
only for the unexpired term of the board member whom the newly appointed member
succeeds. Upon the expiration of a board member's term of office, the board member shall
continue to serve until a successor is appointed and qualified.
new text begin
(b) At the time of their appointments, at least two members must reside outside of the
seven-county metropolitan area.
new text end
new text begin
(c) At the time of their appointments, at least two members must be members of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 4.
Minnesota Statutes 2020, section 148B.31, is amended to read:
148B.31 DUTIES OF THE BOARD.
new text begin (a) new text end The board shall:
(1) adopt and enforce rules for marriage and family therapy licensing, which shall be
designed to protect the public;
(2) develop by rule appropriate techniques, including examinations and other methods,
for determining whether applicants and licensees are qualified under sections 148B.29 to
148B.392;
(3) issue licenses to individuals who are qualified under sections 148B.29 to 148B.392;
(4) establish and implement procedures designed to assure that licensed marriage and
family therapists will comply with the board's rules;
(5) study and investigate the practice of marriage and family therapy within the state in
order to improve the standards imposed for the licensing of marriage and family therapists
and to improve the procedures and methods used for enforcement of the board's standards;
(6) formulate and implement a code of ethics for all licensed marriage and family
therapists; and
(7) establish continuing education requirements for marriage and family therapists.
new text begin
(b) At least four of the 40 continuing education training hours required under Minnesota
Rules, part 5300.0320, subpart 2, must be on increasing the knowledge, understanding,
self-awareness, and practice skills that enable a marriage and family therapist to serve clients
from diverse socioeconomic and cultural backgrounds. Topics include but are not limited
to:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 5.
Minnesota Statutes 2020, section 148B.51, is amended to read:
148B.51 BOARD OF BEHAVIORAL HEALTH AND THERAPY.
new text begin (a) new text end The Board of Behavioral Health and Therapy consists of 13 members appointed by
the governor. Five of the members shall be professional counselors licensed or eligible for
licensure under sections 148B.50 to 148B.593. Five of the members shall be alcohol and
drug counselors licensed under chapter 148F. Three of the members shall be public members
as defined in section 214.02. The board shall annually elect from its membership a chair
and vice-chair. The board shall appoint and employ an executive director who is not a
member of the board. The employment of the executive director shall be subject to the terms
described in section 214.04, subdivision 2a. Chapter 214 applies to the Board of Behavioral
Health and Therapy unless superseded by sections 148B.50 to 148B.593.
new text begin
(b) At the time of their appointments, at least three members must reside outside of the
seven-county metropolitan area.
new text end
new text begin
(c) At the time of their appointments, at least three members must be members of:
new text end
new text begin
(1) a community of color; or
new text end
new text begin
(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.
new text end
Sec. 6.
Minnesota Statutes 2020, section 148B.54, subdivision 2, is amended to read:
Subd. 2.
Continuing education.
new text begin (a) new text end At the completion of the first four years of licensure,
a licensee must provide evidence satisfactory to the board of completion of 12 additional
postgraduate semester credit hours or its equivalent in counseling as determined by the
board, except that no licensee shall be required to show evidence of greater than 60 semester
hours or its equivalent. In addition to completing the requisite graduate coursework, each
licensee shall also complete in the first four years of licensure a minimum of 40 hours of
continuing education activities approved by the board under Minnesota Rules, part 2150.2540.
Graduate credit hours successfully completed in the first four years of licensure may be
applied to both the graduate credit requirement and to the requirement for 40 hours of
continuing education activities. A licensee may receive 15 continuing education hours per
semester credit hour or ten continuing education hours per quarter credit hour. Thereafter,
at the time of renewal, each licensee shall provide evidence satisfactory to the board that
the licensee has completed during each two-year period at least the equivalent of 40 clock
hours of professional postdegree continuing education in programs approved by the board
and continues to be qualified to practice under sections 148B.50 to 148B.593.
new text begin
(b) At least four of the required 40 continuing education clock hours must be on increasing
the knowledge, understanding, self-awareness, and practice skills that enable a licensed
professional counselor and licensed professional clinical counselor to serve clients from
diverse socioeconomic and cultural backgrounds. Topics include but are not limited to:
new text end
new text begin
(1) understanding culture, culture's functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 7.
Minnesota Statutes 2020, section 148E.010, is amended by adding a subdivision
to read:
new text begin Subd. 7f. new text end
new text begin Cultural responsiveness. new text end
new text begin
"Cultural responsiveness" means increasing the
knowledge, understanding, self-awareness, and practice skills that enable a social worker
to serve clients from diverse socioeconomic and cultural backgrounds including:
new text end
new text begin
(1) understanding culture, its functions, and strengths that exist in varied cultures;
new text end
new text begin
(2) understanding clients' cultures and differences among and between cultural groups;
new text end
new text begin
(3) understanding the nature of social diversity and oppression; and
new text end
new text begin
(4) understanding cultural humility.
new text end
Sec. 8.
Minnesota Statutes 2020, section 148E.130, subdivision 1, is amended to read:
Subdivision 1.
Total clock hours required.
(a) A licensee must complete 40 hours of
continuing education for each two-year renewal term. At the time of license renewal, a
licensee must provide evidence satisfactory to the board that the licensee has completed the
required continuing education hours during the previous renewal term. Of the total clock
hours required:
(1) all licensees must completenew text begin :
new text end
new text begin (i)new text end two hours in social work ethics as defined in section 148E.010; new text begin and
new text end
new text begin
(ii) four hours in cultural responsiveness;
new text end
(2) licensed independent clinical social workers must complete 12 clock hours in one
or more of the clinical content areas specified in section 148E.055, subdivision 5, paragraph
(a), clause (2);
(3) licensees providing licensing supervision according to sections 148E.100 to 148E.125,
must complete six clock hours in supervision as defined in section 148E.010; and
(4) no more than half of the required clock hours may be completed via continuing
education independent learning as defined in section 148E.010.
(b) If the licensee's renewal term is prorated to be less or more than 24 months, the total
number of required clock hours is prorated proportionately.
Sec. 9.
Minnesota Statutes 2020, section 148E.130, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin New content clock hours required effective July 1, 2021. new text end
new text begin
(a) The content
clock hours in subdivision 1, paragraph (a), clause (1), item (ii), apply to all new licenses
issued effective July 1, 2021, under section 148E.055.
new text end
new text begin
(b) Any licensee issued a license prior to July 1, 2021, under section 148E.055 must
comply with the clock hours in subdivision 1, including the content clock hours in subdivision
1, paragraph (a), clause (1), item (ii), at the first two-year renewal term after July 1, 2021.
new text end
Sec. 10.
Minnesota Statutes 2020, section 156.12, subdivision 2, is amended to read:
Subd. 2.
Authorized activities.
No provision of this chapter shall be construed to prohibit:
(a) a person from rendering necessary gratuitous assistance in the treatment of any animal
when the assistance does not amount to prescribing, testing for, or diagnosing, operating,
or vaccinating and when the attendance of a licensed veterinarian cannot be procured;
(b) a person who is a regular student in an accredited or approved college of veterinary
medicine from performing duties or actions assigned by instructors or preceptors or working
under the direct supervision of a licensed veterinarian;
(c) a veterinarian regularly licensed in another jurisdiction from consulting with a licensed
veterinarian in this state;
(d) the owner of an animal and the owner's regular employee from caring for and
administering to the animal belonging to the owner, except where the ownership of the
animal was transferred for purposes of circumventing this chapter;
(e) veterinarians who are in compliance with subdivision 6 and who are employed by
the University of Minnesota from performing their duties with the College of Veterinary
Medicine, College of Agriculture, Agricultural Experiment Station, Agricultural Extension
Service, Medical School, School of Public Health, or other unit within the university; or a
person from lecturing or giving instructions or demonstrations at the university or in
connection with a continuing education course or seminar to veterinarians or pathologists
at the University of Minnesota Veterinary Diagnostic Laboratory;
(f) any person from selling or applying any pesticide, insecticide or herbicide;
(g) any person from engaging in bona fide scientific research or investigations which
reasonably requires experimentation involving animals;
(h) any employee of a licensed veterinarian from performing duties other than diagnosis,
prescription or surgical correction under the direction and supervision of the veterinarian,
who shall be responsible for the performance of the employee;
(i) a graduate of a foreign college of veterinary medicine from working under the direct
personal instruction, control, or supervision of a veterinarian faculty member of the College
of Veterinary Medicine, University of Minnesota in order to complete the requirements
necessary to obtain an ECFVG or PAVE certificate;
(j) a licensed chiropractor registered under section 148.01, subdivision 1a, from practicing
animal chiropracticdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(k) a person certified by the Emergency Medical Services Regulatory Board under
chapter 144E from providing emergency medical care to a police dog wounded in the line
of duty.
new text end
Sec. 11. new text begin MENTAL HEALTH PROFESSIONAL LICENSING SUPERVISION.
new text end
new text begin
(a) The Board of Psychology, the Board of Marriage and Family Therapy, the Board of
Social Work, and the Board of Behavioral Health and Therapy must convene to develop
recommendations for:
new text end
new text begin
(1) providing certification of individuals across multiple mental health professions who
may serve as supervisors;
new text end
new text begin
(2) adopting a single, common supervision certificate for all mental health professional
education programs;
new text end
new text begin
(3) determining ways for internship hours to be counted toward licensure in mental
health professions; and
new text end
new text begin
(4) determining ways for practicum hours to count toward supervisory experience.
new text end
new text begin
(b) No later than February 1, 2023, the commissioners must submit a written report to
the members of the legislative committees with jurisdiction over health and human services
on the recommendations developed under paragraph (a).
new text end
ARTICLE 5
PRESCRIPTION DRUGS
Section 1.
new text begin
[62J.841] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of sections 62J.841 to 62J.845, the following
definitions apply.
new text end
new text begin Subd. 2. new text end
new text begin Consumer Price Index. new text end
new text begin
"Consumer Price Index" means the Consumer Price
Index, Annual Average, for All Urban Consumers, CPI-U: U.S. City Average, All Items,
reported by the United States Department of Labor, Bureau of Labor Statistics, or its
successor or, if the index is discontinued, an equivalent index reported by a federal authority
or, if no such index is reported, "Consumer Price Index" means a comparable index chosen
by the Bureau of Labor Statistics.
new text end
new text begin Subd. 3. new text end
new text begin Generic or off-patent drug. new text end
new text begin
"Generic or off-patent drug" means any prescription
drug for which any exclusive marketing rights granted under the Federal Food, Drug, and
Cosmetic Act, section 351 of the federal Public Health Service Act, and federal patent law
have expired, including any drug-device combination product for the delivery of a generic
drug.
new text end
new text begin Subd. 4. new text end
new text begin Manufacturer. new text end
new text begin
"Manufacturer" has the meaning provided in section 151.01,
subdivision 14a.
new text end
new text begin Subd. 5. new text end
new text begin Prescription drug. new text end
new text begin
"Prescription drug" means a drug for human use subject
to United States Code, title 21, section 353(b)(1).
new text end
new text begin Subd. 6. new text end
new text begin Wholesale acquisition cost. new text end
new text begin
"Wholesale acquisition cost" has the meaning
provided in United States Code, title 42, section 1395w-3a.
new text end
new text begin Subd. 7. new text end
new text begin Wholesale distributor. new text end
new text begin
"Wholesale distributor" has the meaning provided in
section 151.441, subdivision 14.
new text end
Sec. 2.
new text begin
[62J.842] EXCESSIVE PRICE INCREASES PROHIBITED.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
No manufacturer shall impose, or cause to be imposed, an
excessive price increase, whether directly or through a wholesale distributor, pharmacy, or
similar intermediary, on the sale of any generic or off-patent drug sold, dispensed, or
delivered to any consumer in the state.
new text end
new text begin Subd. 2. new text end
new text begin Excessive price increase. new text end
new text begin
A price increase is excessive for purposes of this
section when:
new text end
new text begin
(1) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds:
new text end
new text begin
(i) 15 percent of the wholesale acquisition cost over the immediately preceding calendar
year; or
new text end
new text begin
(ii) 40 percent of the wholesale acquisition cost over the immediately preceding three
calendar years; and
new text end
new text begin
(2) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds
$30 for:
new text end
new text begin
(i) a 30-day supply of the drug; or
new text end
new text begin
(ii) a course of treatment lasting less than 30 days.
new text end
new text begin Subd. 3. new text end
new text begin Exemption. new text end
new text begin
It is not a violation of this section for a wholesale distributor or
pharmacy to increase the price of a generic or off-patent drug if the price increase is directly
attributable to additional costs for the drug imposed on the wholesale distributor or pharmacy
by the manufacturer of the drug.
new text end
Sec. 3.
new text begin
[62J.843] REGISTERED AGENT AND OFFICE WITHIN THE STATE.
new text end
new text begin
Any manufacturer that sells, distributes, delivers, or offers for sale any generic or
off-patent drug in the state is required to maintain a registered agent and office within the
state.
new text end
Sec. 4.
new text begin
[62J.844] ENFORCEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Notification. new text end
new text begin
The commissioner of management and budget and any
other state agency that provides or purchases a pharmacy benefit except the Department of
Human Services, and any entity under contract with a state agency to provide a pharmacy
benefit other than an entity under contract with the Department of Human Services, shall
notify the manufacturer of a generic or off-patent drug, the attorney general, and the Board
of Pharmacy of any price increase that is in violation of section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin
Submission of drug cost statement and other information by manufacturer;
investigation by attorney general.
new text end
new text begin
(a) Within 45 days of receiving a notice under subdivision
1, the manufacturer of the generic or off-patent drug shall submit a drug cost statement to
the attorney general. The statement must:
new text end
new text begin
(1) itemize the cost components related to production of the drug, including any fees or
costs imposed by the state such as opioid registration fees;
new text end
new text begin
(2) identify the circumstances and timing of any increase in materials or manufacturing
costs that caused any increase during the preceding calendar year, or preceding three calendar
years as applicable, in the price of the drug; and
new text end
new text begin
(3) provide any other information that the manufacturer believes to be relevant to a
determination of whether a violation of section 62J.842 has occurred.
new text end
new text begin
(b) The attorney general may investigate whether a violation of section 62J.842 has
occurred, is occurring, or is about to occur, in accordance with section 8.31, subdivision 2.
new text end
new text begin Subd. 3. new text end
new text begin Petition to court. new text end
new text begin
(a) On petition of the attorney general, a court may issue an
order:
new text end
new text begin
(1) compelling the manufacturer of a generic or off-patent drug to:
new text end
new text begin
(i) provide the drug cost statement required under subdivision 2, paragraph (a); and
new text end
new text begin
(ii) answer interrogatories, produce records or documents, or be examined under oath,
as required by the attorney general under subdivision 2, paragraph (b);
new text end
new text begin
(2) restraining or enjoining a violation of sections 62J.841 to 62J.845, including issuing
an order requiring that drug prices be restored to levels that comply with section 62J.842;
new text end
new text begin
(3) requiring the manufacturer to provide an accounting to the attorney general of all
revenues resulting from a violation of section 62J.842;
new text end
new text begin
(4) requiring the manufacturer to repay to all consumers, including any third-party payers,
any money acquired as a result of a price increase that violates section 62J.842;
new text end
new text begin
(5) notwithstanding section 16A.151, requiring that all revenues generated from a
violation of section 62J.842 be remitted to the state and deposited into a special fund, to be
used for initiatives to reduce the cost to consumers of acquiring prescription drugs, if a
manufacturer is unable to determine the individual transactions necessary to provide the
repayments described in clause (4);
new text end
new text begin
(6) imposing a civil penalty of up to $10,000 per day for each violation of section 62J.842;
new text end
new text begin
(7) providing for the attorney general's recovery of its costs and disbursements incurred
in bringing an action against a manufacturer found in violation of section 62J.842, including
the costs of investigation and reasonable attorney's fees; and
new text end
new text begin
(8) providing any other appropriate relief, including any other equitable relief as
determined by the court.
new text end
new text begin
(b) For purposes of paragraph (a), clause (6), every individual transaction in violation
of section 62J.842 shall be considered a separate violation.
new text end
new text begin Subd. 4. new text end
new text begin Private right of action. new text end
new text begin
Any action brought pursuant to section 8.31, subdivision
3a, by a person injured by a violation of this section is for the benefit of the public.
new text end
Sec. 5.
new text begin
[62J.845] PROHIBITION ON WITHDRAWAL OF GENERIC OR
OFF-PATENT DRUGS FOR SALE.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
A manufacturer of a generic or off-patent drug is prohibited
from withdrawing that drug from sale or distribution within this state for the purpose of
avoiding the prohibition on excessive price increases under section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin Notice to board and attorney general. new text end
new text begin
Any manufacturer that intends to
withdraw a generic or off-patent drug from sale or distribution within the state shall provide
a written notice of withdrawal to the Board of Pharmacy and the attorney general, at least
180 days prior to the withdrawal.
new text end
new text begin Subd. 3. new text end
new text begin Financial penalty. new text end
new text begin
The attorney general shall assess a penalty of $500,000 on
any manufacturer of a generic or off-patent drug that it determines has failed to comply
with the requirements of this section.
new text end
Sec. 6.
new text begin
[62J.846] SEVERABILITY.
new text end
new text begin
If any provision of sections 62J.841 to 62J.845 or the application thereof to any person
or circumstance is held invalid for any reason in a court of competent jurisdiction, the
invalidity does not affect other provisions or any other application of sections 62J.841 to
62J.845 that can be given effect without the invalid provision or application.
new text end
Sec. 7.
Minnesota Statutes 2020, section 62Q.81, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Prescription drug benefits. new text end
new text begin
(a) A health plan company that offers individual
health plans must ensure that no fewer than 25 percent of the individual health plans the
company offers in each geographic area that the health plan company services at each level
of coverage described in subdivision 1, paragraph (b), clause (3), applies a predeductible,
flat-dollar amount co-payment structure to the entire drug benefit, including all tiers.
new text end
new text begin
(b) A health plan company that offers small group health plans must ensure that no fewer
than 25 percent of small group health plans the company offers in each geographic area that
the health plan company services at each level of coverage described in subdivision 1,
paragraph (b), clause (3), applies a predeductible, flat-dollar amount co-payment structure
to the entire drug benefit, including all tiers.
new text end
new text begin
(c) The highest allowable co-payment for the highest cost drug tier for health plans
offered pursuant to this subdivision must be no greater than 1/12 of the plan's out-of-pocket
maximum for an individual.
new text end
new text begin
(d) The flat-dollar amount co-payment tier structure for prescription drugs under this
subdivision must be graduated and proportionate.
new text end
new text begin
(e) All individual and small group health plans offered pursuant to this subdivision must
be:
new text end
new text begin
(1) clearly and appropriately named to aid the purchaser in the selection process;
new text end
new text begin
(2) marketed in the same manner as other health plans offered by the health plan company;
and
new text end
new text begin
(3) offered for purchase to any individual or small group.
new text end
new text begin
(f) This subdivision does not apply to catastrophic plans, grandfathered plans, large
group health plans, health savings accounts (HSAs), qualified high deductible health benefit
plans, limited health benefit plans, or short-term limited-duration health insurance policies.
new text end
new text begin
(g) Health plan companies must meet the requirements in this subdivision separately for
plans offered through MNsure under chapter 62V and plans offered outside of MNsure.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to individual
and small group health plans offered, issued, or renewed on or after that date.
new text end
Sec. 8.
new text begin
[62Q.83] PRESCRIPTION DRUG BENEFIT TRANSPARENCY AND
MANAGEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Drug" has the meaning given in section 151.01, subdivision 5.
new text end
new text begin
(c) "Enrollee contract term" means the 12-month term during which benefits associated
with health plan company products are in effect. For managed care plans and county-based
purchasing plans under section 256B.69 and chapter 256L, enrollee contract term means a
single calendar quarter.
new text end
new text begin
(d) "Formulary" means a list of prescription drugs that have been developed by clinical
and pharmacy experts and represents the health plan company's medically appropriate and
cost-effective prescription drugs approved for use.
new text end
new text begin
(e) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, and
includes an entity that performs pharmacy benefits management for the health plan company.
new text end
new text begin
(f) "Pharmacy benefits management" means the administration or management of
prescription drug benefits provided by the health plan company for the benefit of its enrollees
and may include but is not limited to procurement of prescription drugs, clinical formulary
development and management services, claims processing, and rebate contracting and
administration.
new text end
new text begin
(g) "Prescription" has the meaning given in section 151.01, subdivision 16a.
new text end
new text begin Subd. 2. new text end
new text begin Prescription drug benefit disclosure. new text end
new text begin
(a) A health plan company that provides
prescription drug benefit coverage and uses a formulary must make its formulary and related
benefit information available by electronic means and, upon request, in writing at least 30
days prior to annual renewal dates.
new text end
new text begin
(b) Formularies must be organized and disclosed consistent with the most recent version
of the United States Pharmacopeia's Model Guidelines.
new text end
new text begin
(c) For each item or category of items on the formulary, the specific enrollee benefit
terms must be identified, including enrollee cost-sharing and expected out-of-pocket costs.
new text end
new text begin Subd. 3. new text end
new text begin Formulary changes. new text end
new text begin
(a) Once a formulary has been established, a health plan
company may, at any time during the enrollee's contract term:
new text end
new text begin
(1) expand its formulary by adding drugs to the formulary;
new text end
new text begin
(2) reduce co-payments or coinsurance; or
new text end
new text begin
(3) move a drug to a benefit category that reduces an enrollee's cost.
new text end
new text begin
(b) A health plan company may remove a brand name drug from its formulary or place
a brand name drug in a benefit category that increases an enrollee's cost only upon the
addition to the formulary of a generic or multisource brand name drug rated as therapeutically
equivalent according to the Food and Drug Administration (FDA) Orange Book or a biologic
drug rated as interchangeable according to the FDA Purple Book at a lower cost to the
enrollee and upon at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
new text end
new text begin
(c) A health plan company may change utilization review requirements or move drugs
to a benefit category that increases an enrollee's cost during the enrollee's contract term
upon at least a 60-day notice to prescribers, pharmacists, and affected enrollees, provided
that these changes do not apply to enrollees who are currently taking the drugs affected by
these changes for the duration of the enrollee's contract term.
new text end
new text begin
(d) A health plan company may remove any drugs from its formulary that have been
deemed unsafe by the FDA; that have been withdrawn by either the FDA or the product
manufacturer; or when an independent source of research, clinical guidelines, or
evidence-based standards has issued drug-specific warnings or recommended changes in
drug usage.
new text end
new text begin Subd. 4. new text end
new text begin Exclusion. new text end
new text begin
This section does not apply to health coverage provided through
the State Employee Group Insurance Plan (SEGIP) under chapter 43A.
new text end
Sec. 9.
new text begin
[62W.0751] ALTERNATIVE BIOLOGICAL PRODUCTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following definitions
have the meanings given.
new text end
new text begin
(b) "Biological product" has the meaning given in section 151.01, subdivision 40.
new text end
new text begin
(c) "Biosimilar" or "biosimilar product" has the meaning given in section 151.01,
subdivision 43.
new text end
new text begin
(d) "Interchangeable biological product" has the meaning given in section 151.01,
subdivision 41.
new text end
new text begin
(e) "Reference biological product" has the meaning given in section 151.01, subdivision
44.
new text end
new text begin Subd. 2. new text end
new text begin
Pharmacy and provider choice related to dispensing reference biological
products, interchangeable biological products, or biosimilar products.
new text end
new text begin
(a) A pharmacy
benefit manager or health carrier must not require or demonstrate a preference for a pharmacy
or health care provider to prescribe or dispense a single biological product for which there
is a United States Food and Drug Administration-approved biosimilar or interchangeable
biological product relative to a reference biological product, except as provided in paragraph
(b).
new text end
new text begin
(b) If a pharmacy benefit manager or health carrier elects coverage of a product listed
in paragraph (a), it must also elect equivalent coverage for at least three reference, biosimilar,
or interchangeable biological products, or the total number of products that have been
approved by the United States Food and Drug Administration relative to the reference
product if less than three, for which the wholesale acquisition cost is less than the wholesale
acquisition cost of the product listed in paragraph (a).
new text end
new text begin
(c) A pharmacy benefit manager or health carrier must not impose limits on access to a
product required to be covered under paragraph (b) that are more restrictive than limits
imposed on access to a product listed in paragraph (a), or that otherwise have the same
effect as giving preferred status to a product listed in paragraph (a) over the product required
to be covered under paragraph (b).
new text end
new text begin
(d) This section does not apply to coverage provided through a public health care program
under chapter 256B or 256L, or health plan coverage through the State Employee Group
Insurance Plan (SEGIP) under chapter 43A.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 10.
Minnesota Statutes 2020, section 62W.11, is amended to read:
62W.11 GAG CLAUSE PROHIBITION.
(a) No contract between a pharmacy benefit manager or health carrier and a pharmacy
or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing
to an enrollee any health care information that the pharmacy or pharmacist deems appropriate
regarding the nature of treatment; the risks or alternatives; the availability of alternative
therapies, consultations, or tests; the decision of utilization reviewers or similar persons to
authorize or deny services; the process that is used to authorize or deny health care services
or benefits; or information on financial incentives and structures used by the health carrier
or pharmacy benefit manager.
(b) A pharmacy or pharmacist must provide to an enrollee information regarding the
enrollee's total cost for each prescription drug dispensed where part or all of the cost of the
prescription is being paid or reimbursed by the employer-sponsored plan or by a health
carrier or pharmacy benefit manager, in accordance with section 151.214, subdivision 1.
(c) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing information regarding the total cost for pharmacy services for a
prescription drug, including the patient's co-payment amount deleted text begin anddeleted text end new text begin ,new text end the pharmacy's own usual
and customary price deleted text begin ofdeleted text end new text begin fornew text end the prescriptionnew text begin drug, the pharmacy's acquisition cost for the
prescription drug, and the amount the pharmacy is being reimbursed by the pharmacy benefit
manager or health carrier for the prescription drugnew text end .
new text begin
(d) A pharmacy benefit manager must not prohibit a pharmacist or pharmacy from
discussing with a health carrier the amount the pharmacy is being paid or reimbursed for a
prescription drug by the pharmacy benefit manager or the pharmacy's acquisition cost for
a prescription drug.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing the availability of any therapeutically equivalent alternative
prescription drugs or alternative methods for purchasing the prescription drug, including
but not limited to paying out-of-pocket the pharmacy's usual and customary price when that
amount is less expensive to the enrollee than the amount the enrollee is required to pay for
the prescription drug under the enrollee's health plan.
Sec. 11.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Biosimilar. new text end
new text begin
"Biosimilar" or "biosimilar product" means a biological product
that the United States Food and Drug Administration has licensed, and determined to be
"biosimilar" under United States Code, title 42, section 262(i)(2).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 12.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 44. new text end
new text begin Reference biological product. new text end
new text begin
"Reference biological product" means the
single biological product for which the United States Food and Drug Administration has
approved an initial biological product license application, against which other biological
products are evaluated for licensure as biosimilar products or interchangeable biological
products.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 151.071, subdivision 1, is amended to read:
Subdivision 1.
Forms of disciplinary action.
When the board finds that a licensee,
registrant, or applicant has engaged in conduct prohibited under subdivision 2, it may do
one or more of the following:
(1) deny the issuance of a license or registration;
(2) refuse to renew a license or registration;
(3) revoke the license or registration;
(4) suspend the license or registration;
(5) impose limitations, conditions, or both on the license or registration, including but
not limited to: the limitation of practice to designated settings; the limitation of the scope
of practice within designated settings; the imposition of retraining or rehabilitation
requirements; the requirement of practice under supervision; the requirement of participation
in a diversion program such as that established pursuant to section 214.31 or the conditioning
of continued practice on demonstration of knowledge or skills by appropriate examination
or other review of skill and competence;
(6) impose a civil penalty not exceeding $10,000 for each separate violation,new text begin except that
a civil penalty not exceeding $25,000 may be imposed for each separate violation of section
62J.842,new text end the amount of the civil penalty to be fixed so as to deprive a licensee or registrant
of any economic advantage gained by reason of the violation, to discourage similar violations
by the licensee or registrant or any other licensee or registrant, or to reimburse the board
for the cost of the investigation and proceeding, including but not limited to, fees paid for
services provided by the Office of Administrative Hearings, legal and investigative services
provided by the Office of the Attorney General, court reporters, witnesses, reproduction of
records, board members' per diem compensation, board staff time, and travel costs and
expenses incurred by board staff and board members; and
(7) reprimand the licensee or registrant.
Sec. 14.
Minnesota Statutes 2020, section 151.071, subdivision 2, is amended to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
dispenser, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board must investigate any complaint of a violation of section 609.215, subdivision 1
or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; deleted text begin and
deleted text end
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the programdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(25) for a manufacturer, a violation of section 62J.842 or section 62J.845.
new text end
Sec. 15.
new text begin
[151.335] DELIVERY THROUGH COMMON CARRIER; COMPLIANCE
WITH TEMPERATURE REQUIREMENTS.
new text end
new text begin
In addition to complying with the requirements of Minnesota Rules, part 6800.3000, a
mail order or specialty pharmacy that employs the United States Postal Service or other
common carrier to deliver a filled prescription directly to a patient must ensure that the drug
is delivered in compliance with temperature requirements established by the manufacturer
of the drug. The pharmacy must develop written policies and procedures that are consistent
with United States Pharmacopeia, chapters 1079 and 1118, and with nationally recognized
standards issued by standard-setting or accreditation organizations recognized by the board
through guidance. The policies and procedures must be provided to the board upon request.
new text end
Sec. 16.
Minnesota Statutes 2020, section 151.555, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility registered under chapter 144D where there is centralized
storage of drugs and 24-hour on-site licensed nursing coverage provided seven days a week;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donationnew text begin ; or any over-the-counter
medication that meets the criteria established under this section for donationnew text end . This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription and nonprescription medical
supplies needed to administer a prescription drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2020, section 151.555, subdivision 7, is amended to read:
Subd. 7.
Standards and procedures for inspecting and storing donated prescription
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
prescription drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory. deleted text begin If
donated drugs or supplies are not inspected immediately upon receipt, a repository must
quarantine the donated drugs or supplies separately from all dispensing stock until the
donated drugs or supplies have been inspected and (1) approved for dispensing under the
program; (2) disposed of pursuant to paragraph (c); or (3) returned to the donor pursuant to
paragraph (d).
deleted text end
(c) The central repository and local repositories shall dispose of all prescription drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or prescription drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least deleted text begin fivedeleted text end new text begin twonew text end years. For each drug or supply
destroyed, the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 151.555, subdivision 11, is amended to read:
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) drug repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) drug repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated prescription
drugs and medical supplies, must be maintained by a repository for a minimum of deleted text begin fivedeleted text end new text begin twonew text end
years. Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the drug repository program from all local repositories shall be
submitted quarterly or upon request to the central repository. Data collected may consist of
the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2020, section 151.555, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Cooperation. new text end
new text begin
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256B.69, subdivision 6, is amended to read:
Subd. 6.
Service delivery.
(a) Each demonstration provider shall be responsible for the
health care coordination for eligible individuals. Demonstration providers:
(1) shall authorize and arrange for the provision of all needed health services including
but not limited to the full range of services listed in sections 256B.02, subdivision 8, and
256B.0625 in order to ensure appropriate health care is delivered to enrollees.
Notwithstanding section 256B.0621, demonstration providers that provide nursing home
and community-based services under this section shall provide relocation service coordination
to enrolled persons age 65 and over;
(2) shall accept the prospective, per capita payment from the commissioner in return for
the provision of comprehensive and coordinated health care services for eligible individuals
enrolled in the program;
(3) may contract with other health care and social service practitioners to provide services
to enrollees; and
(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.
(b) Demonstration providers must comply with the standards for claims settlement under
section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health care and
social service practitioners to provide services to enrollees. A demonstration provider must
pay a clean claim, as defined in Code of Federal Regulations, title 42, section 447.45(b),
within 30 business days of the date of acceptance of the claim.
new text begin
(c) Managed care plans and county-based purchasing plans must comply with section
62Q.83.
new text end
Sec. 21. new text begin STUDY OF PHARMACY AND PROVIDER CHOICE OF BIOLOGICAL
PRODUCTS.
new text end
new text begin
The commissioner of health, within the limits of existing resources, shall analyze the
effect of Minnesota Statutes, section 62W.0751, on the net price for different payors of
biological products, interchangeable biological products, and biosimilar products. The
commissioner of health shall report findings to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance, and insurance, by December 15, 2023.
new text end
Sec. 22. new text begin STUDY OF TEMPERATURE MONITORING.
new text end
new text begin
The Board of Pharmacy shall conduct a study to determine the appropriateness and
feasibility of requiring mail order and specialty pharmacies to enclose in each medication's
packaging a method by which the patient can easily detect improper storage or temperature
variations that may have occurred during the delivery of a medication. The board shall
report the results of the study by January 15, 2022, to the chairs and ranking minority
members of the legislative committees with jurisdiction over health finance and policy.
new text end
ARTICLE 6
HEALTH INSURANCE
Section 1.
Minnesota Statutes 2020, section 62A.04, subdivision 2, is amended to read:
Subd. 2.
Required provisions.
Except as provided in subdivision 4 each such policy
delivered or issued for delivery to any person in this state shall contain the provisions
specified in this subdivision in the words in which the same appear in this section. The
insurer may, at its option, substitute for one or more of such provisions corresponding
provisions of different wording approved by the commissioner which are in each instance
not less favorable in any respect to the insured or the beneficiary. Such provisions shall be
preceded individually by the caption appearing in this subdivision or, at the option of the
insurer, by such appropriate individual or group captions or subcaptions as the commissioner
may approve.
(1) A provision as follows:
ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the
attached papers, if any, constitutes the entire contract of insurance. No change in this policy
shall be valid until approved by an executive officer of the insurer and unless such approval
be endorsed hereon or attached hereto. No agent has authority to change this policy or to
waive any of its provisions.
(2) A provision as follows:
TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue of
this policy no misstatements, except fraudulent misstatements, made by the applicant in the
application for such policy shall be used to void the policy or to deny a claim for loss incurred
or disability (as defined in the policy) commencing after the expiration of such two year
period.
The foregoing policy provision shall not be so construed as to affect any legal requirement
for avoidance of a policy or denial of a claim during such initial two year period, nor to
limit the application of clauses (1), (2), (3), (4) and (5), in the event of misstatement with
respect to age or occupation or other insurance. A policy which the insured has the right to
continue in force subject to its terms by the timely payment of premium (1) until at least
age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date
of issue, may contain in lieu of the foregoing the following provisions (from which the
clause in parentheses may be omitted at the insurer's option) under the caption
"INCONTESTABLE":
After this policy has been in force for a period of two years during the lifetime of the
insured (excluding any period during which the insured is disabled), it shall become
incontestable as to the statements contained in the application.
(b) No claim for loss incurred or disability (as defined in the policy) commencing after
two years from the date of issue of this policy shall be reduced or denied on the ground that
a disease or physical condition not excluded from coverage by name or specific description
effective on the date of loss had existed prior to the effective date of coverage of this policy.
(3)(a) Except as required for qualified health plans sold through MNsure to individuals
receiving advance payments of the premium tax credit, a provision as follows:
GRACE PERIOD: A grace period of ..... (insert a number not less than "7" for weekly
premium policies, "10" for monthly premium policies and "31" for all other policies) days
will be granted for the payment of each premium falling due after the first premium, during
which grace period the policy shall continue in force.
A policy which contains a cancellation provision may add, at the end of the above
provision,
subject to the right of the insurer to cancel in accordance with the cancellation provision
hereof.
A policy in which the insurer reserves the right to refuse any renewal shall have, at the
beginning of the above provision,
Unless not less than five days prior to the premium due date the insurer has delivered
to the insured or has mailed to the insured's last address as shown by the records of the
insurer written notice of its intention not to renew this policy beyond the period for which
the premium has been accepted.
(b) For deleted text begin qualifieddeleted text end new text begin individual and small groupnew text end health plans deleted text begin sold through MNsure to
individuals receiving advance payments of the premium tax creditdeleted text end , a grace period provision
must be included that complies with deleted text begin the Affordable Care Act and is no less restrictive than
the grace period required by the Affordable Care Actdeleted text end new text begin section 62A.65, subdivision 2anew text end .
(4) A provision as follows:
REINSTATEMENT: If any renewal premium be not paid within the time granted the
insured for payment, a subsequent acceptance of premium by the insurer or by any agent
duly authorized by the insurer to accept such premium, without requiring in connection
therewith an application for reinstatement, shall reinstate the policy. If the insurer or such
agent requires an application for reinstatement and issues a conditional receipt for the
premium tendered, the policy will be reinstated upon approval of such application by the
insurer or, lacking such approval, upon the forty-fifth day following the date of such
conditional receipt unless the insurer has previously notified the insured in writing of its
disapproval of such application. For health plans described in section 62A.011, subdivision
3, clause (10), an insurer must accept payment of a renewal premium and reinstate the
policy, if the insured applies for reinstatement no later than 60 days after the due date for
the premium payment, unless:
(1) the insured has in the interim left the state or the insurer's service area; or
(2) the insured has applied for reinstatement on two or more prior occasions.
The reinstated policy shall cover only loss resulting from such accidental injury as may
be sustained after the date of reinstatement and loss due to such sickness as may begin more
than ten days after such date. In all other respects the insured and insurer shall have the
same rights thereunder as they had under the policy immediately before the due date of the
defaulted premium, subject to any provisions endorsed hereon or attached hereto in
connection with the reinstatement. Any premium accepted in connection with a reinstatement
shall be applied to a period for which premium has not been previously paid, but not to any
period more than 60 days prior to the date of reinstatement. The last sentence of the above
provision may be omitted from any policy which the insured has the right to continue in
force subject to its terms by the timely payment of premiums (1) until at least age 50, or,
(2) in the case of a policy issued after age 44, for at least five years from its date of issue.
(5) A provision as follows:
NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20
days after the occurrence or commencement of any loss covered by the policy, or as soon
thereafter as is reasonably possible. Notice given by or on behalf of the insured or the
beneficiary to the insurer at ..... (insert the location of such office as the insurer may designate
for the purpose), or to any authorized agent of the insurer, with information sufficient to
identify the insured, shall be deemed notice to the insurer.
In a policy providing a loss-of-time benefit which may be payable for at least two years,
an insurer may at its option insert the following between the first and second sentences of
the above provision:
Subject to the qualifications set forth below, if the insured suffers loss of time on account
of disability for which indemnity may be payable for at least two years, the insured shall,
at least once in every six months after having given notice of claim, give to the insurer
notice of continuance of said disability, except in the event of legal incapacity. The period
of six months following any filing of proof by the insured or any payment by the insurer
on account of such claim or any denial of liability in whole or in part by the insurer shall
be excluded in applying this provision. Delay in the giving of such notice shall not impair
the insured's right to any indemnity which would otherwise have accrued during the period
of six months preceding the date on which such notice is actually given.
(6) A provision as follows:
CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the
claimant such forms as are usually furnished by it for filing proofs of loss. If such forms
are not furnished within 15 days after the giving of such notice the claimant shall be deemed
to have complied with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written proof covering the
occurrence, the character and the extent of the loss for which claim is made.
(7) A provision as follows:
PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its said
office in case of claim for loss for which this policy provides any periodic payment contingent
upon continuing loss within 90 days after the termination of the period for which the insurer
is liable and in case of claim for any other loss within 90 days after the date of such loss.
Failure to furnish such proof within the time required shall not invalidate nor reduce any
claim if it was not reasonably possible to give proof within such time, provided such proof
is furnished as soon as reasonably possible and in no event, except in the absence of legal
capacity, later than one year from the time proof is otherwise required.
(8) A provision as follows:
TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss
other than loss for which this policy provides periodic payment will be paid immediately
upon receipt of due written proof of such loss. Subject to due written proof of loss, all
accrued indemnities for loss for which this policy provides periodic payment will be paid
..... (insert period for payment which must not be less frequently than monthly) and any
balance remaining unpaid upon the termination of liability will be paid immediately upon
receipt of due written proof.
(9) A provision as follows:
PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with
the beneficiary designation and the provisions respecting such payment which may be
prescribed herein and effective at the time of payment. If no such designation or provision
is then effective, such indemnity shall be payable to the estate of the insured. Any other
accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid
either to such beneficiary or to such estate. All other indemnities will be payable to the
insured.
The following provisions, or either of them, may be included with the foregoing provision
at the option of the insurer:
If any indemnity of this policy shall be payable to the estate of the insured, or to an
insured or beneficiary who is a minor or otherwise not competent to give a valid release,
the insurer may pay such indemnity, up to an amount not exceeding $..... (insert an amount
which shall not exceed $1,000), to any relative by blood or connection by marriage of the
insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any
payment made by the insurer in good faith pursuant to this provision shall fully discharge
the insurer to the extent of such payment.
Subject to any written direction of the insured in the application or otherwise all or a
portion of any indemnities provided by this policy on account of hospital, nursing, medical,
or surgical services may, at the insurer's option and unless the insured requests otherwise
in writing not later than the time of filing proofs of such loss, be paid directly to the hospital
or person rendering such services; but it is not required that the service be rendered by a
particular hospital or person.
(10) A provision as follows:
PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall
have the right and opportunity to examine the person of the insured when and as often as it
may reasonably require during the pendency of a claim hereunder and to make an autopsy
in case of death where it is not forbidden by law.
(11) A provision as follows:
LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this
policy prior to the expiration of 60 days after written proof of loss has been furnished in
accordance with the requirements of this policy. No such action shall be brought after the
expiration of three years after the time written proof of loss is required to be furnished.
(12) A provision as follows:
CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation
of beneficiary, the right to change of beneficiary is reserved to the insured and the consent
of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this
policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.
The first clause of this provision, relating to the irrevocable designation of beneficiary, may
be omitted at the insurer's option.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62A.10, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Prohibition on waiting periods that exceed 90 days. new text end
new text begin
(a) For purposes of this
subdivision, "waiting period" means the period that must pass before coverage becomes
effective for an individual who is otherwise eligible to enroll under the terms of a group
health plan.
new text end
new text begin
(b) A health carrier offering a group health plan must not apply a waiting period that
exceeds 90 days, with exceptions for the circumstances described in paragraphs (c) to (e).
A health carrier does not violate this subdivision solely because an individual is permitted
to take additional time to elect coverage beyond the end of the 90-day waiting period.
new text end
new text begin
(c) If a group health plan conditions eligibility on an employee working full time or
regularly having a specified number of service hours per period, and the plan is unable to
determine whether a newly hired employee is full time or reasonably expected to regularly
work the specific number of hours per period, the plan may take a reasonable period of
time, not to exceed 12 months beginning on any date between the employee's start date and
the first day of the first calendar month after the employee's start date, to determine whether
the employee meets the plan's eligibility condition.
new text end
new text begin
(d) If a group health plan conditions eligibility on an employee having completed a
cumulative number of service hours, the cumulative hours-of-service requirement must not
exceed 1,200 hours.
new text end
new text begin
(e) An orientation period may be added to the 90-day waiting period if the orientation
period is one month or less. The one-month period is determined by adding one calendar
month and subtracting one calendar day, measured from an employee's start date in a position
that is otherwise eligible for coverage.
new text end
new text begin
(f) A group health plan may treat an employee whose employment has terminated and
is later rehired as newly eligible upon rehire and require the rehired employee to meet the
plan's eligibility criteria and waiting period again, if doing so is reasonable under the
circumstances. Treating an employee as rehired is reasonable if the employee has a break
in service of at least 13 weeks, or at least 26 weeks if the employer is an educational
institution.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62A.15, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin Mental health services. new text end
new text begin
All benefits provided by a policy or contract referred
to in subdivision 1 relating to expenses incurred for mental health treatment or services
provided by a mental health professional must also include treatment and services provided
by a clinical trainee to the extent that the services and treatment are within the scope of
practice of the clinical trainee according to Minnesota Rules, part 9505.0371, subpart 5,
item C. This subdivision is intended to provide equal payment of benefits for mental health
treatment and services provided by a mental health professional, as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A, or a clinical trainee and is not intended to change
or add to the benefits provided for in those policies or contracts.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to policies
and contracts offered, issued, or renewed on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62A.15, subdivision 4, is amended to read:
Subd. 4.
Denial of benefits.
(a) No carrier referred to in subdivision 1 may, in the
payment of claims to employees in this state, deny benefits payable for services covered by
the policy or contract if the services are lawfully performed by a licensed chiropractor,
licensed optometrist, a registered nurse meeting the requirements of subdivision 3a, deleted text begin ordeleted text end a
licensed acupuncture practitionernew text begin , or a mental health clinical traineenew text end .
(b) When carriers referred to in subdivision 1 make claim determinations concerning
the appropriateness, quality, or utilization of chiropractic health care for Minnesotans, any
of these determinations that are made by health care professionals must be made by, or
under the direction of, or subject to the review of licensed doctors of chiropractic.
(c) When a carrier referred to in subdivision 1 makes a denial of payment claim
determination concerning the appropriateness, quality, or utilization of acupuncture services
for individuals in this state performed by a licensed acupuncture practitioner, a denial of
payment claim determination that is made by a health professional must be made by, under
the direction of, or subject to the review of a licensed acupuncture practitioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2020, section 62A.65, subdivision 1, is amended to read:
Subdivision 1.
Applicability.
No health carrier, as defined in section 62A.011, shall
offer, sell, issue, or renew any individual health plan, as defined in section 62A.011, to a
Minnesota resident except in compliance with this section. deleted text begin This section does not apply to
the Comprehensive Health Association established in section 62E.10.deleted text end new text begin A health carrier must
only offer, sell, issue, or renew individual health plans on a guaranteed issue basis and at a
premium rate that does not vary based on the health status of the individual.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 6.
Minnesota Statutes 2020, section 62A.65, is amended by adding a subdivision to
read:
new text begin Subd. 2a. new text end
new text begin Grace period for nonpayment of premium. new text end
new text begin
(a) Notwithstanding any other
law to the contrary, an individual health plan may be canceled for nonpayment of premiums,
but must include a grace period as described in this subdivision.
new text end
new text begin
(b) The grace period must be three consecutive months. During the grace period, the
health carrier must:
new text end
new text begin
(1) pay all claims for services that would have been covered if the premium had been
paid, which are provided to the enrollee during the first month of the grace period, and may
pend claims for services provided to an enrollee in the second and third months of the grace
period; and
new text end
new text begin
(2) notify health care providers of the possibility of denied claims when an enrollee is
in the second and third month of the grace period.
new text end
new text begin
(c) In order to stop a cancellation, an enrollee must pay all outstanding premiums before
the end of the grace period.
new text end
new text begin
(d) If a health plan is canceled under this subdivision, the final day of the enrollment is
the last day of the first month of the three-month grace period.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2020, section 62D.095, subdivision 2, is amended to read:
Subd. 2.
Co-payments.
A health maintenance contract may impose a co-payment and
coinsurance consistent with deleted text begin the provisions of the Affordable Care Act as defined under
section 62A.011, subdivision 1adeleted text end new text begin state and federal lawnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 8.
Minnesota Statutes 2020, section 62D.095, subdivision 3, is amended to read:
Subd. 3.
Deductibles.
A health maintenance contract may impose a deductible consistent
with deleted text begin the provisions of the Affordable Care Act as defined under section 62A.011, subdivision
1adeleted text end new text begin state and federal lawnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 9.
Minnesota Statutes 2020, section 62D.095, subdivision 4, is amended to read:
Subd. 4.
Annual out-of-pocket maximums.
A health maintenance contract may impose
an annual out-of-pocket maximum consistent with the provisions of deleted text begin the Affordable Care
Act as defined under section 62A.011, subdivision 1adeleted text end new text begin section 62Q.677, subdivision 6anew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 10.
Minnesota Statutes 2020, section 62D.095, subdivision 5, is amended to read:
Subd. 5.
Exceptions.
No co-payments or deductibles may be imposed on preventive
deleted text begin health caredeleted text end new text begin items andnew text end services deleted text begin consistent with the provisions of the Affordable Care Act as
defined under section 62A.011, subdivision 1adeleted text end new text begin , as defined in section 62Q.46, subdivision
1new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 11.
Minnesota Statutes 2020, section 62Q.01, subdivision 2a, is amended to read:
Subd. 2a.
Dependent child to the limiting age.
"Dependent child to the limiting age"
or "dependent children to the limiting age" means those individuals who are eligible and
covered as a dependent child under the terms of a health plan who have not yet attained 26
years of age. A health plan company must not deny or restrict eligibility for a dependent
child to the limiting age based on financial dependency, residency, marital status, or student
status. For coverage under plans offered by the Minnesota Comprehensive Health
Association, dependent to the limiting age means dependent as defined in section 62A.302,
subdivision 3. Notwithstanding the provisions in this subdivision, a health plan may include:
(1) eligibility requirements regarding the absence of other health plan coverage deleted text begin as
permitted by the Affordable Care Actdeleted text end for grandfathered plan coverage; or
(2) an age greater than 26 in its policy, contract, or certificate of coverage.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 12.
new text begin
[62Q.097] REQUIREMENTS FOR TIMELY PROVIDER
CREDENTIALING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "Clean application for provider credentialing" or "clean application" means an
application for provider credentialing submitted by a health care provider to a health plan
company that is complete, is in the format required by the health plan company, and includes
all information and substantiation required by the health plan company and does not require
evaluation of any identified potential quality or safety concern.
new text end
new text begin
(c) "Provider credentialing" means the process undertaken by a health plan company to
evaluate and approve a health care provider's education, training, residency, licenses,
certifications, and history of significant quality or safety concerns in order to approve the
health care provider to provide health care services to patients at a clinic or facility.
new text end
new text begin Subd. 2. new text end
new text begin Time limit for credentialing determination. new text end
new text begin
A health plan company that
receives an application for provider credentialing must:
new text end
new text begin
(1) if the application is determined to be a clean application for provider credentialing
and if the health care provider submitting the application or the clinic or facility at which
the health care provider provides services requests the information, affirm that the health
care provider's application is a clean application and notify the health care provider or clinic
or facility of the date by which the health plan company will make a determination on the
health care provider's application;
new text end
new text begin
(2) if the application is determined not to be a clean application, inform the health care
provider of the application's deficiencies or missing information or substantiation within
three business days after the health plan company determines the application is not a clean
application; and
new text end
new text begin
(3) make a determination on the health care provider's clean application within 45 days
after receiving the clean application unless the health plan company identifies a substantive
quality or safety concern in the course of provider credentialing that requires further
investigation. Upon notice to the health care provider, clinic, or facility, the health plan
company is allowed 30 additional days to investigate any quality or safety concerns.
new text end
new text begin EFFECTIVE DATE; APPLICATION. new text end
new text begin
This section applies to applications for provider
credentialing submitted to a health plan company on or after January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 62Q.46, is amended to read:
62Q.46 PREVENTIVE ITEMS AND SERVICES.
Subdivision 1.
Coverage for preventive items and services.
(a) "Preventive items and
services" deleted text begin has the meaning specified in the Affordable Care Actdeleted text end new text begin means the items and services
categorized as preventive under subdivision 1anew text end .
(b) A health plan company must provide coverage for preventive items and services at
a participating provider without imposing cost-sharing requirements, including a deductible,
coinsurance, or co-payment. Nothing in this section prohibits a health plan company that
has a network of providers from excluding coverage or imposing cost-sharing requirements
for preventive items or services that are delivered by an out-of-network provider.
(c) A health plan company is not required to provide coverage for any items or services
specified in any recommendation or guideline described in paragraph (a) if the
recommendation or guideline is no longer included as a preventive item or service as defined
in paragraph (a). Annually, a health plan company must determine whether any additional
items or services must be covered without cost-sharing requirements or whether any items
or services are no longer required to be covered.
(d) Nothing in this section prevents a health plan company from using reasonable medical
management techniques to determine the frequency, method, treatment, or setting for a
preventive item or service to the extent not specified in the recommendation or guideline.
(e) This section does not apply to grandfathered plans.
(f) This section does not apply to plans offered by the Minnesota Comprehensive Health
Association.
new text begin Subd. 1a. new text end
new text begin Preventive items and services. new text end
new text begin
The commissioner of commerce must provide
health plan companies with information regarding which items and services must be
categorized as preventive.
new text end
Subd. 2.
Coverage for office visits in conjunction with preventive items and
services.
(a) A health plan company may impose cost-sharing requirements with respect to
an office visit if a preventive item or service is billed separately or is tracked separately as
individual encounter data from the office visit.
(b) A health plan company must not impose cost-sharing requirements with respect to
an office visit if a preventive item or service is not billed separately or is not tracked
separately as individual encounter data from the office visit and the primary purpose of the
office visit is the delivery of the preventive item or service.
(c) A health plan company may impose cost-sharing requirements with respect to an
office visit if a preventive item or service is not billed separately or is not tracked separately
as individual encounter data from the office visit and the primary purpose of the office visit
is not the delivery of the preventive item or service.
Subd. 3.
Additional services not prohibited.
Nothing in this section prohibits a health
plan company from providing coverage for preventive items and services in addition to
those specified in deleted text begin the Affordable Care Actdeleted text end new text begin subdivision 1anew text end , or from denying coverage for
preventive items and services that are not recommended as preventive items and services
under deleted text begin the Affordable Care Actdeleted text end new text begin subdivision 1anew text end . A health plan company may impose
cost-sharing requirements for a treatment not described in deleted text begin the Affordable Care Actdeleted text end new text begin
subdivision 1anew text end even if the treatment results from a preventive item or service described in
deleted text begin the Affordable Care Actdeleted text end new text begin subdivision 1anew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 14.
new text begin
[62Q.472] SCREENING AND TESTING FOR OPIOIDS.
new text end
new text begin
(a) A health plan company shall not place a lifetime or annual limit on screenings and
urinalysis testing for opioids for an enrollee in an inpatient or outpatient substance use
disorder treatment program when ordered by a health care provider and performed by an
accredited clinical laboratory. A health plan company is not prohibited from conducting a
medical necessity review when screenings or urinalysis testing for an enrollee exceeds 24
tests in any 12-month period.
new text end
new text begin
(b) This section does not apply to managed care plans or county-based purchasing plans
when the plan is providing coverage to public health care program enrollees under chapter
256B or 256L.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 15.
Minnesota Statutes 2020, section 62Q.677, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Out-of-pocket annual maximum. new text end
new text begin
By October of each year, the commissioner
of commerce must determine the maximum annual out-of-pocket limits applicable to
individual health plans and small group health plans.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 16.
Minnesota Statutes 2020, section 62Q.81, is amended to read:
62Q.81 ESSENTIAL HEALTH BENEFIT PACKAGE REQUIREMENTS.
Subdivision 1.
Essential health benefits package.
(a) Health plan companies offering
individual and small group health plans must include the essential health benefits package
deleted text begin required under section 1302(a) of the Affordable Care Act and asdeleted text end described in this
subdivision.
(b) The essential health benefits package means new text begin insurance new text end coverage that:
(1) provides new text begin the new text end essential health benefits deleted text begin as outlined in the Affordable Care Actdeleted text end new text begin described
in subdivision 4new text end ;
(2) limits cost-sharing for deleted text begin suchdeleted text end new text begin thenew text end coverage deleted text begin in accordance with the Affordable Care
Actdeleted text end , as described in subdivision 2; and
(3) deleted text begin subject to subdivision 3,deleted text end provides bronze, silver, gold, or platinum level of coverage
deleted text begin in accordance with the Affordable Care Actdeleted text end new text begin , as described in subdivision 3new text end .
Subd. 2.
new text begin Cost-sharing; new text end coverage for enrollees under the age of 21.
new text begin
(a) Cost-sharing
includes (1) deductibles, coinsurance, co-payments, or similar charges, and (2) qualified
medical expenses, as defined in section 223(d)(2) of the Internal Revenue Code of 1986,
as amended. Cost-sharing does not include premiums, balance billing from non-network
providers, or spending for noncovered services.
new text end
new text begin
(b) Cost-sharing per year for individual health plans is limited to the amount allowed
under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986, as amended, increased
by an amount equal to the product of that amount and the premium adjustment percentage.
The premium adjustment percentage is the percentage that the average per capita premium
for health insurance coverage in the United States for the preceding calendar year exceeds
the average per capita premium for 2017. If the amount of the increase is not a multiple of
$50, the increases must be rounded to the next lowest multiple of $50.
new text end
new text begin
(c) Cost-sharing per year for small group health plans is limited to twice the amount
allowed under paragraph (b).
new text end
new text begin (d) new text end If a health plan company offers health plans in any level of coverage deleted text begin specified under
section 1302(d) of the Affordable Care Act, asdeleted text end described in subdivision deleted text begin 1, paragraph (b),
clause (3)deleted text end new text begin 3new text end , the health plan company shall also offer coverage in that level to individuals
who have not attained 21 years of age as of the beginning of a policy year.
Subd. 3.
new text begin Levels of coverage; new text end alternative compliance for catastrophic plans.
new text begin
(a) A
health plan in the bronze level must provide a level of coverage designed to provide benefits
that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided
under the plan.
new text end
new text begin
(b) A health plan in the silver level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 70 percent of the full actuarial value of the benefits
provided under the plan.
new text end
new text begin
(c) A health plan in the gold level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 80 percent of the full actuarial value of the benefits
provided under the plan.
new text end
new text begin
(d) A health plan in the platinum level must provide a level of coverage designed to
provide benefits that are actuarially equivalent to 90 percent of the full actuarial value of
the benefits provided under the plan.
new text end
new text begin (e) new text end A health plan company that does not provide an individual or small group health
plan in the bronze, silver, gold, or platinum level of coveragedeleted text begin , as described in subdivision
1, paragraph (b), clause (3), shall be treated as meetingdeleted text end new text begin meetsnew text end the requirements ofnew text begin thisnew text end section
deleted text begin 1302(d) of the Affordable Care Actdeleted text end with respect to any deleted text begin policydeleted text end new text begin plannew text end year if the health plan
company provides a catastrophic plan that meets thenew text begin followingnew text end requirements deleted text begin of section
1302(e) of the Affordable Care Act.deleted text end new text begin :
new text end
new text begin
(1) enrollment in the health plan is limited only to individuals that:
new text end
new text begin
(i) have not attained age 30 before the beginning of the plan year;
new text end
new text begin
(ii) are unable to access affordable coverage; or
new text end
new text begin
(iii) are experiencing a hardship in reference to the individual's capability to access
coverage; and
new text end
new text begin
(2) the health plan provides:
new text end
new text begin
(i) essential health benefits, except that the plan does not provide benefits for any plan
year until the individual has incurred cost-sharing expenses in an amount equal to the
limitation in effect under subdivision 2; and
new text end
new text begin
(ii) coverage for at least three primary care visits.
new text end
Subd. 4.
Essential health benefits; definition.
new text begin (a) new text end For purposes of this section, "essential
health benefits" deleted text begin has the meaning given under section 1302(b) of the Affordable Care Act
and includesdeleted text end new text begin meansnew text end :
(1) ambulatory patient services;
(2) emergency services;
(3) hospitalization;
(4) laboratory services;
(5) maternity and newborn care;
(6) mental health and substance use disorder services, including behavioral health
treatment;
(7) pediatric services, including oral and vision care;
(8) prescription drugs;
(9) preventive and wellness services and chronic disease management;
(10) rehabilitative and habilitative services and devices; and
(11) additional essential health benefits included in the deleted text begin EHB-benchmark plan, as defined
under the Affordable Care Actdeleted text end new text begin health plan described in paragraph (c)new text end .
new text begin
(b) If a service provider does not have a contractual relationship with the health plan to
provide services, emergency services must be provided without imposing any prior
authorization requirement or limitation on coverage that is more restrictive than the
requirements or limitations that apply to emergency services received from providers who
have a contractual relationship with the health plan. If services are provided out-of-network,
the cost-sharing must be equivalent to services provided in-network.
new text end
new text begin
(c) The scope of essential health benefits under paragraph (a) must be equal to the scope
of benefits provided under a typical employer plan.
new text end
new text begin
(d) Essential health benefits must:
new text end
new text begin
(1) reflect an appropriate balance among the categories to ensure benefits are not unduly
weighted toward any category;
new text end
new text begin
(2) not make coverage decisions, determine reimbursement rates, establish incentive
programs, or design benefits in a manner that discriminates against individuals on the basis
of age, disability, or expected length of life;
new text end
new text begin
(3) account for the health care needs of diverse segments of the population, including
women, children, persons with disabilities, and other groups; and
new text end
new text begin
(4) ensure that health benefits established as essential are not subject to denial against
the individual's wishes on the basis of the individual's age or expected length of life or of
the individual's present or predicted disability, degree of medical dependency, or quality of
life.
new text end
Subd. 5.
Exception.
This section does not apply to a dental plan deleted text begin described in section
1311(d)(2)(B)(ii) of the Affordable Care Actdeleted text end new text begin that is limited in scope and provides pediatric
dental benefitsnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, for health plans offered,
sold, issued, or renewed on or after that date.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.0625, subdivision 10, is amended to read:
Subd. 10.
Laboratory deleted text begin anddeleted text end new text begin ,new text end x-raynew text begin , and opioid screeningnew text end services.
new text begin (a) new text end Medical assistance
covers laboratory and x-ray services.
new text begin
(b) Medical assistance covers screening and urinalysis tests for opioids without lifetime
or annual limits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 18. new text begin COMMISSIONER OF COMMERCE; DETERMINATION OF
PREVENTIVE ITEMS AND SERVICES.
new text end
new text begin
The commissioner of commerce must determine the items and services that are preventive
under Minnesota Statutes, section 62Q.46, subdivision 1a. Items and services that are
preventive must include:
new text end
new text begin
(1) evidence-based items or services that have in effect a rating of A or B pursuant to
the recommendations of the United States Preventive Services Task Force in effect January
1, 2021, and with respect to the individual involved;
new text end
new text begin
(2) immunizations for routine use in children, adolescents, and adults that have in effect
a recommendation from the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention with respect to the individual involved. For the purposes
of this clause, a recommendation from the Advisory Committee on Immunization Practices
of the Centers for Disease Control and Prevention is considered in effect after it has been
adopted by the Director of the Centers for Disease Control and Prevention and a
recommendation is considered to be for routine use if it is listed on the Immunization
Schedules of the Centers for Disease Control and Prevention;
new text end
new text begin
(3) with respect to infants, children, and adolescents, evidence-informed preventive care
and screenings provided for in comprehensive guidelines supported by the Health Resources
and Services Administration; and
new text end
new text begin
(4) with respect to women, additional preventive care and screenings not described in
clause (1), as provided for in comprehensive guidelines supported by the Health Resources
and Services Administration.
new text end
ARTICLE 7
TELEHEALTH
Section 1.
new text begin
[62A.673] COVERAGE OF SERVICES PROVIDED THROUGH
TELEHEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This section may be cited as the "Minnesota Telehealth Act."
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.
new text end
new text begin
(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional as
defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; a mental health
practitioner as defined under section 245.462, subdivision 17, or 245.4871, subdivision 26;
a treatment coordinator under section 245G.11, subdivision 7; an alcohol and drug counselor
under section 245G.11, subdivision 5; and a recovery peer under section 245G.11, subdivision
8.
new text end
new text begin
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
new text end
new text begin
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.
new text end
new text begin
(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
transfer, the originating site also means the location at which a health care provider transfers
or transmits information to the distant site.
new text end
new text begin
(g) "Store-and-forward transfer" means the asynchronous electronic transfer of a patient's
medical information or data from an originating site to a distant site for the purposes of
diagnostic and therapeutic assistance in the care of a patient.
new text end
new text begin
(h) "Telehealth" means the delivery of health care services or consultations through the
use of real-time, two-way interactive audio and visual or audio-only communications to
provide or support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes
the application of secure video conferencing, store-and-forward transfers, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. Telehealth includes audio-only communication between a health care
provider and a patient if the communication is a scheduled appointment and the standard
of care for the service can be met through the use of audio-only communication. Telehealth
does not include communication between health care providers or between a health care
provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth
does not include communication between health care providers that consists solely of a
telephone conversation.
new text end
new text begin
(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.
new text end
new text begin Subd. 3. new text end
new text begin Coverage of telehealth. new text end
new text begin
(a) A health plan sold, issued, or renewed by a health
carrier in Minnesota must (1) cover benefits delivered through telehealth in the same manner
as any other benefits covered under the health plan, and (2) comply with this section.
new text end
new text begin
(b) Coverage for services delivered through telehealth must not be limited on the basis
of geography, location, or distance for travel.
new text end
new text begin
(c) A health carrier must not create a separate provider network or provide incentives
to enrollees to use a separate provider network to deliver services through telehealth that
does not include network providers who provide in-person care to patients for the same
service.
new text end
new text begin
(d) A health carrier may require a deductible, co-payment, or coinsurance payment for
a health care service provided through telehealth, provided that the deductible, co-payment,
or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment,
or coinsurance applicable for the same service provided through in-person contact.
new text end
new text begin
(e) Nothing in this section:
new text end
new text begin
(1) requires a health carrier to provide coverage for services that are not medically
necessary or are not covered under the enrollee's health plan; or
new text end
new text begin
(2) prohibits a health carrier from:
new text end
new text begin
(i) establishing criteria that a health care provider must meet to demonstrate the safety
or efficacy of delivering a particular service through telehealth for which the health carrier
does not already reimburse other health care providers for delivering the service through
telehealth;
new text end
new text begin
(ii) establishing reasonable medical management techniques, provided the criteria or
techniques are not unduly burdensome or unreasonable for the particular service; or
new text end
new text begin
(iii) requiring documentation or billing practices designed to protect the health carrier
or patient from fraudulent claims, provided the practices are not unduly burdensome or
unreasonable for the particular service.
new text end
new text begin
(f) Nothing in this section requires the use of telehealth when a health care provider
determines that the delivery of a health care service through telehealth is not appropriate or
when an enrollee chooses not to receive a health care service through telehealth.
new text end
new text begin Subd. 4. new text end
new text begin Parity between telehealth and in-person services. new text end
new text begin
(a) A health carrier must
not restrict or deny coverage of a health care service that is covered under a health plan
solely:
new text end
new text begin
(1) because the health care service provided by the health care provider through telehealth
is not provided through in-person contact; or
new text end
new text begin
(2) based on the communication technology or application used to deliver the health
care service through telehealth, provided the technology or application complies with this
section and is appropriate for the particular service.
new text end
new text begin
(b) Prior authorization may be required for health care services delivered through
telehealth only if prior authorization is required before the delivery of the same service
through in-person contact.
new text end
new text begin
(c) A health carrier may require a utilization review for services delivered through
telehealth, provided the utilization review is conducted in the same manner and uses the
same clinical review criteria as a utilization review for the same services delivered through
in-person contact.
new text end
new text begin Subd. 5. new text end
new text begin Reimbursement for services delivered through telehealth. new text end
new text begin
(a) A health carrier
must reimburse the health care provider for services delivered through telehealth on the
same basis and at the same rate as the health carrier would apply to those services if the
services had been delivered by the health care provider through in-person contact.
new text end
new text begin
(b) A health carrier must not deny or limit reimbursement based solely on a health care
provider delivering the service or consultation through telehealth instead of through in-person
contact.
new text end
new text begin
(c) A health carrier must not deny or limit reimbursement based solely on the technology
and equipment used by the health care provider to deliver the health care service or
consultation through telehealth, provided the technology and equipment used by the provider
meets the requirements of this section and is appropriate for the particular service.
new text end
new text begin Subd. 6. new text end
new text begin Telehealth equipment. new text end
new text begin
(a) A health carrier must not require a health care
provider to use specific telecommunications technology and equipment as a condition of
coverage under this section, provided the health care provider uses telecommunications
technology and equipment that complies with current industry interoperable standards and
complies with standards required under the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that
Act, unless authorized under this section.
new text end
new text begin
(b) A health carrier must provide coverage for health care services delivered through
telehealth by means of the use of audio-only telephone communication if the communication
is a scheduled appointment and the standard of care for that particular service can be met
through the use of audio-only communication.
new text end
new text begin Subd. 7. new text end
new text begin Telemonitoring services. new text end
new text begin
A health carrier must provide coverage for
telemonitoring services if:
new text end
new text begin
(1) the telemonitoring service is medically appropriate based on the enrollee's medical
condition or status;
new text end
new text begin
(2) the enrollee is cognitively and physically capable of operating the monitoring device
or equipment, or the enrollee has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end
new text begin
(3) the enrollee resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 2.
Minnesota Statutes 2020, section 147.033, is amended to read:
147.033 PRACTICE OF deleted text begin TELEMEDICINEdeleted text end new text begin TELEHEALTHnew text end .
Subdivision 1.
Definition.
For the purposes of this section, deleted text begin "telemedicine" means the
delivery of health care services or consultations while the patient is at an originating site
and the licensed health care provider is at a distant site. A communication between licensed
health care providers that consists solely of a telephone conversation, e-mail, or facsimile
transmission does not constitute telemedicine consultations or services. A communication
between a licensed health care provider and a patient that consists solely of an e-mail or
facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way interactive audio, and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, that facilitate the assessment, diagnosis,
consultation, treatment, education, and care management of a patient's health care.deleted text end new text begin
"telehealth" has the meaning given in section 62A.673, subdivision 2, paragraph (h).
new text end
Subd. 2.
Physician-patient relationship.
A physician-patient relationship may be
established through deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Subd. 3.
Standards of practice and conduct.
A physician providing health care services
by deleted text begin telemedicinedeleted text end new text begin telehealthnew text end in this state shall be held to the same standards of practice and
conduct as provided in this chapter for in-person health care services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 3.
Minnesota Statutes 2020, section 151.37, subdivision 2, is amended to read:
Subd. 2.
Prescribing and filing.
(a) A licensed practitioner in the course of professional
practice only, may prescribe, administer, and dispense a legend drug, and may cause the
same to be administered by a nurse, a physician assistant, or medical student or resident
under the practitioner's direction and supervision, and may cause a person who is an
appropriately certified, registered, or licensed health care professional to prescribe, dispense,
and administer the same within the expressed legal scope of the person's practice as defined
in Minnesota Statutes. A licensed practitioner may prescribe a legend drug, without reference
to a specific patient, by directing a licensed dietitian or licensed nutritionist, pursuant to
section 148.634; a nurse, pursuant to section 148.235, subdivisions 8 and 9; physician
assistant; medical student or resident; or pharmacist according to section 151.01, subdivision
27, to adhere to a particular practice guideline or protocol when treating patients whose
condition falls within such guideline or protocol, and when such guideline or protocol
specifies the circumstances under which the legend drug is to be prescribed and administered.
An individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
This paragraph applies to a physician assistant only if the physician assistant meets the
requirements of deleted text begin section 147A.18deleted text end new text begin sections 147A.02 and 147A.09new text end .
(b) The commissioner of health, if a licensed practitioner, or a person designated by the
commissioner who is a licensed practitioner, may prescribe a legend drug to an individual
or by protocol for mass dispensing purposes where the commissioner finds that the conditions
triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. The
commissioner, if a licensed practitioner, or a designated licensed practitioner, may prescribe,
dispense, or administer a legend drug or other substance listed in subdivision 10 to control
tuberculosis and other communicable diseases. The commissioner may modify state drug
labeling requirements, and medical screening criteria and documentation, where time is
critical and limited labeling and screening are most likely to ensure legend drugs reach the
maximum number of persons in a timely fashion so as to reduce morbidity and mortality.
(c) A licensed practitioner that dispenses for profit a legend drug that is to be administered
orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must file with the
practitioner's licensing board a statement indicating that the practitioner dispenses legend
drugs for profit, the general circumstances under which the practitioner dispenses for profit,
and the types of legend drugs generally dispensed. It is unlawful to dispense legend drugs
for profit after July 31, 1990, unless the statement has been filed with the appropriate
licensing board. For purposes of this paragraph, "profit" means (1) any amount received by
the practitioner in excess of the acquisition cost of a legend drug for legend drugs that are
purchased in prepackaged form, or (2) any amount received by the practitioner in excess
of the acquisition cost of a legend drug plus the cost of making the drug available if the
legend drug requires compounding, packaging, or other treatment. The statement filed under
this paragraph is public data under section 13.03. This paragraph does not apply to a licensed
doctor of veterinary medicine or a registered pharmacist. Any person other than a licensed
practitioner with the authority to prescribe, dispense, and administer a legend drug under
paragraph (a) shall not dispense for profit. To dispense for profit does not include dispensing
by a community health clinic when the profit from dispensing is used to meet operating
expenses.
(d) A prescription drug order for the following drugs is not valid, unless it can be
established that the prescription drug order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying conditions
and contraindications to treatment:
(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;
(3) muscle relaxants;
(4) centrally acting analgesics with opioid activity;
(5) drugs containing butalbital; or
(6) phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.
deleted text begin
For purposes of prescribing drugs listed in clause (6), the requirement for a documented
patient evaluation, including an examination, may be met through the use of telemedicine,
as defined in section 147.033, subdivision 1.
deleted text end
(e) For the purposes of paragraph (d), the requirement for an examination shall be met
ifnew text begin :
new text end
new text begin (1)new text end an in-person examination has been completed in any of the following circumstances:
deleted text begin (1)deleted text end new text begin (i)new text end the prescribing practitioner examines the patient at the time the prescription or
drug order is issued;
deleted text begin (2)deleted text end new text begin (ii)new text end the prescribing practitioner has performed a prior examination of the patient;
deleted text begin (3)deleted text end new text begin (iii)new text end another prescribing practitioner practicing within the same group or clinic as
the prescribing practitioner has examined the patient;
deleted text begin (4)deleted text end new text begin (iv)new text end a consulting practitioner to whom the prescribing practitioner has referred the
patient has examined the patient; or
deleted text begin (5)deleted text end new text begin (v)new text end the referring practitioner has performed an examination in the case of a consultant
practitioner issuing a prescription or drug order when providing services by means of
telemedicinedeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) the prescription order is for a drug listed in paragraph (d), clause (6), or for medication
assisted therapy for a substance use disorder, and the prescribing practitioner has completed
an examination of the patient via telehealth as defined in section 62A.673, subdivision 2,
paragraph (h).
new text end
(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a
drug through the use of a guideline or protocol pursuant to paragraph (a).
(g) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription
or dispensing a legend drug in accordance with the Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases guidance document issued by the United
States Centers for Disease Control.
(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing of
legend drugs through a public health clinic or other distribution mechanism approved by
the commissioner of health or a community health board in order to prevent, mitigate, or
treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of
a biological, chemical, or radiological agent.
(i) No pharmacist employed by, under contract to, or working for a pharmacy located
within the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug based on a prescription that the pharmacist knows, or would reasonably be expected
to know, is not valid under paragraph (d).
(j) No pharmacist employed by, under contract to, or working for a pharmacy located
outside the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug to a resident of this state based on a prescription that the pharmacist knows, or would
reasonably be expected to know, is not valid under paragraph (d).
(k) Nothing in this chapter prohibits the commissioner of health, if a licensed practitioner,
or, if not a licensed practitioner, a designee of the commissioner who is a licensed
practitioner, from prescribing legend drugs for field-delivered therapy in the treatment of
a communicable disease according to the Centers For Disease Control and Prevention Partner
Services Guidelines.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245G.01, subdivision 13, is amended to read:
Subd. 13.
Face-to-face.
"Face-to-face" means two-way, real-time, interactive deleted text begin and visualdeleted text end
communication between a client and a treatment service provider and includes services
delivered in person or via deleted text begin telemedicinedeleted text end new text begin telehealth with priority being given to interactive
audio and visual communication, if availablenew text end . new text begin Meetings required by section 245G.22,
subdivision 4, must be conducted by interactive video and visual communication.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245G.01, subdivision 26, is amended to read:
Subd. 26.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end .
deleted text begin "Telemedicine"deleted text end new text begin "Telehealth"new text end means the delivery
of a substance use disorder treatment service while the client is at an originating site and
the deleted text begin licenseddeleted text end health care provider is at a distant sitenew text begin via telehealth as defined in section
256B.0625, subdivision 3b, andnew text end as specified in section 254B.05, subdivision 5, paragraph
(f).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245G.06, subdivision 1, is amended to read:
Subdivision 1.
General.
Each client must have a person-centered individual treatment
plan developed by an alcohol and drug counselor within ten days from the day of service
initiation for a residential program and within five calendar days on which a treatment
session has been provided from the day of service initiation for a client in a nonresidential
program. Opioid treatment programs must complete the individual treatment plan within
21 days from the day of service initiation. The individual treatment plan must be signed by
the client and the alcohol and drug counselor and document the client's involvement in the
development of the plan. The individual treatment plan is developed upon the qualified staff
member's dated signature. Treatment planning must include ongoing assessment of client
needs. An individual treatment plan must be updated based on new information gathered
about the client's condition, the client's level of participation, and on whether methods
identified have the intended effect. A change to the plan must be signed by the client and
the alcohol and drug counselor. If the client chooses to have family or others involved in
treatment services, the client's individual treatment plan must include how the family or
others will be involved in the client's treatment.new text begin If a client is receiving treatment services
or an assessment via telehealth and the license holder documents the reason the client's
signature cannot be obtained, the alcohol and drug counselor may document the client's
verbal approval or electronic written approval of the treatment plan or change to the treatment
plan in lieu of the client's signature.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 7.
Minnesota Statutes 2020, section 254A.19, subdivision 5, is amended to read:
Subd. 5.
Assessment via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Notwithstanding Minnesota Rules,
part 9530.6615, subpart 3, item A, a chemical use assessment may be conducted via
deleted text begin telemedicinedeleted text end new text begin telehealth as defined in section 256B.0625, subdivision 3bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in section 256B.0625, subdivision 3bnew text end . The use of deleted text begin two-way interactive videodeleted text end new text begin telehealth
to deliver servicesnew text end must be medically appropriate to the condition and needs of the person
being served. Reimbursement shall be at the same rates and under the same conditions that
would otherwise apply to direct face-to-face services. deleted text begin The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0621, subdivision 10, is amended to read:
Subd. 10.
Payment rates.
The commissioner shall set payment rates for targeted case
management under this subdivision. Case managers may bill according to the following
criteria:
(1) for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face contact, telephone contact, and interactive
video contact deleted text begin according to section 256B.0924, subdivision 4adeleted text end , in the lesser of:
(i) 180 days preceding an eligible recipient's discharge from an institution; or
(ii) the limits and conditions which apply to federal Medicaid funding for this service;
(2) for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and
(3) billings for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end services.
(a) Medical assistance covers medically
necessary services and consultations delivered by a deleted text begin licenseddeleted text end health care provider deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end in the same manner as if the service or consultation was
delivered deleted text begin in persondeleted text end new text begin through in-person contactnew text end . deleted text begin Coverage is limited to three telemedicine
services per enrollee per calendar week, except as provided in paragraph (f). Telemedicinedeleted text end
Services new text begin or consultations delivered through telehealth new text end shall be paid at the full allowable
rate.
(b) The commissioner deleted text begin shalldeleted text end new text begin maynew text end establish criteria that a health care provider must attest
to in order to demonstrate the safety or efficacy of delivering a particular service deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end . The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
deleted text begin via telemedicinedeleted text end new text begin through telehealthnew text end ;
(2) has written policies and procedures specific to deleted text begin telemedicinedeleted text end servicesnew text begin delivered through
telehealthnew text end that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the deleted text begin telemedicinedeleted text end service is deleted text begin rendereddeleted text end new text begin delivered through telehealthnew text end ;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to deleted text begin telemedicinedeleted text end new text begin deliveringnew text end servicesnew text begin
through telehealthnew text end .
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end to a
medical assistance enrollee. Health care service records for services deleted text begin provided by telemedicinedeleted text end new text begin
delivered through telehealthnew text end must meet the requirements set forth in Minnesota Rules, part
9505.2175, subparts 1 and 2, and must document:
(1) the type of service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end ;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the deleted text begin licenseddeleted text end health care provider's basis for determining that deleted text begin telemedicinedeleted text end new text begin telehealthnew text end
is an appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission deleted text begin ofdeleted text end new text begin used to delivernew text end the deleted text begin telemedicinedeleted text end service new text begin through telehealth
new text end and records evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's deleted text begin telemedicinedeleted text end consultation with
another physiciannew text begin through telehealthnew text end , the written opinion from the consulting physician
providing the deleted text begin telemedicinedeleted text end new text begin telehealthnew text end consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapterdeleted text begin ,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.deleted text end new text begin :
new text end
new text begin
(1) "telehealth" means the delivery of health care services or consultations through the
use of real-time, two-way interactive audio and visual or audio-only communications to
provide or support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes
the application of secure video conferencing, store-and-forward transfers, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. Unless interactive visual and audio communication is specifically required,
telehealth includes audio-only communication between a health care provider and a patient,
if the communication is a scheduled appointment with the health care provider and the
standard of care for the service can be met through the use of audio-only communication.
Telehealth does not include communication between health care providers, or communication
between a health care provider and a patient that consists solely of an e-mail or facsimile
transmission;
new text end
deleted text begin (e) For purposes of this section, "licenseddeleted text end new text begin (2) "new text end health care provider" means a deleted text begin licenseddeleted text end
health care provider deleted text begin under section 62A.671, subdivision 6deleted text end new text begin as defined under section 62A.673new text end ,
a community paramedic as defined under section 144E.001, subdivision 5f, deleted text begin or a mental
health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision
26, working under the general supervision of a mental health professional, anddeleted text end a community
health worker who meets the criteria under subdivision 49, paragraph (a)deleted text begin ; "health care
provider" is defined under section 62A.671, subdivision 3;deleted text end new text begin , a mental health certified peer
specialist under section 256B.0615, subdivision 5, a mental health certified family peer
specialist under section 256B.0616, subdivision 5, a mental health rehabilitation worker
under section 256B.0623, subdivision 5, paragraph (a), clause (4), and paragraph (b), a
mental health behavioral aide under section 256B.0943, subdivision 7, paragraph (b), clause
(3), a treatment coordinator under section 245G.11, subdivision 7, an alcohol and drug
counselor under section 245G.11, subdivision 5, a recovery peer under section 245G.11,
subdivision 8, and a mental health case manager under section 245.462, subdivision 4;new text end and
new text begin (3) new text end "originating site" deleted text begin is defined under section 62A.671, subdivision 7deleted text end new text begin , "distant site," and
"store-and-forward transfer" have the meanings given in section 62A.673, subdivision 2new text end .
deleted text begin
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
deleted text end
deleted text begin
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
deleted text end
deleted text begin
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 3h. new text end
new text begin Telemonitoring services. new text end
new text begin
(a) Medical assistance covers telemonitoring services
if a recipient:
new text end
new text begin
(1) has been diagnosed and is receiving services for at least one of the following chronic
conditions: hypertension, cancer, congestive heart failure, chronic obstructive pulmonary
disease, asthma, or diabetes;
new text end
new text begin
(2) requires at least five times per week monitoring to manage the chronic condition, as
ordered by the recipient's health care provider;
new text end
new text begin
(3) has had two or more emergency room or inpatient hospitalization stays within the
last 12 months due to the chronic condition or the recipient's health care provider has
identified that telemonitoring services would likely prevent the recipient's admission or
readmission to a hospital, emergency room, or nursing facility;
new text end
new text begin
(4) is cognitively and physically capable of operating the monitoring device or equipment,
or the recipient has a caregiver who is willing and able to assist with the monitoring device
or equipment; and
new text end
new text begin
(5) resides in a setting that is suitable for telemonitoring and not in a setting that has
health care staff on site.
new text end
new text begin
(b) For purposes of this subdivision, "telemonitoring services" means the remote
monitoring of data related to a recipient's vital signs or biometric data by a monitoring
device or equipment that transmits the data electronically to a provider for analysis. The
assessment and monitoring of the health data transmitted by telemonitoring must be
performed by one of the following licensed health care professionals: physician, podiatrist,
registered nurse, advanced practice registered nurse, physician assistant, respiratory therapist,
or licensed professional working under the supervision of a medical director.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0625, subdivision 13h, is amended to
read:
Subd. 13h.
Medication therapy management services.
(a) Medical assistance covers
medication therapy management services for a recipient taking prescriptions to treat or
prevent one or more chronic medical conditions. For purposes of this subdivision,
"medication therapy management" means the provision of the following pharmaceutical
care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's
medications:
(1) performing or obtaining necessary assessments of the patient's health status;
(2) formulating a medication treatment plan, which may include prescribing medications
or products in accordance with section 151.37, subdivision 14, 15, or 16;
(3) monitoring and evaluating the patient's response to therapy, including safety and
effectiveness;
(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
(5) documenting the care delivered and communicating essential information to the
patient's other primary care providers;
(6) providing verbal education and training designed to enhance patient understanding
and appropriate use of the patient's medications;
(7) providing information, support services, and resources designed to enhance patient
adherence with the patient's therapeutic regimens; and
(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.
Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.
(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:
(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;
(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;new text begin and
new text end
deleted text begin
(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the setting,
or in home settings, including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end make use of an electronic patient record system that meets state standards.
(c) For purposes of reimbursement for medication therapy management services, the
commissioner may enroll individual pharmacists as medical assistance providers. The
commissioner may also establish deleted text begin contact requirements between the pharmacist and recipient,
including limitingdeleted text end new text begin limits on new text end the number of reimbursable consultations per recipient.
(d) deleted text begin If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide Thedeleted text end new text begin Medication therapy managementnew text end services new text begin may be provided
new text end via deleted text begin two-way interactive videodeleted text end new text begin telehealth as defined in subdivision 3b and may be delivered
into a patient's residencenew text end . Reimbursement shall be at the same rates and under the same
conditions that would otherwise apply to the services provided. To qualify for reimbursement
under this paragraph, the pharmacist providing the services must meet the requirements of
paragraph (b)deleted text begin , and must be located within an ambulatory care setting that meets the
requirements of paragraph (b), clause (3). The patient must also be located within an
ambulatory care setting that meets the requirements of paragraph (b), clause (3). Services
provided under this paragraph may not be transmitted into the patient's residencedeleted text end .
deleted text begin
(e) Medication therapy management services may be delivered into a patient's residence
via secure interactive video if the medication therapy management services are performed
electronically during a covered home care visit by an enrolled provider. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to the
services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b) and must be located
within an ambulatory care setting that meets the requirements of paragraph (b), clause (3).
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact new text begin or a contact by interactive video that
meets the requirements of subdivision 20b new text end with the child, the child's parents, or the child's
legal representative. To receive payment for an eligible adult, the provider must document:
(1) at least a face-to-face contactnew text begin , or a contact by interactive video that meets the
requirements of subdivision 20b,new text end with the adult or the adult's legal representative or a contact
by interactive video that meets the requirements of subdivision 20b; or
(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by interactive video that meets the requirements
of subdivision 20b with the adult or the adult's legal representative within the preceding
two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribe may negotiate a team rate with a vendor who is a member of the team. The team
shall determine how to distribute the rate among its members. No reimbursement received
by contracted vendors shall be returned to the county or tribe, except to reimburse the county
or tribe for advance funding provided by the county or tribe to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0625, subdivision 20b, is amended to
read:
Subd. 20b.
deleted text begin Mental healthdeleted text end Targeted case management new text begin face-to-face contactnew text end through
interactive video.
deleted text begin
(a) Subject to federal approval, contact made for targeted case management
by interactive video shall be eligible for payment if:
deleted text end
deleted text begin
(1) the person receiving targeted case management services is residing in:
deleted text end
deleted text begin
(i) a hospital;
deleted text end
deleted text begin
(ii) a nursing facility; or
deleted text end
deleted text begin
(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
deleted text end
deleted text begin
establishment or lodging establishment that provides supportive services or health supervision
deleted text end
deleted text begin
services according to section
deleted text end
deleted text begin
that is staffed 24 hours a day, seven days a week;
deleted text end
deleted text begin
(2) interactive video is in the best interests of the person and is deemed appropriate by
deleted text end
deleted text begin
the person receiving targeted case management or the person's legal guardian, the case
deleted text end
deleted text begin
management provider, and the provider operating the setting where the person is residing;
deleted text end
deleted text begin
(3) the use of interactive video is approved as part of the person's written personal service
deleted text end
deleted text begin
or case plan, taking into consideration the person's vulnerability and active personal
deleted text end
deleted text begin
relationships; and
deleted text end
deleted text begin (4) interactive video is used for up to, but not more than, 50 percent of the minimum
required face-to-facedeleted text end deleted text begin contact.deleted text end new text begin (a) Minimum required face-to-face contacts for targeted case
management may be provided through interactive video if interactive video is in the best
interests of the person and is deemed appropriate by the person receiving targeted case
management or the person's legal guardian and the case management provider.
new text end
(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of interactive video under this subdivision and
has the right to refuse the use of interactive video at any time.
(c) The commissioner deleted text begin shalldeleted text end new text begin maynew text end establish criteria that a targeted case management
provider must attest to in order to demonstrate the safety or efficacy of deleted text begin delivering the servicedeleted text end
new text begin meeting the minimum face-to-face contact requirements for targeted case managementnew text end via
interactive video. deleted text begin The attestation may include that the case management provider has:
deleted text end
deleted text begin
(1) written policies and procedures specific to interactive video services that are regularly
deleted text end
deleted text begin
reviewed and updated;
deleted text end
deleted text begin
(2) policies and procedures that adequately address client safety before, during, and after
deleted text end
deleted text begin
the interactive video services are rendered;
deleted text end
deleted text begin
(3) established protocols addressing how and when to discontinue interactive video
deleted text end
deleted text begin
services; and
deleted text end
deleted text begin
(4) established a quality assurance process related to interactive video services.
deleted text end
(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by interactive
video new text begin for the purpose of face-to-face contactnew text end :
(1) the time the deleted text begin servicedeleted text end new text begin contactnew text end began and the time the deleted text begin servicedeleted text end new text begin contactnew text end ended, including
an a.m. and p.m. designation;
(2) the basis for determining that interactive video is an appropriate and effective means
for deleted text begin delivering the service todeleted text end new text begin contactingnew text end the person receiving new text begin targetednew text end case management
services;
(3) the mode of transmission of the interactive video services and records evidencing
that a particular mode of transmission was utilized; new text begin and
new text end
(4) the location of the originating site and the distant sitedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).
deleted text end
new text begin
(e) Interactive video must not be used to meet minimum face-to-face contact requirements
for children who are in out-of-home placement or receiving case management services for
child protection reasons.
new text end
new text begin
(f) For the purposes of this section, "interactive video" means real-time, two-way
interactive audio and visual communications.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.0625, subdivision 46, is amended to read:
Subd. 46.
Mental health deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
deleted text begin Effective January 1, 2006, anddeleted text end Subject
to federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in subdivision 3bnew text end . Use of deleted text begin two-way interactive videodeleted text end new text begin telehealth to deliver servicesnew text end
must be medically appropriate to the condition and needs of the person being served.
Reimbursement is at the same rates and under the same conditions that would otherwise
apply to the service. deleted text begin The interactive video equipment and connection must comply with
Medicare standards in effect at the time the service is provided.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.0911, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For purposes of this section, the following definitions apply:
(a) Until additional requirements apply under paragraph (b), "long-term care consultation
services" means:
(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;
(2) providing recommendations for and referrals to cost-effective community services
that are available to the individual;
(3) development of an individual's person-centered community support plan;
(4) providing information regarding eligibility for Minnesota health care programs;
(5) deleted text begin face-to-facedeleted text end long-term care consultation assessmentsnew text begin conducted according to
subdivision 3anew text end , which may be completed in a hospital, nursing facility, intermediate care
facility for persons with developmental disabilities (ICF/DDs), regional treatment centers,
or the person's current or planned residence;
(6) determination of home and community-based waiver and other service eligibility as
required under chapter 256S and sections 256B.0913, 256B.092, and 256B.49, including
level of care determination for individuals who need an institutional level of care as
determined under subdivision 4e, based on a long-term care consultation assessment and
community support plan development, appropriate referrals to obtain necessary diagnostic
information, and including an eligibility determination for consumer-directed community
supports;
(7) providing recommendations for institutional placement when there are no
cost-effective community services available;
(8) providing access to assistance to transition people back to community settings after
institutional admission;
(9) providing information about competitive employment, with or without supports, for
school-age youth and working-age adults and referrals to the Disability Hub and Disability
Benefits 101 to ensure that an informed choice about competitive employment can be made.
For the purposes of this subdivision, "competitive employment" means work in the
competitive labor market that is performed on a full-time or part-time basis in an integrated
setting, and for which an individual is compensated at or above the minimum wage, but not
less than the customary wage and level of benefits paid by the employer for the same or
similar work performed by individuals without disabilities;
(10) providing information about independent living to ensure that an informed choice
about independent living can be made; and
(11) providing information about self-directed services and supports, including
self-directed funding options, to ensure that an informed choice about self-directed options
can be made.
(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
and 3a, "long-term care consultation services" also means:
(1) service eligibility determination for the following state plan services:
(i) personal care assistance services under section 256B.0625, subdivisions 19a and 19c;
(ii) consumer support grants under section 256.476; or
(iii) community first services and supports under section 256B.85;
(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
gaining access to:
(i) relocation targeted case management services available under section 256B.0621,
subdivision 2, clause (4);
(ii) case management services targeted to vulnerable adults or developmental disabilities
under section 256B.0924; and
(iii) case management services targeted to people with developmental disabilities under
Minnesota Rules, part 9525.0016;
(3) determination of eligibility for semi-independent living services under section
252.275; and
(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
and (3).
(c) "Long-term care options counseling" means the services provided by sections 256.01,
subdivision 24, and 256.975, subdivision 7, and also includes telephone assistance and
follow up once a long-term care consultation assessment has been completed.
(d) "Minnesota health care programs" means the medical assistance program under this
chapter and the alternative care program under section 256B.0913.
(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation services.
(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives, the settings in which the person
receives the services, and the setting in which the person lives.
(g) "Informed choice" means a voluntary choice of services, settings, living arrangement,
and work by a person from all available service and setting options based on accurate and
complete information concerning all available service and setting options and concerning
the person's own preferences, abilities, goals, and objectives. In order for a person to make
an informed choice, all available options must be developed and presented to the person in
a way the person can understand to empower the person to make fully informed choices.
(h) "Available service and setting options" or "available options," with respect to the
home and community-based waivers under chapter 256S and sections 256B.092 and 256B.49,
means all services and settings defined under the waiver plan for which a waiver applicant
or waiver participant is eligible.
(i) "Independent living" means living in a setting that is not controlled by a provider.
Sec. 17.
Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. deleted text begin Face-to-facedeleted text end
Assessments must be conducted according to paragraphs (b) to deleted text begin (i)deleted text end new text begin (q)new text end .
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) new text begin Except as provided in paragraph (q), new text end the assessment must be conducted by a certified
assessor in a face-to-face conversational interview with the person being assessed. The
person's legal representative must provide input during the assessment process and may do
so remotely if requested. At the request of the person, other individuals may participate in
the assessment to provide information on the needs, strengths, and preferences of the person
necessary to develop a community support plan that ensures the person's health and safety.
Except for legal representatives or family members invited by the person, persons
participating in the assessment may not be a provider of service or have any financial interest
in the provision of services. For persons who are to be assessed for elderly waiver customized
living or adult day services under chapter 256S, with the permission of the person being
assessed or the person's designated or legal representative, the client's current or proposed
provider of services may submit a copy of the provider's nursing assessment or written
report outlining its recommendations regarding the client's care needs. The person conducting
the assessment must notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment prior
to the assessment. For a person who is to be assessed for waiver services under section
256B.092 or 256B.49, with the permission of the person being assessed or the person's
designated legal representative, the person's current provider of services may submit a
written report outlining recommendations regarding the person's care needs the person
completed in consultation with someone who is known to the person and has interaction
with the person on a regular basis. The provider must submit the report at least 60 days
before the end of the person's current service agreement. The certified assessor must consider
the content of the submitted report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) deleted text begin Face-to-facedeleted text end Assessment completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous deleted text begin face-to-facedeleted text end
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous deleted text begin face-to-facedeleted text end assessment when all other eligibility requirements are met.
(n) At the time of reassessment, the certified assessor shall assess each person receiving
waiver residential supports and services currently residing in a community residential setting,
licensed adult foster care home that is either not the primary residence of the license holder
or in which the license holder is not the primary caregiver, family adult foster care residence,
customized living setting, or supervised living facility to determine if that person would
prefer to be served in a community-living setting as defined in section 256B.49, subdivision
23, in a setting not controlled by a provider, or to receive integrated community supports
as described in section 245D.03, subdivision 1, paragraph (c), clause (8). The certified
assessor shall offer the person, through a person-centered planning process, the option to
receive alternative housing and service options.
(o) At the time of reassessment, the certified assessor shall assess each person receiving
waiver day services to determine if that person would prefer to receive employment services
as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7). The certified
assessor shall describe to the person through a person-centered planning process the option
to receive employment services.
(p) At the time of reassessment, the certified assessor shall assess each person receiving
non-self-directed waiver services to determine if that person would prefer an available
service and setting option that would permit self-directed services and supports. The certified
assessor shall describe to the person through a person-centered planning process the option
to receive self-directed services and supports.
new text begin
(q) All assessments performed according to this subdivision must be face-to-face unless
the assessment is a reassessment meeting the requirements of this paragraph. Subject to
federal approval, remote reassessments conducted by interactive video or telephone may
substitute for face-to-face reassessments for services provided by alternative care under
section 256B.0913, the elderly waiver under chapter 256S, the developmental disabilities
waiver under section 256B.092, and the community access for disability inclusion,
community alternative care, and brain injury waiver programs under section 256B.49.
Remote reassessments may be substituted for two consecutive reassessments if followed
by a face-to-face reassessment. A remote reassessment is permitted only if the person being
reassessed, the person's legal representative, and the lead agency case manager all agree
that there is no change in the person's condition, there is no need for a change in service,
and that a remote reassessment is appropriate. The person being reassessed, or the person's
legal representative, has the right to refuse a remote reassessment at any time. During a
remote reassessment, if the certified assessor determines in the assessor's sole judgment
that a remote reassessment is inappropriate, the certified assessor shall suspend the remote
reassessment and schedule a face-to-face reassessment to complete the reassessment. All
other requirements of a face-to-face reassessment apply to a remote reassessment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.0911, subdivision 3f, is amended to read:
Subd. 3f.
Long-term care reassessments and community support plan updates.
(a)
Prior to a deleted text begin face-to-facedeleted text end reassessment, the certified assessor must review the person's most
recent assessment. Reassessments must be tailored using the professional judgment of the
assessor to the person's known needs, strengths, preferences, and circumstances.
Reassessments provide information to support the person's informed choice and opportunities
to express choice regarding activities that contribute to quality of life, as well as information
and opportunity to identify goals related to desired employment, community activities, and
preferred living environment. Reassessments require a review of the most recent assessment,
review of the current coordinated service and support plan's effectiveness, monitoring of
services, and the development of an updated person-centered community support plan.
Reassessments must verify continued eligibility, offer alternatives as warranted, and provide
an opportunity for quality assurance of service delivery. deleted text begin Face-to-facedeleted text end Reassessments must
be conducted annually or as required by federal and state laws and rules. For reassessments,
the certified assessor and the individual responsible for developing the coordinated service
and support plan must ensure the continuity of care for the person receiving services and
complete the updated community support plan and the updated coordinated service and
support plan no more than 60 days from the reassessment visit.
(b) The commissioner shall develop mechanisms for providers and case managers to
share information with the assessor to facilitate a reassessment and support planning process
tailored to the person's current needs and preferences.
Sec. 19.
Minnesota Statutes 2020, section 256B.0911, subdivision 4d, is amended to read:
Subd. 4d.
Preadmission screening of individuals under 65 years of age.
(a) It is the
policy of the state of Minnesota to ensure that individuals with disabilities or chronic illness
are served in the most integrated setting appropriate to their needs and have the necessary
information to make informed choices about home and community-based service options.
(b) Individuals under 65 years of age who are admitted to a Medicaid-certified nursing
facility must be screened prior to admission according to the requirements outlined in section
256.975, subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as
required under section 256.975, subdivision 7.
(c) Individuals under 65 years of age who are admitted to nursing facilities with only a
telephone screening must receive a face-to-face assessment from the long-term care
consultation team member of the county in which the facility is located or from the recipient's
county case manager within the timeline established by the commissioner, based on review
of data.
(d) At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.
(e) For individuals under 21 years of age, a screening interview which recommends
nursing facility admission must be face-to-face and approved by the commissioner before
the individual is admitted to the nursing facility.
(f) In the event that an individual under 65 years of age is admitted to a nursing facility
on an emergency basis, the Senior LinkAge Line must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within the timeline established by the commissioner, based on review of data.
(g) At the face-to-face assessment, the long-term care consultation team member or the
case manager must present information about home and community-based options, including
consumer-directed options, so the individual can make informed choices. If the individual
chooses home and community-based services, the long-term care consultation team member
or case manager must complete a written relocation plan within 20 working days of the
visit. The plan shall describe the services needed to move out of the facility and a time line
for the move which is designed to ensure a smooth transition to the individual's home and
community.
(h) An individual under 65 years of age residing in a nursing facility shall receive a
deleted text begin face-to-face assessmentdeleted text end new text begin reassessmentnew text end at least every 12 months to review the person's service
choices and available alternatives unless the individual indicates, in writing, that annual
visits are not desired. In this case, the individual must receive a deleted text begin face-to-face assessmentdeleted text end new text begin
reassessmentnew text end at least once every 36 months for the same purposes. new text begin A remote reassessment
is permitted only if the person being reassessed, the person's legal representative, and the
lead agency case manager all agree that there is no change in the person's condition, there
is no need for a change in service, and that a remote reassessment is appropriate. The person
being reassessed, or the person's legal representative, has the right to refuse a remote
reassessment at any time. During a remote reassessment, if the certified assessor determines
in the assessor's sole judgment that a remote reassessment is inappropriate, the certified
assessor shall suspend the remote reassessment and schedule a face-to-face reassessment
to complete the reassessment. All other requirements of a face-to-face reassessment apply
to a remote reassessment.
new text end
(i) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
agencies directly for deleted text begin face-to-facedeleted text end assessments for individuals under 65 years of age who
are being considered for placement or residing in a nursing facility.
(j) Funding for preadmission screening follow-up shall be provided to the Disability
Hub for the under-60 population by the Department of Human Services to cover options
counseling salaries and expenses to provide the services described in subdivisions 7a to 7c.
The Disability Hub shall employ, or contract with other agencies to employ, within the
limits of available funding, sufficient personnel to provide preadmission screening follow-up
services and shall seek to maximize federal funding for the service as provided under section
256.01, subdivision 2, paragraph (aa).
Sec. 20.
Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:
Subd. 6.
Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
new text begin or a contact by interactive video that meets the requirements of section 256B.0625,
subdivision 20b, new text end with the adult or the adult's legal representative, family, primary caregiver,
or other relevant persons identified as necessary to the development or implementation of
the goals of the personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to other payers. If the service is
provided by a team of contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county, except to reimburse the county for advance funding provided by the county
to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.
(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.
(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:
Subd. 6.
Medical assistance reimbursement of case management services.
(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-facenew text begin , interactive video,new text end or telephone contacts between the case
manager and the client, client's family, primary caregiver, legal representative, or other
relevant person identified as necessary to the development or implementation of the goals
of the individual service plan regarding the status of the client, the individual service plan,
or the goals for the client. These contacts must meet the minimum standards in clauses (1)
and (2):
(1) there must be a face-to-face contactnew text begin , or a contact by interactive video that meets the
requirements of section 256B.0625, subdivision 20b,new text end at least once a month except as provided
in clause (2); and
(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face contact.
new text begin
Face-to-face contacts under this paragraph may be conducted using interactive video for
up to two consecutive contacts following each in-person contact.
new text end
(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).
(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.
(d) Payment for case management provided by county or tribal social services contracted
vendors shall be based on a monthly rate negotiated by the host county or tribal social
services. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribal social services may negotiate a team rate with a vendor who is a member of the
team. The team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county or tribal social
services, except to reimburse the county or tribal social services for advance funding provided
by the county or tribal social services to the vendor.
(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.
new text begin (f) new text end Separate payment rates may be established for different groups of providers to
maximize reimbursement as determined by the commissioner. The payment rate will be
reviewed annually and revised periodically to be consistent with the most recent time study
and other data. Payment for services will be made upon submission of a valid claim and
verification of proper documentation described in subdivision 7. Federal administrative
revenue earned through the time study, or under paragraph (c), shall be distributed according
to earnings, to counties, reservations, or groups of counties or reservations which have the
same payment rate under this subdivision, and to the group of counties or reservations which
are not certified providers under section 256F.10. The commissioner shall modify the
requirements set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to
accomplish this.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.49, subdivision 14, is amended to read:
Subd. 14.
Assessment and reassessment.
(a) Assessments and reassessments shall be
conducted by certified assessors according to section 256B.0911, subdivision 2b.
(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 256B.0911, subdivision 4e, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.
(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only deleted text begin face-to-facedeleted text end assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for purposes
of initial and ongoing access to waiver services payment.
(d) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their 65th
birthday if they continue to meet all other eligibility factors.
Sec. 23.
Minnesota Statutes 2020, section 256J.09, subdivision 3, is amended to read:
Subd. 3.
Submitting application form.
(a) A county agency must offer, in person or
by mail, the application forms prescribed by the commissioner as soon as a person makes
a written or oral inquiry. At that time, the county agency must:
(1) inform the person that assistance begins deleted text begin withdeleted text end new text begin onnew text end the date new text begin that new text end the deleted text begin signeddeleted text end application
is received by the county agency new text begin either as a written application; an application submitted
by telephone; or an application submitted through Internet telepresence; new text end or new text begin on new text end the date new text begin that
new text end all eligibility criteria are met, whichever is later;
(2) new text begin inform a person that the person may submit the application by telephone or through
Internet telepresence;
new text end
new text begin
(3) inform a person that when the person submits the application by telephone or through
Internet telepresence, the county agency must receive a signed written application within
30 days of the date that the person submitted the application by telephone or through Internet
telepresence;
new text end
new text begin (4) new text end inform the person that any delay in submitting the application will reduce the amount
of assistance paid for the month of application;
deleted text begin (3)deleted text end new text begin (5)new text end inform a person that the person may submit the application before an interview;
deleted text begin (4)deleted text end new text begin (6)new text end explain the information that will be verified during the application process by
the county agency as provided in section 256J.32;
deleted text begin (5)deleted text end new text begin (7)new text end inform a person about the county agency's average application processing time
and explain how the application will be processed under subdivision 5;
deleted text begin (6)deleted text end new text begin (8)new text end explain how to contact the county agency if a person's application information
changes and how to withdraw the application;
deleted text begin (7)deleted text end new text begin (9)new text end inform a person that the next step in the application process is an interview and
what a person must do if the application is approved including, but not limited to, attending
orientation under section 256J.45 and complying with employment and training services
requirements in sections 256J.515 to 256J.57;
deleted text begin (8)deleted text end new text begin (10)new text end inform the person that deleted text begin thedeleted text end new text begin annew text end interview must be conductednew text begin . The interview may
be conductednew text end face-to-face in the county officenew text begin or at a location mutually agreed uponnew text end , through
Internet telepresence, or deleted text begin at a location mutually agreed upondeleted text end new text begin by telephonenew text end ;
deleted text begin
(9) inform a person who has received MFIP or DWP in the past 12 months of the option
to have a face-to-face, Internet telepresence, or telephone interview;
deleted text end
deleted text begin (10)deleted text end new text begin (11)new text end explain the child care and transportation services that are available under
paragraph (c) to enable caregivers to attend the interview, screening, and orientation; and
deleted text begin (11)deleted text end new text begin (12)new text end identify any language barriers and arrange for translation assistance during
appointments, including, but not limited to, screening under subdivision 3a, orientation
under section 256J.45, and assessment under section 256J.521.
(b) Upon receipt of a signed application, the county agency must stamp the date of receipt
on the face of the application. The county agency must process the application within the
time period required under subdivision 5. An applicant may withdraw the application at
any time by giving written or oral notice to the county agency. The county agency must
issue a written notice confirming the withdrawal. The notice must inform the applicant of
the county agency's understanding that the applicant has withdrawn the application and no
longer wants to pursue it. When, within ten days of the date of the agency's notice, an
applicant informs a county agency, in writing, that the applicant does not wish to withdraw
the application, the county agency must reinstate the application and finish processing the
application.
(c) Upon a participant's request, the county agency must arrange for transportation and
child care or reimburse the participant for transportation and child care expenses necessary
to enable participants to attend the screening under subdivision 3a and orientation under
section 256J.45.
Sec. 24.
Minnesota Statutes 2020, section 256J.45, subdivision 1, is amended to read:
Subdivision 1.
County agency to provide orientation.
A county agency must provide
deleted text begin a face-to-facedeleted text end new text begin annew text end orientation to each MFIP caregiver unless the caregiver is:
(1) a single parent, or one parent in a two-parent family, employed at least 35 hours per
week; or
(2) a second parent in a two-parent family who is employed for 20 or more hours per
week provided the first parent is employed at least 35 hours per week.
The county agency must inform caregivers who are not exempt under clause (1) or (2) that
failure to attend the orientation is considered an occurrence of noncompliance with program
requirements, and will result in the imposition of a sanction under section 256J.46. If the
client complies with the orientation requirement prior to the first day of the month in which
the grant reduction is proposed to occur, the orientation sanction shall be lifted.
Sec. 25.
Minnesota Statutes 2020, section 256S.05, subdivision 2, is amended to read:
Subd. 2.
Nursing facility level of care determination required.
Notwithstanding other
assessments identified in section 144.0724, subdivision 4, only deleted text begin face-to-facedeleted text end assessments
conducted according to section 256B.0911, subdivisions 3, 3a, and 3b, that result in a nursing
facility level of care determination at initial and subsequent assessments shall be accepted
for purposes of a participant's initial and ongoing participation in the elderly waiver and a
service provider's access to service payments under this chapter.
Sec. 26. new text begin STUDY OF TELEHEALTH.
new text end
new text begin
(a) The commissioner of health, in consultation with the commissioners of human services
and commerce, shall study the impact of telehealth payment methodologies and expansion
under the Minnesota Telehealth Act on the coverage and provision of health care services
under public health care programs and private health insurance. The study shall review and
make recommendations related to:
new text end
new text begin
(1) the impact of telehealth payment methodologies and expansion on access to health
care services, quality of care, and value-based payments and innovation in care delivery;
new text end
new text begin
(2) the short-term and long-term impacts of telehealth payment methodologies and
expansion in reducing health care disparities and providing equitable access for underserved
communities;
new text end
new text begin
(3) the use of audio-only communication in supporting equitable access to health care
services, including behavioral health services for the elderly, rural communities, and
communities of color, and eliminating barriers for vulnerable and underserved populations;
new text end
new text begin
(4) whether there is evidence to suggest that increased access to telehealth improves
health outcomes and, if so, for which services and populations; and
new text end
new text begin
(5) the effect of payment parity on public and private health care costs, health care
premiums, and health outcomes.
new text end
new text begin
(b) When conducting the study, the commissioner shall consult with stakeholders and
communities impacted by telehealth payment and expansion. The commissioner,
notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, may use data available
under that section to conduct the study. The commissioner shall report findings to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
care policy and finance and commerce, by February 15, 2023.
new text end
Sec. 27. new text begin EXPIRATION DATE.
new text end
new text begin
(a) Sections 1 to 15, 20, and 21 expire July 1, 2023.
new text end
new text begin
(b) Notwithstanding paragraph (a), the definition of "originating site" in Minnesota
Statutes, section 256B.0625, subdivision 3b, paragraph (d), clause (3), shall not expire.
new text end
Sec. 28. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall substitute the term "telemedicine" with "telehealth" whenever
the term appears in Minnesota Statutes and substitute Minnesota Statutes, section 62A.673,
whenever references to Minnesota Statutes, sections 62A.67, 62A.671, and 62A.672, appear
in Minnesota Statutes.
new text end
Sec. 29. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 62A.67; 62A.671; and 62A.672,
new text end
new text begin
are repealed
January 1, 2022, and are revived and reenacted July 1, 2023.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256B.0596; and 256B.0924, subdivision 4a,
new text end
new text begin
are
repealed upon federal approval and are revived and reenacted July 1, 2023. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
ARTICLE 8
ECONOMIC SUPPORTS
Section 1.
Minnesota Statutes 2020, section 119B.011, subdivision 15, is amended to read:
Subd. 15.
Income.
"Income" means earned income as defined under section 256P.01,
subdivision 3, unearned income as defined under section 256P.01, subdivision 8, and public
assistance cash benefits, including the Minnesota family investment program, diversionary
work program, work benefit, Minnesota supplemental aid, general assistance, refugee cash
assistance, at-home infant child care subsidy payments, and child support and maintenance
distributed to deleted text begin thedeleted text end new text begin anew text end family under section 256.741, subdivision 2anew text begin , and nonrecurring income
over $60 per quarter unless earmarked and used for the purpose for which it was intendednew text end .
The following are deducted from income: funds used to pay for health insurance premiums
for family members, and child or spousal support paid to or on behalf of a person or persons
who live outside of the household. Income sources new text begin that are new text end not included in this subdivision
and section 256P.06, subdivision 3, are not countednew text begin as incomenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.025, subdivision 4, is amended to read:
Subd. 4.
Changes in eligibility.
(a) The county shall process a change in eligibility
factors according to paragraphs (b) to (g).
(b) A family is subject to the reporting requirements in section 256P.07new text begin , subdivision 6new text end .
(c) If a family reports a change or a change is known to the agency before the family's
regularly scheduled redetermination, the county must act on the change. The commissioner
shall establish standards for verifying a change.
(d) A change in income occurs on the day the participant received the first payment
reflecting the change in income.
(e) During a family's 12-month eligibility period, if the family's income increases and
remains at or below 85 percent of the state median income, adjusted for family size, there
is no change to the family's eligibility. The county shall not request verification of the
change. The co-payment fee shall not increase during the remaining portion of the family's
12-month eligibility period.
(f) During a family's 12-month eligibility period, if the family's income increases and
exceeds 85 percent of the state median income, adjusted for family size, the family is not
eligible for child care assistance. The family must be given 15 calendar days to provide
verification of the change. If the required verification is not returned or confirms ineligibility,
the family's eligibility ends following a subsequent 15-day adverse action notice.
(g) Notwithstanding Minnesota Rules, parts 3400.0040, subpart 3, and 3400.0170,
subpart 1, if an applicant or participant reports that employment ended, the agency may
accept a signed statement from the applicant or participant as verification that employment
ended.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256D.03, is amended by adding a subdivision to
read:
new text begin Subd. 2b. new text end
new text begin Budgeting and reporting. new text end
new text begin
County agencies shall determine eligibility and
calculate benefit amounts for general assistance according to the provisions in sections
256P.06, 256P.07, 256P.09, and 256P.10.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin SNAP employment and training. new text end
new text begin
The commissioner shall implement a
Supplemental Nutrition Assistance Program (SNAP) employment and training program
that meets the SNAP employment and training participation requirements of the United
States Department of Agriculture governed by Code of Federal Regulations, title 7, section
273.7. The commissioner shall operate a SNAP employment and training program in which
SNAP recipients elect to participate. In order to receive SNAP assistance beyond the time
limit, unless residing in an area covered by a time-limit waiver governed by Code of Federal
Regulations, title 7, section 273.24, nonexempt SNAP recipients who do not meet federal
SNAP work requirements must participate in an employment and training program. In
addition to county and tribal agencies that administer SNAP, the commissioner may contract
with third-party providers for SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin County and tribal agency duties. new text end
new text begin
County or tribal agencies that administer
SNAP shall inform adult SNAP recipients about employment and training services and
providers in the recipient's area. County or tribal agencies that administer SNAP may elect
to subcontract with a public or private entity approved by the commissioner to provide
SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Duties of commissioner. new text end
new text begin
In addition to any other duties imposed by law, the
commissioner shall:
new text end
new text begin
(1) supervise the administration of SNAP employment and training services to county,
tribal, and contracted agencies under this section and Code of Federal Regulations, title 7,
section 273.7;
new text end
new text begin
(2) disburse money allocated and reimbursed for SNAP employment and training services
to county, tribal, and contracted agencies;
new text end
new text begin
(3) accept and supervise the disbursement of any funds that may be provided by the
federal government or other sources for SNAP employment and training services;
new text end
new text begin
(4) cooperate with other agencies, including any federal agency or agency of another
state, in all matters concerning the powers and duties of the commissioner under this section;
new text end
new text begin
(5) coordinate with the commissioner of employment and economic development to
deliver employment and training services statewide;
new text end
new text begin
(6) work in partnership with counties, tribes, and other agencies to enhance the reach
and services of a statewide SNAP employment and training program; and
new text end
new text begin
(7) identify eligible nonfederal funds to earn federal reimbursement for SNAP
employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 23. new text end
new text begin Recipient duties. new text end
new text begin
Unless residing in an area covered by a time-limit waiver,
nonexempt SNAP recipients must meet federal SNAP work requirements to receive SNAP
assistance beyond the time limit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Program funding. new text end
new text begin
(a) The United States Department of Agriculture annually
allocates SNAP employment and training funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(b) The United States Department of Agriculture authorizes the disbursement of SNAP
employment and training reimbursement funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(c) Except for funds allocated for state program development and administrative purposes
or designated by the United States Department of Agriculture for a specific project, the
commissioner of human services shall disburse money allocated for federal SNAP
employment and training to counties and tribes that administer SNAP based on a formula
determined by the commissioner that includes but is not limited to the county's or tribe's
proportion of adult SNAP recipients as compared to the statewide total.
new text end
new text begin
(d) The commissioner of human services shall disburse federal funds that the
commissioner receives as reimbursement for SNAP employment and training costs to the
state agency, county, tribe, or contracted agency that incurred the costs being reimbursed.
new text end
new text begin
(e) The commissioner of human services may reallocate unexpended money disbursed
under this section to county, tribal, or contracted agencies that demonstrate a need for
additional funds.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256D.0515, is amended to read:
256D.0515 ASSET LIMITATIONS FOR SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM HOUSEHOLDS.
All Supplemental Nutrition Assistance Program (SNAP) households must be determined
eligible for the benefit discussed under section 256.029. SNAP households must demonstrate
that their gross income is equal to or less than deleted text begin 165deleted text end new text begin 200new text end percent of the federal poverty
guidelines for the same family size.
Sec. 10.
Minnesota Statutes 2020, section 256D.0516, subdivision 2, is amended to read:
Subd. 2.
SNAP reporting requirements.
The commissioner of human services shall
implement simplified reporting as permitted under the Food and Nutrition Act of 2008, as
amended, and the SNAP regulations in Code of Federal Regulations, title 7, part 273. SNAP
benefit recipient households required to report periodically shall not be required to report
more often than one time every six months. deleted text begin This provision shall not apply to households
receiving food benefits under the Minnesota family investment program waiver.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256E.34, subdivision 1, is amended to read:
Subdivision 1.
Distribution of appropriation.
The commissioner must distribute funds
appropriated to the commissioner by law for that purpose to Hunger Solutions, a statewide
association of food shelves organized as a nonprofit corporation as defined under section
501(c)(3) of the Internal Revenue Code of 1986, to distribute to qualifying food shelves. A
food shelf qualifies under this section if:
(1) it is a nonprofit corporation, or is affiliated with a nonprofit corporation, as defined
in section 501(c)(3) of the Internal Revenue Code of 1986new text begin or a federally recognized tribal
nationnew text end ;
(2) it distributes standard food orders without charge to needy individuals. The standard
food order must consist of at least a two-day supply or six pounds per person of nutritionally
balanced food items;
(3) it does not limit food distributions to individuals of a particular religious affiliation,
race, or other criteria unrelated to need or to requirements necessary to administration of a
fair and orderly distribution system;
(4) it does not use the money received or the food distribution program to foster or
advance religious or political views; and
(5) it has a stable address and directly serves individuals.
Sec. 12.
Minnesota Statutes 2020, section 256I.03, subdivision 13, is amended to read:
Subd. 13.
Prospective budgeting.
"Prospective budgeting" deleted text begin means estimating the amount
of monthly income a person will have in the payment monthdeleted text end new text begin has the meaning given in
section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256I.06, subdivision 6, is amended to read:
Subd. 6.
Reports.
Recipients must report changes in circumstances according to section
256P.07 deleted text begin that affect eligibility or housing support payment amounts, other than changes in
earned income, within ten days of the changedeleted text end . Recipients with countable earned income
must complete a household report form at least once every six monthsnew text begin according to section
256P.10new text end . deleted text begin If the report form is not received before the end of the month in which it is due,
the county agency must terminate eligibility for housing support payments. The termination
shall be effective on the first day of the month following the month in which the report was
due. If a complete report is received within the month eligibility was terminated, the
individual is considered to have continued an application for housing support payment
effective the first day of the month the eligibility was terminated.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 1c, paragraph (d).
deleted text begin
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256J.08, subdivision 15, is amended to read:
Subd. 15.
Countable income.
"Countable income" means earned and unearned income
that is deleted text begin not excluded under section 256J.21, subdivision 2deleted text end new text begin described in section 256P.06,
subdivision 3new text end , or disregarded under section 256J.21, subdivision 3new text begin , or section 256P.03new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256J.08, subdivision 71, is amended to read:
Subd. 71.
Prospective budgeting.
"Prospective budgeting" deleted text begin means a method of
determining the amount of the assistance payment in which the budget month and payment
month are the samedeleted text end new text begin has the meaning given in section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256J.08, subdivision 79, is amended to read:
Subd. 79.
Recurring income.
"Recurring income" means a form of income which is:
(1) received periodically, and may be received irregularly when receipt can be anticipated
even though the date of receipt cannot be predicted; and
(2) from the same source or of the same type that is received and budgeted in a
prospective month deleted text begin and is received in one or both of the first two retrospective monthsdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256J.10, is amended to read:
256J.10 MFIP ELIGIBILITY REQUIREMENTS.
To be eligible for MFIP, applicants must meet the general eligibility requirements in
sections 256J.11 to 256J.15, the property limitations in section 256P.02, and the income
limitations in deleted text begin sectiondeleted text end new text begin sectionsnew text end 256J.21new text begin and 256P.06new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256J.21, subdivision 3, is amended to read:
Subd. 3.
Initial income test.
The agency shall determine initial eligibility by considering
all earned and unearned income deleted text begin that is not excluded under subdivision 2deleted text end new text begin as defined in section
256P.06new text end . To be eligible for MFIP, the assistance unit's countable income minus the earned
income disregards in paragraph (a) and section 256P.03 must be below the family wage
level according to section 256J.24new text begin , subdivision 7,new text end for that size assistance unit.
(a) The initial eligibility determination must disregard the following items:
(1) the earned income disregard as determined in section 256P.03;
(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older;
(3) all payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household shall be disregarded from the income
of the person with the legal obligation to pay support; and
(4) an allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver according to section 256J.36.
(b) deleted text begin After initial eligibility is established,deleted text end new text begin The income test is for a six-month period.new text end The
assistance payment calculation is based on deleted text begin the monthly income testdeleted text end new text begin prospective budgeting
according to section 256P.09new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, except for the
amendments in subdivision 3, paragraph (b), which are effective March 1, 2023.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256J.21, subdivision 4, is amended to read:
Subd. 4.
deleted text begin Monthlydeleted text end Income test and determination of assistance payment.
deleted text begin The county
agency shall determine ongoing eligibility and the assistance payment amount according
to the monthly income test.deleted text end To be eligible for MFIP, the result of the computations in
paragraphs (a) to (e) new text begin applied to prospective budgeting new text end must be at least $1.
(a) Apply an income disregard as defined in section 256P.03, to gross earnings and
subtract this amount from the family wage level. If the difference is equal to or greater than
the MFIP transitional standard, the assistance payment is equal to the MFIP transitional
standard. If the difference is less than the MFIP transitional standard, the assistance payment
is equal to the difference. The earned income disregard in this paragraph must be deducted
every month there is earned income.
(b) All payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household must be disregarded from the income
of the person with the legal obligation to pay support.
(c) An allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver must be made according to section 256J.36.
(d) Subtract unearned income dollar for dollar from the MFIP transitional standard to
determine the assistance payment amount.
(e) When income is both earned and unearned, the amount of the assistance payment
must be determined by first treating gross earned income as specified in paragraph (a). After
determining the amount of the assistance payment under paragraph (a), unearned income
must be subtracted from that amount dollar for dollar to determine the assistance payment
amount.
deleted text begin
(f) When the monthly income is greater than the MFIP transitional standard after
deductions and the income will only exceed the standard for one month, the county agency
must suspend the assistance payment for the payment month.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256J.21, subdivision 5, is amended to read:
Subd. 5.
Distribution of income.
new text begin (a) new text end The income of all members of the assistance unit
must be counted. Income may also be deemed from ineligible persons to the assistance unit.
Income must be attributed to the person who earns it or to the assistance unit according to
paragraphs deleted text begin (a) todeleted text end new text begin (b) andnew text end (c).
deleted text begin
(a) Funds distributed from a trust, whether from the principal holdings or sale of trust
property or from the interest and other earnings of the trust holdings, must be considered
income when the income is legally available to an applicant or participant. Trusts are
presumed legally available unless an applicant or participant can document that the trust is
not legally available.
deleted text end
(b) Income from jointly owned property must be divided equally among property owners
unless the terms of ownership provide for a different distribution.
(c) Deductions are not allowed from the gross income of a financially responsible
household member or by the members of an assistance unit to meet a current or prior debt.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256J.24, subdivision 5, is amended to read:
Subd. 5.
MFIP transitional standard.
(a) The MFIP transitional standard is based on
the number of persons in the assistance unit eligible for both food and cash assistance. The
amount of the transitional standard is published annually by the Department of Human
Services.
(b) The amount of the MFIP cash assistance portion of the transitional standard is
increased $100 per month per household. This increase shall be reflected in the MFIP cash
assistance portion of the transitional standard published annually by the commissioner.
new text begin
(c) On October 1 of each year, the commissioner of human services shall adjust the cash
assistance portion under paragraph (a) for inflation based on the CPI-U for the prior calendar
year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for the fiscal year beginning on July 1,
2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256J.30, subdivision 8, is amended to read:
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the
reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the
county agency must immediately deleted text begin return the incomplete form and clearly state what the
caregiver must do for the form to be completedeleted text end new text begin contact the caregiver by phone or in writing
to acquire the necessary information to complete the formnew text end .
(c) The automated eligibility system must send a notice of proposed termination of
assistance to the assistance unit if a complete MFIP household report form is not received
by a county agency. The automated notice must be mailed to the caregiver by approximately
the 16th of the month. When a caregiver submits an incomplete form on or after the date a
notice of proposed termination has been sent, the termination is valid unless the caregiver
submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered
to have continued its application for assistance if a complete MFIP household report form
is received within a calendar month after the month in which the form was due and assistance
shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements
under subdivision 5 when any of the following factors cause a caregiver to fail to provide
the county agency with a completed MFIP household report form before the end of the
month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form
when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the
part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable
care which prevents the caregiver from providing a completed MFIP household report form
before the end of the month in which the form is due.
Sec. 24.
Minnesota Statutes 2020, section 256J.33, subdivision 1, is amended to read:
Subdivision 1.
Determination of eligibility.
new text begin (a)new text end A county agency must determine MFIP
eligibility prospectively deleted text begin for a payment monthdeleted text end based on deleted text begin retrospectivelydeleted text end assessing income
and the county agency's best estimate of the circumstances that will exist in the payment
month.
deleted text begin Except as described in section 256J.34, subdivision 1, when prospective eligibility exists,deleted text end
new text begin (b)new text end A county agency must calculate the amount of the assistance payment using deleted text begin retrospectivedeleted text end new text begin
prospectivenew text end budgeting. To determine MFIP eligibility and the assistance payment amount,
a county agency must apply countable income, described in deleted text begin sectiondeleted text end new text begin sections 256P.06 andnew text end
256J.37, subdivisions 3 to deleted text begin 10deleted text end new text begin 9new text end , received by members of an assistance unit or by other
persons whose income is counted for the assistance unit, described under sections
deleted text begin anddeleted text end 256J.37, subdivisions 1 to 2new text begin , and 256P.06, subdivision 1new text end .
new text begin (c)new text end This income must be applied to the MFIP standard of need or family wage level
subject to this section and sections 256J.34 to 256J.36. new text begin Countablenew text end income received deleted text begin in a
calendar month and not otherwise excluded under section deleted text end deleted text begin 256J.21, subdivision 2deleted text end deleted text begin ,deleted text end must be
applied to the needs of an assistance unit.
new text begin
(d) An assistance unit is not eligible when the countable income equals or exceeds the
MFIP standard of need or the family wage level for the assistance unit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective March 1, 2023. Paragraph (b) is effective
March 1, 2023, except the amendment striking section 256J.21 and inserting section 256P.06
is effective August 1, 2021. Paragraph (c) is effective August 1, 2021, except the amendment
striking "in a calendar month" is effective March 1, 2023. Paragraph (d) is effective March
1, 2023.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256J.33, subdivision 2, is amended to read:
Subd. 2.
Prospective eligibility.
An agency must determine whether the eligibility
requirements that pertain to an assistance unit, including those in sections 256J.11 to 256J.15
and 256P.02, will be met prospectively for the payment deleted text begin monthdeleted text end new text begin periodnew text end . deleted text begin Except for the
provisions in section 256J.34, subdivision 1,deleted text end The income test will be applied deleted text begin retrospectivelydeleted text end new text begin
prospectivelynew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256J.33, subdivision 4, is amended to read:
Subd. 4.
Monthly income test.
A county agency must apply the monthly income test
retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when
the countable income equals or exceeds the MFIP standard of need or the family wage level
for the assistance unit. The income applied against the monthly income test must include:
(1) gross earned income from employmentnew text begin as described in chapter 256Pnew text end , prior to
mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after
the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36deleted text begin ,
unless the employment income is specifically excluded under section 256J.21, subdivision
2deleted text end ;
(2) gross earned income from self-employment less deductions for self-employment
expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or
business state and federal income taxes, personal FICA, personal health and life insurance,
and after the disregards in section 256J.21, subdivision 4, and the allocations in section
256J.36;
(3) unearned income new text begin as described in section 256P.06, subdivision 3, new text end after deductions
for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36deleted text begin ,
unless the income has been specifically excluded in section 256J.21, subdivision 2deleted text end ;
(4) gross earned income from employment as determined under clause (1) which is
received by a member of an assistance unit who is a minor child or minor caregiver and
less than a half-time student;
(5) child support received by an assistance unit, excluded under deleted text begin section 256J.21,
subdivision 2, clause (49), ordeleted text end section 256P.06, subdivision 3, clause (2), item (xvi);
(6) spousal support received by an assistance unit;
(7) the income of a parent when that parent is not included in the assistance unit;
(8) the income of an eligible relative and spouse who seek to be included in the assistance
unit; and
(9) the unearned income of a minor child included in the assistance unit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256J.37, subdivision 1, is amended to read:
Subdivision 1.
Deemed income from ineligible assistance unit members.
The income
of ineligible assistance unit membersnew text begin , except individuals identified in section 256J.24,
subdivision 3, paragraph (a), clause (1),new text end must be deemed after allowing the following
disregards:
(1) an earned income disregard as determined under section 256P.03;
(2) all payments made by the ineligible person according to a court order for spousal
support or the support of children not living in the assistance unit's household; and
(3) an amount for the unmet needs of the ineligible persons who live in the household
who, if eligible, would be assistance unit members under section 256J.24, subdivision 2 or
4, paragraph (b). This amount is equal to the difference between the MFIP transitional
standard when the ineligible persons are included in the assistance unit and the MFIP
transitional standard when the ineligible persons are not included in the assistance unit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256J.37, subdivision 1b, is amended to read:
Subd. 1b.
Deemed income from parents of minor caregivers.
In households where
minor caregivers live with a parent or parents new text begin or a stepparent new text end who do not receive MFIP for
themselves or their minor children, the income of the parents new text begin or a stepparent new text end must be deemed
after allowing the following disregards:
(1) income of the parents equal to 200 percent of the federal poverty guideline for a
family size not including the minor parent and the minor parent's child in the household
deleted text begin according to section 256J.21, subdivision 2, clause (43)deleted text end ; and
(2) all payments made by parents according to a court order for spousal support or the
support of children not living in the parent's household.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256J.37, subdivision 3, is amended to read:
Subd. 3.
Earned income of wage, salary, and contractual employees.
The agency
must include gross earned income less any disregards in the initial deleted text begin and monthlydeleted text end income
test. Gross earned income received by persons employed on a contractual basis must be
prorated over the period covered by the contract even when payments are received over a
lesser period of time.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256J.37, subdivision 3a, is amended to read:
Subd. 3a.
Rental subsidies; unearned income.
(a) Effective July 1, 2003, the agency
shall count $50 of the value of public and assisted rental subsidies provided through the
Department of Housing and Urban Development (HUD) as unearned income to the cash
portion of the MFIP grant. The full amount of the subsidy must be counted as unearned
income when the subsidy is less than $50. The income from this subsidy shall be budgeted
according to section deleted text begin 256J.34deleted text end new text begin 256P.09new text end .
(b) The provisions of this subdivision shall not apply to an MFIP assistance unit which
includes a participant who is:
(1) age 60 or older;
(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
certified by a qualified professional when the illness, injury, or incapacity is expected to
continue for more than 30 days and severely limits the person's ability to obtain or maintain
suitable employment; or
(3) a caregiver whose presence in the home is required due to the illness or incapacity
of another member in the assistance unit, a relative in the household, or a foster child in the
household when the illness or incapacity and the need for the participant's presence in the
home has been certified by a qualified professional and is expected to continue for more
than 30 days.
(c) The provisions of this subdivision shall not apply to an MFIP assistance unit where
the parental caregiver is an SSI participant.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256J.626, subdivision 1, is amended to read:
Subdivision 1.
Consolidated fund.
The consolidated fund is established to support
counties and tribes in meeting their duties under this chapter. Counties and tribes must use
funds from the consolidated fund to develop programs and services that are designed to
improve participant outcomes as measured in section 256J.751, subdivision 2. Counties new text begin and
tribes that administer MFIP eligibility new text end may use the funds for any allowable expenditures
under subdivision 2, including case management. Tribes new text begin that do not administer MFIP
eligibility new text end may use the funds for any allowable expenditures under subdivision 2, including
case management, except those in subdivision 2, paragraph (a), clauses (1) and (6). new text begin All
payments made through the MFIP consolidated fund to support a caregiver's pursuit of
greater economic stability does not count when determining a family's available income.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256J.95, subdivision 9, is amended to read:
Subd. 9.
Property and income limitations.
The asset limits and exclusions in section
256P.02 apply to applicants and participants of DWP. All payments, deleted text begin unless excluded in
section 256J.21deleted text end new text begin as described in section 256P.06, subdivision 3new text end , must be counted as income
to determine eligibility for the diversionary work program. The agency shall treat income
as outlined in section 256J.37, except for subdivision 3a. The initial income test and the
disregards in section 256J.21, subdivision 3, shall be followed for determining eligibility
for the diversionary work program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256P.01, subdivision 3, is amended to read:
Subd. 3.
Earned income.
"Earned income" means deleted text begin cash or in-kinddeleted text end income earned through
the receipt of wages, salary, commissions, bonuses, tips, gratuities, profit from employment
activities, net profit from self-employment activities, payments made by an employer for
regularly accrued vacation or sick leave, severance pay based on accrued leave time,
deleted text begin payments from training programs at a rate at or greater than the state's minimum wage,deleted text end
royalties, honoraria, or other profit from activity that results from the client's work, deleted text begin service,deleted text end
effort, or labornew text begin for purposes other than student financial assistance, rehabilitation programs,
student training programs, or service programs such as AmeriCorpsnew text end . The income must be
in return for, or as a result of, legal activity.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256P.01, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Prospective budgeting. new text end
new text begin
"Prospective budgeting" means estimating the amount
of monthly income that an assistance unit will have in the payment month.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256P.04, subdivision 4, is amended to read:
Subd. 4.
Factors to be verified.
(a) The agency shall verify the following at application:
(1) identity of adults;
(2) age, if necessary to determine eligibility;
(3) immigration status;
(4) income;
(5) spousal support and child support payments made to persons outside the household;
(6) vehicles;
(7) checking and savings accounts;
(8) inconsistent information, if related to eligibility;
(9) residence;new text begin and
new text end
(10) Social Security numberdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
deleted text end
(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, deleted text begin clause (7)deleted text end new text begin clauses (8) and (9)new text end , are not required to
verify the information in paragraph (a), clause (10). When a Social Security number is not
provided to the agency for verification, this requirement is satisfied when each member of
the assistance unit cooperates with the procedures for verification of Social Security numbers,
issuance of duplicate cards, and issuance of new numbers which have been established
jointly between the Social Security Administration and the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023, except for paragraph (b),
which is effective July 1, 2021.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256P.04, subdivision 8, is amended to read:
Subd. 8.
Recertification.
The agency shall recertify eligibility deleted text begin in an annual interview
with the participant. The interview may be conducted by telephone, by Internet telepresence,
or face-to-face in the county office or in another location mutually agreed upon. A participant
must be given the option of a telephone interview or Internet telepresence to recertify
eligibilitydeleted text end new text begin annuallynew text end . During deleted text begin the interviewdeleted text end new text begin recertification and reporting under section 256P.10new text end ,
the agency shall verify the following:
(1) income, unless excluded, including self-employment earnings;
(2) assets when the value is within $200 of the asset limit; and
(3) inconsistent information, if related to eligibility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256P.06, subdivision 2, is amended to read:
Subd. 2.
deleted text begin Exempted individualsdeleted text end new text begin Exemptionsnew text end .
(a) The following members of an assistance
unit under chapters 119B and 256J are exempt from having their earned income count
deleted text begin towardsdeleted text end new text begin towardnew text end the income of an assistance unit:
(1) children under six years old;
(2) caregivers under 20 years of age enrolled at least half-time in school; and
(3) minors enrolled in school full time.
(b) The following members of an assistance unit are exempt from having their earned
and unearned income count deleted text begin towardsdeleted text end new text begin towardnew text end the income of an assistance unit for 12
consecutive calendar months, beginning the month following the marriage date, for benefits
under chapter 256J if the household income does not exceed 275 percent of the federal
poverty guideline:
(1) a new spouse to a caretaker in an existing assistance unit; and
(2) the spouse designated by a newly married couple, both of whom were already
members of an assistance unit under chapter 256J.
(c) If members identified in paragraph (b) also receive assistance under section 119B.05,
they are exempt from having their earned and unearned income count deleted text begin towardsdeleted text end new text begin towardnew text end the
income of the assistance unit if the household income prior to the exemption does not exceed
67 percent of the state median income for recipients for 26 consecutive biweekly periods
beginning the second biweekly period after the marriage date.
new text begin
(d) For individuals who are members of an assistance unit under chapters 256I and 256J,
the assistance standard effective in January 2020 for a household of one under chapter 256J
shall be counted as income under chapter 256I, and any subsequent increases to unearned
income under chapter 256J shall be exempt.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256P.06, subdivision 3, is amended to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winningsnew text begin according to guidance provided for the Supplemental
Nutrition Assistance Programnew text end ;
(vii) unemployment insurance incomenew text begin that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
new text end
new text begin
(A) 18 years of age and enrolled in a secondary school; or
new text end
new text begin (B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-timenew text end ;
(viii) retirement, survivors, and disability insurance payments;
deleted text begin
(ix) nonrecurring income over $60 per quarter unless earmarked and used for the purpose
for which it is intended. Income and use of this income is subject to verification requirements
under section 256P.04;
deleted text end
deleted text begin (x)deleted text end new text begin (ix)new text end retirement benefits;
deleted text begin (xi)deleted text end new text begin (x)new text end cash assistance benefits, as defined by each program in chapters 119B, 256D,
256I, and 256J;
deleted text begin (xii)deleted text end new text begin (xi)new text end tribal per capita payments unless excluded by federal and state law;
deleted text begin (xiii)deleted text end new text begin (xii)new text end income and payments from service and rehabilitation programs that meet or
exceed the state's minimum wage rate;
deleted text begin (xiv)deleted text end new text begin (xiii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;
deleted text begin (xv)deleted text end new text begin (xiv)new text end all child support payments for programs under chapters 119B, 256D, and 256I;
deleted text begin (xvi)deleted text end new text begin (xv)new text end the amount of child support received that exceeds $100 for assistance units
with one child and $200 for assistance units with two or more children for programs under
chapter 256J; deleted text begin and
deleted text end
deleted text begin (xvii)deleted text end new text begin (xvi)new text end spousal supportdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(xvii) workers' compensation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023, except subdivision 3,
clause (2), item (vii), which is effective the day following final enactment and subdivision
3, clause (2), item (xvii), which is effective August 1, 2021.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256P.07, is amended to read:
256P.07 REPORTING OF deleted text begin INCOME ANDdeleted text end CHANGES.
Subdivision 1.
Exempted programs.
Participants who new text begin receive Supplemental Security
Income and new text end qualify for Minnesota supplemental aid under chapter 256D deleted text begin anddeleted text end new text begin ornew text end for housing
support under chapter 256I deleted text begin on the basis of eligibility for Supplemental Security Incomedeleted text end are
exempt from deleted text begin this sectiondeleted text end new text begin reporting incomenew text end .
new text begin Subd. 1a. new text end
new text begin Child care assistance programs. new text end
new text begin
Participants who qualify for child care
assistance programs under chapter 119B are exempt from this section except for the reporting
requirements in subdivision 6.
new text end
Subd. 2.
Reporting requirements.
An applicant or participant must provide information
on an application and any subsequent reporting forms about the assistance unit's
circumstances that affect eligibility or benefits. An applicant or assistance unit must report
changes identified in deleted text begin subdivisiondeleted text end new text begin subdivisionsnew text end 3new text begin , 4, 5, 7, 8, and 9 during the application
period or by the tenth of the month following the month that the change occurrednew text end . When
information is not accurately reported, both an overpayment and a referral for a fraud
investigation may result. When information or documentation is not provided, the receipt
of any benefit may be delayed or denied, depending on the type of information required
and its effect on eligibility.
Subd. 3.
Changes that must be reported.
deleted text begin
An assistance unit must report the changes
or anticipated changes specified in clauses (1) to (12) within ten days of the date they occur,
at the time of recertification of eligibility under section 256P.04, subdivisions 8 and 9, or
within eight calendar days of a reporting period, whichever occurs first. An assistance unit
must report other changes at the time of recertification of eligibility under section 256P.04,
subdivisions 8 and 9, or at the end of a reporting period, as applicable. When an agency
could have reduced or terminated assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (12) had not occurred, the agency must
determine whether a timely notice could have been issued on the day that the change
occurred. When a timely notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error overpayment under section
119B.11, subdivision 2a, or 256P.08. Changes in circumstances that must be reported within
ten days must also be reported for the reporting period in which those changes occurred.
Within ten days, an assistance unit must report:
deleted text end
deleted text begin
(1) a change in earned income of $100 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(2) a change in unearned income of $50 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(3) a change in employment status and hours with the exception of a program under
chapter 119B;
deleted text end
deleted text begin
(4) a change in address or residence;
deleted text end
deleted text begin
(5) a change in household composition with the exception of programs under chapter
256I;
deleted text end
deleted text begin
(6) a receipt of a lump-sum payment with the exception of a program under chapter
119B;
deleted text end
deleted text begin
(7) an increase in assets if over $9,000 with the exception of programs under chapter
119B;
deleted text end
deleted text begin
(8) a change in citizenship or immigration status;
deleted text end
deleted text begin
(9) a change in family status with the exception of programs under chapter 256I;
deleted text end
deleted text begin
(10) a change in disability status of a unit member, with the exception of programs under
chapter 119B;
deleted text end
deleted text begin
(11) a new rent subsidy or a change in rent subsidy with the exception of a program
under chapter 119B; and
deleted text end
deleted text begin
(12) a sale, purchase, or transfer of real property with the exception of a program under
chapter 119B.
deleted text end
new text begin
An assistance unit must report changes or anticipated changes as described
in this section.
new text end
new text begin
(a) An assistance unit must report:
new text end
new text begin
(1) a change in eligibility for Supplemental Security Income, Retirement Survivors
Disability Insurance, or another federal income support;
new text end
new text begin
(2) a change in address or residence;
new text end
new text begin
(3) a change in household composition with the exception of programs under chapter
256I;
new text end
new text begin
(4) cash prizes and winnings according to guidance provided for the Supplemental
Nutrition Assistance Program;
new text end
new text begin
(5) a change in citizenship or immigration status;
new text end
new text begin
(6) a change in family status with the exception of programs under chapter 256I; and
new text end
new text begin
(7) assets when the value is at or above the asset limit.
new text end
new text begin
(b) When an agency could have reduced or terminated assistance for one or more payment
months if a delay in reporting a change specified in clauses (1) to (7) had not occurred, the
agency must determine whether a timely notice could have been issued on the day that the
change occurred. When a timely notice could have been issued, each month's overpayment
subsequent to the notice must be considered a client error overpayment under section
256P.08.
new text end
Subd. 4.
MFIP-specific reporting.
In addition to subdivision 3, an assistance unit under
chapter 256J, deleted text begin within ten days of the change,deleted text end must report:
(1) a pregnancy not resulting in birth when there are no other minor children; deleted text begin and
deleted text end
(2) a change in school attendance of a parent under 20 years of age deleted text begin or of an employed
child.deleted text end new text begin ; and
new text end
new text begin
(3) an individual who is 18 or 19 years of age attending high school who graduates or
drops out of school.
new text end
Subd. 5.
DWP-specific reporting.
In addition to subdivisions 3 and 4, an assistance
unit participating in the diversionary work program under section 256J.95 must report on
an application:
(1) shelter expenses; and
(2) utility expenses.
Subd. 6.
Child care assistance programs-specific reporting.
(a) deleted text begin In addition to
subdivision 3,deleted text end An assistance unit under chapter 119B, within ten days of the change, must
report:
(1) a change in a parentally responsible individual's custody schedule for any child
receiving child care assistance program benefits;
(2) a permanent end in a parentally responsible individual's authorized activity; deleted text begin and
deleted text end
(3) if the unit's family's annual included income exceeds 85 percent of the state median
income, adjusted for family sizedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) a change in address or residence;
new text end
new text begin
(5) a change in household composition;
new text end
new text begin
(6) a change in citizenship or immigration status; and
new text end
new text begin
(7) a change in family status.
new text end
(b) An assistance unit subject to section 119B.095, subdivision 1, paragraph (b), must
report a change in the unit's authorized activity status.
(c) An assistance unit must notify the county when the unit wants to reduce the number
of authorized hours for children in the unit.
Subd. 7.
Minnesota supplemental aid-specific reporting.
new text begin (a) new text end In addition to subdivision
3new text begin and notwithstanding the exemption in subdivision 1new text end , an assistance unit participating in
the Minnesota supplemental aid program under deleted text begin section 256D.44, subdivision 5, paragraph
(g), within ten days of the change,deleted text end new text begin chapter 256Dnew text end must report deleted text begin shelter expenses.deleted text end new text begin :
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater.
new text end
new text begin
(b) An assistance unit receiving housing assistance under section 256D.44, subdivision
5, paragraph (g), including assistance units who also receive Supplemental Security Income,
must report:
new text end
new text begin
(1) a change in shelter expenses; and
new text end
new text begin
(2) a new rent subsidy or a change in a rent subsidy.
new text end
new text begin Subd. 8. new text end
new text begin Housing support-specific reporting. new text end
new text begin
(a) In addition to subdivision 3, an
assistance unit participating in the housing support program under chapter 256I must report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater, with the exception of
participants already subject to six-month reporting requirements in section 256P.10.
new text end
new text begin
(b) Notwithstanding the exemptions in subdivisions 1 and 3, an assistance unit receiving
housing support under chapter 256I, including an assistance unit that receives Supplemental
Security Income, must report:
new text end
new text begin
(1) a new rent subsidy or a change in a rent subsidy;
new text end
new text begin
(2) a change in the disability status of a unit member; and
new text end
new text begin
(3) a change in household composition if the assistance unit is a participant in housing
support under section 256I.04, subdivision 3, paragraph (a), clause (3).
new text end
new text begin Subd. 9. new text end
new text begin General assistance-specific reporting. new text end
new text begin
In addition to subdivision 3, an
assistance unit participating in the general assistance program under chapter 256D must
report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater;
new text end
new text begin
(2) a change in earned income of $100 per month or greater, with the exception of
participants who are already subject to six-month reporting requirements in section 256P.10;
and
new text end
new text begin
(3) changes in any condition that would result in the loss of a basis for eligibility in
section 256D.05, subdivision 1, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 40.
new text begin
[256P.09] PROSPECTIVE BUDGETING OF BENEFITS.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units who qualify for child care
assistance programs under chapter 119B; housing support assistance units under chapter
256I who are not subject to reporting under section 256P.10; and assistance units who
qualify for Minnesota Supplemental Aid under chapter 256D are exempt from this section.
new text end
new text begin Subd. 2. new text end
new text begin Prospective budgeting of benefits. new text end
new text begin
An agency must use prospective budgeting
to calculate an assistance payment amount.
new text end
new text begin Subd. 3. new text end
new text begin Income changes. new text end
new text begin
Prospective budgeting must be used to determine the amount
of the assistance unit's benefit for the following six-month period. An increase in income
shall not affect an assistance unit's eligibility or benefit amount until the next case review
unless otherwise required by section 256P.07. A decrease in income shall be effective on
the date that the change occurs if the change is reported by the tenth of the month following
the month when the change occurred. If the decrease in income is not reported by the tenth
of the month following the month when the change occurred, the change in income shall
be effective the month following the month when the change is reported.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 41.
new text begin
[256P.10] SIX-MONTH REPORTING.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units who qualify for child care
assistance programs under chapter 119B; assistance units who qualify for Minnesota
Supplemental Aid under chapter 256D; and assistance units who qualify for housing support
under chapter 256I and also receive Supplemental Security Income are exempt from this
section.
new text end
new text begin Subd. 2. new text end
new text begin Reporting. new text end
new text begin
(a) Every six months, an assistance unit that qualifies for the
Minnesota family investment program under chapter 256J; an assistance unit that qualifies
for general assistance under chapter 256D with earned income of $100 per month or greater;
or an assistance unit that qualifies for housing support under chapter 256I with earned
income of $100 per month or greater is subject to six month case reviews. The initial
reporting period may be shorter than six months in order to align with other program reporting
periods.
new text end
new text begin
(b) An assistance unit that qualifies for the Minnesota family investment program and
an assistance unit that qualifies for general assistance as described in paragraph (a) must
complete household report forms as prescribed by the commissioner for redetermination of
benefits.
new text end
new text begin
(c) An assistance unit that qualifies for housing support as described in paragraph (a)
must complete household report forms as prescribed by the commissioner to provide
information about earned income.
new text end
new text begin
(d) An assistance unit that qualifies for housing support and also receives assistance
through the Minnesota family investment program shall be subject to the requirements of
this section for purposes of the Minnesota family investment program but not for housing
support.
new text end
new text begin
(e) An assistance unit must submit a household report form in compliance with the
provisions in section 256P.04, subdivision 11.
new text end
new text begin
(f) An assistance unit may choose to report changes under this section at any time.
new text end
new text begin Subd. 3. new text end
new text begin When to terminate assistance. new text end
new text begin
(a) An agency must terminate benefits when
the participant fails to submit the household report form before the end of the six month
review period. If the participant submits the household report form within 30 days of the
termination of benefits, benefits must be reinstated and made available retroactively for the
full benefit month.
new text end
new text begin
(b) When an assistance unit is determined to be ineligible for assistance according to
this section and chapter 256D, 256I, or 256J, the agency must terminate assistance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 42.
Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
new text begin Subd. 5. new text end
new text begin Waivers and modifications. new text end
new text begin
When the peacetime emergency declared by the
governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by
the proper authority, the following waivers and modifications to human services programs
issued by the commissioner of human services pursuant to Executive Orders 20-12 and
20-42, including any amendments to the waivers or modifications issued before the peacetime
emergency expires, shall remain in effect until December 31, 2021, unless necessary federal
approval is not received at any time for a waiver or modification:
new text end
new text begin
(1) Executive Order 21-15: when determining eligibility for cash assistance programs,
not counting as income any emergency economic relief provided through the American
Rescue Plan Act of 2021; and
new text end
new text begin
(2) CV.04.A4: waiving interviews for annual eligibility recertifications of households
receiving cash assistance in which all necessary information has been submitted and verified.
new text end
Sec. 43. new text begin DIRECTION TO COMMISSIONER; LONG-TERM HOMELESS
SUPPORTIVE SERVICES REPORT.
new text end
new text begin
(a) No later than January 15, 2023, the commissioner of human services shall produce
a report which shows the projects funded under Minnesota Statutes, section 256K.26, and
provide a copy of the report to the chairs and ranking minority members of the legislative
committees with jurisdiction over services for persons experiencing homelessness.
new text end
new text begin
(b) This report must be updated annually for two additional years and the commissioner
must provide copies of the updated reports to the chairs and ranking minority members of
the legislative committees with jurisdiction over services for persons experiencing
homelessness by January 15, 2024, and January 15, 2025.
new text end
Sec. 44. new text begin 2022 REPORT TO LEGISLATURE ON RUNAWAY AND HOMELESS
YOUTH.
new text end
new text begin Subdivision 1. new text end
new text begin Report development. new text end
new text begin
The commissioner of human services is exempt
from preparing the report required under Minnesota Statutes, section 256K.45, subdivision
2, in 2023 and shall instead update the information in the 2007 legislative report on runaway
and homeless youth. In developing the updated report, the commissioner must use existing
data, studies, and analysis provided by state, county, and other entities including:
new text end
new text begin
(1) Minnesota Housing Finance Agency analysis on housing availability;
new text end
new text begin
(2) the Minnesota state plan to end homelessness;
new text end
new text begin
(3) the continuum of care counts of youth experiencing homelessness and assessments
as provided by Department of Housing and Urban Development (HUD) required coordinated
entry systems;
new text end
new text begin
(4) the biannual Department of Human Services report on the Homeless Youth Act;
new text end
new text begin
(5) the Wilder Research homeless study;
new text end
new text begin
(6) the Voices of Youth Count sponsored by Hennepin County; and
new text end
new text begin
(7) privately funded analysis, including:
new text end
new text begin
(i) nine evidence-based principles to support youth in overcoming homelessness;
new text end
new text begin
(ii) the return on investment analysis conducted for YouthLink by Foldes Consulting;
and
new text end
new text begin
(iii) the evaluation of Homeless Youth Act resources conducted by Rainbow Research.
new text end
new text begin Subd. 2. new text end
new text begin Key elements; due date. new text end
new text begin
(a) The report must include three key elements where
significant learning has occurred in the state since the 2007 report, including:
new text end
new text begin
(1) the unique causes of youth homelessness;
new text end
new text begin
(2) targeted responses to youth homelessness, including the significance of positive
youth development as fundamental to each targeted response; and
new text end
new text begin
(3) recommendations based on existing reports and analysis on how to end youth
homelessness.
new text end
new text begin
(b) To the extent that data is available, the report must include:
new text end
new text begin
(1) a general accounting of the federal and philanthropic funds leveraged to support
homeless youth activities;
new text end
new text begin
(2) a general accounting of the increase in volunteer responses to support youth
experiencing homelessness; and
new text end
new text begin
(3) a data-driven accounting of geographic areas or distinct populations that have gaps
in service or are not yet served by homeless youth responses.
new text end
new text begin
(c) The commissioner of human services shall consult with and incorporate the expertise
of community-based providers of homeless youth services and other expert stakeholders to
complete the report. The commissioner shall submit the report to the chairs and ranking
minority members of the legislative committees with jurisdiction over youth homelessness
by December 15, 2022.
new text end
Sec. 45. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b,
6c, 7, 8, 9, and 18; 256D.052, subdivision 3; and 256J.21, subdivisions 1 and 2,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256J.08, subdivisions 10, 53, 61, 62, 81, and 83;
256J.30, subdivisions 5, 7, and 8; 256J.33, subdivisions 3, 4, and 5; 256J.34, subdivisions
1, 2, 3, and 4; and 256J.37, subdivision 10,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective August 1, 2021. Paragraph (b) is effective
March 1, 2023.
new text end
ARTICLE 9
CHILD CARE ASSISTANCE
Section 1.
Minnesota Statutes 2020, section 119B.03, subdivision 4, is amended to read:
Subd. 4.
Funding priority.
(a) First priority for child care assistance under the basic
sliding fee program must be given to eligible non-MFIP families who do not have a high
school diploma or commissioner of education-selected high school equivalency certification
or who need remedial and basic skill courses in order to pursue employment or to pursue
education leading to employment and who need child care assistance to participate in the
education program. This includes student parents as defined under section 119B.011,
subdivision 19b. Within this priority, the following subpriorities must be used:
(1) child care needs of minor parents;
(2) child care needs of parents under 21 years of age; and
(3) child care needs of other parents within the priority group described in this paragraph.
(b) Second priority must be given to deleted text begin parents who have completed their MFIP or DWP
transition year, or parents who are no longer receiving or eligible for diversionary work
program supportsdeleted text end new text begin families in which at least one parent is a veteran, as defined under section
197.447new text end .
(c) Third priority must be given to new text begin eligible new text end families who deleted text begin are eligible for portable basic
sliding fee assistance through the portability pool under subdivision 9deleted text end new text begin do not meet the
specifications of paragraph (a), (b), (d), or (e)new text end .
(d) Fourth priority must be given to families deleted text begin in which at least one parent is a veteran as
defined under section 197.447deleted text end new text begin who are eligible for portable basic sliding fee assistance
through the portability pool under subdivision 9new text end .
new text begin
(e) Fifth priority must be given to eligible families receiving services under section
119B.011, subdivision 20a, if the parents have completed their MFIP or DWP transition
year, or if the parents are no longer receiving or eligible for DWP supports.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end Families under paragraph deleted text begin (b)deleted text end new text begin (e)new text end must be added to the basic sliding fee waiting
list on the date they deleted text begin begin thedeleted text end new text begin complete theirnew text end transition year under section 119B.011,
subdivision 20deleted text begin , and must be moved into the basic sliding fee program as soon as possible
after they complete their transition yeardeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.03, subdivision 6, is amended to read:
Subd. 6.
Allocation formula.
The new text begin allocation component of new text end basic sliding fee state and
federal funds shall be allocated on a calendar year basis. Funds shall be allocated first in
amounts equal to each county's guaranteed floor according to subdivision 8, with any
remaining available funds allocated according to the following formula:
(a) One-fourth of the funds shall be allocated in proportion to each county's total
expenditures for the basic sliding fee child care program reported during the most recent
fiscal year completed at the time of the notice of allocation.
(b) Up to one-fourth of the funds shall be allocated in proportion to the number of families
participating in the transition year child care program as reported during and averaged over
the most recent six months completed at the time of the notice of allocation. Funds in excess
of the amount necessary to serve all families in this category shall be allocated according
to paragraph deleted text begin (f)deleted text end new text begin (e)new text end .
deleted text begin
(c) Up to one-fourth of the funds shall be allocated in proportion to the average of each
county's most recent six months of reported first, second, and third priority waiting list as
defined in subdivision 2 and the reinstatement list of those families whose assistance was
terminated with the approval of the commissioner under Minnesota Rules, part 3400.0183,
subpart 1. Funds in excess of the amount necessary to serve all families in this category
shall be allocated according to paragraph (f).
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end Up to deleted text begin one-fourthdeleted text end new text begin one-halfnew text end of the funds shall be allocated in proportion to the
average of each county's most recent deleted text begin sixdeleted text end new text begin 12new text end months of reported waiting list as defined in
subdivision 2 and the reinstatement list of those families whose assistance was terminated
with the approval of the commissioner under Minnesota Rules, part 3400.0183, subpart 1.
Funds in excess of the amount necessary to serve all families in this category shall be
allocated according to paragraph deleted text begin (f)deleted text end new text begin (e)new text end .
deleted text begin (e)deleted text end new text begin (d)new text end The amount necessary to serve all families in paragraphs (b)deleted text begin , (c),deleted text end and deleted text begin (d)deleted text end new text begin (c)new text end shall
be calculated based on the basic sliding fee average cost of care per family in the county
with the highest cost in the most recently completed calendar year.
deleted text begin (f)deleted text end new text begin (e)new text end Funds in excess of the amount necessary to serve all families in paragraphs (b)deleted text begin ,
(c),deleted text end and deleted text begin (d)deleted text end new text begin (c)new text end shall be allocated in proportion to each county's total expenditures for the
basic sliding fee child care program reported during the most recent fiscal year completed
at the time of the notice of allocation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022. The 2022 calendar year
shall be a phase-in year for the allocation formula in this section using phase-in provisions
determined by the commissioner of human services.
new text end
Sec. 3.
Minnesota Statutes 2020, section 119B.09, subdivision 4, is amended to read:
Subd. 4.
Eligibility; annual income; calculation.
(a) Annual income of the applicant
family is the current monthly income of the family multiplied by 12 or the income for the
12-month period immediately preceding the date of application, or income calculated by
the method which provides the most accurate assessment of income available to the family.
(b) Self-employment income must be calculated based on gross receipts less operating
expenses.
(c) Income changes are processed under section 119B.025, subdivision 4. Included lump
sums counted as income under section deleted text begin 256P.06, subdivision 3deleted text end new text begin 119B.011, subdivision 15new text end ,
must be annualized over 12 months. Income must be verified with documentary evidence.
If the applicant does not have sufficient evidence of income, verification must be obtained
from the source of the income.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2023.
new text end
Sec. 4.
Minnesota Statutes 2020, section 119B.11, subdivision 2a, is amended to read:
Subd. 2a.
Recovery of overpayments.
(a) An amount of child care assistance paid to a
recipient new text begin or provider new text end in excess of the payment due is recoverable by the county agency new text begin or
commissioner new text end under paragraphs (b) and (c), even when the overpayment was caused by
agency error or circumstances outside the responsibility and control of the family or provider.
(b) An overpayment must be recouped or recovered from the family if the overpayment
benefited the family by causing the family to pay less for child care expenses than the family
otherwise would have been required to pay under child care assistance program requirements.
If the family remains eligible for child care assistance, the overpayment must be recovered
through recoupment as identified in Minnesota Rules, part 3400.0187, except that the
overpayments must be calculated and collected on a service period basis. If the family no
longer remains eligible for child care assistance, the county new text begin or commissioner new text end may choose
to initiate efforts to recover overpayments from the family for overpayment less than $50.
If the overpayment is greater than or equal to $50, the county new text begin or commissioner new text end shall seek
voluntary repayment of the overpayment from the family. If the county new text begin or commissioner new text end is
unable to recoup the overpayment through voluntary repayment, the county new text begin or commissioner
new text end shall initiate civil court proceedings to recover the overpayment unless the county'snew text begin or
commissioner'snew text end costs to recover the overpayment will exceed the amount of the overpayment.
A family with an outstanding debt under this subdivision is not eligible for child care
assistance until: (1) the debt is paid in full; deleted text begin ordeleted text end (2) satisfactory arrangements are made with
the county new text begin or commissioner new text end to retire the debt consistent with the requirements of this chapter
and Minnesota Rules, chapter 3400, and the family is in compliance with the arrangementsnew text begin ;
or (3) the commissioner determines that it is in the best interests of the state to compromise
debts owed to the state pursuant to section 16D.15new text end . new text begin The commissioner's authority to recoup
and recover overpayments from families in this paragraph is limited to investigations
conducted under chapter 245E.
new text end
(c) The county new text begin or commissioner new text end must recover an overpayment from a provider if the
overpayment did not benefit the family by causing it to receive more child care assistance
or to pay less for child care expenses than the family otherwise would have been eligible
to receive or required to pay under child care assistance program requirements, and benefited
the provider by causing the provider to receive more child care assistance than otherwise
would have been paid on the family's behalf under child care assistance program
requirements. If the provider continues to care for children receiving child care assistance,
the overpayment must be recovered through deleted text begin reductions in child care assistance payments
for services as described in an agreement with the countydeleted text end new text begin recoupment as identified in
Minnesota Rules, part 3400.0187new text end . The provider may not charge families using that provider
more to cover the cost of recouping the overpayment. If the provider no longer cares for
children receiving child care assistance, the county new text begin or commissioner new text end may choose to initiate
efforts to recover overpayments of less than $50 from the provider. If the overpayment is
greater than or equal to $50, the county new text begin or commissioner new text end shall seek voluntary repayment
of the overpayment from the provider. If the county new text begin or commissioner new text end is unable to recoup
the overpayment through voluntary repayment, the county new text begin or commissioner new text end shall initiate
civil court proceedings to recover the overpayment unless the county'snew text begin or commissioner'snew text end
costs to recover the overpayment will exceed the amount of the overpayment. A provider
with an outstanding debt under this subdivision is not eligible to care for children receiving
child care assistance until:
(1) the debt is paid in full; deleted text begin or
deleted text end
(2) satisfactory arrangements are made with the county new text begin or commissioner new text end to retire the
debt consistent with the requirements of this chapter and Minnesota Rules, chapter 3400,
and the provider is in compliance with the arrangementsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) the commissioner determines that it is in the best interests of the state to compromise
debts owed to the state pursuant to section 16D.15.
new text end
(d) When both the family and the provider acted together to intentionally cause the
overpayment, both the family and the provider are jointly liable for the overpayment
regardless of who benefited from the overpayment. The county new text begin or commissioner new text end must
recover the overpayment as provided in paragraphs (b) and (c). When the family or the
provider is in compliance with a repayment agreement, the party in compliance is eligible
to receive child care assistance or to care for children receiving child care assistance despite
the other party's noncompliance with repayment arrangements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 5.
Minnesota Statutes 2020, section 119B.125, subdivision 1, is amended to read:
Subdivision 1.
Authorization.
deleted text begin Except as provided in subdivision 5,deleted text end A county or the
commissioner must authorize the provider chosen by an applicant or a participant before
the county can authorize payment for care provided by that provider. The commissioner
must establish the requirements necessary for authorization of providers. A provider must
be reauthorized every two years. A legal, nonlicensed family child care provider also must
be reauthorized when another person over the age of 13 joins the household, a current
household member turns 13, or there is reason to believe that a household member has a
factor that prevents authorization. The provider is required to report all family changes that
would require reauthorization. When a provider has been authorized for payment for
providing care for families in more than one county, the county responsible for
reauthorization of that provider is the county of the family with a current authorization for
that provider and who has used the provider for the longest length of time.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 6.
Minnesota Statutes 2020, section 119B.13, subdivision 1, is amended to read:
Subdivision 1.
Subsidy restrictions.
(a) The maximum rate paid for child care assistance
in any county or county price cluster under the child care fund shall be deleted text begin the greater of the
25th percentile of the 2018 child care provider rate survey or the rates in effect at the time
of the update.deleted text end new text begin set in accordance with rates and policies established by the commissioner,
dependent on federal funds, and consistent with federal law, up to a maximum of the 75th
percentile of the most recent child care provider rate survey, but in no event shall the
maximum rate be less than the greater of the 50th percentile of the most recent child care
provider rate survey or the rates in effect at the time of the update. The rate increase is
effective no later than the first full service period on or after January 1 of the year following
the provider rate survey.new text end For a child care provider located within the boundaries of a city
located in two or more of the counties of Benton, Sherburne, and Stearns, the maximum
rate paid for child care assistance shall be equal to the maximum rate paid in the county
with the highest maximum reimbursement rates or the provider's charge, whichever is less.
The commissioner may: (1) assign a county with no reported provider prices to a similar
price cluster; and (2) consider county level access when determining final price clusters.
(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
(d) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.
(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:
(1) the daily rate for one day of care;
(2) the weekly rate for one week of care by the child's primary provider; and
(3) two daily rates during two weeks of care by a child's secondary provider.
(f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
(g) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.
deleted text begin
(h) All maximum provider rates changes shall be implemented on the Monday following
the effective date of the maximum provider rate.
deleted text end
deleted text begin (i) Beginning September 21, 2020,deleted text end new text begin (h)new text end The maximum registration fee paid for child care
assistance in any county or county price cluster under the child care fund shall be deleted text begin the greater
of the 25th percentile of the 2018 child care provider rate survey or the registration fee in
effect at the time of the update.deleted text end new text begin set in accordance with rates and policies established by the
commissioner, dependent on federal funds, and consistent with federal law, up to a maximum
of the 75th percentile of the most recent child care provider rate survey, but in no event
shall the maximum registration fee be less than the greater of the 50th percentile of the most
recent child care provider rate survey or the registration fee in effect at the time of the update.
Each maximum registration fee update must be implemented on the same schedule as
maximum child care assistance rate increases under paragraph (a). new text end Maximum registration
fees must be set for licensed family child care and for child care centers. For a child care
provider located in the boundaries of a city located in two or more of the counties of Benton,
Sherburne, and Stearns, the maximum registration fee paid for child care assistance shall
be equal to the maximum registration fee paid in the county with the highest maximum
registration fee or the provider's charge, whichever is less.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2020, section 119B.13, subdivision 1a, is amended to read:
Subd. 1a.
Legal nonlicensed family child care provider rates.
(a) Legal nonlicensed
family child care providers receiving reimbursement under this chapter must be paid on an
hourly basis for care provided to families receiving assistance.
(b) The maximum rate paid to legal nonlicensed family child care providers must be deleted text begin 68deleted text end new text begin
90new text end percent of the county maximum hourly rate for licensed family child care providers.new text begin The
rate increase is effective the first full service period on or after January 1 of the year following
the provider rate survey.new text end In counties or county price clusters where the maximum hourly
rate for licensed family child care providers is higher than the maximum weekly rate for
those providers divided by 50, the maximum hourly rate that may be paid to legal nonlicensed
family child care providers is the rate equal to the maximum weekly rate for licensed family
child care providers divided by 50 and then multiplied by deleted text begin 0.68deleted text end new text begin 0.90new text end . The maximum payment
to a provider for one day of care must not exceed the maximum hourly rate times ten. The
maximum payment to a provider for one week of care must not exceed the maximum hourly
rate times 50.
(c) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(d) Legal nonlicensed family child care providers receiving reimbursement under this
chapter may not be paid registration fees for families receiving assistance.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 119B.13, subdivision 6, is amended to read:
Subd. 6.
Provider payments.
(a) A provider shall bill only for services documented
according to section 119B.125, subdivision 6. The provider shall bill for services provided
within ten days of the end of the service period. Payments under the child care fund shall
be made within 21 days of receiving a complete bill from the provider. Counties or the state
may establish policies that make payments on a more frequent basis.
(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.
(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of deleted text begin sixdeleted text end new text begin threenew text end months from the date the provider is issued
an authorization of care and billing form.new text begin For a family at application, if a provider provided
child care during a time period without receiving an authorization of care and a billing form,
a county may only make child care assistance payments to the provider retroactively from
the date that child care began, or from the date that the family's eligibility began under
section 119B.09, subdivision 7, or from the date that the family meets authorization
requirements, not to exceed six months from the date the provider is issued an authorization
of care and billing form, whichever is later.
new text end
(d) A county or the commissioner may refuse to issue a child care authorization to a
new text begin certified, new text end licensednew text begin ,new text end or legal nonlicensed provider, revoke an existing child care authorization
to a new text begin certified, new text end licensednew text begin ,new text end or legal nonlicensed provider, stop payment issued to a new text begin certified,
new text end licensednew text begin ,new text end or legal nonlicensed provider, or refuse to pay a bill submitted by a new text begin certified,
new text end licensednew text begin ,new text end or legal nonlicensed provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;
(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;
(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;
(4) the provider is operating after:
(i) an order of suspension of the provider's license issued by the commissioner;
(ii) an order of revocation of the provider's licensenew text begin issued by the commissionernew text end ; or
(iii) deleted text begin a final order of conditional license issued by the commissioner for as long as the
conditional license is in effectdeleted text end new text begin an order of decertification issued to the providernew text end ;
(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request;
(6) the provider gives false child care price information; or
(7) the provider fails to report decreases in a child's attendance as required under section
119B.125, subdivision 9.
(e) For purposes of paragraph (d), clauses (3), (5), (6), and (7), the county or the
commissioner may withhold the provider's authorization or payment for a period of time
not to exceed three months beyond the time the condition has been corrected.
(f) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.
new text begin
(g) If the commissioner or responsible county agency suspends or refuses payment to a
provider under paragraph (d), clause (1) or (2), or chapter 245E and the provider has:
new text end
new text begin
(1) a disqualification for wrongfully obtaining assistance under section 256.98,
subdivision 8, paragraph (c);
new text end
new text begin
(2) an administrative disqualification under section 256.046, subdivision 3; or
new text end
new text begin
(3) a termination under section 245E.02, subdivision 4, paragraph (c), clause (4), or
245E.06;
new text end
new text begin
then the provider forfeits the payment to the commissioner or the responsible county agency,
regardless of the amount assessed in an overpayment, charged in a criminal complaint, or
ordered as criminal restitution.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 119B.13, subdivision 7, is amended to read:
Subd. 7.
Absent days.
(a) Licensed child care providers and license-exempt centers
must not be reimbursed for more than 25 full-day absent days per child, excluding holidays,
in a calendar year, or for more than ten consecutive full-day absent days. "Absent day"
means any day that the child is authorized and scheduled to be in care with a licensed
provider or license-exempt center, and the child is absent from the care for the entire day.
Legal nonlicensed family child care providers must not be reimbursed for absent days. If a
child attends for part of the time authorized to be in care in a day, but is absent for part of
the time authorized to be in care in that same day, the absent time must be reimbursed but
the time must not count toward the absent days limit. Child care providers must only be
reimbursed for absent days if the provider has a written policy for child absences and charges
all other families in care for similar absences.
(b) Notwithstanding paragraph (a), children with documented medical conditions that
cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
full-day absent days limit. Absences due to a documented medical condition of a parent or
sibling who lives in the same residence as the child receiving child care assistance do not
count against the absent days limit in a calendar year. Documentation of medical conditions
must be on the forms and submitted according to the timelines established by the
commissioner. A public health nurse or school nurse may verify the illness in lieu of a
medical practitioner. If a provider sends a child home early due to a medical reason,
including, but not limited to, fever or contagious illness, the child care center director or
lead teacher may verify the illness in lieu of a medical practitioner.
(c) Notwithstanding paragraph (a), children in families may exceed the absent days limit
if at least one parent: (1) is under the age of 21; (2) does not have a high school diploma or
commissioner of education-selected high school equivalency certification; and (3) is a
student in a school district or another similar program that provides or arranges for child
care, parenting support, social services, career and employment supports, and academic
support to achieve high school graduation, upon request of the program and approval of the
county. If a child attends part of an authorized day, payment to the provider must be for the
full amount of care authorized for that day.
(d) Child care providers must be reimbursed for up to ten federal or state holidays or
designated holidays per year when the provider charges all families for these days and the
holiday or designated holiday falls on a day when the child is authorized to be in attendance.
Parents may substitute other cultural or religious holidays for the ten recognized state and
federal holidays. Holidays do not count toward the absent days limit.
(e) A family deleted text begin or child care providerdeleted text end must not be assessed an overpayment for an absent
day payment unless (1) there was an error in the amount of care authorized for the family,
new text begin or new text end (2) all of the allowed full-day absent payments for the child have been paiddeleted text begin , or (3) the
family or provider did not timely report a change as required under lawdeleted text end .
(f) The provider and family shall receive notification of the number of absent days used
upon initial provider authorization for a family and ongoing notification of the number of
absent days used as of the date of the notification.
(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent days
per child, excluding holidays, in a calendar year; and ten consecutive full-day absent days.
(h) For purposes of this subdivision, "holidays limit" means ten full-day holidays per
child, excluding absent days, in a calendar year.
(i) If a day meets the criteria of an absent day or a holiday under this subdivision, the
provider must bill that day as an absent day or holiday. A provider's failure to properly bill
an absent day or a holiday results in an overpayment, regardless of whether the child reached,
or is exempt from, the absent days limit or holidays limit for the calendar year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 10.
Minnesota Statutes 2020, section 119B.25, subdivision 3, is amended to read:
Subd. 3.
Financing program.
A nonprofit corporation that receives a grant under this
section shall use the money to:
(1) establish a revolving loan fund to make loans to existing, expanding, and new licensed
and legal unlicensed child care and early childhood education sites;
(2) establish a fund to guarantee private loans to improve or construct a child care or
early childhood education site;
(3) establish a fund to provide forgivable loans or grants to match all or part of a loan
made under this section;
(4) establish a fund as a reserve against bad debt; deleted text begin and
deleted text end
(5) establish a fund to provide business planning assistance for child care providersdeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(6) provide training and consultation for child care providers to build and strengthen
their businesses and acquire key business skills.
new text end
The nonprofit corporation shall establish the terms and conditions for loans and loan
guarantees including, but not limited to, interest rates, repayment agreements, private match
requirements, and conditions for loan forgiveness. The nonprofit corporation shall establish
a minimum interest rate for loans to ensure that necessary loan administration costs are
covered. The nonprofit corporation may use interest earnings for administrative expenses.
Sec. 11. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 119B.125, subdivision 5,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
ARTICLE 10
CHILD PROTECTION
Section 1.
Minnesota Statutes 2020, section 256N.25, subdivision 2, is amended to read:
Subd. 2.
Negotiation of agreement.
(a) When a child is determined to be eligible for
Northstar kinship assistance or adoption assistance, the financially responsible agency, or,
if there is no financially responsible agency, the agency designated by the commissioner,
must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
the caregiver and agency reach concurrence as to the terms of the agreement, both parties
shall sign the agreement. The agency must submit the agreement, along with the eligibility
determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
the commissioner for final review, approval, and signature according to subdivision 1.
(b) A monthly payment is provided as part of the adoption assistance or Northstar kinship
assistance agreement to support the care of children unless the child is eligible for adoption
assistance and determined to be an at-risk child, in which case no payment will be made
unless and until the caregiver obtains written documentation from a qualified expert that
the potential disability upon which eligibility for the agreement was based has manifested
itself.
(1) The amount of the payment made on behalf of a child eligible for Northstar kinship
assistance or adoption assistance is determined through agreement between the prospective
relative custodian or the adoptive parent and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, using the
assessment tool established by the commissioner in section 256N.24, subdivision 2, and the
associated benefit and payments outlined in section 256N.26. Except as provided under
section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes the monthly
benefit level for a child under foster care. The monthly payment under a Northstar kinship
assistance agreement or adoption assistance agreement may be negotiated up to the monthly
benefit level under foster care. In no case may the amount of the payment under a Northstar
kinship assistance agreement or adoption assistance agreement exceed the foster care
maintenance payment which would have been paid during the month if the child with respect
to whom the Northstar kinship assistance or adoption assistance payment is made had been
in a foster family home in the state.
(2) The rate schedule for the agreement is determined based on the age of the child on
the date that the prospective adoptive parent or parents or relative custodian or custodians
sign the agreement.
(3) The income of the relative custodian or custodians or adoptive parent or parents must
not be taken into consideration when determining eligibility for Northstar kinship assistance
or adoption assistance or the amount of the payments under section 256N.26.
(4) With the concurrence of the relative custodian or adoptive parent, the amount of the
payment may be adjusted periodically using the assessment tool established by the
commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
subdivision 3 when there is a change in the child's needs or the family's circumstances.
(5) An adoptive parent of an at-risk child with an adoption assistance agreement may
request a reassessment of the child under section 256N.24, subdivision 10, and renegotiation
of the adoption assistance agreement under subdivision 3 to include a monthly payment, if
the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner.
(c) For Northstar kinship assistance agreements:
(1) the initial amount of the monthly Northstar kinship assistance payment must be
equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less any
offsets under section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective relative custodian and specified in that agreement, unless the Northstar
kinship assistance agreement is entered into when a child is under the age of six; and
(2) the amount of the monthly payment for a Northstar kinship assistance agreement for
a child who is under the age of six must be as specified in section 256N.26, subdivision 5.
(d) For adoption assistance agreements:
(1) for a child in foster care with the prospective adoptive parent immediately prior to
adoptive placement, the initial amount of the monthly adoption assistance payment must
be equivalent to the foster care rate in effect at the time that the agreement is signed deleted text begin less
any offsets in section 256N.26, subdivision 11deleted text end , or a lesser negotiated amount if agreed to
by the prospective adoptive parents and specified in that agreement, unless the child is
identified as at-risk or the adoption assistance agreement is entered into when a child is
under the age of six;
(2) for an at-risk child who must be assigned level A as outlined in section 256N.26, no
payment will be made unless and until the potential disability manifests itself, as documented
by an appropriate professional, and the commissioner authorizes commencement of payment
by modifying the agreement accordingly;
(3) the amount of the monthly payment for an adoption assistance agreement for a child
under the age of six, other than an at-risk child, must be as specified in section 256N.26,
subdivision 5;
(4) for a child who is in the Northstar kinship assistance program immediately prior to
adoptive placement, the initial amount of the adoption assistance payment must be equivalent
to the Northstar kinship assistance payment in effect at the time that the adoption assistance
agreement is signed or a lesser amount if agreed to by the prospective adoptive parent and
specified in that agreement, unless the child is identified as an at-risk child; and
(5) for a child who is not in foster care placement or the Northstar kinship assistance
program immediately prior to adoptive placement or negotiation of the adoption assistance
agreement, the initial amount of the adoption assistance agreement must be determined
using the assessment tool and process in this section and the corresponding payment amount
outlined in section 256N.26.
Sec. 2.
Minnesota Statutes 2020, section 256N.25, subdivision 3, is amended to read:
Subd. 3.
Renegotiation of agreement.
(a) A relative custodian or adoptive parent of a
child with a Northstar kinship assistance or adoption assistance agreement may request
renegotiation of the agreement when there is a change in the needs of the child or in the
family's circumstances. When a relative custodian or adoptive parent requests renegotiation
of the agreement, a reassessment of the child must be completed consistent with section
256N.24, subdivisions 10 and 11. If the reassessment indicates that the child's level has
changed, the financially responsible agency or, if there is no financially responsible agency,
the agency designated by the commissioner or the commissioner's designee, and the caregiver
must renegotiate the agreement to include a payment with the level determined through the
reassessment process. The agreement must not be renegotiated unless the commissioner,
the financially responsible agency, and the caregiver mutually agree to the changes. The
effective date of any renegotiated agreement must be determined by the commissioner.
(b) An adoptive parent of an at-risk child with an adoption assistance agreement may
request renegotiation of the agreement to include a monthly payment under section 256N.26
if the caregiver has written documentation from a qualified expert that the potential disability
upon which eligibility for the agreement was based has manifested itself. Documentation
of the disability must be limited to evidence deemed appropriate by the commissioner. Prior
to renegotiating the agreement, a reassessment of the child must be conducted as outlined
in section 256N.24, subdivision 10. The reassessment must be used to renegotiate the
agreement to include an appropriate monthly payment. The agreement must not be
renegotiated unless the commissioner, the financially responsible agency, and the caregiver
mutually agree to the changes. The effective date of any renegotiated agreement must be
determined by the commissioner.
deleted text begin
(c) Renegotiation of a Northstar kinship assistance or adoption assistance agreement is
required when one of the circumstances outlined in section 256N.26, subdivision 13, occurs.
deleted text end
Sec. 3.
Minnesota Statutes 2020, section 256N.26, subdivision 11, is amended to read:
Subd. 11.
Child income or income attributable to the child.
(a) A monthly Northstar
kinship assistance or adoption assistance payment must be considered as income and
resources attributable to the child. Northstar kinship assistance and adoption assistance are
exempt from garnishment, except as permissible under the laws of the state where the child
resides.
(b) When a child is placed into foster care, any income and resources attributable to the
child are treated as provided in sections 252.27 and 260C.331, or 260B.331, as applicable
to the child being placed.
(c) deleted text begin Consideration of income and resources attributable to the child must be part of the
negotiation process outlined in section 256N.25, subdivision 2. In some circumstances, the
receipt of other income on behalf of the child may impact the amount of the monthly payment
received by the relative custodian or adoptive parent on behalf of the child through Northstar
Care for Children.deleted text end Supplemental Security Income (SSI), retirement survivor's disability
insurance (RSDI), veteran's benefits, railroad retirement benefits, and black lung benefits
are considered income and resources attributable to the child.
Sec. 4.
Minnesota Statutes 2020, section 256N.26, subdivision 13, is amended to read:
Subd. 13.
Treatment of retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, and black lung benefits.
deleted text begin (a)deleted text end If a child placed in foster care
receives retirement survivor's disability insurance, veteran's benefits, railroad retirement
benefits, or black lung benefits at the time of foster care placement or subsequent to
placement in foster care, the financially responsible agency may apply to be the payee for
the child for the duration of the child's placement in foster care. If it is anticipated that a
child will be eligible to receive retirement survivor's disability insurance, veteran's benefits,
railroad retirement benefits, or black lung benefits after finalization of the adoption or
assignment of permanent legal and physical custody, the permanent caregiver shall apply
to be the payee of those benefits on the child's behalf. deleted text begin The monthly amount of the other
benefits must be considered an offset to the amount of the payment the child is determined
eligible for under Northstar Care for Children.
deleted text end
deleted text begin
(b) If a child becomes eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits, after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the other benefits must be considered an offset to the amount of the
payment the child is determined eligible for under Northstar Care for Children.
deleted text end
deleted text begin
(c) If a child ceases to be eligible for retirement survivor's disability insurance, veteran's
benefits, railroad retirement benefits, or black lung benefits after the initial amount of the
payment under Northstar Care for Children is finalized, the permanent caregiver shall contact
the commissioner to redetermine the payment under Northstar Care for Children. The
monthly amount of the payment under Northstar Care for Children must be the amount the
child was determined to be eligible for prior to consideration of any offset.
deleted text end
deleted text begin
(d) If the monthly payment received on behalf of the child under retirement survivor's
disability insurance, veteran's benefits, railroad retirement benefits, or black lung benefits
changes after the adoption assistance or Northstar kinship assistance agreement is finalized,
the permanent caregiver shall notify the commissioner as to the new monthly payment
amount, regardless of the amount of the change in payment. If the monthly payment changes
by $75 or more, even if the change occurs incrementally over the duration of the term of
the adoption assistance or Northstar kinship assistance agreement, the monthly payment
under Northstar Care for Children must be adjusted without further consent to reflect the
amount of the increase or decrease in the offset amount. Any subsequent change to the
payment must be reported and handled in the same manner. A change of monthly payments
of less than $75 is not a permissible reason to renegotiate the adoption assistance or Northstar
kinship assistance agreement under section 256N.25, subdivision 3. The commissioner shall
review and revise the limit at which the adoption assistance or Northstar kinship assistance
agreement must be renegotiated in accordance with subdivision 9.
deleted text end
Sec. 5.
Minnesota Statutes 2020, section 260.761, subdivision 2, is amended to read:
Subd. 2.
Agency and court notice to tribes.
(a) When a local social services agency
has information that a family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking
assessmentnew text end being conducted may involve an Indian child, the local social services agency
shall notify the Indian child's tribe of the family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver
sex trafficking assessmentnew text end according to section 260E.18. Initial notice shall be provided by
telephone and by e-mail or facsimile. The local social services agency shall request that the
tribe or a designated tribal representative participate in evaluating the family circumstances,
identifying family and tribal community resources, and developing case plans.
(b) When a local social services agency has information that a child receiving services
may be an Indian child, the local social services agency shall notify the tribe by telephone
and by e-mail or facsimile of the child's full name and date of birth, the full names and dates
of birth of the child's biological parents, and, if known, the full names and dates of birth of
the child's grandparents and of the child's Indian custodian. This notification must be provided
so the tribe can determine if the child is enrolled in the tribe or eligible for membership,
and must be provided within seven days. If information regarding the child's grandparents
or Indian custodian is not available within the seven-day period, the local social services
agency shall continue to request this information and shall notify the tribe when it is received.
Notice shall be provided to all tribes to which the child may have any tribal lineage. If the
identity or location of the child's parent or Indian custodian and tribe cannot be determined,
the local social services agency shall provide the notice required in this paragraph to the
United States secretary of the interior.
(c) In accordance with sections 260C.151 and 260C.152, when a court has reason to
believe that a child placed in emergency protective care is an Indian child, the court
administrator or a designee shall, as soon as possible and before a hearing takes place, notify
the tribal social services agency by telephone and by e-mail or facsimile of the date, time,
and location of the emergency protective case hearing. The court shall make efforts to allow
appearances by telephone for tribal representatives, parents, and Indian custodians.
(d) A local social services agency must provide the notices required under this subdivision
at the earliest possible time to facilitate involvement of the Indian child's tribe. Nothing in
this subdivision is intended to hinder the ability of the local social services agency and the
court to respond to an emergency situation. Lack of participation by a tribe shall not prevent
the tribe from intervening in services and proceedings at a later date. A tribe may participate
new text begin in a case new text end at any time. At any stage of the local social services agency's involvement with
an Indian child, the agency shall provide full cooperation to the tribal social services agency,
including disclosure of all data concerning the Indian child. Nothing in this subdivision
relieves the local social services agency of satisfying the notice requirements in the Indian
Child Welfare Act.
Sec. 6.
Minnesota Statutes 2020, section 260C.007, subdivision 14, is amended to read:
Subd. 14.
Egregious harm.
"Egregious harm" means the infliction of bodily harm to a
child or neglect of a child which demonstrates a grossly inadequate ability to provide
minimally adequate parental care. deleted text begin Thedeleted text end Egregious harm need not have occurred in the state
or in the county where a termination of parental rights action is otherwise properly venued.
Egregious harm includes, but is not limited to:
(1) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes a violation of sections 609.185 to
609.2114, 609.222, subdivision 2, 609.223, or any other similar law of any other state;
(2) the infliction of "substantial bodily harm" to a child, as defined in section 609.02,
subdivision 7a;
(3) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony malicious punishment of a
child under section 609.377;
(4) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony unreasonable restraint of a
child under section 609.255, subdivision 3;
(5) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony neglect or endangerment of
a child under section 609.378;
(6) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes assault under section 609.221, 609.222,
or 609.223;
(7) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes new text begin sex trafficking, new text end solicitation,
inducement, deleted text begin ordeleted text end promotion of, or receiving profit derived from prostitution under section
609.322;
(8) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes murder or voluntary manslaughter
as defined by United States Code, title 18, section 1111(a) or 1112(a);
(9) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes aiding or abetting, attempting,
conspiring, or soliciting to commit a murder or voluntary manslaughter that constitutes a
violation of United States Code, title 18, section 1111(a) or 1112(a); or
(10) conduct toward a child that constitutes criminal sexual conduct under sections
609.342 to 609.345.
Sec. 7.
Minnesota Statutes 2020, section 260E.01, is amended to read:
260E.01 POLICY.
(a) The legislature hereby declares that the public policy of this state is to protect children
whose health or welfare may be jeopardized through maltreatment. While it is recognized
that most parents want to keep their children safe, sometimes circumstances or conditions
interfere with their ability to do so. When this occurs, the health and safety of the children
must be of paramount concern. Intervention and prevention efforts must address immediate
concerns for child safety and the ongoing risk of maltreatment and should engage the
protective capacities of families. In furtherance of this public policy, it is the intent of the
legislature under this chapter to:
(1) protect children and promote child safety;
(2) strengthen the family;
(3) make the home, school, and community safe for children by promoting responsible
child care in all settings; and
(4) provide, when necessary, a safe temporary or permanent home environment for
maltreated children.
(b) In addition, it is the policy of this state to:
(1) require the reporting of maltreatment of children in the home, school, and community
settings;
(2) provide for deleted text begin thedeleted text end voluntary reporting of maltreatment of children;
(3) require an investigation when the report alleges sexual abuse or substantial child
endangermentnew text begin , except when the report alleges sex trafficking by a noncaregiver sex traffickernew text end ;
(4) provide a family assessment, if appropriate, when the report does not allege sexual
abuse or substantial child endangerment; deleted text begin and
deleted text end
(5) new text begin provide a noncaregiver sex trafficking assessment when the report alleges sex
trafficking by a noncaregiver sex trafficker; and
new text end
new text begin (6) new text end provide protective, family support, and family preservation services when needed
in appropriate cases.
Sec. 8.
Minnesota Statutes 2020, section 260E.02, subdivision 1, is amended to read:
Subdivision 1.
Establishment of team.
A county shall establish a multidisciplinary
child protection team that may include, but new text begin is new text end not deleted text begin bedeleted text end limited to, the director of the local
welfare agency or designees, the county attorney or designees, the county sheriff or designees,
representatives of health and education, representatives of mental healthnew text begin , representatives of
agencies providing specialized services or responding to youth who experience or are at
risk of experiencing sex trafficking or sexual exploitation,new text end or other appropriate human
services or community-based agencies, and parent groups. As used in this section, a
"community-based agency" may include, but is not limited to, schools, social services
agencies, family service and mental health collaboratives, children's advocacy centers, early
childhood and family education programs, Head Start, or other agencies serving children
and families. A member of the team must be designated as the lead person of the team
responsible for the planning process to develop standards for the team's activities with
battered women's and domestic abuse programs and services.
Sec. 9.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision to
read:
new text begin Subd. 15a. new text end
new text begin Noncaregiver sex trafficker. new text end
new text begin
"Noncaregiver sex trafficker" means an
individual who is alleged to have engaged in the act of sex trafficking a child, who is not a
person responsible for the child's care, who does not have a significant relationship with
the child as defined in section 609.341, and who is not a person in a current or recent position
of authority as defined in section 609.341, subdivision 10.
new text end
Sec. 10.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision
to read:
new text begin Subd. 15b. new text end
new text begin Noncaregiver sex trafficking assessment. new text end
new text begin
"Noncaregiver sex trafficking
assessment" is a comprehensive assessment of child safety, the risk of subsequent child
maltreatment, and strengths and needs of the child and family. The local welfare agency
shall only perform a noncaregiver sex trafficking assessment when a maltreatment report
alleges sex trafficking of a child by someone other than the child's caregiver. A noncaregiver
sex trafficking assessment does not include a determination of whether child maltreatment
occurred. A noncaregiver sex trafficking assessment includes a determination of a family's
need for services to address the safety of the child or children, the safety of family members,
and the risk of subsequent child maltreatment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 260E.03, subdivision 22, is amended to read:
Subd. 22.
Substantial child endangerment.
"Substantial child endangerment" means
that a person responsible for a child's care, by act or omission, commits or attempts to
commit an act against a child deleted text begin under theirdeleted text end new text begin in the person'snew text end care that constitutes any of the
following:
(1) egregious harm under subdivision 5;
(2) abandonment under section 260C.301, subdivision 2;
(3) neglect under subdivision 15, paragraph (a), clause (2), that substantially endangers
the child's physical or mental health, including a growth delay, which may be referred to
as failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
(4) murder in the first, second, or third degree under section 609.185, 609.19, or 609.195;
(5) manslaughter in the first or second degree under section 609.20 or 609.205;
(6) assault in the first, second, or third degree under section 609.221, 609.222, or 609.223;
(7) new text begin sex trafficking, new text end solicitation, inducement, deleted text begin anddeleted text end new text begin ornew text end promotion of prostitution under
section 609.322;
(8) criminal sexual conduct under sections 609.342 to 609.3451;
(9) solicitation of children to engage in sexual conduct under section 609.352;
(10) malicious punishment or neglect or endangerment of a child under section 609.377
or 609.378;
(11) use of a minor in sexual performance under section 617.246; or
(12) parental behavior, status, or condition deleted text begin that mandates thatdeleted text end new text begin requiringnew text end the county
attorneynew text begin tonew text end file a termination of parental rights petition under section 260C.503, subdivision
2.
Sec. 12.
Minnesota Statutes 2020, section 260E.14, subdivision 2, is amended to read:
Subd. 2.
Sexual abuse.
(a) The local welfare agency is the agency responsible for
investigating an allegation of sexual abuse if the alleged offender is the parent, guardian,
sibling, or an individual functioning within the family unit as a person responsible for the
child's care, or a person with a significant relationship to the child if that person resides in
the child's household.
(b) The local welfare agency is also responsible for new text begin assessing or new text end investigating when a
child is identified as a victim of sex trafficking.
Sec. 13.
Minnesota Statutes 2020, section 260E.14, subdivision 5, is amended to read:
Subd. 5.
Law enforcement.
(a) The local law enforcement agency is the agency
responsible for investigating a report of maltreatment if a violation of a criminal statute is
alleged.
(b) Law enforcement and the responsible agency must coordinate their investigations
or assessments as required under this chapter when deleted text begin thedeleted text end new text begin : (1) anew text end report alleges maltreatment
that is a violation of a criminal statute by a person who is a parent, guardian, sibling, person
responsible for the child's care deleted text begin functioningdeleted text end within the family unit, ornew text begin by anew text end person who lives
in the child's household and who has a significant relationship to the childdeleted text begin ,deleted text end in a setting other
than a facility as defined in section 260E.03new text begin ; or (2) a report alleges sex trafficking of a childnew text end .
Sec. 14.
Minnesota Statutes 2020, section 260E.17, subdivision 1, is amended to read:
Subdivision 1.
Local welfare agency.
(a) Upon receipt of a report, the local welfare
agency shall determine whether to conduct a family assessment deleted text begin ordeleted text end new text begin ,new text end an investigationnew text begin , or a
noncaregiver sex trafficking assessmentnew text end as appropriate to prevent or provide a remedy for
maltreatment.
(b) The local welfare agency shall conduct an investigation when the report involves
sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
(c) The local welfare agency shall begin an immediate investigation deleted text begin if,deleted text end at any time when
the local welfare agency is deleted text begin usingdeleted text end new text begin responding withnew text end a family assessment deleted text begin response,deleted text end new text begin andnew text end the
local welfare agency determines that there is reason to believe that sexual abuse deleted text begin ordeleted text end new text begin ,new text end substantial
child endangermentnew text begin ,new text end or a serious threat to the child's safety exists.
(d) The local welfare agency may conduct a family assessment for reports that do not
allege sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
In determining that a family assessment is appropriate, the local welfare agency may consider
issues of child safety, parental cooperation, and the need for an immediate response.
(e) The local welfare agency may conduct a family assessment deleted text begin ondeleted text end new text begin fornew text end a report that was
initially screened and assigned for an investigation. In determining that a complete
investigation is not required, the local welfare agency must document the reason for
terminating the investigation and notify the local law enforcement agency if the local law
enforcement agency is conducting a joint investigation.
new text begin
(f) The local welfare agency shall conduct a noncaregiver sex trafficking assessment
when a maltreatment report alleges sex trafficking of a child and the alleged offender is a
noncaregiver sex trafficker as defined by section 260E.03, subdivision 15a.
new text end
new text begin
(g) During a noncaregiver sex trafficking assessment, the local welfare agency shall
initiate an immediate investigation if there is reason to believe that a child's parent, caregiver,
or household member allegedly engaged in the act of sex trafficking a child or was alleged
to have engaged in any conduct requiring the agency to conduct an investigation.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260E.18, is amended to read:
260E.18 NOTICE TO CHILD'S TRIBE.
The local welfare agency shall provide immediate notice, according to section 260.761,
subdivision 2, to an Indian child's tribe when the agency has reason to believe new text begin that new text end the family
assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking assessmentnew text end may involve an
Indian child. For purposes of this section, "immediate notice" means notice provided within
24 hours.
Sec. 16.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall deleted text begin conduct adeleted text end new text begin havenew text end face-to-face contact with the child reported to be maltreated
and with the child's primary caregiver sufficient to complete a safety assessment and ensure
the immediate safety of the child.
(b) new text begin Except in a noncaregiver sex trafficking assessment, new text end thenew text begin local welfare agency shall
havenew text end face-to-face contact with the child and primary caregiver deleted text begin shall occurdeleted text end immediately if
sexual abuse or substantial child endangerment is alleged and within five calendar days for
all other reports. If the alleged offender was not already interviewed as the primary caregiver,
the local welfare agency shall also conduct a face-to-face interview with the alleged offender
in the early stages of the assessment or investigationnew text begin , except in a noncaregiver sex trafficking
assessmentnew text end .
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.new text begin
In a noncaregiver sex trafficking assessment, the local child welfare agency is not required
to interview the alleged offender.
new text end
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statementnew text begin , except
in a noncaregiver sex trafficking assessment where the local welfare agency may rely on
law enforcement datanew text end . The alleged offender may submit supporting documentation relevant
to the assessment or investigation.
Sec. 17.
Minnesota Statutes 2020, section 260E.24, subdivision 2, is amended to read:
Subd. 2.
Determination after family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
After conducting a family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end , the local welfare agency shall determine whether child protective services are
needed to address the safety of the child and other family members and the risk of subsequent
maltreatment.
Sec. 18.
Minnesota Statutes 2020, section 260E.24, subdivision 7, is amended to read:
Subd. 7.
Notification at conclusion of family assessmentnew text begin or a noncaregiver sex
trafficking assessmentnew text end .
Within ten working days of the conclusion of a family assessmentnew text begin
or a noncaregiver sex trafficking assessmentnew text end , the local welfare agency shall notify the parent
or guardian of the child of the need for services to address child safety concerns or significant
risk of subsequent maltreatment. The local welfare agency and the family may also jointly
agree that family support and family preservation services are needed.
Sec. 19.
Minnesota Statutes 2020, section 260E.33, subdivision 1, is amended to read:
Subdivision 1.
Followingnew text begin anew text end family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
Administrative reconsideration is not applicable to a family assessment new text begin or
noncaregiver sex trafficking assessment new text end since no determination concerning maltreatment
is made.
Sec. 20.
Minnesota Statutes 2020, section 260E.35, subdivision 6, is amended to read:
Subd. 6.
Data retention.
(a) Notwithstanding sections 138.163 and 138.17, a record
maintained or a record derived from a report of maltreatment by a local welfare agency,
agency responsible for assessing or investigating the report, court services agency, or school
under this chapter shall be destroyed as provided in paragraphs (b) to (e) by the responsible
authority.
(b) For a report alleging maltreatment that was not accepted for new text begin an new text end assessment or new text begin an
new text end investigation, a family assessment case, new text begin a noncaregiver sex trafficking assessment case, new text end and
a case where an investigation results in no determination of maltreatment or the need for
child protective services, the record must be maintained for a period of five years after the
datenew text begin thatnew text end the report was not accepted for assessment or investigation or the date of the final
entry in the case record. A record of a report that was not accepted must contain sufficient
information to identify the subjects of the report, the nature of the alleged maltreatment,
and the reasons deleted text begin as todeleted text end why the report was not accepted. Records under this paragraph may
not be used for employment, background checks, or purposes other than to assist in future
screening decisions and risk and safety assessments.
(c) All records relating to reports that, upon investigation, indicate deleted text begin eitherdeleted text end maltreatment
or a need for child protective services shall be maintained for ten years after the date of the
final entry in the case record.
(d) All records regarding a report of maltreatment, including a notification of intent to
interview that was received by a school under section 260E.22, subdivision 7, shall be
destroyed by the school when ordered to do so by the agency conducting the assessment or
investigation. The agency shall order the destruction of the notification when other records
relating to the report under investigation or assessment are destroyed under this subdivision.
(e) Private or confidential data released to a court services agency under subdivision 3,
paragraph (d), must be destroyed by the court services agency when ordered to do so by the
local welfare agency that released the data. The local welfare agency or agency responsible
for assessing or investigating the report shall order destruction of the data when other records
relating to the assessment or investigation are destroyed under this subdivision.
ARTICLE 11
CHILD PROTECTION POLICY
Section 1.
Minnesota Statutes 2020, section 245.4885, subdivision 1, is amended to read:
Subdivision 1.
Admission criteria.
(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a treatment foster care setting, residential treatment facility, or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if public funds are used to pay for the new text begin child's new text end services.
(b) The responsible social services agency shall determine the appropriate level of care
for a child when county-controlled funds are used to pay for the child's services or placement
in a qualified residential treatment facility under chapter 260C and licensed by the
commissioner under chapter 245A. In accordance with section 260C.157, a juvenile treatment
screening team shall conduct a screeningnew text begin of a childnew text end before the team may recommend whether
to place a child in a qualified residential treatment program as defined in section 260C.007,
subdivision 26d. When a social services agency does not have responsibility for a child's
placement and the child is enrolled in a prepaid health program under section 256B.69, the
enrolled child's contracted health plan must determine the appropriate level of carenew text begin for the
childnew text end . When Indian Health Services funds or funds of a tribally owned facility funded under
the Indian Self-Determination and Education Assistance Act, Public Law 93-638, are to be
usednew text begin for a childnew text end , the Indian Health Services or 638 tribal health facility must determine the
appropriate level of carenew text begin for the childnew text end . When more than one entity bears responsibility fornew text begin
a child'snew text end coverage, the entities shall coordinate level of care determination activitiesnew text begin for the
childnew text end to the extent possible.
(c) The responsible social services agency must make thenew text begin child'snew text end level of care
determination available to thenew text begin child'snew text end juvenile treatment screening team, as permitted under
chapter 13. The level of care determination shall inform the juvenile treatment screening
team process and the assessment in section 260C.704 when considering whether to place
the child in a qualified residential treatment program. When the responsible social services
agency is not involved in determining a child's placement, the child's level of care
determination shall determine whether the proposed treatment:
(1) is necessary;
(2) is appropriate to the child's individual treatment needs;
(3) cannot be effectively provided in the child's home; and
(4) provides a length of stay as short as possible consistent with the individual child's
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the responsible social services
agency or other entity may not determine that a screeningnew text begin of a childnew text end under section 260C.157
or referral or admission to a treatment foster care setting or residential treatment facility is
not appropriate solely because services were not first provided to the child in a less restrictive
setting and the child failed to make progress toward or meet treatment goals in the less
restrictive setting. The level of care determination must be based on a diagnostic assessmentnew text begin
of a childnew text end that includes a functional assessment which evaluatesnew text begin the child'snew text end family, school,
and community living situations; and an assessment of the child's need for care out of the
home using a validated tool which assesses a child's functional status and assigns an
appropriate level of carenew text begin to the childnew text end . The validated tool must be approved by the
commissioner of human servicesnew text begin and may be the validated tool approved for the child's
assessment under section 260C.704 if the juvenile treatment screening team recommended
placement of the child in a qualified residential treatment programnew text end . If a diagnostic assessment
including a functional assessment has been completed by a mental health professional within
the past 180 days, a new diagnostic assessment need not be completed unless in the opinion
of the current treating mental health professional the child's mental health status has changed
markedly since the assessment was completed. The child's parent shall be notified if an
assessment will not be completed and of the reasons. A copy of the notice shall be placed
in the child's file. Recommendations developed as part of the level of care determination
process shall include specific community services needed by the child and, if appropriate,
the child's family, and shall indicate whether deleted text begin or notdeleted text end these services are available and accessible
to the child andnew text begin the child'snew text end family.
(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual family
community support plan is being developed by the case manager, if assigned.
(f) When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 new text begin and chapter
260Dnew text end unless a court terminates the parent's rights or court orders restrict the parent from
participating in case planning, visitation, or parental responsibilities.
(g) The level of care determination, deleted text begin anddeleted text end placement decision, and recommendations for
mental health services must be documented in the child's record, as required in deleted text begin chapterdeleted text end
new text begin chaptersnew text end 260Cnew text begin and 260Dnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin
At risk of becoming a victim of sex trafficking or commercial sexual
exploitation.
new text end
new text begin
For the purposes of section 245A.25, a youth who is "at risk of becoming a
victim of sex trafficking or commercial sexual exploitation" means a youth who meets the
criteria established by the commissioner of human services for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Children's residential facility. new text end
new text begin
"Children's residential facility" is defined as
a residential program licensed under this chapter or chapter 241 according to the applicable
standards in Minnesota Rules, parts 2960.0010 to 2960.0710.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6d. new text end
new text begin Foster family setting. new text end
new text begin
"Foster family setting" has the meaning given in
Minnesota Rules, chapter 2960.3010, subpart 23, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6e. new text end
new text begin Foster residence setting. new text end
new text begin
"Foster residence setting" has the meaning given
in Minnesota Rules, chapter 2960.3010, subpart 26, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 18a. new text end
new text begin Trauma. new text end
new text begin
For the purposes of section 245A.25, "trauma" means an event,
series of events, or set of circumstances experienced by an individual as physically or
emotionally harmful or life-threatening and has lasting adverse effects on the individual's
functioning and mental, physical, social, emotional, or spiritual well-being. Trauma includes
the cumulative emotional or psychological harm of group traumatic experiences transmitted
across generations within a community that are often associated with racial and ethnic
population groups that have suffered major intergenerational losses.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Victim of sex trafficking or commercial sexual exploitation. new text end
new text begin
For the purposes
of section 245A.25, "victim of sex trafficking or commercial sexual exploitation" means a
person who meets the definitions in section 260C.007, subdivision 31, clauses (4) and (5).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 24. new text end
new text begin Youth. new text end
new text begin
For the purposes of section 245A.25, "youth" means a "child" as
defined in section 260C.007, subdivision 4, and includes individuals under 21 years of age
who are in foster care pursuant to section 260C.451.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.041, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin
First date of working in a facility or setting; documentation
requirements.
new text end
new text begin
Children's residential facility and foster residence setting license holders
must document the first date that a person who is a background study subject begins working
in the license holder's facility or setting. If the license holder does not maintain documentation
of each background study subject's first date of working in the facility or setting in the
license holder's personnel files, the license holder must provide documentation to the
commissioner that contains the first date that each background study subject began working
in the license holder's program upon the commissioner's request.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 10.
new text begin
[245A.25] RESIDENTIAL PROGRAM CERTIFICATIONS FOR
COMPLIANCE WITH THE FAMILY FIRST PREVENTION SERVICES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Certification scope and applicability. new text end
new text begin
(a) This section establishes the
requirements that a children's residential facility or child foster residence setting must meet
to be certified for the purposes of Title IV-E funding requirements as:
new text end
new text begin
(1) a qualified residential treatment program;
new text end
new text begin
(2) a residential setting specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) a residential setting specializing in providing prenatal, postpartum, or parenting
support for youth; or
new text end
new text begin
(4) a supervised independent living setting for youth who are 18 years of age or older.
new text end
new text begin
(b) This section does not apply to a foster family setting in which the license holder
resides in the foster home.
new text end
new text begin
(c) Children's residential facilities licensed as detention settings according to Minnesota
Rules, parts 2960.0230 to 2960.0290, or secure programs according to Minnesota Rules,
parts 2960.0300 to 2960.0420, may not be certified under this section.
new text end
new text begin
(d) For purposes of this section, "license holder" means an individual, organization, or
government entity that was issued a children's residential facility or foster residence setting
license by the commissioner of human services under this chapter or by the commissioner
of corrections under chapter 241.
new text end
new text begin
(e) Certifications issued under this section for foster residence settings may only be
issued by the commissioner of human services and are not delegated to county or private
licensing agencies under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Program certification types and requests for certification. new text end
new text begin
(a) By July 1,
2021, the commissioner of human services must offer certifications to license holders for
the following types of programs:
new text end
new text begin
(1) qualified residential treatment programs;
new text end
new text begin
(2) residential settings specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) residential settings specializing in providing prenatal, postpartum, or parenting
support for youth; and
new text end
new text begin
(4) supervised independent living settings for youth who are 18 years of age or older.
new text end
new text begin
(b) An applicant or license holder must submit a request for certification under this
section on a form and in a manner prescribed by the commissioner of human services. The
decision of the commissioner of human services to grant or deny a certification request is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Trauma-informed care. new text end
new text begin
(a) Programs certified under subdivisions 4 or 5 must
provide services to a person according to a trauma-informed model of care that meets the
requirements of this subdivision, except that programs certified under subdivision 5 are not
required to meet the requirements of paragraph (e).
new text end
new text begin
(b) For the purposes of this section, "trauma-informed care" is defined as care that:
new text end
new text begin
(1) acknowledges the effects of trauma on a person receiving services and on the person's
family;
new text end
new text begin
(2) modifies services to respond to the effects of trauma on the person receiving services;
new text end
new text begin
(3) emphasizes skill and strength-building rather than symptom management; and
new text end
new text begin
(4) focuses on the physical and psychological safety of the person receiving services
and the person's family.
new text end
new text begin
(c) The license holder must have a process for identifying the signs and symptoms of
trauma in a youth and must address the youth's needs related to trauma. This process must
include:
new text end
new text begin
(1) screening for trauma by completing a trauma-specific screening tool with each youth
upon the youth's admission or obtaining the results of a trauma-specific screening tool that
was completed with the youth within 30 days prior to the youth's admission to the program;
and
new text end
new text begin
(2) ensuring that trauma-based interventions targeting specific trauma-related symptoms
are available to each youth when needed to assist the youth in obtaining services. For
qualified residential treatment programs, this must include the provision of services in
paragraph (e).
new text end
new text begin
(d) The license holder must develop and provide services to each youth according to the
principles of trauma-informed care including:
new text end
new text begin
(1) recognizing the impact of trauma on a youth when determining the youth's service
needs and providing services to the youth;
new text end
new text begin
(2) allowing each youth to participate in reviewing and developing the youth's
individualized treatment or service plan;
new text end
new text begin
(3) providing services to each youth that are person-centered and culturally responsive;
and
new text end
new text begin
(4) adjusting services for each youth to address additional needs of the youth.
new text end
new text begin
(e) In addition to the other requirements of this subdivision, qualified residential treatment
programs must use a trauma-based treatment model that includes:
new text end
new text begin
(1) assessing each youth to determine if the youth needs trauma-specific treatment
interventions;
new text end
new text begin
(2) identifying in each youth's treatment plan how the program will provide
trauma-specific treatment interventions to the youth;
new text end
new text begin
(3) providing trauma-specific treatment interventions to a youth that target the youth's
specific trauma-related symptoms; and
new text end
new text begin
(4) training all clinical staff of the program on trauma-specific treatment interventions.
new text end
new text begin
(f) At the license holder's program, the license holder must provide a physical, social,
and emotional environment that:
new text end
new text begin
(1) promotes the physical and psychological safety of each youth;
new text end
new text begin
(2) avoids aspects that may be retraumatizing;
new text end
new text begin
(3) responds to trauma experienced by each youth and the youth's other needs; and
new text end
new text begin
(4) includes designated spaces that are available to each youth for engaging in sensory
and self-soothing activities.
new text end
new text begin
(g) The license holder must base the program's policies and procedures on
trauma-informed principles. In the program's policies and procedures, the license holder
must:
new text end
new text begin
(1) describe how the program provides services according to a trauma-informed model
of care;
new text end
new text begin
(2) describe how the program's environment fulfills the requirements of paragraph (f);
new text end
new text begin
(3) prohibit the use of aversive consequences for a youth's violation of program rules
or any other reason;
new text end
new text begin
(4) describe the process for how the license holder incorporates trauma-informed
principles and practices into the organizational culture of the license holder's program; and
new text end
new text begin
(5) if the program is certified to use restrictive procedures under Minnesota Rules, part
2960.0710, describe how the program uses restrictive procedures only when necessary for
a youth in a manner that addresses the youth's history of trauma and avoids causing the
youth additional trauma.
new text end
new text begin
(h) Prior to allowing a staff person to have direct contact, as defined in section 245C.02,
subdivision 11, with a youth and annually thereafter, the license holder must train each staff
person about:
new text end
new text begin
(1) concepts of trauma-informed care and how to provide services to each youth according
to these concepts; and
new text end
new text begin
(2) impacts of each youth's culture, race, gender, and sexual orientation on the youth's
behavioral health and traumatic experiences.
new text end
new text begin Subd. 4. new text end
new text begin Qualified residential treatment programs; certification requirements. new text end
new text begin
(a)
To be certified as a qualified residential treatment program, a license holder must meet:
new text end
new text begin
(1) the definition of a qualified residential treatment program in section 260C.007,
subdivision 26d;
new text end
new text begin
(2) the requirements for providing trauma-informed care and using a trauma-based
treatment model in subdivision 3; and
new text end
new text begin
(3) the requirements of this subdivision.
new text end
new text begin
(b) For each youth placed at the license holder's program, the license holder must
collaborate with the responsible social services agency and other appropriate parties to
implement the youth's out-of-home placement plan and the youth's short-term and long-term
mental health and behavioral health goals in the assessment required by sections 260C.212,
subdivision 1; 260C.704; and 260C.708.
new text end
new text begin
(c) A qualified residential treatment program must use a trauma-based treatment model
that meets all of the requirements of subdivision 3 that is designed to address the needs,
including clinical needs, of youth with serious emotional or behavioral disorders or
disturbances. The license holder must develop, document, and review a treatment plan for
each youth according to the requirements of Minnesota Rules, parts 2960.0180, subpart 2,
item B; and 2960.0190, subpart 2.
new text end
new text begin
(d) The following types of staff must be on-site according to the program's treatment
model and must be available 24 hours a day and seven days a week to provide care within
the scope of their practice:
new text end
new text begin
(1) a registered nurse or licensed practical nurse licensed by the Minnesota Board of
Nursing to practice professional nursing or practical nursing as defined in section 148.171,
subdivisions 14 and 15; and
new text end
new text begin
(2) other licensed clinical staff to meet each youth's clinical needs.
new text end
new text begin
(e) A qualified residential treatment program must be accredited by one of the following
independent, not-for-profit organizations:
new text end
new text begin
(1) the Commission on Accreditation of Rehabilitation Facilities (CARF);
new text end
new text begin
(2) the Joint Commission;
new text end
new text begin
(3) the Council on Accreditation (COA); or
new text end
new text begin
(4) another independent, not-for-profit accrediting organization approved by the Secretary
of the United States Department of Health and Human Services.
new text end
new text begin
(f) The license holder must facilitate participation of a youth's family members in the
youth's treatment program, consistent with the youth's best interests and according to the
youth's out-of-home placement plan required by sections 260C.212, subdivision 1; and
260C.708.
new text end
new text begin
(g) The license holder must contact and facilitate outreach to each youth's family
members, including the youth's siblings, and must document outreach to the youth's family
members in the youth's file, including the contact method and each family member's contact
information. In the youth's file, the license holder must record and maintain the contact
information for all known biological family members and fictive kin of the youth.
new text end
new text begin
(h) The license holder must document in the youth's file how the program integrates
family members into the treatment process for the youth, including after the youth's discharge
from the program, and how the program maintains the youth's connections to the youth's
siblings.
new text end
new text begin
(i) The program must provide discharge planning and family-based aftercare support to
each youth for at least six months after the youth's discharge from the program. When
providing aftercare to a youth, the program must have monthly contact with the youth and
the youth's caregivers to promote the youth's engagement in aftercare services and to regularly
evaluate the family's needs. The program's monthly contact with the youth may be
face-to-face, by telephone, or virtual.
new text end
new text begin
(j) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (b) to (i).
new text end
new text begin Subd. 5. new text end
new text begin
Residential settings specializing in providing care and supportive services
for youth who have been or are at risk of becoming victims of sex trafficking or
commercial sexual exploitation; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing care and supportive services for youth who have
been or are at risk of becoming victims of sex trafficking or commercial sexual exploitation,
a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) Settings certified according to this subdivision are exempt from the requirements of
section 245A.04, subdivision 11, paragraph (b).
new text end
new text begin
(c) The program must use a trauma-informed model of care that meets all of the applicable
requirements of subdivision 3, and that is designed to address the needs, including emotional
and mental health needs, of youth who have been or are at risk of becoming victims of sex
trafficking or commercial sexual exploitation.
new text end
new text begin
(d) The program must provide high quality care and supportive services for youth who
have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation and must:
new text end
new text begin
(1) offer a safe setting to each youth designed to prevent ongoing and future trafficking
of the youth;
new text end
new text begin
(2) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(3) assist each youth with accessing medical, mental health, legal, advocacy, and family
services based on the youth's individual needs;
new text end
new text begin
(4) provide each youth with relevant educational, life skills, and employment supports
based on the youth's individual needs;
new text end
new text begin
(5) offer a trafficking prevention education curriculum and provide support for each
youth at risk of future sex trafficking or commercial sexual exploitation; and
new text end
new text begin
(6) engage with the discharge planning process for each youth and the youth's family.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (c) and (d).
new text end
new text begin
(f) The license holder must ensure that each staff person who has direct contact, as
defined in section 245C.02, subdivision 11, with a youth served by the license holder's
program completes a human trafficking training approved by the Department of Human
Services' Children and Family Services Administration before the staff person has direct
contact with a youth served by the program and annually thereafter. For programs certified
prior to January 1, 2022, the license holder must ensure that each staff person at the license
holder's program completes the initial training by January 1, 2022.
new text end
new text begin Subd. 6. new text end
new text begin
Residential settings specializing in providing prenatal, postpartum, or
parenting supports for youth; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing prenatal, postpartum, or parenting supports for
youth, a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) The license holder must collaborate with the responsible social services agency and
other appropriate parties to implement each youth's out-of-home placement plan required
by section 260C.212, subdivision 1.
new text end
new text begin
(c) The license holder must specialize in providing prenatal, postpartum, or parenting
supports for youth and must:
new text end
new text begin
(1) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(2) assist each youth with accessing postpartum services during the same period of time
that a woman is considered pregnant for the purposes of medical assistance eligibility under
section 256B.055, subdivision 6, including providing each youth with:
new text end
new text begin
(i) sexual and reproductive health services and education; and
new text end
new text begin
(ii) a postpartum mental health assessment and follow-up services; and
new text end
new text begin
(3) discharge planning that includes the youth and the youth's family.
new text end
new text begin
(d) On or before the date of a child's initial physical presence at the facility, the license
holder must provide education to the child's parent related to safe bathing and reducing the
risk of sudden unexpected infant death and abusive head trauma from shaking infants and
young children. The license holder must use the educational material developed by the
commissioner of human services to comply with this requirement. At a minimum, the
education must address:
new text end
new text begin
(1) instruction that: (i) a child or infant should never be left unattended around water;
(ii) a tub should be filled with only two to four inches of water for infants; and (iii) an infant
should never be put into a tub when the water is running; and
new text end
new text begin
(2) the risk factors related to sudden unexpected infant death and abusive head trauma
from shaking infants and young children and means of reducing the risks, including the
safety precautions identified in section 245A.1435 and the risks of co-sleeping.
new text end
new text begin
The license holder must document the parent's receipt of the education and keep the
documentation in the parent's file. The documentation must indicate whether the parent
agrees to comply with the safeguards described in this paragraph. If the parent refuses to
comply, program staff must provide additional education to the parent as described in the
parental supervision plan. The parental supervision plan must include the intervention,
frequency, and staff responsible for the duration of the parent's participation in the program
or until the parent agrees to comply with the safeguards described in this paragraph.
new text end
new text begin
(e) On or before the date of a child's initial physical presence at the facility, the license
holder must document the parent's capacity to meet the health and safety needs of the child
while on the facility premises considering the following factors:
new text end
new text begin
(1) the parent's physical and mental health;
new text end
new text begin
(2) the parent being under the influence of drugs, alcohol, medications, or other chemicals;
new text end
new text begin
(3) the child's physical and mental health; and
new text end
new text begin
(4) any other information available to the license holder indicating that the parent may
not be able to adequately care for the child.
new text end
new text begin
(f) The license holder must have written procedures specifying the actions that staff shall
take if a parent is or becomes unable to adequately care for the parent's child.
new text end
new text begin
(g) If the parent refuses to comply with the safeguards described in paragraph (d) or is
unable to adequately care for the child, the license holder must develop a parental supervision
plan in conjunction with the parent. The plan must account for any factors in paragraph (e)
that contribute to the parent's inability to adequately care for the child. The plan must be
dated and signed by the staff person who completed the plan.
new text end
new text begin
(h) The license holder must have written procedures addressing whether the program
permits a parent to arrange for supervision of the parent's child by another youth in the
program. If permitted, the facility must have a procedure that requires staff approval of the
supervision arrangement before the supervision by the nonparental youth occurs. The
procedure for approval must include an assessment of the nonparental youth's capacity to
assume the supervisory responsibilities using the criteria in paragraph (e). The license holder
must document the license holder's approval of the supervisory arrangement and the
assessment of the nonparental youth's capacity to supervise the child and must keep this
documentation in the file of the parent whose child is being supervised by the nonparental
youth.
new text end
new text begin
(i) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (h).
new text end
new text begin Subd. 7. new text end
new text begin
Supervised independent living settings for youth 18 years of age or older;
certification requirements.
new text end
new text begin
(a) To be certified as a supervised independent living setting
for youth who are 18 years of age or older, a license holder must meet the requirements of
this subdivision.
new text end
new text begin
(b) A license holder must provide training, counseling, instruction, supervision, and
assistance for independent living, to meet the needs of the youth being served.
new text end
new text begin
(c) A license holder may provide services to assist the youth with locating housing,
money management, meal preparation, shopping, health care, transportation, and any other
support services necessary to meet the youth's needs and improve the youth's ability to
conduct such tasks independently.
new text end
new text begin
(d) The service plan for the youth must contain an objective of independent living skills.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (d).
new text end
new text begin Subd. 8. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) For a program licensed by the commissioner
of human services, the commissioner of human services may review a program's compliance
with certification requirements by conducting an inspection, a licensing review, or an
investigation of the program. The commissioner may issue a correction order to the license
holder for a program's noncompliance with the certification requirements of this section.
For a program licensed by the commissioner of human services, a license holder must make
a request for reconsideration of a correction order according to section 245A.06, subdivision
2.
new text end
new text begin
(b) For a program licensed by the commissioner of corrections, the commissioner of
human services may review the program's compliance with the requirements for a certification
issued under this section biennially and may issue a correction order identifying the program's
noncompliance with the requirements of this section. The correction order must state the
following:
new text end
new text begin
(1) the conditions that constitute a violation of a law or rule;
new text end
new text begin
(2) the specific law or rule violated; and
new text end
new text begin
(3) the time allowed for the program to correct each violation.
new text end
new text begin
(c) For a program licensed by the commissioner of corrections, if a license holder believes
that there are errors in the correction order of the commissioner of human services, the
license holder may ask the Department of Human Services to reconsider the parts of the
correction order that the license holder alleges are in error. To submit a request for
reconsideration, the license holder must send a written request for reconsideration by United
States mail to the commissioner of human services. The request for reconsideration must
be postmarked within 20 calendar days of the date that the correction order was received
by the license holder and must:
new text end
new text begin
(1) specify the parts of the correction order that are alleged to be in error;
new text end
new text begin
(2) explain why the parts of the correction order are in error; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
A request for reconsideration does not stay any provisions or requirements of the correction
order. The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin
(d) Nothing in this subdivision prohibits the commissioner of human services from
decertifying a license holder according to subdivision 9 prior to issuing a correction order.
new text end
new text begin Subd. 9. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner of human services may rescind a
certification issued under this section if a license holder fails to comply with the certification
requirements in this section.
new text end
new text begin
(b) The license holder may request reconsideration of a decertification by notifying the
commissioner of human services by certified mail or personal service. The license holder
must request reconsideration of a decertification in writing. If the license holder sends the
request for reconsideration of a decertification by certified mail, the license holder must
send the request by United States mail to the commissioner of human services and the
request must be postmarked within 20 calendar days after the license holder received the
notice of decertification. If the license holder requests reconsideration of a decertification
by personal service, the request for reconsideration must be received by the commissioner
of human services within 20 calendar days after the license holder received the notice of
decertification. When submitting a request for reconsideration of a decertification, the license
holder must submit a written argument or evidence in support of the request for
reconsideration.
new text end
new text begin
(c) The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 10. new text end
new text begin Variances. new text end
new text begin
The commissioner of human services may grant variances to the
requirements in this section that do not affect a youth's health or safety or compliance with
federal requirements for Title IV-E funding if the conditions in section 245A.04, subdivision
9, are met.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256.01, subdivision 14b, is amended to read:
Subd. 14b.
American Indian child welfare projects.
(a) The commissioner of human
services may authorize projects to initiate tribal delivery of child welfare services to American
Indian children and their parents and custodians living on the reservation. The commissioner
has authority to solicit and determine which tribes may participate in a project. Grants may
be issued to Minnesota Indian tribes to support the projects. The commissioner may waive
existing state rules as needed to accomplish the projects. The commissioner may authorize
projects to use alternative methods of (1) screening, investigating, and assessing reports of
child maltreatment, and (2) administrative reconsideration, administrative appeal, and
judicial appeal of maltreatment determinations, provided the alternative methods used by
the projects comply with the provisions of section 256.045 and chapter 260E that deal with
the rights of individuals who are the subjects of reports or investigations, including notice
and appeal rights and data practices requirements. The commissioner shall only authorize
alternative methods that comply with the public policy under section 260E.01. The
commissioner may seek any federal approval necessary to carry out the projects as well as
seek and use any funds available to the commissioner, including use of federal funds,
foundation funds, existing grant funds, and other funds. The commissioner is authorized to
advance state funds as necessary to operate the projects. Federal reimbursement applicable
to the projects is appropriated to the commissioner for the purposes of the projects. The
projects must be required to address responsibility for safety, permanency, and well-being
of children.
(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.
(c) In order to qualify for an American Indian child welfare project, a tribe must:
(1) be one of the existing tribes with reservation land in Minnesota;
(2) have a tribal court with jurisdiction over child custody proceedings;
(3) have a substantial number of children for whom determinations of maltreatment have
occurred;
(4)(i) have capacity to respond to reports of abuse and neglect under chapter 260E; or
(ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
(5) provide a wide range of services to families in need of child welfare services; deleted text begin and
deleted text end
(6) have a tribal-state title IV-E agreement in effectdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) enter into host Tribal contracts pursuant to section 256.0112, subdivision 6.
new text end
(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:
(1) assessment and prevention of child abuse and neglect;
(2) family preservation;
(3) facilitative, supportive, and reunification services;
(4) out-of-home placement for children removed from the home for child protective
purposes; and
(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.
(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under chapter 260E for those children during the time within
which the tribal project is in effect and funded. The commissioner shall work with tribes
and affected counties to develop procedures for data collection, evaluation, and clarification
of ongoing role and financial responsibilities of the county and tribe for child welfare services
prior to initiation of the project. Children who have not been identified by the tribe as
participating in the project shall remain the responsibility of the county. Nothing in this
section shall alter responsibilities of the county for law enforcement or court services.
(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:
(1) the child must be receiving child protective services;
(2) the child must be in foster care; or
(3) the child's parents must have had parental rights suspended or terminated.
Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.
(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.
(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.
(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256.0112, subdivision 6, is amended to read:
Subd. 6.
Contracting within and across county lines; lead county contractsnew text begin ; lead
tribal contractsnew text end .
Paragraphs (a) to (e) govern contracting within and across county lines
and lead county contracts.new text begin Paragraphs (a) to (e) govern contracting within and across
reservation boundaries and lead tribal contracts for initiative tribes under section 256.01,
subdivision 14b. For purposes of this subdivision, "local agency" includes a tribe or a county
agency.
new text end
(a) Once a local agency and an approved vendor execute a contract that meets the
requirements of this subdivision, the contract governs all other purchases of service from
the vendor by all other local agencies for the term of the contract. The local agency that
negotiated and entered into the contract becomes the leadnew text begin tribe ornew text end county for the contract.
(b) When the local agency in the county new text begin or reservation new text end where a vendor is located wants
to purchase services from that vendor and the vendor has no contract with the local agency
or any othernew text begin tribe ornew text end county, the local agency must negotiate and execute a contract with
the vendor.
(c) When a local agency deleted text begin in one countydeleted text end wants to purchase services from a vendor located
in another countynew text begin or reservationnew text end , it must notify the local agency in the countynew text begin or reservationnew text end
where the vendor is located. Within 30 days of being notified, the local agency in the vendor's
countynew text begin or reservationnew text end must:
(1) if it has a contract with the vendor, send a copy to the inquiring new text begin local new text end agency;
(2) if there is a contract with the vendor for which another local agency is the leadnew text begin tribe
ornew text end county, identify the lead new text begin tribe or new text end county to the inquiring agency; or
(3) if no local agency has a contract with the vendor, inform the inquiring agency whether
it will negotiate a contract and become the lead new text begin tribe or new text end county. If the agency where the
vendor is located will not negotiate a contract with the vendor because of concerns related
to clients' health and safety, the agency must share those concerns with the inquiring new text begin local
new text end agency.
(d) If the local agency in the county where the vendor is located declines to negotiate a
contract with the vendor or fails to respond within 30 days of receiving the notification
under paragraph (c), the inquiring agency is authorized to negotiate a contract and must
notify the local agency that declined or failed to respond.
(e) When the inquiring deleted text begin countydeleted text end new text begin local agencynew text end under paragraph (d) becomes the leadnew text begin tribe
ornew text end county for a contract and the contract expires and needs to be renegotiated, that new text begin tribe or
new text end county must again follow the requirements under paragraph (c) and notify the local agency
where the vendor is located. The local agency where the vendor is located has the option
of becoming the leadnew text begin tribe ornew text end county for the new contract. If the local agency does not
exercise the option, paragraph (d) applies.
(f) This subdivision does not affect the requirement to seek county concurrence under
section 256B.092, subdivision 8a, when the services are to be purchased for a person with
a developmental disability or under section 245.4711, subdivision 3, when the services to
be purchased are for an adult with serious and persistent mental illness.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2020, section 260C.007, subdivision 6, is amended to read:
Subd. 6.
Child in need of protection or services.
"Child in need of protection or
services" means a child who is in need of protection or services because the child:
(1) is abandoned or without parent, guardian, or custodian;
(2)(i) has been a victim of physical or sexual abuse as defined in section 260E.03,
subdivision 18 or 20, (ii) resides with or has resided with a victim of child abuse as defined
in subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or child
abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment as
defined in subdivision 15;
(3) is without necessary food, clothing, shelter, education, or other required care for the
child's physical or mental health or morals because the child's parent, guardian, or custodian
is unable or unwilling to provide that care;
(4) is without the special care made necessary by a physical, mental, or emotional
condition because the child's parent, guardian, or custodian is unable or unwilling to provide
that care;
(5) is medically neglected, which includes, but is not limited to, the withholding of
medically indicated treatment from an infant with a disability with a life-threatening
condition. The term "withholding of medically indicated treatment" means the failure to
respond to the infant's life-threatening conditions by providing treatment, including
appropriate nutrition, hydration, and medication which, in the treating physician's or advanced
practice registered nurse's reasonable medical judgment, will be most likely to be effective
in ameliorating or correcting all conditions, except that the term does not include the failure
to provide treatment other than appropriate nutrition, hydration, or medication to an infant
when, in the treating physician's or advanced practice registered nurse's reasonable medical
judgment:
(i) the infant is chronically and irreversibly comatose;
(ii) the provision of the treatment would merely prolong dying, not be effective in
ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
futile in terms of the survival of the infant; or
(iii) the provision of the treatment would be virtually futile in terms of the survival of
the infant and the treatment itself under the circumstances would be inhumane;
(6) is one whose parent, guardian, or other custodian for good cause desires to be relieved
of the child's care and custody, including a child who entered foster care under a voluntary
placement agreement between the parent and the responsible social services agency under
section 260C.227;
(7) has been placed for adoption or care in violation of law;
(8) is without proper parental care because of the emotional, mental, or physical disability,
or state of immaturity of the child's parent, guardian, or other custodian;
(9) is one whose behavior, condition, or environment is such as to be injurious or
dangerous to the child or others. An injurious or dangerous environment may include, but
is not limited to, the exposure of a child to criminal activity in the child's home;
(10) is experiencing growth delays, which may be referred to as failure to thrive, that
have been diagnosed by a physician and are due to parental neglect;
(11) is a sexually exploited youth;
(12) has committed a delinquent act or a juvenile petty offense before becoming deleted text begin tendeleted text end new text begin 13new text end
years old;
(13) is a runaway;
(14) is a habitual truant;
(15) has been found incompetent to proceed or has been found not guilty by reason of
mental illness or mental deficiency in connection with a delinquency proceeding, a
certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
proceeding involving a juvenile petty offense; or
(16) has a parent whose parental rights to one or more other children were involuntarily
terminated or whose custodial rights to another child have been involuntarily transferred to
a relative and there is a case plan prepared by the responsible social services agency
documenting a compelling reason why filing the termination of parental rights petition under
section 260C.503, subdivision 2, is not in the best interests of the child.
Sec. 14.
Minnesota Statutes 2020, section 260C.007, subdivision 26c, is amended to read:
Subd. 26c.
Qualified individual.
new text begin (a) new text end "Qualified individual" means a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is deleted text begin notdeleted text end new text begin qualified to conduct the assessment approved
by the commissioner. The qualified individual must not benew text end an employee of the responsible
social services agency and who is not connected to or affiliated with any placement setting
in which a responsible social services agency has placed children.
new text begin
(b) When the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, applies to a child, the county must contact the child's tribe without delay to
give the tribe the option to designate a qualified individual who is a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is not employed by the responsible social services
agency and who is not connected to or affiliated with any placement setting in which a
responsible social services agency has placed children. Only a federal waiver that
demonstrates maintained objectivity may allow a responsible social services agency employee
or tribal employee affiliated with any placement setting in which the responsible social
services agency has placed children to be designated the qualified individual.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260C.007, subdivision 31, is amended to read:
Subd. 31.
Sexually exploited youth.
"Sexually exploited youth" means an individual
who:
(1) is alleged to have engaged in conduct which would, if committed by an adult, violate
any federal, state, or local law relating to being hired, offering to be hired, or agreeing to
be hired by another individual to engage in sexual penetration or sexual conduct;
(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
609.3451, 609.3453, 609.352, 617.246, or 617.247;
(3) is a victim of a crime described in United States Code, title 18, section 2260; 2421;
2422; 2423; 2425; 2425A; or 2256; deleted text begin or
deleted text end
(4) is a sex trafficking victim as defined in section 609.321, subdivision 7bdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is a victim of commercial sexual exploitation as defined in United States Code, title
22, section 7102(11)(A) and (12).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 16.
Minnesota Statutes 2020, section 260C.157, subdivision 3, is amended to read:
Subd. 3.
Juvenile treatment screening team.
(a) The responsible social services agency
shall establish a juvenile treatment screening team to conduct screenings under this chapter
deleted text begin and section , subdivision 3,deleted text end new text begin and chapter 260Dnew text end for a child to receive treatment for
an emotional disturbance, a developmental disability, or related condition in a residential
treatment facility licensed by the commissioner of human services under chapter 245A, or
licensed or approved by a tribe. A screening team is not required for a child to be in: (1) a
residential facility specializing in prenatal, postpartum, or parenting support; (2) a facility
specializing in high-quality residential care and supportive services to children and youth
who deleted text begin aredeleted text end new text begin have been or are at risk of becoming victims ofnew text end sex-trafficking deleted text begin victims or are at
risk of becoming sex-trafficking victimsdeleted text end new text begin or commercial sexual exploitationnew text end ; (3) supervised
settings for youthnew text begin who arenew text end 18 years deleted text begin olddeleted text end new text begin of agenew text end or oldernew text begin andnew text end living independently; or (4) a
licensed residential family-based treatment facility for substance abuse consistent with
section 260C.190. Screenings are also not required when a child must be placed in a facility
due to an emotional crisis or other mental health emergency.
(b) The responsible social services agency shall conduct screenings within 15 days of a
request for a screening, unless the screening is for the purpose of residential treatment and
the child is enrolled in a prepaid health program under section 256B.69, in which case the
agency shall conduct the screening within ten working days of a request. The responsible
social services agency shall convene the new text begin juvenile treatment screening new text end team, which may be
constituted under section 245.4885 or 256B.092 or Minnesota Rules, parts 9530.6600 to
9530.6655. The team shall consist of social workers; persons with expertise in the treatment
of juveniles who are emotionally deleted text begin disableddeleted text end new text begin disturbednew text end , chemically dependent, or have a
developmental disability; and the child's parent, guardian, or permanent legal custodian.
The team may include the child's relatives as defined in section 260C.007, subdivisions 26b
and 27, the child's foster care provider, and professionals who are a resource to the child's
family such as teachers, medical or mental health providers, and clergy, as appropriate,
consistent with the family and permanency team as defined in section 260C.007, subdivision
16a. Prior to forming the team, the responsible social services agency must consult with new text begin the
child's parents,new text end the child if the child is age 14 or older, deleted text begin the child's parents,deleted text end and, if applicable,
the child's tribe new text begin to obtain recommendations regarding which individuals to include on the
team andnew text end to ensure that the team is family-centered and will act in the child's best deleted text begin interestdeleted text end
new text begin interestsnew text end . If the child, child's parents, or legal guardians raise concerns about specific relatives
or professionals, the team should not include those individuals. This provision does not
apply to paragraph (c).
(c) If the agency provides notice to tribes under section 260.761, and the child screened
is an Indian child, the responsible social services agency must make a rigorous and concerted
effort to include a designated representative of the Indian child's tribe on the juvenile
treatment screening team, unless the child's tribal authority declines to appoint a
representative. The Indian child's tribe may delegate its authority to represent the child to
any other federally recognized Indian tribe, as defined in section 260.755, subdivision 12.
The provisions of the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, and the Minnesota Indian Family Preservation Act, sections 260.751 to
260.835, apply to this section.
(d) If the court, prior to, or as part of, a final disposition or other court order, proposes
to place a child with an emotional disturbance or developmental disability or related condition
in residential treatment, the responsible social services agency must conduct a screening.
If the team recommends treating the child in a qualified residential treatment program, the
agency must follow the requirements of sections 260C.70 to 260C.714.
The court shall ascertain whether the child is an Indian child and shall notify the
responsible social services agency and, if the child is an Indian child, shall notify the Indian
child's tribe as paragraph (c) requires.
(e) When the responsible social services agency is responsible for placing and caring
for the child and the screening team recommends placing a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the agency must: (1)
begin the assessment and processes required in section 260C.704 without delay; and (2)
conduct a relative search according to section 260C.221 to assemble the child's family and
permanency team under section 260C.706. Prior to notifying relatives regarding the family
and permanency team, the responsible social services agency must consult with new text begin the child's
parent or legal guardian,new text end the child if the child is age 14 or older, deleted text begin the child's parentsdeleted text end and, if
applicable, the child's tribe to ensure that the agency is providing notice to individuals who
will act in the child's best deleted text begin interestdeleted text end new text begin interestsnew text end . The child and the child's parents may identify
a culturally competent qualified individual to complete the child's assessment. The agency
shall make efforts to refer the assessment to the identified qualified individual. The
assessment may not be delayed for the purpose of having the assessment completed by a
specific qualified individual.
(f) When a screening team determines that a child does not need treatment in a qualified
residential treatment program, the screening team must:
(1) document the services and supports that will prevent the child's foster care placement
and will support the child remaining at home;
(2) document the services and supports that the agency will arrange to place the child
in a family foster home; or
(3) document the services and supports that the agency has provided in any other setting.
(g) When the Indian child's tribe or tribal health care services provider or Indian Health
Services provider proposes to place a child for the primary purpose of treatment for an
emotional disturbance, a developmental disability, or co-occurring emotional disturbance
and chemical dependency, the Indian child's tribe or the tribe delegated by the child's tribe
shall submit necessary documentation to the county juvenile treatment screening team,
which must invite the Indian child's tribe to designate a representative to the screening team.
(h) The responsible social services agency must conduct and document the screening in
a format approved by the commissioner of human services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 260C.212, subdivision 1a, is amended to read:
Subd. 1a.
Out-of-home placement plan update.
(a) Within 30 days of placing the child
in foster care, the agency must file thenew text begin child'snew text end initial out-of-home placement plan with the
court. After filing thenew text begin child'snew text end initial out-of-home placement plan, the agency shall update
and file thenew text begin child'snew text end out-of-home placement plan with the court as follows:
(1) when the agency moves a child to a different foster care setting, the agency shall
inform the court within 30 days of the new text begin child's new text end placement change or court-ordered trial home
visit. The agency must file the new text begin child's new text end updated out-of-home placement plan with the court
at the next required review hearing;
(2) when the agency places a child in a qualified residential treatment program as defined
in section 260C.007, subdivision 26d, or moves a child from one qualified residential
treatment program to a different qualified residential treatment program, the agency must
update thenew text begin child'snew text end out-of-home placement plan within 60 days. To meet the requirements
of section 260C.708, the agency must file thenew text begin child'snew text end out-of-home placement plan deleted text begin with the
court as part of the 60-day hearing anddeleted text end new text begin along with the agency's report seeking the court's
approval of the child's placement at a qualified residential treatment program under section
260C.71. After the court issues an order, the agencynew text end must update thenew text begin child's out-of-home
placementnew text end plan deleted text begin after the court hearingdeleted text end to document the court's approval or disapproval of
the child's placement in a qualified residential treatment program;
(3) when the agency places a child with the child's parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190, the agency
must identify the treatment programnew text begin where the child will be placednew text end in the child's out-of-home
placement plan prior to the child's placement. The agency must file thenew text begin child'snew text end out-of-home
placement plan with the court at the next required review hearing; and
(4) under sections 260C.227 and 260C.521, the agency must update thenew text begin child'snew text end
out-of-home placement plan and file thenew text begin child's out-of-home placementnew text end plan with the court.
(b) When none of the items in paragraph (a) apply, the agency must update thenew text begin child'snew text end
out-of-home placement plan no later than 180 days after the child's initial placement and
every six months thereafter, consistent with section 260C.203, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 18.
Minnesota Statutes 2020, section 260C.212, subdivision 13, is amended to read:
Subd. 13.
Protecting missing and runaway children and youth at risk of sex
traffickingnew text begin or commercial sexual exploitationnew text end .
(a) The local social services agency shall
expeditiously locate any child missing from foster care.
(b) The local social services agency shall report immediately, but no later than 24 hours,
after receiving information on a missing or abducted child to the local law enforcement
agency for entry into the National Crime Information Center (NCIC) database of the Federal
Bureau of Investigation, and to the National Center for Missing and Exploited Children.
(c) The local social services agency shall not discharge a child from foster care or close
the social services case until diligent efforts have been exhausted to locate the child and the
court terminates the agency's jurisdiction.
(d) The local social services agency shall determine the primary factors that contributed
to the child's running away or otherwise being absent from care and, to the extent possible
and appropriate, respond to those factors in current and subsequent placements.
(e) The local social services agency shall determine what the child experienced while
absent from care, including screening the child to determine if the child is a possible sex
traffickingnew text begin or commercial sexual exploitationnew text end victim as defined in section deleted text begin 609.321,
subdivision 7bdeleted text end new text begin 260C.007, subdivision 31new text end .
(f) The local social services agency shall report immediately, but no later than 24 hours,
to the local law enforcement agency any reasonable cause to believe a child is, or is at risk
of being, a sex traffickingnew text begin or commercial sexual exploitationnew text end victim.
(g) The local social services agency shall determine appropriate services as described
in section 145.4717 with respect to any child for whom the local social services agency has
responsibility for placement, care, or supervision when the local social services agency has
reasonable cause to believenew text begin thatnew text end the child is, or is at risk of being, a sex traffickingnew text begin or
commercial sexual exploitationnew text end victim.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 19.
Minnesota Statutes 2020, section 260C.4412, is amended to read:
260C.4412 PAYMENT FOR RESIDENTIAL PLACEMENTS.
(a) When a child is placed in a foster care group residential setting under Minnesota
Rules, parts 2960.0020 to 2960.0710, a foster residence licensed under chapter 245A that
meets the standards of Minnesota Rules, parts 2960.3200 to 2960.3230, or a children's
residential facility licensed or approved by a tribe, foster care maintenance payments must
be made on behalf of the child to cover the cost of providing food, clothing, shelter, daily
supervision, school supplies, child's personal incidentals and supports, reasonable travel for
visitation, or other transportation needs associated with the items listed. Daily supervision
in the group residential setting includes routine day-to-day direction and arrangements to
ensure the well-being and safety of the child. It may also include reasonable costs of
administration and operation of the facility.
(b) The commissioner of human services shall specify the title IV-E administrative
procedures under section 256.82 for each of the following residential program settings:
(1) residential programs licensed under chapter 245A or licensed by a tribe, including:
(i) qualified residential treatment programs as defined in section 260C.007, subdivision
26d;
(ii) program settings specializing in providing prenatal, postpartum, or parenting supports
for youth; and
(iii) program settings providing high-quality residential care and supportive services to
children and youth who are, or are at risk of becoming, sex trafficking victims;
(2) licensed residential family-based substance use disorder treatment programs as
defined in section 260C.007, subdivision 22a; and
(3) supervised settings in which a foster child age 18 or older may live independently,
consistent with section 260C.451.
new text begin
(c) A lead county contract under section 256.0112, subdivision 6, is not required to
establish the foster care maintenance payment in paragraph (a) for foster residence settings
licensed under chapter 245A that meet the standards of Minnesota Rules, parts 2960.3200
to 2960.3230. The foster care maintenance payment for these settings must be consistent
with section 256N.26, subdivision 3, and subject to the annual revision as specified in section
256N.26, subdivision 9.
new text end
Sec. 20.
Minnesota Statutes 2020, section 260C.452, is amended to read:
260C.452 SUCCESSFUL TRANSITION TO ADULTHOOD.
Subdivision 1.
Scopenew text begin and purposenew text end .
new text begin
(a) For purposes of this section, "youth" means a
person who is at least 14 years of age and under 23 years of age.
new text end
new text begin (b) new text end This section pertains to a deleted text begin childdeleted text end new text begin youthnew text end whonew text begin :
new text end
new text begin (1)new text end isnew text begin in foster care and is 14 years of age or older, including a youth who isnew text end under the
guardianship of the commissioner of human servicesdeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (2)new text end has a permanency disposition of permanent custody to the agencydeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (3)new text end will leave foster care deleted text begin at 18 to 21 years of age.deleted text end new text begin when the youth is 18 years of age or
older and under 21 years of age;
new text end
new text begin
(4) has left foster care due to adoption when the youth was 16 years of age or older;
new text end
new text begin
(5) has left foster care due to a transfer of permanent legal and physical custody to a
relative, or Tribal equivalent, when the youth was 16 years of age or older; or
new text end
new text begin
(6) was reunified with the youth's primary caretaker when the youth was 14 years of age
or older and under 18 years of age.
new text end
new text begin
(c) The purpose of this section is to provide support to each youth who is transitioning
to adulthood by providing services to the youth in the areas of:
new text end
new text begin
(1) education;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) daily living skills such as financial literacy training and driving instruction; preventive
health activities including promoting abstinence from substance use and smoking; and
nutrition education and pregnancy prevention;
new text end
new text begin
(4) forming meaningful, permanent connections with caring adults;
new text end
new text begin
(5) engaging in age and developmentally appropriate activities under section 260C.212,
subdivision 14, and positive youth development;
new text end
new text begin
(6) financial, housing, counseling, and other services to assist a youth over 18 years of
age in achieving self-sufficiency and accepting personal responsibility for the transition
from adolescence to adulthood; and
new text end
new text begin
(7) making vouchers available for education and training.
new text end
new text begin
(d) The responsible social services agency may provide support and case management
services to a youth as defined in paragraph (a) until the youth reaches the age of 23 years.
According to section 260C.451, a youth's placement in a foster care setting will end when
the youth reaches the age of 21 years.
new text end
new text begin Subd. 1a. new text end
new text begin Case management services. new text end
new text begin
Case management services include the
responsibility for planning, coordinating, authorizing, monitoring, and evaluating services
for a youth and shall be provided to a youth by the responsible social services agency or
the contracted agency. Case management services include the out-of-home placement plan
under section 260C.212, subdivision 1, when the youth is in out-of-home placement.
new text end
Subd. 2.
Independent living plan.
When the deleted text begin childdeleted text end new text begin youthnew text end is 14 years of age or oldernew text begin and
is receiving support from the responsible social services agency under this sectionnew text end , the
responsible social services agency, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall complete thenew text begin
youth'snew text end independent living plan according to section 260C.212, subdivision 1, paragraph
(c), clause (12)new text begin , regardless of the youth's current placement statusnew text end .
deleted text begin Subd. 3. deleted text end
deleted text begin Notification. deleted text end
deleted text begin
Six months before the child is expected to be discharged from
foster care, the responsible social services agency shall provide written notice to the child
regarding the right to continued access to services for certain children in foster care past 18
years of age and of the right to appeal a denial of social services under section 256.045.
deleted text end
Subd. 4.
Administrative or court review of placements.
(a) When the deleted text begin childdeleted text end new text begin youthnew text end is
14 years of age or older, the court, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall review thenew text begin
youth'snew text end independent living plan according to section 260C.203, paragraph (d).
(b) The responsible social services agency shall file a copy of the notification deleted text begin required
in subdivision 3deleted text end new text begin of foster care benefits for a youth who is 18 years of age or older according
to section 260C.451, subdivision 1,new text end with the court. If the responsible social services agency
does not file the notice by the time the deleted text begin childdeleted text end new text begin youthnew text end is 17-1/2 years of age, the court shall
require the responsible social services agency to file the notice.
(c) new text begin When a youth is 18 years of age or older, new text end the court shall ensure that the responsible
social services agency assists the deleted text begin childdeleted text end new text begin youthnew text end in obtaining the following documents before
the deleted text begin childdeleted text end new text begin youthnew text end leaves foster care: a Social Security card; an official or certified copy of the
deleted text begin child'sdeleted text end new text begin youth'snew text end birth certificate; a state identification card or driver's license, tribal enrollment
identification card, green card, or school visa; health insurance information; the deleted text begin child'sdeleted text end new text begin
youth'snew text end school, medical, and dental records; a contact list of the deleted text begin child'sdeleted text end new text begin youth'snew text end medical,
dental, and mental health providers; and contact information for the deleted text begin child'sdeleted text end new text begin youth'snew text end siblings,
if the siblings are in foster care.
(d) For a deleted text begin childdeleted text end new text begin youthnew text end who will be discharged from foster care at 18 years of age or older
new text begin because the youth is not eligible for extended foster care benefits or chooses to leave foster
carenew text end , the responsible social services agency must develop a personalized transition plan as
directed by the deleted text begin childdeleted text end new text begin youthnew text end during the 90-day period immediately prior to the expected date
of discharge. The transition plan must be as detailed as the deleted text begin childdeleted text end new text begin youthnew text end elects and include
specific options, including but not limited to:
(1) affordable housing with necessary supports that does not include a homeless shelter;
(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;
(3) education, including application to the Education and Training Voucher Program;
(4) local opportunities for mentors and continuing support servicesdeleted text begin , including the Healthy
Transitions and Homeless Prevention program, if availabledeleted text end ;
(5) workforce supports and employment services;
(6) a copy of the deleted text begin child'sdeleted text end new text begin youth'snew text end consumer credit report as defined in section 13C.001
and assistance in interpreting and resolving any inaccuracies in the report, at no cost to the
deleted text begin childdeleted text end new text begin youthnew text end ;
(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
deleted text begin childdeleted text end new text begin youthnew text end if the deleted text begin childdeleted text end new text begin youthnew text end becomes unable to participate in decisions;
(8) appropriate contact information through 21 years of age if the deleted text begin childdeleted text end new text begin youthnew text end needs
information or help dealing with a crisis situation; and
(9) official documentation that the youth was previously in foster care.
Subd. 5.
Notice of termination of deleted text begin foster caredeleted text end new text begin social servicesnew text end .
(a) deleted text begin Whendeleted text end new text begin Beforenew text end a deleted text begin childdeleted text end new text begin
youth who is 18 years of age or oldernew text end leaves foster care deleted text begin at 18 years of age or olderdeleted text end , the
responsible social services agency shall give the deleted text begin childdeleted text end new text begin youthnew text end written notice that foster care
shall terminate 30 days from the datenew text begin thatnew text end the notice is sentnew text begin by the agency according to
section 260C.451, subdivision 8new text end .
deleted text begin
(b) The child or the child's guardian ad litem may file a motion asking the court to review
the responsible social services agency's determination within 15 days of receiving the notice.
The child shall not be discharged from foster care until the motion is heard. The responsible
social services agency shall work with the child to transition out of foster care.
deleted text end
deleted text begin
(c) The written notice of termination of benefits shall be on a form prescribed by the
commissioner and shall give notice of the right to have the responsible social services
agency's determination reviewed by the court under this section or sections 260C.203,
260C.317, and 260C.515, subdivision 5 or 6. A copy of the termination notice shall be sent
to the child and the child's attorney, if any, the foster care provider, the child's guardian ad
litem, and the court. The responsible social services agency is not responsible for paying
foster care benefits for any period of time after the child leaves foster care.
deleted text end
new text begin
(b) Before case management services will end for a youth who is at least 18 years of
age and under 23 years of age, the responsible social services agency shall give the youth:
(1) written notice that case management services for the youth shall terminate; and (2)
written notice that the youth has the right to appeal the termination of case management
services under section 256.045, subdivision 3, by responding in writing within ten days of
the date that the agency mailed the notice. The termination notice must include information
about services for which the youth is eligible and how to access the services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 260C.704, is amended to read:
260C.704 REQUIREMENTS FOR THE QUALIFIED INDIVIDUAL'S
ASSESSMENT OF THE CHILD FOR PLACEMENT IN A QUALIFIED
RESIDENTIAL TREATMENT PROGRAM.
(a) A qualified individual must complete an assessment of the child prior to deleted text begin or withindeleted text end
deleted text begin 30 days ofdeleted text end the child's placement in a qualified residential treatment program in a format
approved by the commissioner of human servicesdeleted text begin , anddeleted text end new text begin unless, due to a crisis, the child must
immediately be placed in a qualified residential treatment program. When a child must
immediately be placed in a qualified residential treatment program without an assessment,
the qualified individual must complete the child's assessment within 30 days of the child's
placement. The qualified individualnew text end must:
(1) assess the child's needs and strengths, using an age-appropriate, evidence-based,
validated, functional assessment approved by the commissioner of human services;
(2) determine whether the child's needs can be met by the child's family members or
through placement in a family foster home; or, if not, determine which residential setting
would provide the child with the most effective and appropriate level of care to the child
in the least restrictive environment;
(3) develop a list of short- and long-term mental and behavioral health goals for the
child; and
(4) work with the child's family and permanency team using culturally competent
practices.
new text begin
If a level of care determination was conducted under section 245.4885, that information
must be shared with the qualified individual and the juvenile treatment screening team.
new text end
(b) The child and the child's parents, when appropriate, may request that a specific
culturally competent qualified individual complete the child's assessment. The agency shall
make efforts to refer the child to the identified qualified individual to complete the
assessment. The assessment must not be delayed for a specific qualified individual to
complete the assessment.
(c) The qualified individual must provide the assessment, when complete, to the
responsible social services agencydeleted text begin , the child's parents or legal guardians, the guardian ad
litem, and the courtdeleted text end new text begin . If the assessment recommends placement of the child in a qualified
residential treatment facility, the agency must distribute the assessment to the child's parent
or legal guardian and file the assessment with the court reportnew text end as required in section 260C.71new text begin ,
subdivision 2. If the assessment does not recommend placement in a qualified residential
treatment facility, the agency must provide a copy of the assessment to the parents or legal
guardians and the guardian ad litem and file the assessment determination with the court at
the next required hearing as required in section 260C.71, subdivision 5new text end . If court rules and
chapter 13 permit disclosure of the results of the child's assessment, the agency may share
the results of the child's assessment with the child's foster care provider, other members of
the child's family, and the family and permanency team. The agency must not share the
child's private medical data with the family and permanency team unless: (1) chapter 13
permits the agency to disclose the child's private medical data to the family and permanency
team; or (2) the child's parent has authorized the agency to disclose the child's private medical
data to the family and permanency team.
(d) For an Indian child, the assessment of the child must follow the order of placement
preferences in the Indian Child Welfare Act of 1978, United States Code, title 25, section
1915.
(e) In the assessment determination, the qualified individual must specify in writing:
(1) the reasons why the child's needs cannot be met by the child's family or in a family
foster home. A shortage of family foster homes is not an acceptable reason for determining
that a family foster home cannot meet a child's needs;
(2) why the recommended placement in a qualified residential treatment program will
provide the child with the most effective and appropriate level of care to meet the child's
needs in the least restrictive environment possible and how placing the child at the treatment
program is consistent with the short-term and long-term goals of the child's permanency
plan; and
(3) if the qualified individual's placement recommendation is not the placement setting
that the parent, family and permanency team, child, or tribe prefer, the qualified individual
must identify the reasons why the qualified individual does not recommend the parent's,
family and permanency team's, child's, or tribe's placement preferences. The out-of-home
placement plan under section 260C.708 must also include reasons why the qualified
individual did not recommend the preferences of the parents, family and permanency team,
child, or tribe.
(f) If the qualified individual determines that the child's family or a family foster home
or other less restrictive placement may meet the child's needs, the agency must move the
child out of the qualified residential treatment program and transition the child to a less
restrictive setting within 30 days of the determination.new text begin If the responsible social services
agency has placement authority of the child, the agency must make a plan for the child's
placement according to section 260C.212, subdivision 2. The agency must file the child's
assessment determination with the court at the next required hearing.
new text end
new text begin
(g) If the qualified individual recommends placing the child in a qualified residential
treatment program and if the responsible social services agency has placement authority of
the child, the agency shall make referrals to appropriate qualified residential treatment
programs and upon acceptance by an appropriate program, place the child in an approved
or certified qualified residential treatment program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 260C.706, is amended to read:
260C.706 FAMILY AND PERMANENCY TEAM REQUIREMENTS.
(a) When the responsible social services agency's juvenile treatment screening team, as
defined in section 260C.157, recommends placing the child in a qualified residential treatment
program, the agency must assemble a family and permanency team within ten days.
(1) The team must include all appropriate biological family members, the child's parents,
legal guardians or custodians, foster care providers, and relatives as defined in section
260C.007, subdivisions deleted text begin 26cdeleted text end new text begin 26bnew text end and 27, and professionals, as appropriate, who are a resource
to the child's family, such as teachers, medical or mental health providers, or clergy.
(2) When a child is placed in foster care prior to the qualified residential treatment
program, the agency shall include relatives responding to the relative search notice as
required under section 260C.221 on this team, unless the juvenile court finds that contacting
a specific relative would deleted text begin endangerdeleted text end new text begin present a safety or health risk tonew text end the parent, guardian,
child, sibling, or any other family member.
(3) When a qualified residential treatment program is the child's initial placement setting,
the responsible social services agency must engage with the child and the child's parents to
determine the appropriate family and permanency team members.
(4) When the permanency goal is to reunify the child with the child's parent or legal
guardian, the purpose of the relative search and focus of the family and permanency team
is to preserve family relationships and identify and develop supports for the child and parents.
(5) The responsible agency must make a good faith effort to identify and assemble all
appropriate individuals to be part of the child's family and permanency team and request
input from the parents regarding relative search efforts consistent with section 260C.221.
The out-of-home placement plan in section 260C.708 must include all contact information
for the team members, as well as contact information for family members or relatives who
are not a part of the family and permanency team.
(6) If the child is age 14 or older, the team must include members of the family and
permanency team that the child selects in accordance with section 260C.212, subdivision
1, paragraph (b).
(7) Consistent with section 260C.221, a responsible social services agency may disclose
relevant and appropriate private data about the child to relatives in order for the relatives
to participate in caring and planning for the child's placement.
(8) If the child is an Indian child under section 260.751, the responsible social services
agency must make active efforts to include the child's tribal representative on the family
and permanency team.
(b) The family and permanency team shall meet regarding the assessment required under
section 260C.704 to determine whether it is necessary and appropriate to place the child in
a qualified residential treatment program and to participate in case planning under section
260C.708.
(c) When reunification of the child with the child's parent or legal guardian is the
permanency plan, the family and permanency team shall support the parent-child relationship
by recognizing the parent's legal authority, consulting with the parent regarding ongoing
planning for the child, and assisting the parent with visiting and contacting the child.
(d) When the agency's permanency plan is to transfer the child's permanent legal and
physical custody to a relative or for the child's adoption, the team shall:
(1) coordinate with the proposed guardian to provide the child with educational services,
medical care, and dental care;
(2) coordinate with the proposed guardian, the agency, and the foster care facility to
meet the child's treatment needs after the child is placed in a permanent placement with the
proposed guardian;
(3) plan to meet the child's need for safety, stability, and connection with the child's
family and community after the child is placed in a permanent placement with the proposed
guardian; and
(4) in the case of an Indian child, communicate with the child's tribe to identify necessary
and appropriate services for the child, transition planning for the child, the child's treatment
needs, and how to maintain the child's connections to the child's community, family, and
tribe.
(e) The agency shall invite the family and permanency team to participate in case planning
and the agency shall give the team notice of court reviews under sections 260C.152 and
260C.221 until: (1) the child is reunited with the child's parents; or (2) the child's foster care
placement ends and the child is in a permanent placement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 260C.708, is amended to read:
260C.708 OUT-OF-HOME PLACEMENT PLAN FOR QUALIFIED
RESIDENTIAL TREATMENT PROGRAM PLACEMENTS.
(a) When the responsible social services agency places a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the out-of-home
placement plan must include:
(1) the case plan requirements in section deleted text begin 260.212, subdivision 1deleted text end new text begin 260C.212new text end ;
(2) the reasonable and good faith efforts of the responsible social services agency to
identify and include all of the individuals required to be on the child's family and permanency
team under section 260C.007;
(3) all contact information for members of the child's family and permanency team and
for other relatives who are not part of the family and permanency team;
(4) evidence that the agency scheduled meetings of the family and permanency team,
including meetings relating to the assessment required under section 260C.704, at a time
and place convenient for the family;
new text begin
(5) evidence that the family and permanency team is involved in the assessment required
under section 260C.704 to determine the appropriateness of the child's placement in a
qualified residential treatment program;
new text end
new text begin
(6) the family and permanency team's placement preferences for the child in the
assessment required under section 260C.704. When making a decision about the child's
placement preferences, the family and permanency team must recognize:
new text end
new text begin
(i) that the agency should place a child with the child's siblings unless a court finds that
placing a child with the child's siblings is not possible due to a child's specialized placement
needs or is otherwise contrary to the child's best interests; and
new text end
new text begin
(ii) that the agency should place an Indian child according to the requirements of the
Indian Child Welfare Act, the Minnesota Family Preservation Act under sections 260.751
to 260.835, and section 260C.193, subdivision 3, paragraph (g);
new text end
deleted text begin (5)deleted text end new text begin (7)new text end when reunification of the child with the child's parent or legal guardian is the
agency's goal, evidence demonstrating that the parent or legal guardian provided input about
the members of the family and permanency team under section 260C.706;
deleted text begin (6)deleted text end new text begin (8)new text end when the agency's permanency goal is to reunify the child with the child's parent
or legal guardian, the out-of-home placement plan must identify services and supports that
maintain the parent-child relationship and the parent's legal authority, decision-making, and
responsibility for ongoing planning for the child. In addition, the agency must assist the
parent with visiting and contacting the child;
deleted text begin (7)deleted text end new text begin (9)new text end when the agency's permanency goal is to transfer permanent legal and physical
custody of the child to a proposed guardian or to finalize the child's adoption, the case plan
must document the agency's steps to transfer permanent legal and physical custody of the
child or finalize adoption, as required in section 260C.212, subdivision 1, paragraph (c),
clauses (6) and (7); and
deleted text begin (8)deleted text end new text begin (10)new text end the qualified individual's recommendation regarding the child's placement in a
qualified residential treatment program and the court approval or disapproval of the placement
as required in section 260C.71.
(b) If the placement preferences of the family and permanency team, child, and tribe, if
applicable, are not consistent with the placement setting that the qualified individual
recommends, the case plan must include the reasons why the qualified individual did not
recommend following the preferences of the family and permanency team, child, and the
tribe.
(c) The agency must file the out-of-home placement plan with the court as part of the
60-day deleted text begin hearingdeleted text end new text begin court ordernew text end under section 260C.71.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 24.
Minnesota Statutes 2020, section 260C.71, is amended to read:
260C.71 COURT APPROVAL REQUIREMENTS.
new text begin Subdivision 1. new text end
new text begin Judicial review. new text end
new text begin
When the responsible social services agency has legal
authority to place a child at a qualified residential treatment facility under section 260C.007,
subdivision 21a, and the child's assessment under section 260C.704 recommends placing
the child in a qualified residential treatment facility, the agency shall place the child at a
qualified residential facility. Within 60 days of placing the child at a qualified residential
treatment facility, the agency must obtain a court order finding that the child's placement
is appropriate and meets the child's individualized needs.
new text end
new text begin Subd. 2. new text end
new text begin Qualified residential treatment program; agency report to court. new text end
new text begin
(a) The
responsible social services agency shall file a written report with the court after receiving
the qualified individual's assessment as specified in section 260C.704 prior to the child's
placement or within 35 days of the date of the child's placement in a qualified residential
treatment facility. The written report shall contain or have attached:
new text end
new text begin
(1) the child's name, date of birth, race, gender, and current address;
new text end
new text begin
(2) the names, races, dates of birth, residence, and post office address of the child's
parents or legal custodian, or guardian;
new text end
new text begin
(3) the name and address of the qualified residential treatment program, including a
chief administrator of the facility;
new text end
new text begin
(4) a statement of the facts that necessitated the child's foster care placement;
new text end
new text begin
(5) the child's out-of-home placement plan under section 260C.212, subdivision 1,
including the requirements in section 260C.708;
new text end
new text begin
(6) if the child is placed in an out-of-state qualified residential treatment program, the
compelling reasons why the child's needs cannot be met by an in-state placement;
new text end
new text begin
(7) the qualified individual's assessment of the child under section 260C.704, paragraph
(c), in a format approved by the commissioner;
new text end
new text begin
(8) if, at the time required for the report under this subdivision, the child's parent or legal
guardian, a child who is ten years of age or older, the family and permanency team, or a
tribe disagrees with the recommended qualified residential treatment program placement,
the agency shall include information regarding the disagreement, and to the extent possible,
the basis for the disagreement in the report;
new text end
new text begin
(9) any other information that the responsible social services agency, child's parent, legal
custodian or guardian, child, or in the case of an Indian child, tribe would like the court to
consider; and
new text end
new text begin
(10) the agency shall file the written report with the court and serve on the parties a
request for a hearing or a court order without a hearing.
new text end
new text begin
(b) The agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the court review requirements of this section and the child's and
child's parent's or legal guardian's right to submit information to the court:
new text end
new text begin
(1) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the reporting date and the date by which the agency must receive
information from the child and child's parent so that the agency is able to submit the report
required by this subdivision to the court;
new text end
new text begin
(2) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older that the court will hold a hearing upon the request of the child or the
child's parent; and
new text end
new text begin
(3) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older that they have the right to request a hearing and the right to present
information to the court for the court's review under this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Court hearing. new text end
new text begin
(a) The court shall hold a hearing when a party or a child who
is ten years of age or older requests a hearing.
new text end
new text begin
(b) In all other circumstances, the court has the discretion to hold a hearing or issue an
order without a hearing.
new text end
new text begin Subd. 4. new text end
new text begin Court findings and order. new text end
(a) Within 60 days from the beginning of each
placement in a qualified residential treatment programnew text begin when the qualified individual's
assessment of the child recommends placing the child in a qualified residential treatment
programnew text end , the court mustnew text begin consider the qualified individual's assessment of the child under
section 260C.704 and issue an order tonew text end :
deleted text begin
(1) consider the qualified individual's assessment of whether it is necessary and
appropriate to place the child in a qualified residential treatment program under section
260C.704;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a family foster home can meet the child's needs, whether it is
necessary and appropriate to place a child in a qualified residential treatment program that
is the least restrictive environment possible, and whether the child's placement is consistent
with the child's short and long term goals as specified in the permanency plan; and
deleted text begin (3)deleted text end new text begin (2)new text end approve or disapprove of the child's placement.
(b) deleted text begin In the out-of-home placement plan, the agency must document the court's approval
or disapproval of the placement, as specified in section 260C.708.deleted text end new text begin If the court disapproves
of the child's placement in a qualified residential treatment program, the responsible social
services agency shall: (1) remove the child from the qualified residential treatment program
within 30 days of the court's order; and (2) make a plan for the child's placement that is
consistent with the child's best interests under section 260C.212, subdivision 2.
new text end
new text begin Subd. 5. new text end
new text begin Court review and approval not required. new text end
new text begin
When the responsible social services
agency has legal authority to place a child under section 260C.007, subdivision 21a, and
the qualified individual's assessment of the child does not recommend placing the child in
a qualified residential treatment program, the court is not required to hold a hearing and the
court is not required to issue an order. Pursuant to section 260C.704, paragraph (f), the
responsible social services agency shall make a plan for the child's placement consistent
with the child's best interests under section 260C.212, subdivision 2. The agency must file
the agency's assessment determination for the child with the court at the next required
hearing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 25.
Minnesota Statutes 2020, section 260C.712, is amended to read:
260C.712 ONGOING REVIEWS AND PERMANENCY HEARING
REQUIREMENTS.
As long as a child remains placed in a qualified residential treatment program, the
responsible social services agency shall submit evidence at each administrative review under
section 260C.203; each court review under sections 260C.202, 260C.203, deleted text begin anddeleted text end 260C.204new text begin ,
260D.06, 260D.07, and 260D.08new text end ; and each permanency hearing under section 260C.515,
260C.519, deleted text begin ordeleted text end 260C.521,new text begin or 260D.07new text end that:
(1) demonstrates that an ongoing assessment of the strengths and needs of the child
continues to support the determination that the child's needs cannot be met through placement
in a family foster home;
(2) demonstrates that the placement of the child in a qualified residential treatment
program provides the most effective and appropriate level of care for the child in the least
restrictive environment;
(3) demonstrates how the placement is consistent with the short-term and long-term
goals for the child, as specified in the child's permanency plan;
(4) documents how the child's specific treatment or service needs will be met in the
placement;
(5) documents the length of time that the agency expects the child to need treatment or
services; deleted text begin and
deleted text end
(6) documents the responsible social services agency's efforts to prepare the child to
return home or to be placed with a fit and willing relative, legal guardian, adoptive parent,
or foster familydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) if the child is placed in a qualified residential treatment program out-of-state, the
compelling reasons for placing the child out-of-state and the reasons that the child's needs
cannot be met by an in-state placement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 260C.714, is amended to read:
260C.714 REVIEW OF EXTENDED QUALIFIED RESIDENTIAL TREATMENT
PROGRAM PLACEMENTS.
(a) When a responsible social services agency places a child in a qualified residential
treatment program for more than 12 consecutive months or 18 nonconsecutive months or,
in the case of a child who is under 13 years of age, for more than six consecutive or
nonconsecutive months, the agency must submit: (1) the signed approval by the county
social services director of the responsible social services agency; and (2) the evidence
supporting the child's placement at the most recent court review or permanency hearing
under section 260C.712deleted text begin , paragraph (b)deleted text end .
(b) The commissioner shall specify the procedures and requirements for the agency's
review and approval of a child's extended qualified residential treatment program placement.
The commissioner may consult with counties, tribes, child-placing agencies, mental health
providers, licensed facilities, the child, the child's parents, and the family and permanency
team members to develop case plan requirements and engage in periodic reviews of the
case plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 260D.01, is amended to read:
260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.
(a) Sections 260D.01 to 260D.10, may be cited as the "child in voluntary foster care for
treatment" provisions of the Juvenile Court Act.
(b) The juvenile court has original and exclusive jurisdiction over a child in voluntary
foster care for treatment upon the filing of a report or petition required under this chapter.
All obligations of thenew text begin responsible social servicesnew text end agency to a child and family in foster care
contained in chapter 260C not inconsistent with this chapter are also obligations of the
agency with regard to a child in foster care for treatment under this chapter.
(c) This chapter shall be construed consistently with the mission of the children's mental
health service system as set out in section 245.487, subdivision 3, and the duties of an agency
under sections 256B.092 and 260C.157 and Minnesota Rules, parts 9525.0004 to 9525.0016,
to meet the needs of a child with a developmental disability or related condition. This
chapter:
(1) establishes voluntary foster care through a voluntary foster care agreement as the
means for an agency and a parent to provide needed treatment when the child must be in
foster care to receive necessary treatment for an emotional disturbance or developmental
disability or related condition;
(2) establishes court review requirements for a child in voluntary foster care for treatment
due to emotional disturbance or developmental disability or a related condition;
(3) establishes the ongoing responsibility of the parent as legal custodian to visit the
child, to plan together with the agency for the child's treatment needs, to be available and
accessible to the agency to make treatment decisions, and to obtain necessary medical,
dental, and other care for the child; deleted text begin and
deleted text end
(4) applies to voluntary foster care when the child's parent and the agency agree that the
child's treatment needs require foster care either:
(i) due to a level of care determination by the agency's screening team informed by thenew text begin
child'snew text end diagnostic and functional assessment under section 245.4885; or
(ii) due to a determination regarding the level of services needed bynew text begin the child bynew text end the
responsible social deleted text begin services'deleted text end new text begin services agency'snew text end screening team under section 256B.092, and
Minnesota Rules, parts 9525.0004 to 9525.0016deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) includes the requirements for a child's placement in sections 260C.70 to 260C.714,
when the juvenile treatment screening team recommends placing a child in a qualified
residential treatment program, except as modified by this chapter.
new text end
(d) This chapter does not apply when there is a current determination under chapter
260E that the child requires child protective services or when the child is in foster care for
any reason other than treatment for the child's emotional disturbance or developmental
disability or related condition. When there is a determination under chapter 260E that the
child requires child protective services based on an assessment that there are safety and risk
issues for the child that have not been mitigated through the parent's engagement in services
or otherwise, or when the child is in foster care for any reason other than the child's emotional
disturbance or developmental disability or related condition, the provisions of chapter 260C
apply.
(e) The paramount consideration in all proceedings concerning a child in voluntary foster
care for treatment is the safety, health, and the best interests of the child. The purpose of
this chapter is:
(1) to ensurenew text begin thatnew text end a child with a disability is provided the services necessary to treat or
ameliorate the symptoms of the child's disability;
(2) to preserve and strengthen the child's family ties whenever possible and in the child's
best interests, approving the child's placement away from the child's parents only when the
child's need for care or treatment requires deleted text begin itdeleted text end new text begin out-of-home placementnew text end and the child cannot
be maintained in the home of the parent; and
(3) to ensurenew text begin thatnew text end the child's parent retains legal custody of the child and associated
decision-making authority unless the child's parent willfully fails or is unable to make
decisions that meet the child's safety, health, and best interests. The court may not find that
the parent willfully fails or is unable to make decisions that meet the child's needs solely
because the parent disagrees with the agency's choice of foster care facility, unless the
agency files a petition under chapter 260C, and establishes by clear and convincing evidence
that the child is in need of protection or services.
(f) The legal parent-child relationship shall be supported under this chapter by maintaining
the parent's legal authority and responsibility for ongoing planning for the child and by the
agency's assisting the parent, deleted text begin wheredeleted text end new text begin whennew text end necessary, to exercise the parent's ongoing right
and obligation to visit or to have reasonable contact with the child. Ongoing planning means:
(1) actively participating in the planning and provision of educational services, medical,
and dental care for the child;
(2) actively planning and participating with the agency and the foster care facility for
the child's treatment needs; deleted text begin and
deleted text end
(3) planning to meet the child's need for safety, stability, and permanency, and the child's
need to stay connected to the child's family and communitydeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) engaging with the responsible social services agency to ensure that the family and
permanency team under section 260C.706 consists of appropriate family members. For
purposes of voluntary placement of a child in foster care for treatment under chapter 260D,
prior to forming the child's family and permanency team, the responsible social services
agency must consult with the child's parent or legal guardian, the child if the child is 14
years of age or older, and, if applicable, the child's tribe to obtain recommendations regarding
which individuals to include on the team and to ensure that the team is family-centered and
will act in the child's best interests. If the child, child's parents, or legal guardians raise
concerns about specific relatives or professionals, the team should not include those
individuals unless the individual is a treating professional or an important connection to the
youth as outlined in the case or crisis plan; and
new text end
new text begin
(5) For a voluntary placement under this chapter in a qualified residential treatment
program, as defined in section 260C.007, subdivision 26d, for purposes of engaging in a
relative search as provided in section 260C.221, the county agency must consult with the
child's parent or legal guardian, the child if the child is 14 years of age or older, and, if
applicable, the child's tribe to obtain recommendations regarding which adult relatives the
county agency should notify. If the child, child's parents, or legal guardians raise concerns
about specific relatives, the county agency should not notify those relatives.
new text end
(g) The provisions of section 260.012 to ensure placement prevention, family
reunification, and all active and reasonable effort requirements of that section apply. This
chapter shall be construed consistently with the requirements of the Indian Child Welfare
Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the
Minnesota Indian Family Preservation Act, sections 260.751 to 260.835.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 260D.05, is amended to read:
260D.05 ADMINISTRATIVE REVIEW OF CHILD IN VOLUNTARY FOSTER
CARE FOR TREATMENT.
The administrative reviews required under section 260C.203 must be conducted for a
child in voluntary foster care for treatment, except that the initial administrative review
must take place prior to the submission of the report to the court required under section
260D.06, subdivision 2.new text begin When a child is placed in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d, the responsible social services agency
must submit evidence to the court as specified in section 260C.712.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 260D.06, subdivision 2, is amended to read:
Subd. 2.
Agency report to court; court review.
The agency shall obtain judicial review
by reporting to the court according to the following procedures:
(a) A written report shall be forwarded to the court within 165 days of the date of the
voluntary placement agreement. The written report shall contain or have attached:
(1) a statement of facts that necessitate the child's foster care placement;
(2) the child's name, date of birth, race, gender, and current address;
(3) the names, race, date of birth, residence, and post office addresses of the child's
parents or legal custodian;
(4) a statement regarding the child's eligibility for membership or enrollment in an Indian
tribe and the agency's compliance with applicable provisions of sections 260.751 to 260.835;
(5) the names and addresses of the foster parents or chief administrator of the facility in
which the child is placed, if the child is not in a family foster home or group home;
(6) a copy of the out-of-home placement plan required under section 260C.212,
subdivision 1;
(7) a written summary of the proceedings of any administrative review required under
section 260C.203; deleted text begin and
deleted text end
(8) new text begin evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d; and
new text end
new text begin (9) new text end any other information the agency, parent or legal custodian, the child or the foster
parent, or other residential facility wants the court to consider.
(b) In the case of a child in placement due to emotional disturbance, the written report
shall include as an attachment, the child's individual treatment plan developed by the child's
treatment professional, as provided in section 245.4871, subdivision 21, or the child's
standard written plan, as provided in section 125A.023, subdivision 3, paragraph (e).
(c) In the case of a child in placement due to developmental disability or a related
condition, the written report shall include as an attachment, the child's individual service
plan, as provided in section 256B.092, subdivision 1b; the child's individual program plan,
as provided in Minnesota Rules, part 9525.0004, subpart 11; the child's waiver care plan;
or the child's standard written plan, as provided in section 125A.023, subdivision 3, paragraph
(e).
(d) The agency must inform the child, age 12 or older, the child's parent, and the foster
parent or foster care facility of the reporting and court review requirements of this section
and of their right to submit information to the court:
(1) if the child or the child's parent or the foster care provider wants to send information
to the court, the agency shall advise those persons of the reporting date and the date by
which the agency must receive the information they want forwarded to the court so the
agency is timely able submit it with the agency's report required under this subdivision;
(2) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care facility that they have the right to be heard in person by the court and how to
exercise that right;
(3) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care provider that an in-court hearing will be held if requested by the child, the parent,
or the foster care provider; and
(4) if, at the time required for the report under this section, a child, age 12 or older,
disagrees about the foster care facility or services provided under the out-of-home placement
plan required under section 260C.212, subdivision 1, the agency shall include information
regarding the child's disagreement, and to the extent possible, the basis for the child's
disagreement in the report required under this section.
(e) After receiving the required report, the court has jurisdiction to make the following
determinations and must do so within ten days of receiving the forwarded report, whether
a hearing is requested:
(1) whether the voluntary foster care arrangement is in the child's best interests;
(2) whether the parent and agency are appropriately planning for the child; and
(3) in the case of a child age 12 or older, who disagrees with the foster care facility or
services provided under the out-of-home placement plan, whether it is appropriate to appoint
counsel and a guardian ad litem for the child using standards and procedures under section
260C.163.
(f) Unless requested by a parent, representative of the foster care facility, or the child,
no in-court hearing is required in order for the court to make findings and issue an order as
required in paragraph (e).
(g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit, individualized findings to support its determination. The
individualized findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported under paragraph (d).
(h) The court shall send a copy of the order to the county attorney, the agency, parent,
child, age 12 or older, and the foster parent or foster care facility.
(i) The court shall also send the parent, the child, age 12 or older, the foster parent, or
representative of the foster care facility notice of the permanency review hearing required
under section 260D.07, paragraph (e).
(j) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent are not appropriately planning for the child,
the court shall notify the agency, the parent, the foster parent or foster care facility, the child,
age 12 or older, and the county attorney of the court's determinations and the basis for the
court's determinations. In this case, the court shall set the matter for hearing and appoint a
guardian ad litem for the child under section 260C.163, subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 30.
Minnesota Statutes 2020, section 260D.07, is amended to read:
260D.07 REQUIRED PERMANENCY REVIEW HEARING.
(a) When the court has found that the voluntary arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child pursuant to the report
submitted under section 260D.06, and the child continues in voluntary foster care as defined
in section 260D.02, subdivision 10, for 13 months from the date of the voluntary foster care
agreement, or has been in placement for 15 of the last 22 months, the agency must:
(1) terminate the voluntary foster care agreement and return the child home; or
(2) determine whether there are compelling reasons to continue the voluntary foster care
arrangement and, if the agency determines there are compelling reasons, seek judicial
approval of its determination; or
(3) file a petition for the termination of parental rights.
(b) When the agency is asking for the court's approval of its determination that there are
compelling reasons to continue the child in the voluntary foster care arrangement, the agency
shall file a "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" and ask the court to proceed under this section.
(c) The "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" shall be drafted or approved by the county attorney and be under oath. The
petition shall include:
(1) the date of the voluntary placement agreement;
(2) whether the petition is due to the child's developmental disability or emotional
disturbance;
(3) the plan for the ongoing care of the child and the parent's participation in the plan;
(4) a description of the parent's visitation and contact with the child;
(5) the date of the court finding that the foster care placement was in the best interests
of the child, if required under section 260D.06, or the date the agency filed the motion under
section 260D.09, paragraph (b);
(6) the agency's reasonable efforts to finalize the permanent plan for the child, including
returning the child to the care of the child's family; deleted text begin and
deleted text end
(7) a citation to this chapter as the basis for the petitiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d.
new text end
(d) An updated copy of the out-of-home placement plan required under section 260C.212,
subdivision 1, shall be filed with the petition.
(e) The court shall set the date for the permanency review hearing no later than 14 months
after the child has been in placement or within 30 days of the petition filing date when the
child has been in placement 15 of the last 22 months. The court shall serve the petition
together with a notice of hearing by United States mail on the parent, the child age 12 or
older, the child's guardian ad litem, if one has been appointed, the agency, the county
attorney, and counsel for any party.
(f) The court shall conduct the permanency review hearing on the petition no later than
14 months after the date of the voluntary placement agreement, within 30 days of the filing
of the petition when the child has been in placement 15 of the last 22 months, or within 15
days of a motion to terminate jurisdiction and to dismiss an order for foster care under
chapter 260C, as provided in section 260D.09, paragraph (b).
(g) At the permanency review hearing, the court shall:
(1) inquire of the parent if the parent has reviewed the "Petition for Permanency Review
Regarding a Child in Voluntary Foster Care for Treatment," whether the petition is accurate,
and whether the parent agrees to the continued voluntary foster care arrangement as being
in the child's best interests;
(2) inquire of the parent if the parent is satisfied with the agency's reasonable efforts to
finalize the permanent plan for the child, including whether there are services available and
accessible to the parent that might allow the child to safely be with the child's family;
(3) inquire of the parent if the parent consents to the court entering an order that:
(i) approves the responsible agency's reasonable efforts to finalize the permanent plan
for the child, which includes ongoing future planning for the safety, health, and best interests
of the child; and
(ii) approves the responsible agency's determination that there are compelling reasons
why the continued voluntary foster care arrangement is in the child's best interests; and
(4) inquire of the child's guardian ad litem and any other party whether the guardian or
the party agrees that:
(i) the court should approve the responsible agency's reasonable efforts to finalize the
permanent plan for the child, which includes ongoing and future planning for the safety,
health, and best interests of the child; and
(ii) the court should approve of the responsible agency's determination that there are
compelling reasons why the continued voluntary foster care arrangement is in the child's
best interests.
(h) At a permanency review hearing under this section, the court may take the following
actions based on the contents of the sworn petition and the consent of the parent:
(1) approve the agency's compelling reasons that the voluntary foster care arrangement
is in the best interests of the child; and
(2) find that the agency has made reasonable efforts to finalize the permanent plan for
the child.
(i) A child, age 12 or older, may object to the agency's request that the court approve its
compelling reasons for the continued voluntary arrangement and may be heard on the reasons
for the objection. Notwithstanding the child's objection, the court may approve the agency's
compelling reasons and the voluntary arrangement.
(j) If the court does not approve the voluntary arrangement after hearing from the child
or the child's guardian ad litem, the court shall dismiss the petition. In this case, either:
(1) the child must be returned to the care of the parent; or
(2) the agency must file a petition under section 260C.141, asking for appropriate relief
under sections 260C.301 or 260C.503 to 260C.521.
(k) When the court approves the agency's compelling reasons for the child to continue
in voluntary foster care for treatment, and finds that the agency has made reasonable efforts
to finalize a permanent plan for the child, the court shall approve the continued voluntary
foster care arrangement, and continue the matter under the court's jurisdiction for the purposes
of reviewing the child's placement every 12 months while the child is in foster care.
(l) A finding that the court approves the continued voluntary placement means the agency
has continued legal authority to place the child while a voluntary placement agreement
remains in effect. The parent or the agency may terminate a voluntary agreement as provided
in section 260D.10. Termination of a voluntary foster care placement of an Indian child is
governed by section 260.765, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 260D.08, is amended to read:
260D.08 ANNUAL REVIEW.
(a) After the court conducts a permanency review hearing under section 260D.07, the
matter must be returned to the court for further review of the responsible social services
reasonable efforts to finalize the permanent plan for the child and the child's foster care
placement at least every 12 months while the child is in foster care. The court shall give
notice to the parent and child, age 12 or older, and the foster parents of the continued review
requirements under this section at the permanency review hearing.
(b) Every 12 months, the court shall determine whether the agency made reasonable
efforts to finalize the permanency plan for the child, which means the exercise of due
diligence by the agency to:
(1) ensure that the agreement for voluntary foster care is the most appropriate legal
arrangement to meet the child's safety, health, and best interests and to conduct a genuine
examination of whether there is another permanency disposition order under chapter 260C,
including returning the child home, that would better serve the child's need for a stable and
permanent home;
(2) engage and support the parent in continued involvement in planning and decision
making for the needs of the child;
(3) strengthen the child's ties to the parent, relatives, and community;
(4) implement the out-of-home placement plan required under section 260C.212,
subdivision 1, and ensure that the plan requires the provision of appropriate services to
address the physical health, mental health, and educational needs of the child; deleted text begin and
deleted text end
new text begin
(5) submit evidence to the court as specified in section 260C.712 when a child is placed
in a qualified residential treatment program setting as defined in section 260C.007,
subdivision 26d; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end ensure appropriate planning for the child's safe, permanent, and independent
living arrangement after the child's 18th birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 260D.14, is amended to read:
260D.14 SUCCESSFUL TRANSITION TO ADULTHOOD FOR deleted text begin CHILDRENdeleted text end new text begin
YOUTHnew text end IN VOLUNTARY PLACEMENT.
Subdivision 1.
Case planning.
When deleted text begin the childdeleted text end new text begin a youthnew text end is 14 years of age or older, the
responsible social services agency shall ensurenew text begin thatnew text end a deleted text begin childdeleted text end new text begin youthnew text end in foster care under this
chapter is provided with the case plan requirements in section 260C.212, subdivisions 1
and 14.
Subd. 2.
Notification.
The responsible social services agency shall providenew text begin a youth withnew text end
written notice of deleted text begin the right to continued access to services for certain children in foster care
past 18 years of age under section 260C.452, subdivision 3deleted text end new text begin foster care benefits that a youth
who is 18 years of age or older may continue to receive according to section 260C.451,
subdivision 1new text end , and of the right to appeal a denial of social services under section 256.045.
The notice must be provided to the deleted text begin childdeleted text end new text begin youthnew text end six months before the deleted text begin child'sdeleted text end new text begin youth'snew text end 18th
birthday.
Subd. 3.
Administrative or court reviews.
When deleted text begin the childdeleted text end new text begin a youthnew text end is deleted text begin 17deleted text end new text begin 14new text end years of
age or older, the administrative review or court hearing must include a review of the
responsible social services agency's support for the deleted text begin child'sdeleted text end new text begin youth'snew text end successful transition to
adulthood as required in section 260C.452, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 260E.06, subdivision 1, is amended to read:
Subdivision 1.
Mandatory reporters.
(a) A person who knows or has reason to believe
a child is being maltreated, as defined in section 260E.03, or has been maltreated within
the preceding three years shall immediately report the information to the local welfare
agency, agency responsible for assessing or investigating the report, police department,
county sheriff, tribal social services agency, or tribal police department if the person is:
(1) a professional or professional's delegate who is engaged in the practice of the healing
arts, social services, hospital administration, psychological or psychiatric treatment, child
care, education, correctional supervision, probation and correctional services, or law
enforcement; deleted text begin or
deleted text end
(2) employed as a member of the clergy and received the information while engaged in
ministerial duties, provided that a member of the clergy is not required by this subdivision
to report information that is otherwise privileged under section 595.02, subdivision 1,
paragraph (c)deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) an owner, administrator, or employee who is 18 years of age or older of a public or
private youth recreation program or other organization that provides services or activities
requiring face-to-face contact with and supervision of children.
new text end
(b) "Practice of social services" for the purposes of this subdivision includes but is not
limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.
Sec. 34.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall conduct a face-to-face contact with the child reported to be maltreated and
with the child's primary caregiver sufficient to complete a safety assessment and ensure the
immediate safety of the child.
(b) deleted text begin Thedeleted text end Face-to-face contact with the child and primary caregiver shall occur immediately
if sexual abuse or substantial child endangerment is alleged and within five calendar days
for all other reports. If the alleged offender was not already interviewed as the primary
caregiver, the local welfare agency shall also conduct a face-to-face interview with the
alleged offender in the early stages of the assessment or investigation.new text begin Face-to-face contact
with the child and primary caregiver in response to a report alleging sexual abuse or
substantial child endangerment may be postponed for no more than five calendar days if
the child is residing in a location that is confirmed to restrict contact with the alleged offender
as established in guidelines issued by the commissioner, or if the local welfare agency is
pursuing a court order for the child's caregiver to produce the child for questioning under
section 260E.22, subdivision 5.
new text end
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statement. The
alleged offender may submit supporting documentation relevant to the assessment or
investigation.
Sec. 35.
Minnesota Statutes 2020, section 260E.31, subdivision 1, is amended to read:
Subdivision 1.
Reports required.
(a) Except as provided in paragraph (b), a person
mandated to report under this chapter shall immediately report to the local welfare agency
if the person knows or has reason to believe that a woman is pregnant and has used a
controlled substance for a nonmedical purpose during the pregnancy, including but not
limited to tetrahydrocannabinol, or has consumed alcoholic beverages during the pregnancy
in any way that is habitual or excessive.
(b) A health care professional or a social service professional who is mandated to report
under this chapter is exempt from reporting under paragraph (a) deleted text begin a woman's use or
consumption of tetrahydrocannabinol or alcoholic beverages during pregnancydeleted text end if the
professional is providing new text begin or collaborating with other professionals to provide new text end the woman
with prenatal carenew text begin , postpartum care,new text end or other health care servicesnew text begin , including care of the
woman's infantnew text end . new text begin If the woman does not continue to receive regular prenatal or postpartum
care, after the woman's health care professional has made attempts to contact the woman,
then the professional is required to report under paragraph (a).
new text end
(c) Any person may make a voluntary report if the person knows or has reason to believe
that a woman is pregnant and has used a controlled substance for a nonmedical purpose
during the pregnancy, including but not limited to tetrahydrocannabinol, or has consumed
alcoholic beverages during the pregnancy in any way that is habitual or excessive.
(d) An oral report shall be made immediately by telephone or otherwise. An oral report
made by a person required to report shall be followed within 72 hours, exclusive of weekends
and holidays, by a report in writing to the local welfare agency. Any report shall be of
sufficient content to identify the pregnant woman, the nature and extent of the use, if known,
and the name and address of the reporter. The local welfare agency shall accept a report
made under paragraph (c) notwithstanding refusal by a voluntary reporter to provide the
reporter's name or address as long as the report is otherwise sufficient.
(e) For purposes of this section, "prenatal care" means the comprehensive package of
medical and psychological support provided throughout the pregnancy.
Sec. 36.
Minnesota Statutes 2020, section 260E.33, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Notification of contested case hearing. new text end
new text begin
When an appeal of a lead investigative
agency determination results in a contested case hearing under chapter 245A or 245C, the
administrative law judge shall notify the parent, legal custodian, or guardian of the child
who is the subject of the maltreatment determination. The notice must be sent by certified
mail and inform the parent, legal custodian, or guardian of the child of the right to file a
signed written statement in the proceedings and the right to attend and participate in the
hearing. The parent, legal custodian, or guardian of the child may file a written statement
with the administrative law judge hearing the case no later than five business days before
commencement of the hearing. The administrative law judge shall include the written
statement in the hearing record and consider the statement in deciding the appeal. The lead
investigative agency shall provide to the administrative law judge the address of the parent,
legal custodian, or guardian of the child. If the lead investigative agency is not reasonably
able to determine the address of the parent, legal custodian, or guardian of the child, the
administrative law judge is not required to send a hearing notice under this subdivision.
new text end
Sec. 37.
Minnesota Statutes 2020, section 260E.36, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Sex trafficking and sexual exploitation training requirement. new text end
new text begin
As required
by the Child Abuse Prevention and Treatment Act amendments through Public Law 114-22
and to implement Public Law 115-123, all child protection social workers and social services
staff who have responsibility for child protective duties under this chapter or chapter 260C
shall complete training implemented by the commissioner of human services regarding sex
trafficking and sexual exploitation of children and youth.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 38. new text begin DIRECTION TO THE COMMISSIONER; QUALIFIED RESIDENTIAL
TREATMENT TRANSITION SUPPORTS.
new text end
new text begin
The commissioner of human services shall consult with stakeholders to develop policies
regarding aftercare supports for the transition of a child from a qualified residential treatment
program, as defined in Minnesota Statutes, section 260C.007, subdivision 26d, to
reunification with the child's parent or legal guardian, including potential placement in a
less restrictive setting prior to reunification that aligns with the child's permanency plan and
person-centered support plan, when applicable. The policies must be consistent with
Minnesota Rules, part 2960.0190, and Minnesota Statutes, section 245A.25, subdivision 4,
paragraph (i), and address the coordination of the qualified residential treatment program
discharge planning and aftercare supports where needed, the county social services case
plan, and services from community-based providers, to maintain the child's progress with
behavioral health goals in the child's treatment plan. The commissioner must complete
development of the policy guidance by December 31, 2022.
new text end
Sec. 39. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall place the following first grade headnote in Minnesota
Statutes, chapter 260C, preceding Minnesota Statutes, sections 260C.70 to 260C.714:
PLACEMENT OF CHILDREN IN QUALIFIED RESIDENTIAL TREATMENT.
new text end
ARTICLE 12
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2020, section 16A.151, subdivision 2, is amended to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, deleted text begin against
one or more opioid manufacturers or opioid wholesale drug distributorsdeleted text end related to alleged
violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids, must
be deposited in a separate account in the state treasury and the commissioner shall notify
the chairs and ranking minority members of the Finance Committee in the senate and the
Ways and Means Committee in the house of representatives that an account has been created.
This paragraph does not apply to attorney fees and costs awarded to the state or the Attorney
General's Office, to contract attorneys hired by the state or Attorney General's Office, or to
other state agency attorneys. If the licensing fees under section 151.065, subdivision 1,
clause (16), and subdivision 3, clause (14), are reduced and the registration fee under section
151.066, subdivision 3, is repealed in accordance with section 256.043, subdivision 4, then
the commissioner shall transfer from the separate account created in this paragraph to the
opiate epidemic response fund under section 256.043 an amount that ensures that $20,940,000
each fiscal year is available for distribution in accordance with section 256.043, subdivisions
2 and 3.
Sec. 2.
Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
(a) "Mental health practitioner" means a person
providing services to adults with mental illness or children with emotional disturbance who
is qualified in at least one of the ways described in paragraphs (b) to (g). A mental health
practitioner for a child client must have training working with children. A mental health
practitioner for an adult client must have training working with adults.
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, substance use disorder, or emotional disturbance; or
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
(3) is working in a day treatment program under section 245.4712, subdivision 2; deleted text begin or
deleted text end
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fieldsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is in the process of completing a practicum or internship as part of a formal
undergraduate or graduate training program in social work, psychology, or counseling.
new text end
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, substance use disorder, or emotional disturbance; or
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
Sec. 3.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intakedeleted text begin , except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9deleted text end .
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
Sec. 4.
Minnesota Statutes 2020, section 245.4882, subdivision 1, is amended to read:
Subdivision 1.
Availability of residential treatment services.
County boards must
provide or contract for enough residential treatment services to meet the needs of each child
with severe emotional disturbance residing in the county and needing this level of care.
Length of stay is based on the child's residential treatment need and shall be deleted text begin subject to the
six-month review process established in section , and for children in voluntary
placement for treatment, the court review process in section 260D.06deleted text end new text begin reviewed every 90
daysnew text end . Services must be appropriate to the child's age and treatment needs and must be made
available as close to the county as possible. Residential treatment must be designed to:
(1) help the child improve family living and social interaction skills;
(2) help the child gain the necessary skills to return to the community;
(3) stabilize crisis admissions; and
(4) work with families throughout the placement to improve the ability of the families
to care for children with severe emotional disturbance in the home.
Sec. 5.
Minnesota Statutes 2020, section 245.4882, subdivision 3, is amended to read:
Subd. 3.
Transition to community.
Residential treatment facilities and regional treatment
centers serving children must plan for and assist those children and their families in making
a transition to less restrictive community-based services. new text begin Discharge planning for the child
to return to the community must include identification of and referrals to appropriate home
and community supports that meet the needs of the child and family. Discharge planning
must begin within 30 days after the child enters residential treatment and be updated every
60 days. new text end Residential treatment facilities must also arrange for appropriate follow-up care
in the community. Before a child is discharged, the residential treatment facility or regional
treatment center shall provide notification to the child's case manager, if any, so that the
case manager can monitor and coordinate the transition and make timely arrangements for
the child's appropriate follow-up care in the community.
Sec. 6.
Minnesota Statutes 2020, section 245.4885, subdivision 1, is amended to read:
Subdivision 1.
Admission criteria.
(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a treatment foster care setting, residential treatment facility, or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if deleted text begin publicdeleted text end new text begin countynew text end funds are used to pay for thenew text begin child'snew text end services.
(b) The deleted text begin responsible social services agencydeleted text end new text begin county boardnew text end shall determine the appropriate
level of care for a child when county-controlled funds are used to pay for the child's deleted text begin services
or placement in a qualified residential treatment facility under chapter deleted text end deleted text begin 260Cdeleted text end deleted text begin and licensed
by the commissioner under chapter deleted text end deleted text begin 245Adeleted text end deleted text begin . In accordance with section 260C.157, a juvenile
treatment screening team shall conduct a screening before the team may recommend whether
to place a childdeleted text end new text begin residential treatment under this chapter, including residential treatment
providednew text end in a qualified residential treatment program as defined in section 260C.007,
subdivision 26d. When a deleted text begin social services agencydeleted text end new text begin county boardnew text end does not have responsibility
for a child's placement and the child is enrolled in a prepaid health program under section
256B.69, the enrolled child's contracted health plan must determine the appropriate level
of carenew text begin for the childnew text end . When Indian Health Services funds or funds of a tribally owned facility
funded under the Indian Self-Determination and Education Assistance Act, Public Law
93-638, are deleted text begin to bedeleted text end usednew text begin for the childnew text end , the Indian Health Services or 638 tribal health facility
must determine the appropriate level of carenew text begin for the childnew text end . When more than one entity bears
responsibility fornew text begin a child'snew text end coverage, the entities shall coordinate level of care determination
activities new text begin for the child new text end to the extent possible.
(c) The deleted text begin responsible social services agency must make the level of care determination
available to the juvenile treatment screening team, as permitted under chapter deleted text end deleted text begin 13deleted text end deleted text begin . The level
of care determination shall inform the juvenile treatment screening team process and the
assessment in section 260C.704 when considering whether to place the child in a qualified
residential treatment program. When the responsible social services agency is not involved
in determining a child's placement, thedeleted text end child's level of care determination shall determine
whether the proposed treatment:
(1) is necessary;
(2) is appropriate to the child's individual treatment needs;
(3) cannot be effectively provided in the child's home; and
(4) provides a length of stay as short as possible consistent with the individual child's
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the deleted text begin responsible social services
agencydeleted text end new text begin county boardnew text end or other entity may not determine that a screening deleted text begin under section
260C.157 ordeleted text end new text begin ,new text end referralnew text begin ,new text end or admission to a deleted text begin treatment foster care setting ordeleted text end residential treatment
facility is not appropriate solely because services were not first provided to the child in a
less restrictive setting and the child failed to make progress toward or meet treatment goals
in the less restrictive setting. The level of care determination must be based on a diagnostic
assessmentnew text begin of a childnew text end that deleted text begin includes a functional assessment whichdeleted text end evaluates family, school,
and community living situations; and an assessment of the child's need for care out of the
home using a validated tool which assesses a child's functional status and assigns an
appropriate level of carenew text begin to the childnew text end . The validated tool must be approved by the
commissioner of human services. If a diagnostic assessment deleted text begin including a functional assessmentdeleted text end
has been completed by a mental health professional within the past 180 days, a new diagnostic
assessment need not be completed unless in the opinion of the current treating mental health
professional the child's mental health status has changed markedly since the assessment
was completed. The child's parent shall be notified if an assessment will not be completed
and of the reasons. A copy of the notice shall be placed in the child's file. Recommendations
developed as part of the level of care determination process shall include specific community
services needed by the child and, if appropriate, the child's family, and shall indicate whether
or not these services are available and accessible to the child andnew text begin the child'snew text end family.new text begin The
child and the child's family must be invited to any meeting where the level of care
determination is discussed and decisions regarding residential treatment are made. The child
and the child's family may invite other relatives, friends, or advocates to attend these
meetings.
new text end
(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual family
community support plan is being developed by the case manager, if assigned.
deleted text begin
(f) When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 unless a court
terminates the parent's rights or court orders restrict the parent from participating in case
planning, visitation, or parental responsibilities.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end The level of care determination, and placement decision, and recommendations
for mental health services must be documented in the child's recorddeleted text begin , as required in chapter
deleted text end deleted text begin 260Cdeleted text end new text begin and made available to the child's family, as appropriatenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of out-of-home placement. A child is not required to have case
management services to receive respite care services;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minoritiesnew text begin , including
supervision of clinical trainees who are Black, indigenous, or people of color, providing
services in clinics that serve clients enrolled in medical assistancenew text end ;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services under section 245.4901;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(18) mental health services based on traditional, spiritual, and holistic healing practices,
provided by cultural healers from African American, American Indian, Asian American,
Latinx, Pacific Islander, and Pan-African communities.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
Sec. 8.
new text begin
[245.4902] CULTURALLY INFORMED AND CULTURALLY RESPONSIVE
MENTAL HEALTH TASK FORCE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; duties. new text end
new text begin
The Culturally Informed and Culturally
Responsive Mental Health Task Force is established to evaluate and make recommendations
on improving the provision of culturally informed and culturally responsive mental health
services throughout Minnesota. The task force must make recommendations on:
new text end
new text begin
(1) recruiting mental health providers from diverse racial and ethnic communities;
new text end
new text begin
(2) training all mental health providers on cultural competency and cultural humility;
new text end
new text begin
(3) assessing the extent to which mental health provider organizations embrace diversity
and demonstrate proficiency in culturally competent mental health treatment and services;
and
new text end
new text begin
(4) increasing the number of mental health organizations owned, managed, or led by
individuals who are Black, indigenous, or people of color.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The task force must consist of the following 16 members:
new text end
new text begin
(1) the commissioner of human services or the commissioner's designee;
new text end
new text begin
(2) one representative from the Board of Psychology;
new text end
new text begin
(3) one representative from the Board of Marriage and Family Therapy;
new text end
new text begin
(4) one representative from the Board of Behavioral Health and Therapy;
new text end
new text begin
(5) one representative from the Board of Social Work;
new text end
new text begin
(6) three members representing undergraduate and graduate-level mental health
professional education programs, appointed by the governor;
new text end
new text begin
(7) three mental health providers who are members of communities of color or
underrepresented communities, as defined in section 148E.010, subdivision 20, appointed
by the governor;
new text end
new text begin
(8) two members representing mental health advocacy organizations, appointed by the
governor;
new text end
new text begin
(9) two mental health providers, appointed by the governor; and
new text end
new text begin
(10) one expert in providing training and education in cultural competency and cultural
responsiveness, appointed by the governor.
new text end
new text begin
(b) Appointments to the task force must be made no later than June 1, 2022.
new text end
new text begin
(c) Member compensation and reimbursement for expenses are governed by section
15.059, subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Chairs; meetings. new text end
new text begin
The members of the task force must elect two cochairs of
the task force no earlier than July 1, 2022, and the cochairs must convene the first meeting
of the task force no later than August 15, 2022. The task force must meet upon the call of
the cochairs, sufficiently often to accomplish the duties identified in this section. The task
force is subject to the open meeting law under chapter 13D.
new text end
new text begin Subd. 4. new text end
new text begin Administrative support. new text end
new text begin
The Department of Human Services must provide
administrative support and meeting space for the task force.
new text end
new text begin Subd. 5. new text end
new text begin Reports. new text end
new text begin
No later than January 1, 2023, and by January 1 of each year thereafter,
the task force must submit a written report to the members of the legislative committees
with jurisdiction over health and human services on the recommendations developed under
subdivision 1.
new text end
new text begin Subd. 6. new text end
new text begin Expiration. new text end
new text begin
The task force expires on January 1, 2025.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs)new text begin that satisfy all federal requirements necessary for CCBHCs certified under this
section to be eligible for reimbursement under medical assistance, without service area
limits based on geographic area or regionnew text end . new text begin The commissioner shall consult with CCBHC
stakeholders before establishing and implementing changes in the certification process and
requirements.new text end Entities that choose to be CCBHCs must:
deleted text begin
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
deleted text end
new text begin
(1) comply with state licensing requirements and other requirements issued by the
commissioner;
new text end
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization servicesnew text begin through existing
mobile crisis servicesnew text end ; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veteransdeleted text begin ;deleted text end new text begin . CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
new text end
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be certified as mental health clinics under section 245.69, subdivision 2;
(9) comply with standards new text begin established by the commissioner new text end relating to deleted text begin mental health
services in Minnesota Rules, parts 9505.0370 to 9505.0372deleted text end new text begin CCBHC screenings, assessments,
and evaluationsnew text end ;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under sections
256B.0624 and 256B.0944;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If deleted text begin an entitydeleted text end new text begin a certified CCBHCnew text end is unable to provide one or more of the services listed
in paragraph (a), clauses (6) to (17), the deleted text begin commissioner may certify the entity as adeleted text end CCBHCdeleted text begin ,
if the entity has a currentdeleted text end new text begin maynew text end contract with another entity that has the required authority
to provide that service and that meets deleted text begin federal CCBHCdeleted text end new text begin the followingnew text end criteria as a designated
collaborating organizationdeleted text begin , or, to the extent allowed by the federal CCBHC criteria, the
commissioner may approve a referral arrangement. The CCBHC must meet federal
requirements regarding the type and scope of services to be provided directly by the CCBHC.deleted text end new text begin :
new text end
new text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
new text end
new text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end
new text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end
new text begin
(4) the entity meets any additional requirements issued by the commissioner.
new text end
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirementsnew text begin
for services reimbursed under medical assistancenew text end . If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
Sec. 10.
Minnesota Statutes 2020, section 245.735, subdivision 5, is amended to read:
Subd. 5.
Information systems support.
The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with new text begin state and new text end federal requirements.
Sec. 11.
Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Demonstration entities. new text end
new text begin
The commissioner may operate the demonstration
program established by section 223 of the Protecting Access to Medicare Act if federal
funding for the demonstration program remains available from the United States Department
of Health and Human Services. To the extent practicable, the commissioner shall align the
requirements of the demonstration program with the requirements under this section for
CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to
participate as a billing provider in both the CCBHC federal demonstration and the benefit
for CCBHCs under the medical assistance program.
new text end
Sec. 12.
Minnesota Statutes 2020, section 254B.01, subdivision 4a, is amended to read:
Subd. 4a.
Culturally specific new text begin or culturally responsive new text end program.
(a) "Culturally specific
new text begin or culturally responsive new text end program" means a substance use disorder treatment service program
or subprogram that is deleted text begin recovery-focused anddeleted text end new text begin culturally responsive or new text end culturally specific when
the programnew text begin attests that itnew text end :
(1) improves service quality to and outcomes of a specific deleted text begin populationdeleted text end new text begin community that
shares a common language, racial, ethnic, or social backgroundnew text end by advancing health equity
to help eliminate health disparities; deleted text begin and
deleted text end
(2) ensures effective, equitable, comprehensive, and respectful quality care services that
are responsive to an individual within a specific deleted text begin population'sdeleted text end new text begin community'snew text end values, beliefs
and practices, health literacy, preferred language, and other communication needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) is compliant with the national standards for culturally and linguistically appropriate
services or other equivalent standards, as determined by the commissioner.
new text end
(b) A tribally licensed substance use disorder program that is designated as serving a
culturally specific population by the applicable tribal government is deemed to satisfy this
subdivision.
new text begin
(c) A program satisfies the requirements of this subdivision if it attests that the program:
new text end
new text begin
(1) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
new text end
new text begin
(2) is governed with significant input from individuals of that specific background; and
new text end
new text begin
(3) employs individuals to provide treatment services, at least 50 percent of whom are
members of the specific community being served.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 4b. new text end
new text begin Disability responsive program. new text end
new text begin
"Disability responsive program" means a
program that:
new text end
new text begin
(1) is designed to serve individuals with disabilities, including individuals with traumatic
brain injuries, developmental disabilities, cognitive disabilities, and physical disabilities;
and
new text end
new text begin
(2) employs individuals to provide treatment services who have the necessary professional
training, as approved by the commissioner, to serve individuals with the specific disabilities
that the program is designed to serve.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 14.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502deleted text begin ;
deleted text end
(2) culturally specificnew text begin or culturally responsivenew text end programs as defined in section 254B.01,
subdivision 4adeleted text begin ,deleted text end new text begin ;new text end or
new text begin
(3) disability responsive programs as defined in section 254B.01, subdivision 4b.
new text end
deleted text begin
programs or subprograms serving special populations, if the program or subprogram
meets the following requirements:
deleted text end
deleted text begin
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
deleted text end
deleted text begin
(ii) is governed with significant input from individuals of that specific background; and
deleted text end
deleted text begin
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
deleted text end
deleted text begin
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
deleted text end
deleted text begin
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
deleted text end
deleted text begin
(i) the program meets the co-occurring requirements in section 245G.20;
deleted text end
deleted text begin
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
deleted text end
deleted text begin
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
deleted text end
deleted text begin
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
deleted text end
deleted text begin
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
deleted text end
deleted text begin
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
deleted text end
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
deleted text begin
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
deleted text end
deleted text begin (f)deleted text end new text begin (e) new text end Subject to federal approval, deleted text begin chemical dependencydeleted text end new text begin substance use disorder new text end services
that are otherwise covered as direct face-to-face services may be provided via two-way
interactive videonew text begin according to section 256B.0625, subdivision 3bnew text end . deleted text begin The use of two-way
interactive video must be medically appropriate to the condition and needs of the person
being served. Reimbursement shall be at the same rates and under the same conditions that
would otherwise apply to direct face-to-face services. The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end For the purpose of reimbursement under this section, substance use disorder
treatment services provided in a group setting without a group participant maximum or
maximum client to staff ratio under chapter 245G shall not exceed a client to staff ratio of
48 to one. At least one of the attending staff must meet the qualifications as established
under this chapter for the type of treatment service provided. A recovery peer may not be
included as part of the staff ratio.
new text begin
(g) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, except paragraph (e) is effective July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 254B.12, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin
Culturally specific or culturally responsive program and disability
responsive program provider rate increase.
new text end
new text begin
For the chemical dependency services listed
in section 254B.05, subdivision 5, provided by programs that meet the requirements of
section 254B.05, subdivision 5, paragraph (c), clauses (1), (2), and (3), on or after January
1, 2022, payment rates shall increase by five percent over the rates in effect on January 1,
2021. The commissioner shall increase prepaid medical assistance capitation rates as
appropriate to reflect this increase.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later.
new text end
Sec. 16.
new text begin
[254B.151] SUBSTANCE USE DISORDER COMMUNITY OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of human services, in
consultation with substance use disorder subject matter experts, shall establish a substance
use disorder community of practice. The purposes of the community of practice are to
improve treatment outcomes for individuals with substance use disorders and reduce
disparities by using evidence-based and best practices through peer-to-peer and
person-to-provider sharing.
new text end
new text begin Subd. 2. new text end
new text begin Participants; meetings. new text end
new text begin
(a) The community of practice must include the
following participants:
new text end
new text begin
(1) researchers or members of the academic community who are substance use disorder
subject matter experts, who do not have financial relationships with treatment providers;
new text end
new text begin
(2) substance use disorder treatment providers;
new text end
new text begin
(3) representatives from recovery community organizations;
new text end
new text begin
(4) a representative from the Department of Human Services;
new text end
new text begin
(5) a representative from the Department of Health;
new text end
new text begin
(6) a representative from the Department of Corrections;
new text end
new text begin
(7) representatives from county social services agencies;
new text end
new text begin
(8) representatives from tribal nations or tribal social services providers; and
new text end
new text begin
(9) representatives from managed care organizations.
new text end
new text begin
(b) The community of practice must include individuals who have used substance use
disorder treatment services and must highlight the voices and experiences of individuals
who are Black, indigenous, people of color, and people from other communities that are
disproportionately impacted by substance use disorders.
new text end
new text begin
(c) The community of practice must meet regularly and must hold its first meeting before
January 1, 2022.
new text end
new text begin
(d) Compensation and reimbursement for expenses for participants in paragraph (b) are
governed by section 15.059, subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
(a) The community of practice must:
new text end
new text begin
(1) identify gaps in substance use disorder treatment services;
new text end
new text begin
(2) enhance collective knowledge of issues related to substance use disorder;
new text end
new text begin
(3) understand evidence-based practices, best practices, and promising approaches to
address substance use disorder;
new text end
new text begin
(4) use knowledge gathered through the community of practice to develop strategic plans
to improve outcomes for individuals who participate in substance use disorder treatment
and related services in Minnesota;
new text end
new text begin
(5) increase knowledge about the challenges and opportunities learned by implementing
strategies; and
new text end
new text begin
(6) develop capacity for community advocacy.
new text end
new text begin
(b) The commissioner, in collaboration with subject matter experts and other participants,
may issue reports and recommendations to the legislative chairs and ranking minority
members of committees with jurisdiction over health and human services policy and finance
and local and regional governments.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256.042, subdivision 2, is amended to read:
Subd. 2.
Membership.
(a) The council shall consist of the following deleted text begin 19deleted text end new text begin 28new text end voting
members, appointed by the commissioner of human services except as otherwise specified,
and three nonvoting members:
(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;
(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;
(3) one member appointed by the Board of Pharmacy;
(4) one member who is a physician appointed by the Minnesota Medical Association;
(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;
(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;
(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;
(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;
(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;
(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;
(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;
(12) deleted text begin twodeleted text end new text begin 11new text end members representing Indian tribes, one representing deleted text begin the Ojibwe tribes and
one representing the Dakota tribesdeleted text end new text begin each of Minnesota's tribal nationsnew text end ;
(13) one public member who is a Minnesota resident and who is suffering from chronic
pain, intractable pain, or a rare disease or condition;
(14) one mental health advocate representing persons with mental illness;
(15) one member appointed by the Minnesota Hospital Association;
(16) one member representing a local health department; and
(17) the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.
(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half of council members appointed by the commissioner reside outside of the
seven-county metropolitan area. Of the members appointed by the commissioner, to the
extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.
(c) The council is governed by section 15.059, except that members of the council shall
serve three-year terms and shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.
(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.
(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.
(f) The council is subject to chapter 13D.
Sec. 18.
Minnesota Statutes 2020, section 256.042, subdivision 4, is amended to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming deleted text begin fiscaldeleted text end new text begin calendarnew text end
year to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance, by deleted text begin Marchdeleted text end new text begin Decembernew text end 1 of
each year, beginning March 1, 2020.
(b) The commissioner of human services shall award grants from the opiate epidemic
response fund under section 256.043. The grants shall be awarded to proposals selected by
the advisory council that address the priorities in subdivision 1, paragraph (a), clauses (1)
to (4), unless otherwise appropriated by the legislature. No more than deleted text begin threedeleted text end new text begin tennew text end percent of
the grant amount may be used by a grantee for administration.
Sec. 19.
Minnesota Statutes 2020, section 256.043, subdivision 3, is amended to read:
Subd. 3.
Appropriations from fund.
(a) After the appropriations in Laws 2019, chapter
63, article 3, section 1, paragraphs (e), (f), (g), and (h) are made, $249,000 is appropriated
to the commissioner of human services for the provision of administrative services to the
Opiate Epidemic Response Advisory Council and for the administration of the grants awarded
under paragraph (e).
(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.
(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
(d) After the appropriations in paragraphs (a) to (c) are made, 50 percent of the remaining
amount is appropriated to the commissioner of human services for distribution to county
social service and tribal social service agencies to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to counties and tribal social service agencies based on out-of-home
placement episodes where parental drug abuse is the primary reason for the out-of-home
placement using data from the previous calendar year. County and tribal social service
agencies receiving funds from the opiate epidemic response fund must annually report to
the commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and tribal social service agencies must not use funds received under this paragraph to supplant
current state or local funding received for child protection services for children and families
who are affected by addiction.
(e) After making the appropriations in paragraphs (a) to (d), the remaining amount in
the fund is appropriated to the commissioner to award grants as specified by the Opiate
Epidemic Response Advisory Council in accordance with section 256.042, unless otherwise
appropriated by the legislature.
new text begin
(f) Beginning in fiscal year 2022 and each year thereafter, funds for county social service
and tribal social service agencies under paragraph (d) and grant funds specified by the Opiate
Epidemic Response Advisory Council under paragraph (e) shall be distributed on a calendar
year basis.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256B.0624, subdivision 7, is amended to read:
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 11;
(2) staff must be qualified as defined in subdivision 8; and
(3) services must be delivered according to the treatment plan and include face-to-face
contact with the recipient by qualified staff for further assessment, help with referrals,
updating of the crisis stabilization treatment plan, supportive counseling, skills training,
and collaboration with other service providers in the community.
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
(c) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves no more than four adult residents, and one or more individuals are present at the
setting to receive residential crisis stabilization services, the residential staff must include,
for at least eight hours per day, at least one individual who meets the qualifications in
subdivision 8, paragraph (a), clause (1) or (2).new text begin The commissioner shall establish a statewide
per diem rate for crisis stabilization services provided under this paragraph to medical
assistance enrollees. The rate for a provider shall not exceed the rate charged by that provider
for the same service to other payers. Payment shall not be made to more than one entity for
each individual for services provided under this paragraph on a given day. The commissioner
shall set rates prospectively for the annual rate period. The commissioner shall require
providers to submit annual cost reports on a uniform cost reporting form and shall use
submitted cost reports to inform the rate-setting process. The commissioner shall recalculate
the statewide per diem every year.
new text end
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 5m, is amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
(b) The commissioner shall deleted text begin establish standards and methodologies for adeleted text end new text begin reimburse
CCBHCs on a per-visit basis under the new text end prospective payment system for medical assistance
payments deleted text begin for services delivered by a CCBHC, in accordance with guidance issued by the
Centers for Medicare and Medicaid Servicesdeleted text end new text begin as described in paragraph (c)new text end . The commissioner
shall include a quality deleted text begin bonusdeleted text end new text begin incentivenew text end payment in the prospective payment system deleted text begin based
on federal criteriadeleted text end new text begin , as described in paragraph (e)new text end . There is no county share for medical
assistance services when reimbursed through the CCBHC prospective payment system.
(c) deleted text begin Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:deleted text end new text begin The commissioner shall ensure that the prospective
payment system for CCBHC payments under medical assistance meets the following
requirements:
new text end
new text begin
(1) the prospective payment rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
costs for CCBHCs divided by the total annual number of CCBHC visits. For calculating
the payment rate, total annual visits include visits covered by medical assistance and visits
not covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
new text end
new text begin
(2) payment shall be limited to one payment per day per medical assistance enrollee for
each CCBHC visit eligible for reimbursement. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
new text end
new text begin
(3) new payment rates set by the commissioner for newly certified CCBHCs under
section 245.735, subdivision 3, shall be based on rates for established CCBHCs with a
similar scope of services. If no comparable CCBHC exists, the commissioner shall establish
a clinic-specific rate using audited historical cost report data adjusted for the estimated cost
of delivering CCBHC services, including the estimated cost of providing the full scope of
services and the projected change in visits resulting from the change in scope;
new text end
deleted text begin (1)deleted text end new text begin (4)new text end the commissioner shall rebase CCBHC rates deleted text begin at leastdeleted text end new text begin oncenew text end every three years new text begin and
12 months following an initial rate or a rate change due to a change in the scope of services,
whichever is earliernew text end ;
deleted text begin (2)deleted text end new text begin (5)new text end the commissioner shall provide for a 60-day appeals process new text begin after notice of the
results new text end of the rebasing;
deleted text begin
(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
deleted text end
deleted text begin (4)deleted text end new text begin (6)new text end the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
deleted text begin (5)deleted text end new text begin (7)new text end payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap paymentsnew text begin . The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the prospective payment system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafternew text end ;
deleted text begin
(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services;
deleted text end
deleted text begin (7)deleted text end new text begin (8)new text end the prospective payment rate for each CCBHC shall be deleted text begin adjusted annuallydeleted text end new text begin updatednew text end
bynew text begin trending each provider-specific rate bynew text end the Medicare Economic Index deleted text begin as defined for the
federal section 223 CCBHC demonstrationdeleted text end new text begin for primary care services. This update shall
occur each year in between rebasing periods determined by the commissioner in accordance
with clause (4). CCBHCs must provide data on costs and visits to the state annually using
the CCBHC cost report established by the commissionernew text end ; and
new text begin
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Rate adjustments for changes in scope shall occur no more than
once per year in between rebasing periods per CCBHC and are effective on the date of the
annual CCBHC rate update.
new text end
deleted text begin
(8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
for changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner in consultation with CCBHCs.
deleted text end
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
new text begin
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
new text end
new text begin
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the prospective payment system described in
paragraph (c);
new text end
new text begin
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
new text end
new text begin
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
new text end
new text begin
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
new text end
new text begin
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
new text end
new text begin
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
new text end
new text begin
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
new text end
new text begin
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the adult's legal representative or a
contact by interactive video that meets the requirements of subdivision 20b; or
(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by interactive video that meets the requirements
of subdivision 20b with the adult or the adult's legal representative within the preceding
two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county deleted text begin or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribedeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment for
mental health case management provided by vendors who contract with a Tribe must be
based on a monthly rate negotiated by the Tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the
rate charged by the vendor for the same service to other payers. If the service is provided
by a team of contracted vendors, the deleted text begin county or tribe may negotiate a team rate with a vendor
who is a member of the team. Thedeleted text end team shall determine how to distribute the rate among
its members. No reimbursement received by contracted vendors shall be returned to the
county or tribe, except to reimburse the county or tribe for advance funding provided by
the county or tribe to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
Sec. 23.
Minnesota Statutes 2020, section 256B.0759, subdivision 2, is amended to read:
Subd. 2.
Provider participation.
new text begin (a) Outpatient new text end substance use disorder treatment
providers may elect to participate in the demonstration project and meet the requirements
of subdivision 3. To participate, a provider must notify the commissioner of the provider's
intent to participate in a format required by the commissioner and enroll as a demonstration
project provider.
new text begin
(b) A program licensed by the Department of Human Services as a residential treatment
program according to section 245G.21 and that receives payment under this chapter must
enroll as a demonstration project provider and meet the requirements of subdivision 3 by
January 1, 2022. The commissioner may grant an extension, for a period not to exceed six
months, to a program that is unable to meet the requirements of subdivision 3 due to
demonstrated extraordinary circumstances. A program seeking an extension must apply in
a format approved by the commissioner by November 1, 2021. A program that does not
meet the requirements under this paragraph by July 1, 2023, is ineligible for payment for
services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(c) A program licensed by the Department of Human Services as a withdrawal
management program according to chapter 245F and that receives payment under this
chapter must enroll as a demonstration project provider and meet the requirements of
subdivision 3 by January 1, 2022. The commissioner may grant an extension, for a period
not to exceed six months, to a program that is unable to meet the requirements of subdivision
3 due to demonstrated extraordinary circumstances. A program seeking an extension must
apply in a format approved by the commissioner by November 1, 2021. A program that
does not meet the requirements under this paragraph by July 1, 2023, is ineligible for payment
for services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(d) An out-of-state residential substance use disorder treatment program that receives
payment under this chapter must enroll as a demonstration project provider and meet the
requirements of subdivision 3 by January 1, 2022. The commissioner may grant an extension,
for a period not to exceed six months, to a program that is unable to meet the requirements
of subdivision 3 due to demonstrated extraordinary circumstances. A program seeking an
extension must apply in a format approved by the commissioner by November 1, 2021.
Programs that do not meet the requirements under this paragraph by July 1, 2023, are
ineligible for payment for services provided under sections 254B.05 and 256B.0625.
new text end
new text begin
(e) Tribally licensed programs may elect to participate in the demonstration project and
meet the requirements of subdivision 3. The Department of Human Services must consult
with tribal nations to discuss participation in the substance use disorder demonstration
project.
new text end
new text begin
(f) All rate enhancements for services rendered by demonstration project providers that
voluntarily enrolled before July 1, 2021, are applicable only to dates of service on or after
the effective date of the provider's enrollment in the demonstration project, except as
authorized under paragraph (g). The commissioner shall recoup any rate enhancements paid
under paragraph (g) to a provider that does not meet the requirements of subdivision 3 by
July 1, 2021.
new text end
new text begin
(g) The commissioner may allow providers enrolled in the demonstration project before
July 1, 2021, to receive applicable rate enhancements authorized under subdivision 4 for
services provided to fee-for-service enrollees on dates of service no earlier than July 22,
2020, and to managed care enrollees on dates of service no earlier than January 1, 2021, if:
new text end
new text begin
(1) the provider attests that during the time period for which it is seeking the rate
enhancement, it was taking meaningful steps and had a reasonable plan approved by the
commissioner to meet the demonstration project requirements in subdivision 3;
new text end
new text begin
(2) the provider submits the attestation and evidence of meeting the requirements of
subdivision 3, including all information requested by the commissioner, in a format specified
by the commissioner; and
new text end
new text begin
(3) the commissioner received the provider's application for enrollment on or before
June 1, 2021.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later, except paragraphs (f) and (g) are effective the day following final
enactment.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0759, subdivision 4, is amended to read:
Subd. 4.
Provider payment rates.
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirementsnew text begin , provider standards
under subdivision 3,new text end and provide evidence of formal referral arrangements with providers
delivering step-up or step-down levels of care.
new text begin
(b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the requirements in paragraph (a) are not
met. Payments withheld from the provider must be made once the commissioner determines
that the requirements in paragraph (a) are met.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clause (8), provided on or after July 1, 2020, payment rates must be increased
by deleted text begin 15deleted text end new text begin 30new text end percent over the rates in effect on December 31, 2019.
deleted text begin (c)deleted text end new text begin (d)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clauses (1), (6), and (7), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by deleted text begin tendeleted text end new text begin 25new text end percent over the rates
in effect on December 31, 2020.
deleted text begin (d)deleted text end new text begin (e)new text end Effective January 1, 2021, and contingent on annual federal approval, managed
care plans and county-based purchasing plans must reimburse providers of the substance
use disorder services meeting the criteria described in paragraph (a) who are employed by
or under contract with the plan an amount that is at least equal to the fee-for-service base
rate payment for the substance use disorder services described in paragraphs deleted text begin (b)deleted text end new text begin (c)new text end and deleted text begin (c)deleted text end new text begin
(d)new text end . The commissioner must monitor the effect of this requirement on the rate of access to
substance use disorder services and residential substance use disorder rates. Capitation rates
paid to managed care organizations and county-based purchasing plans must reflect the
impact of this requirement. This paragraph expires if federal approval is not received at any
time as required under this paragraph.
deleted text begin (e)deleted text end new text begin (f)new text end Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph deleted text begin (d)deleted text end new text begin (e)new text end applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph deleted text begin (d)deleted text end new text begin (e)new text end is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except the amendments to
the payment rate percentage increases in paragraphs (c) and (d) are effective January 1,
2022.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Data and outcome measures; public posting. new text end
new text begin
Beginning July 1, 2021, and at
least annually thereafter, all data and outcome measures from the previous year of the
demonstration project shall be posted publicly on the Department of Human Services website
in an accessible and user-friendly format.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Federal approval; demonstration project extension. new text end
new text begin
The commissioner shall
seek a five-year extension of the demonstration project under this section and to receive
enhanced federal financial participation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Demonstration project evaluation work group. new text end
new text begin
Beginning October 1, 2021,
the commissioner shall assemble a work group of relevant stakeholders, including but not
limited to demonstration project participants and the Minnesota Association of Resources
for Recovery and Chemical Health, that shall meet quarterly for the duration of the
demonstration to evaluate the long-term sustainability of any improvements to quality or
access to substance use disorder treatment services caused by participation in the
demonstration project. The work group shall also determine how to implement successful
outcomes of the demonstration project once the project expires.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 28.
new text begin
[256B.076] CASE MANAGEMENT SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) It is the policy of this state to ensure that individuals on
medical assistance receive cost-effective and coordinated care, including efforts to address
the profound effects of housing instability, food insecurity, and other social determinants
of health. Therefore, subject to federal approval, medical assistance covers targeted case
management services as described in this section.
new text end
new text begin
(b) The commissioner, in collaboration with tribes, counties, providers, and individuals
served, must propose further modifications to targeted case management services to ensure
a program that complies with all federal requirements, delivers services in a cost-effective
and efficient manner, creates uniform expectations for targeted case management services,
addresses health disparities, and promotes person- and family-centered services.
new text end
new text begin Subd. 2. new text end
new text begin Rate setting. new text end
new text begin
(a) The commissioner must develop and implement a statewide
rate methodology for any county that subcontracts targeted case management services to a
vendor. On January 1, 2022, or upon federal approval, whichever is later, a county must
use this methodology for any targeted case management services paid by medical assistance
and delivered through a subcontractor.
new text end
new text begin
(b) In setting this rate, the commissioner must include the following:
new text end
new text begin
(1) prevailing wages;
new text end
new text begin
(2) employee-related expense factor;
new text end
new text begin
(3) paid time off and training factors;
new text end
new text begin
(4) supervision and span of control;
new text end
new text begin
(5) distribution of time factor;
new text end
new text begin
(6) administrative factor;
new text end
new text begin
(7) absence factor;
new text end
new text begin
(8) program support factor; and
new text end
new text begin
(9) caseload sizes as described in subdivision 3.
new text end
new text begin
(c) A county may request that the commissioner authorize a rate based on a lower caseload
size when a subcontractor is assigned to serve individuals with needs, such as homelessness
or specific linguistic or cultural needs, that significantly exceed other eligible populations.
A county must include the following in the request:
new text end
new text begin
(1) the number of clients to be served by a full-time equivalent staffer;
new text end
new text begin
(2) the specific factors that require a case manager to provide significantly more hours
of reimbursable services to a client; and
new text end
new text begin
(3) how the county intends to monitor case size and outcomes.
new text end
new text begin
(d) The commissioner must adjust only the factor for caseload in paragraph (b), clause
(9), in response to a request under paragraph (c).
new text end
new text begin Subd. 3. new text end
new text begin Caseload sizes. new text end
new text begin
A county-subcontracted provider of targeted case management
services to the following populations must not exceed the following limits:
new text end
new text begin
(1) for children with severe emotional disturbance, 15 clients to one full-time equivalent
case manager;
new text end
new text begin
(2) for adults with severe and persistent mental illness, 30 clients to one full-time
equivalent case manager;
new text end
new text begin
(3) for child welfare targeted case management, 25 clients to one full-time equivalent
case manager; and
new text end
new text begin
(4) for vulnerable adults and adults who have developmental disabilities, 45 clients to
one full-time equivalent case manager.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:
Subd. 6.
Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
with the adult or the adult's legal representative, family, primary caregiver, or other relevant
persons identified as necessary to the development or implementation of the goals of the
personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate deleted text begin negotiated by the host countydeleted text end new text begin calculated in accordance with
section 256B.076, subdivision 2new text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged by
the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county may negotiate a team rate with a vendor who is a member
of the team. Thedeleted text end team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county, except to
reimburse the county for advance funding provided by the county to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.
(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.
(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
Sec. 30.
Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:
Subd. 6.
Medical assistance reimbursement of case management services.
(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the minimum standards in clauses (1) and (2):
(1) there must be a face-to-face contact at least once a month except as provided in clause
(2); and
(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face contact.
(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).
(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.
(d) Payment for case management provided by county deleted text begin or tribal social servicesdeleted text end contracted
vendors deleted text begin shall be based on a monthly rate negotiated by the host county or tribal social
servicesdeleted text end new text begin must be calculated in accordance with section 256B.076, subdivision 2. Payment
for case management provided by vendors who contract with a Tribe must be based on a
monthly rate negotiated by the Tribenew text end . The deleted text begin negotiateddeleted text end rate must not exceed the rate charged
by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the deleted text begin county or tribal social services may negotiate a team rate with a
vendor who is a member of the team. Thedeleted text end team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county or tribal social services, except to reimburse the county or tribal social services
for advance funding provided by the county or tribal social services to the vendor.
(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.
Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.
Sec. 31. new text begin DIRECTION TO THE COMMISSIONER; ADULT MENTAL HEALTH
INITIATIVES REFORM.
new text end
new text begin
In establishing a legislative proposal for reforming the funding formula to distribute
adult mental health initiative funds, the commissioner of human services shall ensure that
funding currently received as a result of the closure of the Moose Lake Regional Treatment
Center is not reallocated from any region that does not have a community behavioral health
hospital. Upon finalization of the adult mental health initiatives reform, the commissioner
shall notify the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services finance and policy.
new text end
Sec. 32. new text begin DIRECTION TO THE COMMISSIONER; ALTERNATIVE MENTAL
HEALTH PROFESSIONAL LICENSING PATHWAYS WORK GROUP.
new text end
new text begin
(a) The commissioners of human services and health must convene a work group
consisting of representatives from the Board of Psychology; the Board of Marriage and
Family Therapy; the Board of Social Work; the Board of Behavioral Health and Therapy;
five mental health providers from diverse cultural communities; a representative from the
Minnesota Council of Health Plans; a representative from a state health care program; two
representatives from mental health associations or community mental health clinics led by
individuals who are Black, indigenous, or people of color; and representatives from mental
health professional graduate programs to evaluate and make recommendations on possible
alternative pathways to mental health professional licensure in Minnesota. The work group
must:
new text end
new text begin
(1) identify barriers to licensure in mental health professions;
new text end
new text begin
(2) collect data on the number of individuals graduating from educational programs but
not passing licensing exams;
new text end
new text begin
(3) evaluate the feasibility of alternative pathways for licensure in mental health
professions, ensuring provider competency and professionalism; and
new text end
new text begin
(4) consult with national behavioral health testing entities.
new text end
new text begin
(b) Mental health providers participating in the work group may be reimbursed for
expenses in the same manner as authorized by the commissioner's plan adopted under
Minnesota Statutes, section 43A.18, subdivision 2, upon approval by the commissioner.
Members who, as a result of time spent attending work group meetings, incur child care
expenses that would not otherwise have been incurred, may be reimbursed for those expenses
upon approval by the commissioner. Reimbursements may be approved for no more than
five individual providers.
new text end
new text begin
(c) No later than February 1, 2023, the commissioners must submit a written report to
the members of the legislative committees with jurisdiction over health and human services
on the work group's findings and recommendations developed on alternative licensing
pathways.
new text end
Sec. 33. new text begin DIRECTION TO THE COMMISSIONER; CHILDREN'S MENTAL
HEALTH RESIDENTIAL TREATMENT WORK GROUP.
new text end
new text begin
The commissioner of human services, in consultation with counties, children's mental
health residential providers, and children's mental health advocates, must organize a work
group and develop recommendations on how to efficiently and effectively fund room and
board costs for children's mental health residential treatment under the children's mental
health act. The work group may also provide recommendations on how to address systemic
barriers in transitioning children into the community and community-based treatment options.
The commissioner shall submit the recommendations to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by February 15, 2022.
new text end
Sec. 34. new text begin DIRECTION TO THE COMMISSIONER; CULTURALLY AND
LINGUISTICALLY APPROPRIATE SERVICES.
new text end
new text begin
The commissioner of human services, in consultation with substance use disorder
treatment providers, lead agencies, and individuals who receive substance use disorder
treatment services, shall develop a statewide implementation and transition plan for culturally
and linguistically appropriate services (CLAS) national standards, including technical
assistance for providers to transition to the CLAS standards and to improve disparate
treatment outcomes. The commissioner must consult with individuals who are Black,
indigenous, people of color, and linguistically diverse in the development of the
implementation and transition plans under this section.
new text end
Sec. 35. new text begin DIRECTION TO THE COMMISSIONER; RATE RECOMMENDATIONS
FOR OPIOID TREATMENT PROGRAMS.
new text end
new text begin
The commissioner of human services shall evaluate the rate structure for opioid treatment
programs licensed under Minnesota Statutes, section 245G.22, and report recommendations,
including a revised rate structure and proposed draft legislation, to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance by October 1, 2021.
new text end
Sec. 36. new text begin DIRECTION TO THE COMMISSIONER; SOBER HOUSING PROGRAM
RECOMMENDATIONS.
new text end
new text begin
(a) The commissioner of human services, in consultation with stakeholders, must develop
recommendations on:
new text end
new text begin
(1) increasing access to sober housing programs;
new text end
new text begin
(2) promoting person-centered practices and cultural responsiveness in sober housing
programs;
new text end
new text begin
(3) potential oversight of sober housing programs; and
new text end
new text begin
(4) providing consumer protections for individuals in sober housing programs with
substance use disorders and individuals with co-occurring mental illnesses.
new text end
new text begin
(b) Stakeholders include but are not limited to the Minnesota Association of Sober
Homes, the Minnesota Association of Resources for Recovery and Chemical Health,
Minnesota Recovery Connection, NAMI Minnesota, the National Alliance of Recovery
Residencies (NARR), Oxford Houses, Inc., sober housing programs based in Minnesota
that are not members of the Minnesota Association of Sober Homes, a member of Alcoholics
Anonymous, and residents and former residents of sober housing programs based in
Minnesota. Stakeholders must equitably represent various geographic areas of the state and
must include individuals in recovery and providers representing Black, indigenous, people
of color, or immigrant communities.
new text end
new text begin
(c) The commissioner must complete and submit a report on these recommendations to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services policy and finance on or before March 1, 2022.
new text end
Sec. 37. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PAPERWORK REDUCTION.
new text end
new text begin
(a) The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment professional associations, and other
relevant stakeholders, shall develop, assess, and recommend systems improvements to
minimize regulatory paperwork and improve systems for substance use disorder programs
licensed under Minnesota Statutes, chapter 245A, and regulated under Minnesota Statutes,
chapters 245F and 245G, and Minnesota Rules, chapters 2960 and 9530. The commissioner
of human services shall make available any resources needed from other divisions within
the department to implement systems improvements.
new text end
new text begin
(b) The commissioner of health shall make available needed information and resources
from the Division of Health Policy.
new text end
new text begin
(c) The Office of MN.IT Services shall provide advance consultation and implementation
of the changes needed in data systems.
new text end
new text begin
(d) The commissioner of human services shall contract with a vendor that has experience
with developing statewide system changes for multiple states at the payer and provider
levels. If the commissioner, after exercising reasonable diligence, is unable to secure a
vendor with the requisite qualifications, then the commissioner may select the best qualified
vendor available. When developing recommendations, the commissioner shall consider
input from all stakeholders. The commissioner's recommendations shall maximize benefits
for clients and utility for providers, regulatory agencies, and payers.
new text end
new text begin
(e) The commissioner of human services and contracted vendor shall follow the
recommendations from the report issued in response to Laws 2019, First Special Session
chapter 9, article 6, section 76.
new text end
new text begin
(f) By December 15, 2022, the commissioner of human services shall take steps to
implement paperwork reductions and systems improvements within the commissioner's
authority and submit to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services a report that includes recommendations
for changes in statutes that would further enhance systems improvements to reduce
paperwork. The report shall include a summary of the approaches developed and assessed
by the commissioner of human services and stakeholders and the results of any assessments
conducted.
new text end
Sec. 38. new text begin DIRECTION TO THE COMMISSIONER; TRIBAL OVERPAYMENT
PROTOCOLS.
new text end
new text begin
The commissioner of human services, in consultation with the Tribal nations, shall
develop protocols that must be used to address and attempt to resolve any future overpayment
involving any Tribal nation in Minnesota.
new text end
Sec. 39. new text begin SUBSTANCE USE DISORDER TREATMENT RATE RESTRUCTURE
ANALYSIS.
new text end
new text begin
(a) By January 1, 2022, the commissioner shall issue a request for proposals for
frameworks and modeling of substance use disorder rates. Rates must be predicated on a
uniform methodology that is transparent, culturally responsive, supports staffing needed to
treat a patient's assessed need, and promotes quality service delivery and patient choice.
The commissioner must consult with substance use disorder treatment programs across the
spectrum of services, substance use disorder treatment programs from across each region
of the state, and culturally responsive providers in the development of the request for proposal
process and for the duration of the contract.
new text end
new text begin
(b) By January 15, 2023, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance on the results of the vendor's work. The report must
include legislative language necessary to implement a new substance use disorder treatment
rate methodology and a detailed fiscal analysis.
new text end
Sec. 40. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall replace "EXCELLENCE IN MENTAL HEALTH
DEMONSTRATION PROJECT" with "CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINIC SERVICES" in the section headnote for Minnesota Statutes, section
245.735.
new text end
Sec. 41. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.0596,
new text end
new text begin
is repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, and 4,
new text end
new text begin
are repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2020, section 245.4871, subdivision 32a,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (c) is effective September 30, 2021.
new text end
ARTICLE 13
DIRECT CARE AND TREATMENT
Section 1.
Minnesota Statutes 2020, section 246.54, subdivision 1b, is amended to read:
Subd. 1b.
Community behavioral health hospitals.
A county's payment of the cost of
care provided at state-operated community-based behavioral health hospitalsnew text begin for adults and
childrennew text end shall be according to the following schedule:
(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and
(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.
ARTICLE 14
DISABILITY SERVICES AND CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the deleted text begin commissioner of healthdeleted text end new text begin federal databasenew text end MDS assessments that conform with
the assessment schedule defined by deleted text begin Code of Federal Regulations, title 42, section 483.20,
and published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, indeleted text end the Long Term Carenew text begin Facility Residentnew text end Assessment
Instrument User's Manual, version 3.0,deleted text begin and subsequent updates whendeleted text end new text begin or its successornew text end issued
by the Centers for Medicare and Medicaid Services. The commissioner of health may
substitute successor manuals or question and answer documents published by the United
States Department of Health and Human Services, Centers for Medicare and Medicaid
Services, to replace or supplement the current version of the manual or document.
(b) The assessments new text begin required under the Omnibus Budget Reconciliation Act of 1987
(OBRA) new text end used to determine a case mix classification for reimbursement include the following:
(1) a new admissionnew text begin comprehensivenew text end assessmentnew text begin , which must have an assessment reference
date (ARD) within 14 calendar days after admission, excluding readmissionsnew text end ;
(2) an annual new text begin comprehensive new text end assessmentnew text begin ,new text end which must have an deleted text begin assessment reference date
(ARD)deleted text end new text begin ARDnew text end within 92 days of deleted text begin thedeleted text end new text begin anew text end previousnew text begin quarterly reviewnew text end assessment deleted text begin and thedeleted text end new text begin or anew text end
previous comprehensive assessmentnew text begin , which must occur at least once every 366 daysnew text end ;
(3) a significant change in statusnew text begin comprehensivenew text end assessmentnew text begin , whichnew text end must deleted text begin be completeddeleted text end new text begin
have an ARDnew text end within 14 days deleted text begin of the identification ofdeleted text end new text begin after the facility determines, or should
have determined, that there has beennew text end a significant changenew text begin in the resident's physical or mental
conditionnew text end , whethernew text begin annew text end improvement or new text begin a new text end decline, and regardless of the amount of time since
the last deleted text begin significant change in statusdeleted text end new text begin comprehensivenew text end assessmentnew text begin or quarterly review
assessmentnew text end ;
(4) deleted text begin alldeleted text end new text begin anew text end quarterly deleted text begin assessmentsdeleted text end new text begin review assessmentnew text end must have an deleted text begin assessment reference
date (ARD)deleted text end new text begin ARDnew text end within 92 days of the ARD of the previousnew text begin quarterly review assessment
or a previous comprehensivenew text end assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; deleted text begin and
deleted text end
(6) any significant correction to a prior quarterlynew text begin reviewnew text end assessment, if the assessment
being corrected is the current one being used for RUG classificationdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) a required significant change in status assessment when:
new text end
new text begin
(i) all speech, occupational, and physical therapies have ended. The ARD of this
assessment must be set on day eight after all therapy services have ended; and
new text end
new text begin
(ii) isolation for an infectious disease has ended. The ARD of this assessment must be
set on day 15 after isolation has ended; and
new text end
new text begin
(8) any modifications to the most recent assessments under clauses (1) to (7).
new text end
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
Sec. 2.
Minnesota Statutes 2020, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end
(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agencydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 and residing in the
customized living setting before July 1, 2022, for which a license is required. A customized
living service provider subject to this exception may rebut the presumption that a license
is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
new text end
new text begin
(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
new text end
new text begin
(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
new text end
new text begin
(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
new text end
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.
(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.
(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256.9741, subdivision 1, is amended to read:
Subdivision 1.
Long-term care facility.
"Long-term care facility" means a nursing home
licensed under sections 144A.02 to 144A.10; a boarding care home licensed under sections
144.50 to 144.56; an assisted living facility or an assisted living facility with dementia care
licensed under chapter 144G; deleted text begin ordeleted text end a licensed or registered residential setting that provides or
arranges for the provision of home care servicesnew text begin ; or a setting defined under section 144G.08,
subdivision 7, clauses (10) to (13), that provides or arranges for the provision of home care
servicesnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.0659, is amended by adding a subdivision
to read:
new text begin Subd. 11b. new text end
new text begin Personal care assistants; notice of change of employment required. new text end
new text begin
Within
six months of ceasing employment as a personal care assistant with any personal care
assistance provider agency, the personal care assistant must notify the commissioner on a
form prescribed by the commissioner that the personal care assistant is no longer providing
personal care assistance services on behalf of a personal care assistance provider agency
with whom the personal care assistant was previously affiliated.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256B.0659, is amended by adding a subdivision
to read:
new text begin Subd. 14a. new text end
new text begin Documentation of qualified professional services provided. new text end
new text begin
Qualified
professional services for a recipient must be documented in a manner determined by the
commissioner and must include the qualified professional's full name and individual provider
number.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256B.0659, subdivision 21, is amended to read:
Subd. 21.
Requirements for provider enrollment of personal care assistance provider
agencies.
(a) All personal care assistance provider agencies must provide, at the time of
enrollmentdeleted text begin , reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissionerdeleted text end new text begin as a personal care assistance provider agency,
including at reenrollment or revalidationnew text end , information and documentation deleted text begin that includes,deleted text end new text begin .
The information and documentation must be in a format determined by the commissioner
and includenew text end but deleted text begin isdeleted text end notnew text begin benew text end limited todeleted text begin , the followingdeleted text end :
(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;
(2) proof of surety bond coverage for each business location providing services. Upon
new enrollment, or if the provider's Medicaid revenue in the previous calendar year is up
to and including $300,000, the provider agency must purchase a surety bond of $50,000. If
the Medicaid revenue in the previous year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000 for each business location
providing service;
(4) proof of workers' compensation insurance coverage identifying the business location
where personal care assistance services are provided;
(5) proof of liability insurance coverage identifying the business location where personal
care assistance services are provided and naming the department as a certificate holder;
(6) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
new text begin identification, prevention, detection, and reporting of fraud or any billing, record-keeping,
or other administrative noncompliance; new text end and employee and consumer safety including process
for notification and resolution of consumer grievances, identification and prevention of
communicable diseases, and employee misconduct;
(7) copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:
(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;
(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and
(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;
(8) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
(9) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section, including the requirements
under subdivision 11, paragraph (d), if enhanced personal care assistance services are
provided and submitted for an enhanced rate under subdivision 17a;
(10) documentation of the agency's marketing practices;
(11) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;
(12) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; deleted text begin and
deleted text end
(13) deleted text begin effective May 15, 2010,deleted text end documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signeddeleted text begin .deleted text end new text begin ;
new text end
new text begin
(14) a copy of the personal care assistance provider agency's self-auditing policy and
other materials demonstrating the personal care assistance provider agency's internal program
integrity procedures;
new text end
new text begin
(15) a copy of the personal care assistance provider agency's policy for notifying its
qualified professionals of the qualified professional's obligation to notify the commissioner
within 30 days that a qualified professional is no longer employed by the agency; and
new text end
new text begin
(16) a copy of the personal care assistance provider agency's policy for notifying the
commissioner within six months that a personal care assistant is no longer employed by the
agency.
new text end
new text begin
(b) All personal care assistance provider agencies must provide annually to the
commissioner the information described in paragraph (a), clauses (2) to (5).
new text end
deleted text begin (b)deleted text end new text begin (c)new text end Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. deleted text begin The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.
deleted text end
deleted text begin (c)deleted text end new text begin (d)new text end All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before submitting an application for enrollment of the
agency as a provider. new text begin The mandatory training, or any substantially similar refresher training
developed by the commissioner, must be completed every two years thereafter. new text end All personal
care assistance provider agencies shall also require qualified professionals to complete the
training required by subdivision 13 before submitting an application for enrollment of the
agency as a provider. Employees in management and supervisory positions and owners who
are active in the day-to-day operations of an agency who have completed the required
training as an employee with a personal care assistance provider agency do not need to
repeat the required training if they are hired by another agency, if they have completed the
training within the past deleted text begin threedeleted text end new text begin twonew text end years. deleted text begin By September 1, 2010,deleted text end The required training must
be available with meaningful access according to title VI of the Civil Rights Act and federal
regulations adopted under that law or any guidance from the United States Health and
Human Services Department. The required training must be available online or by electronic
remote connection. The required training must provide for competency testing. Personal
care assistance provider agency billing staff shall complete training about personal care
assistance program financial management. deleted text begin This training is effective July 1, 2009. Any
personal care assistance provider agency enrolled before that date shall, if it has not already,
complete the provider training within 18 months of July 1, 2009.deleted text end Any new owners or
employees in management and supervisory positions involved in the day-to-day operations
are required to complete mandatory training as a requisite of working for the agency. Personal
care assistance provider agencies certified for participation in Medicare as home health
agencies are exempt from the training required in this subdivision. When available,
Medicare-certified home health agency owners, supervisors, or managers must successfully
complete the competency test.
deleted text begin (d)deleted text end new text begin (e)new text end All surety bonds, fidelity bonds, workers' compensation insurance, and liability
insurance required by this subdivision must be maintained continuously. After initial
enrollment, a provider must submit proof of bonds and required coverages at any time at
the request of the commissioner. Services provided while there are lapses in coverage are
not eligible for payment. Lapses in coverage may result in sanctions, including termination.
The commissioner shall send instructions and a due date to submit the requested information
to the personal care assistance provider agency.
new text begin
(f) Personal care assistance provider agencies enrolling for the first time must also
provide, at the time of enrollment as a personal care assistance provider agency in a format
determined by the commissioner, information and documentation. The information and
documentation must include proof of sufficient initial operating capital to support the
infrastructure necessary to allow for ongoing compliance with the requirements of this
section. Sufficient operating capital may be demonstrated as follows:
new text end
new text begin
(1) copies of business bank account statements showing at least $5,000 in cash reserves;
new text end
new text begin
(2) proof of a cash reserve or business line of credit sufficient to equal two payrolls of
the agency's current or projected business; or
new text end
new text begin
(3) any other manner prescribed by the commissioner.
new text end
new text begin
(g) At the time of revalidation as a personal care assistance provider agency, all personal
care assistance provider agencies must provide information and documentation in a format
determined by the commissioner that includes but is not limited to the following:
new text end
new text begin
(1) documentation of the payroll paid for the preceding 12 months or other time period
as prescribed by the commissioner; and
new text end
new text begin
(2) financial statements demonstrating compliance with the use of revenue requirements
of paragraph (a), clause (12).
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0659, subdivision 24, is amended to read:
Subd. 24.
Personal care assistance provider agency; general duties.
A personal care
assistance provider agency shall:
(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;
(2) comply with general medical assistance coverage requirements;
(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;
(4) comply with background study requirements;
(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;
(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;
(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;
(8) withhold and pay all applicable federal and state taxes;
(9) document that the agency uses a minimum of 72.5 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits. The revenue generated by the qualified professional and
the reasonable costs associated with the qualified professional shall not be used in making
this calculation;
(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
(11) enter into a written agreement under subdivision 20 before services are provided;
(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;
(13) provide the recipient with a copy of the home care bill of rights at start of service;
(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissioner;
(15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; deleted text begin and
deleted text end
(16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the deleted text begin PCAsdeleted text end new text begin personal care assistantsnew text end whose
services meet the requirements under subdivision 11, paragraph (d)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(17) notify the commissioner on a form prescribed by the commissioner within 30 days
following the date upon which a qualified professional is no longer employed by or otherwise
affiliated with the personal care assistance provider agency for whom the qualified
professional previously provided qualified professional services; and
new text end
new text begin
(18) notify the commissioner on a form prescribed by the commissioner within six
months following the date upon which a personal care assistant is no longer employed by
or otherwise affiliated with the personal care assistance provider agency for whom the
personal care assistant previously provided personal care assistance services.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. Face-to-face
assessments must be conducted according to paragraphs (b) to (i).
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) The assessment must be conducted by a certified assessor in a face-to-face
conversational interview with the person being assessed. The person's legal representative
must provide input during the assessment process and may do so remotely if requested. At
the request of the person, other individuals may participate in the assessment to provide
information on the needs, strengths, and preferences of the person necessary to develop a
community support plan that ensures the person's health and safety. Except for legal
representatives or family members invited by the person, persons participating in the
assessment may not be a provider of service or have any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living or adult
day services under chapter 256S, with the permission of the person being assessed or the
person's designated or legal representative, the client's current or proposed provider of
services may submit a copy of the provider's nursing assessment or written report outlining
its recommendations regarding the client's care needs. The person conducting the assessment
must notify the provider of the date by which this information is to be submitted. This
information shall be provided to the person conducting the assessment prior to the assessment.
For a person who is to be assessed for waiver services under section 256B.092 or 256B.49,
with the permission of the person being assessed or the person's designated legal
representative, the person's current provider of services may submit a written report outlining
recommendations regarding the person's care needs the person completed in consultation
with someone who is known to the person and has interaction with the person on a regular
basis. The provider must submit the report at least 60 days before the end of the person's
current service agreement. The certified assessor must consider the content of the submitted
report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) Face-to-face assessment completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.
new text begin
(n) If a person who receives home- and community-based waiver services under section
256B.0913, 256B.092, or 256B.49, or chapter 256S, temporarily enters for 121 days or less
a hospital, institution of mental disease, nursing facility, intensive residential treatment
services program, transitional care unit, or inpatient substance use disorder treatment setting,
the person may return to the community with home- and community-based waiver services
under the same waiver, without requiring an assessment or reassessment under this section,
unless the person's annual reassessment is otherwise due. Nothing in this section shall change
annual long-term care consultation reassessment requirements, payment for institutional or
treatment services, medical assistance financial eligibility, or any other law.
new text end
deleted text begin (n)deleted text end new text begin (o)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver residential supports and services currently residing in a community
residential setting, licensed adult foster care home that is either not the primary residence
of the license holder or in which the license holder is not the primary caregiver, family adult
foster care residence, customized living setting, or supervised living facility to determine
if that person would prefer to be served in a community-living setting as defined in section
256B.49, subdivision 23, in a setting not controlled by a provider, or to receive integrated
community supports as described in section 245D.03, subdivision 1, paragraph (c), clause
(8). The certified assessor shall offer the person, through a person-centered planning process,
the option to receive alternative housing and service options.
deleted text begin (o)deleted text end new text begin (p)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver day services to determine if that person would prefer to receive employment
services as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7).
The certified assessor shall describe to the person through a person-centered planning process
the option to receive employment services.
deleted text begin (p)deleted text end new text begin (q)new text end At the time of reassessment, the certified assessor shall assess each person
receiving non-self-directed waiver services to determine if that person would prefer an
available service and setting option that would permit self-directed services and supports.
The certified assessor shall describe to the person through a person-centered planning process
the option to receive self-directed services and supports.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.092, subdivision 4, is amended to read:
Subd. 4.
Home and community-based services for developmental disabilities.
(a)
The commissioner shall make payments to approved vendors participating in the medical
assistance program to pay costs of providing home and community-based services, including
case management service activities provided as an approved home and community-based
service, to medical assistance eligible persons with developmental disabilities who have
been screened under subdivision 7 and according to federal requirements. Federal
requirements include those services and limitations included in the federally approved
application for home and community-based services for persons with developmental
disabilities and subsequent amendments.
deleted text begin
(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental disabilities
authorized but not receiving those services as of June 30, 1995, based upon the average
resource need of persons with similar functional characteristics. To ensure service continuity
for service recipients receiving home and community-based waivered services for persons
with developmental disabilities prior to July 1, 1995, the commissioner shall make available
to the county of financial responsibility home and community-based waivered services
resources based upon fiscal year 1995 authorized levels.
deleted text end
deleted text begin
(c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers for the elderly authorized
under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.092, subdivision 5, is amended to read:
Subd. 5.
Federal waivers.
(a) The commissioner shall apply for any federal waivers
necessary to secure, to the extent allowed by law, federal financial participation under United
States Code, title 42, sections 1396 et seq., as amended, for the provision of services to
persons who, in the absence of the services, would need the level of care provided in a
regional treatment center or a community intermediate care facility for persons with
developmental disabilities. The commissioner may seek amendments to the waivers or apply
for additional waivers under United States Code, title 42, sections 1396 et seq., as amended,
to contain costs. The commissioner shall ensure that payment for the cost of providing home
and community-based alternative services under the federal waiver plan shall not exceed
the cost of intermediate care services including day training and habilitation services that
would have been provided without the waivered services.
The commissioner shall seek an amendment to the 1915c home and community-based
waiver to allow properly licensed adult foster care homes to provide residential services to
up to five individuals with developmental disabilities. If the amendment to the waiver is
approved, adult foster care providers that can accommodate five individuals shall increase
their capacity to five beds, provided the providers continue to meet all applicable licensing
requirements.
(b) The commissioner, in administering home and community-based waivers for persons
with developmental disabilities, shall ensure that day services for eligible persons are not
provided by the person's residential service provider, unless the person or the person's legal
representative is offered a choice of providers and agrees in writing to provision of day
services by the residential service provider. The coordinated service and support plan for
individuals who choose to have their residential service provider provide their day services
must describe how health, safety, protection, and habilitation needs will be met, including
how frequent and regular contact with persons other than the residential service provider
will occur. The coordinated service and support plan must address the provision of services
during the day outside the residence on weekdays.
(c) When a lead agency is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.0916 for an individual, the lead agency shall
offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the coordinated service and support plan. The reduction
in the authorized services for an individual due to changes in funding for waivered services
may not exceed the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.
new text begin
(d) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
new text end
new text begin
(e) The transition to two disability home and community-based services waiver programs
must align with the independent living first policy under section 256B.4905. Unless
superseded by any other state or federal law, waiver eligibility criteria shall be the same for
each waiver. The waiver program that a person uses shall be determined by the support
planning process and whether the person chooses to live in a provider-controlled setting or
in the person's own home.
new text end
new text begin
(f) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 90 days after federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.092, subdivision 12, is amended to read:
Subd. 12.
deleted text begin Waivereddeleted text end new text begin Waivernew text end services statewide priorities.
(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for developmental disabilities
(DD) waiver services, as of January 1, 2010. The statewide priorities must include, but are
not limited to, individuals who continue to have a need for waiver services after they have
maximized the use of state plan services and other funding resources, including natural
supports, prior to accessing waiver services, and who meet at least one of the following
criteria:
(1) no longer require the intensity of services provided where they are currently living;
or
(2) make a request to move from an institutional setting.
(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:
(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;
(2) are moving from an institution due to bed closures;
(3) experience a sudden closure of their current living arrangement;
(4) require protection from confirmed abuse, neglect, or exploitation;
(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or
(6) meet other priorities established by the department.
(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end
Sec. 12.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Regional quality councils and systems improvement. new text end
new text begin
The commissioner of
human services shall maintain the regional quality councils initially established under
Minnesota Statutes 2020, section 256B.097, subdivision 4. The regional quality councils
shall:
new text end
new text begin
(1) support efforts and initiatives that drive overall systems and social change to promote
inclusion of people who have disabilities in the state of Minnesota;
new text end
new text begin
(2) improve person-centered outcomes in disability services; and
new text end
new text begin
(3) identify or enhance quality of life indicators for people who have disabilities.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Membership and staff. new text end
new text begin
(a) Regional quality councils shall be comprised of
key stakeholders including, but not limited to:
new text end
new text begin
(1) individuals who have disabilities;
new text end
new text begin
(2) family members of people who have disabilities;
new text end
new text begin
(3) disability service providers;
new text end
new text begin
(4) disability advocacy groups;
new text end
new text begin
(5) lead agency staff; and
new text end
new text begin
(6) staff of state agencies with jurisdiction over special education and disability services.
new text end
new text begin
(b) Membership in a regional quality council must be representative of the communities
in which the council operates, with an emphasis on individuals with lived experience from
diverse racial and cultural backgrounds.
new text end
new text begin
(c) Each regional quality council may hire staff to perform the duties assigned in
subdivision 9.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Duties. new text end
new text begin
(a) Each regional quality council shall:
new text end
new text begin
(1) identify issues and barriers that impede Minnesotans who have disabilities from
optimizing choice of home and community-based services;
new text end
new text begin
(2) promote informed decision making, autonomy, and self-direction;
new text end
new text begin
(3) analyze and review quality outcomes and critical incident data, and immediately
report incidents of life safety concerns to the Department of Human Services Licensing
Division;
new text end
new text begin
(4) inform a comprehensive system for effective incident reporting, investigation, analysis,
and follow-up;
new text end
new text begin
(5) collaborate on projects and initiatives to advance priorities shared with state agencies,
lead agencies, educational institutions, advocacy organizations, community partners, and
other entities engaged in disability service improvements;
new text end
new text begin
(6) establish partnerships and working relationships with individuals and groups in the
regions;
new text end
new text begin
(7) identify and implement regional and statewide quality improvement projects;
new text end
new text begin
(8) transform systems and drive social change in alignment with the disability rights and
disability justice movements identified by leaders who have disabilities;
new text end
new text begin
(9) provide information and training programs for persons who have disabilities and
their families and legal representatives on formal and informal support options and quality
expectations;
new text end
new text begin
(10) make recommendations to state agencies and other key decision-makers regarding
disability services and supports;
new text end
new text begin
(11) submit every two years a report to committees with jurisdiction over disability
services on the status, outcomes, improvement priorities, and activities in the region;
new text end
new text begin
(12) support people by advocating to resolve complaints between the counties, providers,
persons receiving services, and their families and legal representatives; and
new text end
new text begin
(13) recruit, train, and assign duties to regional quality council teams, including council
members, interns, and volunteers, taking into account the skills necessary for the team
members to be successful in this work.
new text end
new text begin
(b) Each regional quality council may engage in quality improvement initiatives related
to but not limited to:
new text end
new text begin
(1) the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
including brain injuries and services for those persons who qualify for nursing facility level
of care or hospital facility level of care and any other services licensed under chapter 245D;
new text end
new text begin
(2) home care services under section 256B.0651;
new text end
new text begin
(3) family support grants under section 252.32;
new text end
new text begin
(4) consumer support grants under section 256.476;
new text end
new text begin
(5) semi-independent living services under section 252.275; and
new text end
new text begin
(6) services provided through an intermediate care facility for persons with developmental
disabilities.
new text end
new text begin
(c) Each regional quality council's work must be informed and directed by the needs
and desires of persons who have disabilities in the region in which the council operates.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Compensation. new text end
new text begin
(a) A member of a regional quality council who does not
receive a salary or wages from an employer may be paid a per diem and reimbursed for
expenses related to the member's participation in efforts and initiatives described in
subdivision 9 in the same manner and in an amount not to exceed the amount authorized
by the commissioner's plan adopted under section 43A.18, subdivision 2.
new text end
new text begin
(b) Regional quality councils may charge fees for their services.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision
to read:
new text begin Subd. 3c. new text end
new text begin
Contact information for consumer surveys for nursing facilities and home
and community-based services.
new text end
new text begin
For purposes of conducting the consumer surveys under
subdivisions 3 and 3a, the commissioner may request contact information of clients and
associated key representatives. Providers must furnish the contact information available to
the provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision
to read:
new text begin Subd. 3d. new text end
new text begin
Resident experience survey and family survey for assisted living
facilities.
new text end
new text begin
The commissioner shall develop and administer a resident experience survey for
assisted living facility residents and a family survey for families of assisted living facility
residents. Money appropriated to the commissioner to administer the resident experience
survey and family survey is available in either fiscal year of the biennium in which it is
appropriated.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.49, subdivision 11, is amended to read:
Subd. 11.
Authority.
(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the new text begin federal new text end Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:
(1) promote the support of persons with disabilities in the most integrated settings;
(2) expand the availability of services for persons who are eligible for medical assistance;
(3) promote cost-effective options to institutional care; and
(4) obtain federal financial participation.
(b) The provision of deleted text begin waivereddeleted text end new text begin waivernew text end services to medical assistance recipients with
disabilities shall comply with the requirements outlined in the federally approved applications
for home and community-based services and subsequent amendments, including provision
of services according to a service plan designed to meet the needs of the individual. For
purposes of this section, the approved home and community-based application is considered
the necessary federal requirement.
(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.
(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
new text begin federal new text end Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.
(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.
(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.
new text begin
(g) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.
new text end
new text begin
(h) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 90 days after federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.49, subdivision 11a, is amended to read:
Subd. 11a.
deleted text begin Waivereddeleted text end new text begin Waivernew text end services statewide priorities.
(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for community alternative
care, community access for disability inclusion, and brain injury waiver services, as of
January 1, 2010. The statewide priorities must include, but are not limited to, individuals
who continue to have a need for waiver services after they have maximized the use of state
plan services and other funding resources, including natural supports, prior to accessing
waiver services, and who meet at least one of the following criteria:
(1) no longer require the intensity of services provided where they are currently living;
or
(2) make a request to move from an institutional setting.
(b) After the priorities in paragraph (a) are met, priority must also be given to individuals
who meet at least one of the following criteria:
(1) have unstable living situations due to the age, incapacity, or sudden loss of the primary
caregivers;
(2) are moving from an institution due to bed closures;
(3) experience a sudden closure of their current living arrangement;
(4) require protection from confirmed abuse, neglect, or exploitation;
(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or
(6) meet other priorities established by the department.
(c) When allocating new text begin new enrollment new text end resources to lead agencies, the commissioner must
take into consideration the number of individuals waiting who meet statewide priorities deleted text begin and
the lead agencies' current use of waiver funds and existing service optionsdeleted text end . deleted text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary base
level reserve amount for each county, group of counties, and tribe.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256B.49, subdivision 17, is amended to read:
Subd. 17.
Cost of services and supports.
(a) The commissioner shall ensure that the
average per capita expenditures estimated in any fiscal year for home and community-based
waiver recipients does not exceed the average per capita expenditures that would have been
made to provide institutional services for recipients in the absence of the waiver.
deleted text begin
(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based waivered
service resources available to support recipients with disabilities in need of the level of care
provided in a nursing facility or a hospital. The commissioner shall allocate resources to
single counties and county partnerships in a manner that reflects consideration of:
deleted text end
deleted text begin
(1) an incentive-based payment process for achieving outcomes;
deleted text end
deleted text begin
(2) the need for a state-level risk pool;
deleted text end
deleted text begin
(3) the need for retention of management responsibility at the state agency level; and
deleted text end
deleted text begin
(4) a phase-in strategy as appropriate.
deleted text end
deleted text begin
(c) Until the allocation methods described in paragraph (b) are implemented, the annual
allowable reimbursement level of home and community-based waiver services shall be the
greater of:
deleted text end
deleted text begin
(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of any
provider rate increase appropriated for home and community-based services; or
deleted text end
deleted text begin
(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The increased
reimbursement level must be necessary to allow the recipient to be discharged from an
institution or to prevent imminent placement in an institution. The additional reimbursement
may be used to secure environmental modifications; assistive technology and equipment;
and increased costs for supervision, training, and support services necessary to address the
recipient's extraordinary needs. The commissioner may approve an increased reimbursement
level for up to one year of the recipient's relocation from an institution or up to six months
of a determination that a current waiver recipient is at imminent risk of being placed in an
institution.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end Beginning July 1, 2001, medically necessary home care nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
to 256B.0654 and 256B.0659. The rate established by the commissioner for registered nurse
or licensed practical nurse services under any home and community-based waiver as of
January 1, 2001, shall not be reduced.
deleted text begin (e)deleted text end new text begin (c)new text end Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care services,
the county must negotiate a revised per diem rate for room and board and waiver services
that reflects the legislated rate reduction and results in an overall average per diem reduction
for all foster care recipients in that home. The revised per diem must allow the provider to
maintain, as much as possible, the level of services or enhanced services provided in the
residence, while mitigating the losses of the legislated rate reduction.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin
Customized living moratorium for brain injury and community access
for disability inclusion waivers.
new text end
new text begin
(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), the commissioner shall not enroll new customized living settings
serving four or fewer people in a single-family home to deliver customized living services
as defined under the brain injury or community access for disability inclusion waiver plans
under section 256B.49 to prevent new developments of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14.
new text end
new text begin
(b) The commissioner may approve an exception to paragraph (a) when:
new text end
new text begin
(1) a customized living setting with a change in ownership at the same address is in
existence and operational on or before June 30, 2021; and
new text end
new text begin
(2) a customized living setting is serving four or fewer people in a multiple-family
dwelling if each person has a personal self-contained living unit that contains living, sleeping,
eating, cooking, and bathroom areas.
new text end
new text begin
(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.
new text end
new text begin
(d) For any new customized living settings operational on or after July 1, 2021, serving
four or fewer people in a single-family home to deliver customized living services as defined
in paragraph (a), the authorizing lead agency is financially responsible for all home and
community-based service payments in the setting.
new text end
new text begin
(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person on or before June 30, 2021, in the customized living
setting.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021. This section applies only
to customized living services as defined under the brain injury or community access for
disability inclusion waiver plans under Minnesota Statutes, section 256B.49.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);
(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);
(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employersdeleted text begin , except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employersdeleted text end ;
(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);
(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).
(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin
(c) Component values for family foster care are:
deleted text end
deleted text begin
(1) competitive workforce factor: 4.7 percent;
deleted text end
deleted text begin
(2) supervisory span of control ratio: 11 percent;
deleted text end
deleted text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end
deleted text begin
(4) employee-related cost ratio: 23.6 percent;
deleted text end
deleted text begin
(5) general administrative support ratio: 3.3 percent;
deleted text end
deleted text begin
(6) program-related expense ratio: 1.3 percent; and
deleted text end
deleted text begin
(7) absence factor: 1.7 percent.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end Component values for day training and habilitation, day support services, and
prevocational services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: ten percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
new text begin
(d) Component values for day support services and prevocational services delivered
remotely are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 5.6 percent;
new text end
new text begin
(6) client programming and support ratio: 7.67 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 1.8 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 9.4 percent.
new text end
(e) Component values for adult day services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: 7.4 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
(f) Component values for unit-based services with programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan supports ratio: 15.5 percent;
(6) client programming and supports ratio: 4.7 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 6.1 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(g) Component values for unit-based services with programming delivered remotely
are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan supports ratio: 5.6 percent;
new text end
new text begin
(6) client programming and supports ratio: 1.53 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 6.1 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (g)deleted text end new text begin (h)new text end Component values for unit-based services without programming except respite
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 7.0 percent;
(6) client programming and support ratio: 2.3 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 2.9 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(i) Component values for unit-based services without programming delivered remotely,
except respite, are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 1.3 percent;
new text end
new text begin
(6) client programming and support ratio: 1.14 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 2.9 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (h)deleted text end new text begin (j)new text end Component values for unit-based services without programming for respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 2.9 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin (i)deleted text end new text begin (k)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.
deleted text begin (j)deleted text end new text begin (l)new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:
(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
(3) workforce data as required under subdivision 10a, paragraph (g).
The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
deleted text begin (k)deleted text end new text begin (m)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (6); paragraph deleted text begin (e)deleted text end new text begin (d)new text end , clause (6);
paragraph deleted text begin (f)deleted text end new text begin (e)new text end , clause (6); deleted text begin anddeleted text end paragraph deleted text begin (g)deleted text end new text begin (f)new text end , clause (6); new text begin paragraph (g), clause (6);
paragraph (h), clause 6; and paragraph (i), clause (6); new text end subdivision 6, paragraphs (b), clauses
(9) and (10), and (e), clause (10); deleted text begin anddeleted text end subdivision 7, clauses (11), (17), and (18)new text begin ; and
subdivision 18new text end , for changes in the Consumer Price Index. The commissioner shall adjust
these values higher or lower by the percentage change in the CPI-U from the date of the
previous update to the data available 30 months and one day prior to the scheduled update.
The commissioner shall publish these updated values and load them into the rate management
system.
deleted text begin (l)deleted text end new text begin (n)new text end Upon the implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin (k)new text end and deleted text begin (k)deleted text end new text begin (m)new text end , rate
adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108,
article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be removed
from service rates calculated under this section.
deleted text begin (m)deleted text end new text begin (o)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)deleted text end new text begin
(k)new text end and deleted text begin (k)deleted text end new text begin (m)new text end .
deleted text begin (n)deleted text end new text begin (p)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, deleted text begin family residential services, foster care
services,deleted text end new text begin and new text end integrated community supportsdeleted text begin , and supportive living services dailydeleted text end .
(b) Payments for community residential servicesdeleted text begin , corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care servicesdeleted text end
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;
(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;
(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);
(9) for client programming and supports, the commissioner shall add $2,179; and
(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(c) The total rate must be calculated using the following steps:
(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(d) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.new text begin Customized living and 24-hour customized living rates determined under
this section shall not include more than 24 hours of support in a daily unit. The commissioner
shall establish acuity-based input limits, based on case mix, for customized living and
24-hour customized living rates determined under this section.
new text end
(e) Payments for integrated community support services must be calculated as follows:
(1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;
(2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;
(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;
(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);
(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;
(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);
(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;
(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
(f) The total rate must be calculated as follows:
(1) add the results of paragraph (e), clauses (9) and (10);
(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.
(h) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:
Subd. 7.
Payments for day programs.
Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day servicesnew text begin , provided in person or remotely,new text end must
be calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;
(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (2)new text begin , for in-person services or
subdivision 5, paragraph (d), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (d), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (d), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (d), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (d)deleted text end new text begin (c)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (d), clause (6), for remote servicesnew text end ;
(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needsnew text begin for in-person service onlynew text end ;
(12) for adult day bath services, add $7.01 per 15 minute unit;
(13) this is the subtotal rate;
(14) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;
(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;
(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including employment exploration services, employment
development services, housing access coordination, individualized home supports with
family training, individualized home supports with training, in-home family support,
independent living skills training, and hourly supported living services provided to an
individual outside of any day or residential service plannew text begin , provided in person or remotely,new text end
must be calculated as follows, unless the services are authorized separately under subdivision
6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (f), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (2),new text begin for in-person services or subdivision
5, paragraph (g), clause (2), for remote services,new text end and the appropriate supervision wage in
subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(3)new text begin , for in-person services or subdivision 5, paragraph (g), clause (3), for remote servicesnew text end .
This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan supports ratio in subdivision 5, paragraph (f), clause (5)new text begin , for in-person services or
subdivision 5, paragraph (g), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (4)new text begin , for in-person services
or subdivision 5, paragraph (g), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and supports ratio in subdivision 5, paragraph (f), clause (6)new text begin , for
in-person services or subdivision 5, paragraph (g), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills training, individualized home supports with training, and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed two; and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.4914, subdivision 9, is amended to read:
Subd. 9.
Payments for unit-based services without programming.
Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plannew text begin , provided in person or remotely,new text end must be calculated
as follows unless the services are authorized separately under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (2)new text begin , for in-person services or
subdivision 5, paragraph (i), clause (2), for remote servicesnew text end , and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (i), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (i), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (i), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (i), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for respite services, determine the number of day units of service to meet an
individual's needs;
(15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (1);
(17) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (16);
(18) multiply the number of direct staff hours by the appropriate staff wage;
(19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin
(j)new text end , clause (3). This is defined as the direct staffing rate;
(21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (j)new text end , clause (4);
(22) this is the subtotal rate;
(23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;
(25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
(26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
(27) adjust the result of clauses (13), (25), and (26) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256B.4914, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Payments for family residential services. new text end
new text begin
The commissioner shall establish
rates for family residential services based on a person's assessed needs as described in the
federally approved waiver plans.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plansnew text begin :
new text end
new text begin (1)new text end use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659deleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider agency with which the plan has a contract.
new text end
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.85, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this sectionnew text begin and section 256B.851new text end , the terms
defined in this subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, and is specified in a community support plan, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section 256B.0651;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physician and requiring specialized assistance
from another on a daily basis; and
(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in section 256S.10.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
may not be found to be dependent in an activity of daily living if, because of the child's age,
an adult would either perform the activity for the child or assist the child with the activity
and the assistance needed is the assistance appropriate for a typical child of the same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression deleted text begin towardsdeleted text end new text begin towardnew text end self or others or
destruction of property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker may not determine medication
dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected. If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:
(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into an agreement to receive
services at the same time and in the same setting by the same employer.
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 30.
new text begin
[256B.851] COMMUNITY FIRST SERVICES AND SUPPORTS; PAYMENT
RATES.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
(a) The payment methodologies in this section apply to:
new text end
new text begin
(1) community first services and supports (CFSS), extended CFSS, and enhanced rate
CFSS under section 256B.85; and
new text end
new text begin
(2) personal care assistance services under section 256B.0625, subdivisions 19a and
19c; extended personal care assistance service as defined in section 256B.0659, subdivision
1; and enhanced rate personal care assistance services under section 256B.0659, subdivision
17a.
new text end
new text begin
(b) This section does not change existing personal care assistance program or community
first services and supports policies and procedures.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given in section 256B.85, subdivision 2, and as follows.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Component value" means an underlying factor that is built into the rate methodology
to calculate service rates and is part of the cost of providing services.
new text end
new text begin
(d) "Payment rate" or "rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
new text end
new text begin Subd. 3. new text end
new text begin Payment rates; base wage index. new text end
new text begin
When initially establishing the base wage
component values, the commissioner must use the Minnesota-specific median wage for the
standard occupational classification (SOC) codes published by the Bureau of Labor Statistics
in the edition of the Occupational Handbook available January 1, 2021. The commissioner
must calculate the base wage component values as follows for:
new text end
new text begin
(1) personal care assistance services, CFSS, extended personal care assistance services,
and extended CFSS. The base wage component value equals the median wage for personal
care aide (SOC code 31-1120);
new text end
new text begin
(2) enhanced rate personal care assistance services and enhanced rate CFSS. The base
wage component value equals the product of median wage for personal care aide (SOC
code 31-1120) and the value of the enhanced rate under section 256B.0659, subdivision
17a; and
new text end
new text begin
(3) qualified professional services and CFSS worker training and development. The base
wage component value equals the sum of 70 percent of the median wage for registered nurse
(SOC code 29-1141), 15 percent of the median wage for health care social worker (SOC
code 21-1099), and 15 percent of the median wage for social and human service assistant
(SOC code 21-1093).
new text end
new text begin Subd. 4. new text end
new text begin Payment rates; total wage index. new text end
new text begin
(a) The commissioner must multiply the
base wage component values in subdivision 3 by one plus the appropriate competitive
workforce factor. The product is the total wage component value.
new text end
new text begin
(b) For personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, and enhanced
rate CFSS, the initial competitive workforce factor is 4.7 percent.
new text end
new text begin
(c) For qualified professional services and CFSS worker training and development, the
competitive workforce factor is zero percent.
new text end
new text begin
(d) On August 1, 2024, and every two years thereafter, the commissioner shall report
recommendations to the chairs and ranking minority members of the legislative committees
and divisions with jurisdiction over health and human services policy and finance an update
of the competitive workforce factors in this subdivision using the most recently available
data. The commissioner shall make adjustments to the competitive workforce factor toward
the percent difference between: (1) the median wage for personal care aide (SOC code
31-1120); and (2) the weighted average wage for all other SOC codes with the same Bureau
of Labor Statistics classifications for education, experience, and training required for job
competency.
new text end
new text begin
(e) The commissioner shall recommend an increase or decrease of the competitive
workforce factor from its previous value by no more than three percentage points. If, after
a biennial adjustment, the competitive workforce factor is less than or equal to zero, the
competitive workforce factor shall be zero.
new text end
new text begin Subd. 5. new text end
new text begin Payment rates; component values. new text end
new text begin
(a) The commissioner must use the
following component values:
new text end
new text begin
(1) employee vacation, sick, and training factor, 8.71 percent;
new text end
new text begin
(2) employer taxes and workers' compensation factor, 11.56 percent;
new text end
new text begin
(3) employee benefits factor, 12.04 percent;
new text end
new text begin
(4) client programming and supports factor, 2.30 percent;
new text end
new text begin
(5) program plan support factor, 7.00 percent;
new text end
new text begin
(6) general business and administrative expenses factor, 13.25 percent;
new text end
new text begin
(7) program administration expenses factor, 2.90 percent; and
new text end
new text begin
(8) absence and utilization factor, 3.90 percent.
new text end
new text begin
(b) For purposes of implementation, the commissioner shall use the following
implementation components:
new text end
new text begin
(1) personal care assistance services and CFSS: 75.45 percent;
new text end
new text begin
(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45
percent; and
new text end
new text begin
(3) qualified professional services and CFSS worker training and development: 75.45
percent.
new text end
new text begin Subd. 6. new text end
new text begin Payment rates; rate determination. new text end
new text begin
(a) The commissioner must determine
the rate for personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, enhanced rate
CFSS, qualified professional services, and CFSS worker training and development as
follows:
new text end
new text begin
(1) multiply the appropriate total wage component value calculated in subdivision 4 by
one plus the employee vacation, sick, and training factor in subdivision 5;
new text end
new text begin
(2) for program plan support, multiply the result of clause (1) by one plus the program
plan support factor in subdivision 5;
new text end
new text begin
(3) for employee-related expenses, add the employer taxes and workers' compensation
factor in subdivision 5 and the employee benefits factor in subdivision 5. The sum is
employee-related expenses. Multiply the product of clause (2) by one plus the value for
employee-related expenses;
new text end
new text begin
(4) for client programming and supports, multiply the product of clause (3) by one plus
the client programming and supports factor in subdivision 5;
new text end
new text begin
(5) for administrative expenses, add the general business and administrative expenses
factor in subdivision 5, the program administration expenses factor in subdivision 5, and
the absence and utilization factor in subdivision 5;
new text end
new text begin
(6) divide the result of clause (4) by one minus the result of clause (5). The quotient is
the hourly rate;
new text end
new text begin
(7) multiply the hourly rate by the appropriate implementation component under
subdivision 5. This is the adjusted hourly rate; and
new text end
new text begin
(8) divide the adjusted hourly rate by four. The quotient is the total adjusted payment
rate.
new text end
new text begin
(b) The commissioner must publish the total adjusted payment rates.
new text end
new text begin Subd. 7. new text end
new text begin
Personal care provider agency; required reporting and analysis of cost
data.
new text end
new text begin
(a) The commissioner shall evaluate on an ongoing basis whether the base wage
component values and component values in this section appropriately address the cost to
provide the service. The commissioner shall make recommendations to adjust the rate
methodology as indicated by the evaluation. As determined by the commissioner and in
consultation with stakeholders, agencies enrolled to provide services with rates determined
under this section must submit requested cost data to the commissioner. The commissioner
may request cost data, including but not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) staff vacancy rates; and
new text end
new text begin
(11) other data relating to costs required to provide services requested by the
commissioner.
new text end
new text begin
(b) At least once in any three-year period, a provider must submit the required cost data
for a fiscal year that ended not more than 18 months prior to the submission date. The
commissioner must provide each provider a 90-day notice prior to its submission due date.
If a provider fails to submit required cost data, the commissioner must provide notice to a
provider that has not provided required cost data 30 days after the required submission date
and a second notice to a provider that has not provided required cost data 60 days after the
required submission date. The commissioner must temporarily suspend payments to a
provider if the commissioner has not received required cost data 90 days after the required
submission date. The commissioner must make withheld payments when the required cost
data is received by the commissioner.
new text end
new text begin
(c) The commissioner must conduct a random validation of data submitted under this
subdivision to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.
new text end
new text begin
(d) The commissioner shall analyze cost documentation in paragraph (a) and may submit
recommendations on component values, updated base wage component values, and
competitive workforce factors to the chair and ranking minority members of the legislative
committees and divisions with jurisdiction over human services policy and finance every
two years beginning August 1, 2026. The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.
new text end
new text begin
(e) The commissioner, in consultation with stakeholders, must develop and implement
a process for providing training and technical assistance necessary to support provider
submission of cost data required under this subdivision.
new text end
new text begin Subd. 8. new text end
new text begin Payment rates; reports required. new text end
new text begin
(a) The commissioner must assess the
standard component values and publish evaluation findings and recommended changes to
the rate methodology in a report to the legislature by August 1, 2026.
new text end
new text begin
(b) The commissioner must assess the long-term impacts of the rate methodology
implementation on staff providing services with rates determined under this section, including
but not limited to measuring changes in wages, benefits provided, hours worked, and
retention. The commissioner must publish evaluation findings in a report to the legislature
by August 1, 2028, and once every two years thereafter.
new text end
new text begin Subd. 9. new text end
new text begin Self-directed services workforce. new text end
new text begin
Nothing in this section limits the
commissioner's authority over terms and conditions for individual providers in covered
programs as defined in section 256B.0711. The commissioner's authority over terms and
conditions for individual providers in covered programs remains subject to the state's
obligations to meet and negotiate under chapter 179A, as modified and made applicable to
individual providers under section 179A.54, and to agreements with any exclusive
representative of individual providers, as authorized by chapter 179A, as modified and made
applicable to individual providers under section 179A.54. A change in the rate for services
within the covered programs defined in section 256B.0711 does not constitute a change in
a term or condition for individual providers in covered programs and is not subject to the
state's obligation to meet and negotiate under chapter 179A, except that, notwithstanding
any other law to the contrary, the state shall meet and negotiate with the exclusive
representative of individual providers over wage and benefit increases made possible by
rate increases provided between January 1, 2023 and June 30, 2023. Any resulting tentative
agreement shall be submitted to the legislature to be accepted or rejected in accordance with
sections 3.855 and 179A.22.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to deleted text begin 226deleted text end new text begin 500new text end supportive
housing units in Anoka, new text begin Carver, new text end Dakota, Hennepin, deleted text begin ordeleted text end Ramseynew text begin , Scott, or Washingtonnew text end County
for homeless adults with a mental illness, a history of substance abuse, or human
immunodeficiency virus or acquired immunodeficiency syndrome. For purposes of this
section, "homeless adult" means a person who is living on the street or in a shelter deleted text begin or
discharged from a regional treatment center, community hospital, or residential treatment
program anddeleted text end new text begin ,new text end has no appropriate housing availablenew text begin ,new text end and lacks the resources and support
necessary to access appropriate housing. deleted text begin At least 70 percent of the supportive housing units
must serve homeless adults with mental illness, substance abuse problems, or human
immunodeficiency virus or acquired immunodeficiency syndrome who are about to be or,
within the previous six months, have been discharged from a regional treatment center, or
a state-contracted psychiatric bed in a community hospital, or a residential mental health
or chemical dependency treatment program.deleted text end If a person meets the requirements of subdivision
1, paragraph (a)new text begin or (b)new text end , and receives a federal or state housing subsidy, the housing support
rate for that person is limited to the supplementary rate under section 256I.05, subdivision
1adeleted text begin , and is determined by subtracting the amount of the person's countable income that
exceeds the MSA equivalent rate from the housing support supplementary service ratedeleted text end . A
resident in a demonstration project site who no longer participates in the demonstration
program shall retain eligibility for a housing support payment in an amount determined
under section 256I.06, subdivision 8, using the MSA equivalent ratedeleted text begin . Service funding under
section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
available and the services can be provided through a managed care entity. If federal matching
funds are not available, then service funding will continue under section 256I.05, subdivision
1adeleted text end ;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a housing support contract with the county and has been licensed as a board and lodge
facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a housing support provider that currently operates a 304-bed facility
in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; and
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed chemical dependency treatment program.
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
new text begin
(c) The appropriation for this subdivision must include administrative funding equal to
the cost of two full-time equivalent employees to process eligibility. The commissioner
must disburse administrative funding to the fiscal agent for the counties under this
subdivision.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the deleted text begin countydeleted text end agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient under a home and community-based waiver
under title XIX of the new text begin federal new text end Social Security Act; or funding from the medical assistance
program under section 256B.0659, for personal care services for residents in the setting; or
residing in a setting which receives funding under section 245.73. If funding is available
for other necessary services through a home and community-based waiver, or personal care
services under section 256B.0659, then the housing support rate is limited to the rate set in
subdivision 1. Unless otherwise provided in law, in no case may the supplementary service
rate exceed $426.37. The registration and licensure requirement does not apply to
establishments which are exempt from state licensure because they are located on Indian
reservations and for which the tribe has prescribed health and safety requirements. Service
payments under this section may be prohibited under rules to prevent the supplanting of
federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
the approval of the Secretary of Health and Human Services to provide home and
community-based waiver services under title XIX of the new text begin federal new text end Social Security Act for
residents who are not eligible for an existing home and community-based waiver due to a
primary diagnosis of mental illness or chemical dependency and shall apply for a waiver if
it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the deleted text begin county or countiesdeleted text end new text begin agencynew text end in which the affected beds
are located. The commissioner may also make cost-neutral transfers from the housing support
fund to deleted text begin county human servicedeleted text end agencies for beds permanently removed from the housing
support census under a plan submitted by the deleted text begin countydeleted text end agency and approved by the
commissioner. The commissioner shall report the amount of any transfers under this provision
annually to the legislature.
(c) deleted text begin Countiesdeleted text end new text begin Agenciesnew text end must not negotiate supplementary service rates with providers of
housing support that are licensed as board and lodging with special services and that do not
encourage a policy of sobriety on their premises and make referrals to available community
services for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).
(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.
(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.
(d) When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences are reported in advance
to the county agency's social service staff. Advance reporting is not required for emergency
absences due to crisis, illness, or injury.new text begin For purposes of maintaining housing while
temporarily absent due to residential behavioral health treatment or health care treatment
that requires admission to an inpatient hospital, nursing facility, or other health care facility,
the room and board rate for an individual is payable beyond an 18-calendar-day absence
period, not to exceed 150 days in a calendar year.
new text end
(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the establishment experiences a 25 percent increase or decrease in
the total number of its beds, if the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or if the residence physically
moves, or changes its licensure, and incurs a resulting increase in operation and property
costs.
(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.
Sec. 34.
Minnesota Statutes 2020, section 256I.05, subdivision 11, is amended to read:
Subd. 11.
Transfer of emergency shelter funds.
(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to deleted text begin county human service
agenciesdeleted text end new text begin the agencynew text end for emergency shelter beds removed from the housing support census
under a biennial plan submitted by the deleted text begin countydeleted text end new text begin agencynew text end and approved by the commissioner.
The plan must describe: (1) anticipated and actual outcomes for persons experiencing
homelessness in emergency shelters; (2) improved efficiencies in administration; (3)
requirements for individual eligibility; and (4) plans for quality assurance monitoring and
quality assurance outcomes. The commissioner shall review the deleted text begin countydeleted text end new text begin agencynew text end plan to
monitor implementation and outcomes at least biennially, and more frequently if the
commissioner deems necessary.
(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
deleted text begin countydeleted text end new text begin agencynew text end may return beds to the housing support fund with 180 days' notice, including
financial reconciliation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256S.18, subdivision 7, is amended to read:
Subd. 7.
Monthly case mix budget cap exception.
The commissioner shall approve an
exception to the monthly case mix budget cap in deleted text begin paragraph (a)deleted text end new text begin subdivision 3new text end to account for
the additional cost of providing enhanced rate personal care assistance services under section
256B.0659 or new text begin enhanced rate community first services and supports under section new text end 256B.85.
deleted text begin The exception shall not exceed 107.5 percent of the budget otherwise available to the
individual.deleted text end new text begin The commissioner must calculate the difference between the rate for personal
care assistance services and enhanced rate personal care assistance services. The additional
budget amount approved under an exception must not exceed this difference. new text end The exception
must be reapproved on an annual basis at the time of a participant's annual reassessment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256S.20, subdivision 1, is amended to read:
Subdivision 1.
Customized living services provider requirements.
deleted text begin Only a provider
licensed by the Department of Health as a comprehensive home care provider may providedeleted text end new text begin
(a) To delivernew text end customized living services or 24-hour customized living servicesdeleted text begin .deleted text end new text begin , a provider
must:
new text end
new text begin
(1) be licensed as an assisted living facility under chapter 144G; or
new text end
new text begin (2) be licensed as a comprehensive home care provider under chapter 144A and be
delivering services: (i) in a setting defined under section 144G.08, subdivision 7, clauses
(11) to (13); or (ii) in an affordable housing setting under section 144G.08, subdivision 7,
clause (10), that is delivering authorized customized living services to a person in the setting
on or before June 30, 2022.new text end A licensed home care provider is subject to section 256B.0651,
subdivision 14.
new text begin
(b) Settings under paragraph (a), clause (2), must comply with section 256S.2003.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 37.
new text begin
[256S.2003] CUSTOMIZED LIVING SERVICES; REQUIREMENTS OF
PROVIDERS IN DESIGNATED SETTINGS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Designated provider" means a home care provider licensed under chapter 144A that
provides customized living services to some or all of the residents of a designated setting
and that is either the setting itself or another entity with which the setting has a contract or
business relationship.
new text end
new text begin
(c) "Designated setting" means a setting defined under section 256S.20, subdivision 1,
paragraph (a), clause (2).
new text end
new text begin
(d) "Resident" means a person receiving customized living services in a designated
setting.
new text end
new text begin Subd. 2. new text end
new text begin Attestation of compliance with requirements. new text end
new text begin
Upon enrollment with the
department to provide customized living services, a designated provider of customized
living services must submit an attestation that the provider is in compliance with subdivisions
3 to 8.
new text end
new text begin Subd. 3. new text end
new text begin Contracts. new text end
new text begin
(a) Every designated provider must execute a written contract with
a resident or the resident's representative and must operate in accordance with the terms of
the contract. The resident or the resident's representative must be given a complete copy of
the contract and all supporting documents and attachments and any changes whenever
changes are made.
new text end
new text begin
(b) The contract must include at least the following elements in itself or through
supporting documents or attachments:
new text end
new text begin
(1) the name, street address, and mailing address of the designated provider;
new text end
new text begin
(2) the name and mailing address of the owner or owners of the designated provider
and, if the owner or owners are not natural persons, identification of the type of business
entity of the owner or owners;
new text end
new text begin
(3) the name and mailing address of the managing agent, through management agreement
or lease agreement, of the designated provider, if different from the owner or owners;
new text end
new text begin
(4) the name and address of at least one natural person who is authorized to accept service
of process on behalf of the owner or owners and managing agent;
new text end
new text begin
(5) a statement identifying the designated provider's home care license number;
new text end
new text begin
(6) the term of the contract;
new text end
new text begin
(7) an itemization and description of the services to be provided to the resident;
new text end
new text begin
(8) a conspicuous notice informing the resident of the policy concerning the conditions
under which and the process through which the contract may be modified, amended, or
terminated;
new text end
new text begin
(9) a description of the designated provider's complaint resolution process available to
residents including the toll-free complaint line for the Office of Ombudsman for Long-Term
Care;
new text end
new text begin
(10) the resident's designated representative, if any;
new text end
new text begin
(11) the designated provider's referral procedures if the contract is terminated;
new text end
new text begin
(12) a statement regarding the ability of a resident to receive services from service
providers with whom the designated provider does not have an arrangement;
new text end
new text begin
(13) a statement regarding the availability of public funds for payment for residence or
services; and
new text end
new text begin
(14) a statement regarding the availability of and contact information for long-term care
consultation services under section 256B.0911 in the county in which the establishment is
located.
new text end
new text begin
(c) The contract must include a statement regarding:
new text end
new text begin
(1) the ability of a resident to furnish and decorate the resident's unit within the terms
of the lease;
new text end
new text begin
(2) a resident's right to access food at any time;
new text end
new text begin
(3) a resident's right to choose the resident's visitors and times of visits;
new text end
new text begin
(4) a resident's right to choose a roommate if sharing a unit; and
new text end
new text begin
(5) a resident's right to have and use a lockable door to the resident's unit. The designated
setting must provide the locks on the unit. Only a staff member with a specific need to enter
the unit shall have keys, and advance notice must be given to the resident before entrance,
when possible.
new text end
new text begin
(d) A restriction of a resident's rights under this subdivision is allowed only if determined
necessary for health and safety reasons identified by the home care provider's registered
nurse in an initial assessment or reassessment, as defined under section 144A.4791,
subdivision 8, and documented in the written service plan under section 144A.4791,
subdivision 9. Any restrictions of those rights for people served under this chapter and
section 256B.49 must be documented in the resident's coordinated service and support plan,
as defined under sections 256B.49, subdivision 15, and 256S.10.
new text end
new text begin
(e) The contract and related documents executed by each resident or resident's
representative must be maintained by the designated provider in files from the date of
execution until three years after the contract is terminated.
new text end
new text begin Subd. 4. new text end
new text begin Training in dementia. new text end
new text begin
(a) If a designated provider has a special program or
special care unit for residents with Alzheimer's disease or other dementias or advertises,
markets, or otherwise promotes the provision of services for persons with Alzheimer's
disease or other dementias, whether in a segregated or general unit, employees of the provider
must meet the following training requirements:
new text end
new text begin
(1) supervisors of direct-care staff must have at least eight hours of initial training on
topics specified under paragraph (b) within 120 working hours of the employment start
date, and must have at least two hours of training on topics related to dementia care for each
12 months of employment thereafter;
new text end
new text begin
(2) direct-care employees must have completed at least eight hours of initial training on
topics specified under paragraph (b) within 160 working hours of the employment start
date. Until this initial training is complete, an employee must not provide direct care unless
there is another employee on site who has completed the initial eight hours of training on
topics related to dementia care and who can act as a resource and assist if issues arise. A
trainer of the requirements under paragraph (b), or a supervisor meeting the requirements
in clause (1), must be available for consultation with the new employee until the training
requirement is complete. Direct-care employees must have at least two hours of training on
topics related to dementia care for each 12 months of employment thereafter;
new text end
new text begin
(3) staff who do not provide direct care, including maintenance, housekeeping, and food
service staff, must have at least four hours of initial training on topics specified under
paragraph (b) within 160 working hours of the employment start date, and must have at
least two hours of training on topics related to dementia care for each 12 months of
employment thereafter; and
new text end
new text begin
(4) new employees may satisfy the initial training requirements under clauses (1) to (3)
by producing written proof of previously completed required training within the past 18
months.
new text end
new text begin
(b) Areas of required training include:
new text end
new text begin
(1) an explanation of Alzheimer's disease and related disorders;
new text end
new text begin
(2) assistance with activities of daily living;
new text end
new text begin
(3) problem solving with challenging behaviors; and
new text end
new text begin
(4) communication skills.
new text end
new text begin
(c) The provider must provide to residents and prospective residents in written or
electronic form a description of the training program, the categories of employees trained,
the frequency of training, and the basic topics covered.
new text end
new text begin Subd. 5. new text end
new text begin Restraints. new text end
new text begin
Residents must be free from any physical or chemical restraints
imposed for purposes of discipline or convenience.
new text end
new text begin Subd. 6. new text end
new text begin Termination of contract. new text end
new text begin
A designated provider must include with notice of
termination of contract information about how to contact the ombudsman for long-term
care, including the address and telephone number, along with a statement of how to request
problem-solving assistance.
new text end
new text begin Subd. 7. new text end
new text begin Manager requirements. new text end
new text begin
(a) The person primarily responsible for oversight
and management of the designated provider, as designated by the owner, must obtain at
least 30 hours of continuing education every two years of employment as the manager in
topics relevant to the operations of the facility and the needs of its tenants. Continuing
education earned to maintain a professional license, such as a nursing home administrator
license, nursing license, social worker license, or real estate license, can be used to complete
this requirement.
new text end
new text begin
(b) New managers may satisfy the initial dementia training requirements by producing
written proof of previously completed required training within the past 18 months.
new text end
new text begin Subd. 8. new text end
new text begin Emergency planning. new text end
new text begin
(a) Each designated provider must meet the following
requirements:
new text end
new text begin
(1) have a written emergency disaster plan that contains a plan for evacuation, addresses
elements of sheltering in-place, identifies temporary relocation sites, and details staff
assignments in the event of a disaster or an emergency;
new text end
new text begin
(2) prominently post an emergency disaster plan;
new text end
new text begin
(3) provide building emergency exit diagrams to all residents upon signing a contract;
new text end
new text begin
(4) post emergency exit diagrams on each floor; and
new text end
new text begin
(5) have a written policy and procedure regarding missing residents.
new text end
new text begin
(b) Each designated provider must provide emergency and disaster training to all staff
during the initial staff orientation and annually thereafter and must make emergency and
disaster training available to all residents annually. Staff who have not received emergency
and disaster training are allowed to work only when trained staff are also working on site.
new text end
new text begin
(c) Each designated provider location must conduct and document a fire drill or other
emergency drill at least once every six months. To the extent possible, drills must be
coordinated with local fire departments or other community emergency resources.
new text end
new text begin Subd. 9. new text end
new text begin Other laws. new text end
new text begin
Each designated provider must comply with chapter 504B, and
must obtain and maintain all other licenses, permits, registrations, or other required
governmental approvals. A designated provider is not required to obtain a lodging license
under chapter 157 and related rules.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 38. new text begin SELF-DIRECTED WORKER CONTRACT RATIFICATION.
new text end
new text begin
The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota, submitted to the Legislative Coordinating
Commission on March 1, 2021, is ratified.
new text end
Sec. 39. new text begin DIRECTION TO THE COMMISSIONER; CUSTOMIZED LIVING
REPORT.
new text end
new text begin
(a) By January 15, 2022, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance. The report must include the commissioner's:
new text end
new text begin
(1) assessment of the prevalence of customized living services provided under Minnesota
Statutes, section 256B.49, supplanting the provision of residential services and supports
licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under
Minnesota Statutes, chapter 245A;
new text end
new text begin
(2) recommendations regarding the continuation of the moratorium on home and
community-based services customized living settings under Minnesota Statutes, section
256B.49, subdivision 28;
new text end
new text begin
(3) other policy recommendations to ensure that customized living services are being
provided in a manner consistent with the policy objectives of the foster care licensing
moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and
new text end
new text begin
(4) recommendations for needed statutory changes to implement the transition from
existing four-person or fewer customized living settings to corporate adult foster care or
community residential settings.
new text end
new text begin
(b) The commissioner of health shall provide the commissioner of human services with
the required data to complete the report in paragraph (a) and implement the moratorium on
home and community-based services customized living settings under Minnesota Statutes,
section 256B.49, subdivision 28. The data must include, at a minimum, each registered
housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as
a customized living setting to deliver customized living services as defined under the brain
injury or community access for disability inclusion waiver plans under Minnesota Statutes,
section 256B.49.
new text end
Sec. 40. new text begin DIRECTION TO COMMISSIONER; PROVIDER STANDARDS FOR
CUSTOMIZED LIVING SERVICES IN DESIGNATED SETTINGS.
new text end
new text begin
The commissioner of human services shall review policies and provider standards for
customized living services provided in settings identified in Minnesota Statutes, section
256S.20, subdivision 1, paragraph (a), clause (2), in consultation with stakeholders. The
commissioner may provide recommendations to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over customized living services
by February 15, 2022, regarding appropriate regulatory oversight and payment policies for
customized living services delivered in these settings.
new text end
Sec. 41. new text begin GOVERNOR'S COUNCIL ON AN AGE-FRIENDLY MINNESOTA.
new text end
new text begin
The Governor's Council on an Age-Friendly Minnesota, established in Executive Order
19-38, shall: (1) work to advance age-friendly policies; and (2) coordinate state, local, and
private partners' collaborative work on emergency preparedness, with a focus on older
adults, communities, and persons in zip codes most impacted by the COVID-19 pandemic.
The Governor's Council on an Age-Friendly Minnesota is extended and expires October 1,
2022.
new text end
Sec. 42. new text begin PERSONAL CARE ASSISTANCE COMPENSATION FOR SERVICES
PROVIDED BY A PARENT OR SPOUSE.
new text end
new text begin
(a) Notwithstanding Minnesota Statutes, section 256B.0659, subdivisions 3, paragraph
(a), clause (1); 11, paragraph (c); and 19, paragraph (b), clause (3), a parent, stepparent, or
legal guardian of a minor who is a personal care assistance recipient or a spouse of a personal
care assistance recipient may provide and be paid for providing personal care assistance
services.
new text end
new text begin
(b) This section expires upon full implementation and phase-in of the community first
services and supports program under Minnesota Statutes, section 256B.85.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment or
upon federal approval. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 43. new text begin RATE INCREASE FOR DIRECT SUPPORT SERVICES WORKFORCE.
new text end
new text begin
(a) Effective October 1, 2021, or upon federal approval, whichever is later, if the labor
agreement between the state of Minnesota and the Service Employees International Union
Healthcare Minnesota under Minnesota Statutes, section 179A.54, is approved pursuant to
Minnesota Statutes, section 3.855, the commissioner of human services shall increase:
new text end
new text begin
(1) reimbursement rates, individual budgets, grants, or allocations by 4.14 percent for
services under paragraph (b) provided on or after October 1, 2021, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
new text end
new text begin
(2) reimbursement rates, individual budgets, grants, or allocations by 2.95 percent for
services under paragraph (b) provided on or after July 1, 2022, or upon federal approval,
whichever is later, to implement the minimum hourly wage, holiday, and paid time off
provisions of that agreement;
new text end
new text begin
(3) individual budgets, grants, or allocations by 1.58 percent for services under paragraph
(c) provided on or after October 1, 2021, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement; and
new text end
new text begin
(4) individual budgets, grants, or allocations by .81 percent for services under paragraph
(c) provided on or after July 1, 2022, or upon federal approval, whichever is later, to
implement the minimum hourly wage, holiday, and paid time off provisions of that
agreement.
new text end
new text begin
(b) The rate changes described in paragraph (a), clauses (1) and (2), apply to direct
support services provided through a covered program, as defined in Minnesota Statutes,
section 256B.0711, subdivision 1, with the exception of consumer-directed community
supports available under programs established pursuant to home and community-based
service waivers authorized under section 1915(c) of the federal Social Security Act and
Minnesota Statutes, including but not limited to chapter 256S and sections 256B.092 and
256B.49, and under the alternative care program under Minnesota Statutes, section
256B.0913.
new text end
new text begin
(c) The funding changes described in paragraph (a), clauses (3) and (4), apply to
consumer-directed community supports available under programs established pursuant to
home and community-based service waivers authorized under section 1915(c) of the federal
Social Security Act, and Minnesota Statutes, including but not limited to chapter 256S and
sections 256B.092 and 256B.49, and under the alternative care program under Minnesota
Statutes, section 256B.0913.
new text end
Sec. 44. new text begin WAIVER REIMAGINE PHASE II.
new text end
new text begin
(a) The commissioner of human services must implement a two-home and
community-based services waiver program structure, as authorized under section 1915(c)
of the federal Social Security Act, that serves persons who are determined by a certified
assessor to require the levels of care provided in a nursing home, a hospital, a neurobehavioral
hospital, or an intermediate care facility for persons with developmental disabilities.
new text end
new text begin
(b) The commissioner of human services must implement an individualized budget
methodology, as authorized under section 1915(c) of the federal Social Security Act, that
serves persons who are determined by a certified assessor to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities.
new text end
new text begin
(c) The commissioner of human services may seek all federal authority necessary to
implement this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2024, or 90 days after
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 45. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.097, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed effective July 1, 2021.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256B.0916, subdivisions 2, 3, 4, 5, 8, 11, and 12;
and 256B.49, subdivisions 26 and 27,
new text end
new text begin
are repealed effective January 1, 2023, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2020, section 256S.20, subdivision 2,
new text end
new text begin
is repealed effective August
1, 2021.
new text end
ARTICLE 15
COMMUNITY SUPPORTS POLICY
Section 1.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e) new text begin The treatment team must completenew text end an individual treatment plan new text begin for each client and
the individual treatment plannew text end must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 2.
Minnesota Statutes 2020, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans use the assessment and
authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all personal
care assistance services under section 256B.0659new text begin and community first services and supports
under section 256B.85new text end .
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
Sec. 3.
Minnesota Statutes 2020, section 256B.85, subdivision 1, is amended to read:
Subdivision 1.
Basis and scope.
(a) Upon federal approval, the commissioner shall
establish a state plan option for the provision of home and community-based personal
assistance service and supports called "community first services and supports (CFSS)."
(b) CFSS is a participant-controlled method of selecting and providing services and
supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports to
perform that function.
(c) CFSS is available statewide to eligible people to assist with accomplishing activities
of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related
procedures and tasks through hands-on assistance to accomplish the task or constant
supervision and cueing to accomplish the task; and to assist with acquiring, maintaining,
and enhancing the skills necessary to accomplish ADLs, IADLs, and health-related
procedures and tasks. CFSS allows payment for new text begin the participant for new text end certain supports and
goods such as environmental modifications and technology that are intended to replace or
decrease the need for human assistance.
(d) Upon federal approval, CFSS will replace the personal care assistance program under
sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
new text begin
(e) For the purposes of this section, notwithstanding the provisions of section 144A.43,
subdivision 3, supports purchased under CFSS are not considered home care services.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.85, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means deleted text begin eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.deleted text end new text begin :
new text end
new text begin
(1) dressing, including assistance with choosing, applying, and changing clothing and
applying special appliances, wraps, or clothing;
new text end
new text begin
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Grooming includes nail
care, except for recipients who are diabetic or have poor circulation;
new text end
new text begin
(3) bathing, including assistance with basic personal hygiene and skin care;
new text end
new text begin
(4) eating, including assistance with hand washing and applying orthotics required for
eating, transfers, or feeding;
new text end
new text begin
(5) transfers, including assistance with transferring the participant from one seating or
reclining area to another;
new text end
new text begin
(6) mobility, including assistance with ambulation and use of a wheelchair. Mobility
does not include providing transportation for a participant;
new text end
new text begin
(7) positioning, including assistance with positioning or turning a participant for necessary
care and comfort; and
new text end
new text begin
(8) toileting, including assistance with bowel or bladder elimination and care, transfers,
mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing
the perineal area, inspection of the skin, and adjusting clothing.
new text end
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, new text begin advanced practice registered nurse, or physician's assistant
new text end and is specified in a community support plan, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section 256B.0651;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physiciannew text begin , advanced practice registered nurse,
or physician's assistantnew text end and requiring specialized assistance from another on a daily basis;
and
(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
deleted text begin maydeleted text end new text begin mustnew text end not be found to be dependent in an activity of daily living if, because of the child's
age, an adult would either perform the activity for the child or assist the child with the
activity and the assistance needed is the assistance appropriate for a typical child of the
same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.new text begin Extended CFSS excludes the purchase of goods.
new text end
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression towards self or others or destruction
of property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker deleted text begin maydeleted text end new text begin mustnew text end not determine
medication dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. deleted text begin This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected.deleted text end If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. deleted text begin Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:
deleted text end
deleted text begin
(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
deleted text end
deleted text begin
(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and
deleted text end
deleted text begin
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
deleted text end
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into deleted text begin andeleted text end new text begin a writtennew text end agreement to
receive services at the same time deleted text begin anddeleted text end new text begin ,new text end in the same setting deleted text begin bydeleted text end new text begin , and throughnew text end the same deleted text begin employerdeleted text end new text begin
agency-provider or FMS providernew text end .
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
Sec. 5.
Minnesota Statutes 2020, section 256B.85, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) CFSS is available to a person who deleted text begin meets one of the followingdeleted text end :
deleted text begin
(1) is an enrollee of medical assistance as determined under section 256B.055, 256B.056,
or 256B.057, subdivisions 5 and 9;
deleted text end
new text begin
(1) is determined eligible for medical assistance under this chapter, excluding those
under section 256B.057, subdivisions 3, 3a, 3b, and 4;
new text end
(2) is a participant in the alternative care program under section 256B.0913;
(3) is a waiver participant as defined under chapter 256S or section 256B.092, 256B.093,
or 256B.49; or
(4) has medical services identified in a person's individualized education program and
is eligible for services as determined in section 256B.0625, subdivision 26.
(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and
(2) is not a participant under a family support grant under section 252.32.
(c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
Sec. 6.
Minnesota Statutes 2020, section 256B.85, subdivision 4, is amended to read:
Subd. 4.
Eligibility for other services.
Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state plan
benefit or other services available through new text begin the new text end alternative carenew text begin programnew text end .
Sec. 7.
Minnesota Statutes 2020, section 256B.85, subdivision 5, is amended to read:
Subd. 5.
Assessment requirements.
(a) The assessment of functional need must:
(1) be conducted by a certified assessor according to the criteria established in section
256B.0911, subdivision 3a;
(2) be conducted face-to-face, initially and at least annually thereafter, or when there is
a significant change in the participant's condition or a change in the need for services and
supports, or at the request of the participant when the participant experiences a change in
condition or needs a change in the services or supports; and
(3) be completed using the format established by the commissioner.
(b) The results of the assessment and any recommendations and authorizations for CFSS
must be determined and communicated in writing by the lead agency's deleted text begin certifieddeleted text end assessor as
defined in section 256B.0911 to the participant deleted text begin and the agency-provider or FMS provider
chosen by the participantdeleted text end new text begin or the participant's representative and chosen CFSS providersnew text end
within deleted text begin 40 calendardeleted text end new text begin ten business new text end days and must include the participant's right to appeal new text begin the
assessment new text end under section 256.045, subdivision 3.
(c) The lead agency assessor may authorize a temporary authorization for CFSS services
to be provided under the agency-provider model. new text begin The lead agency assessor may authorize
a temporary authorization for CFSS services to be provided under the agency-provider
model without using the assessment process described in this subdivision. new text end Authorization
for a temporary level of CFSS services under the agency-provider model is limited to the
time specified by the commissioner, but shall not exceed 45 days. The level of services
authorized under this paragraph shall have no bearing on a future authorization. deleted text begin Participants
approved for a temporary authorization shall access the consultation servicedeleted text end new text begin For CFSS
services needed beyond the 45-day temporary authorization, the lead agency must conduct
an assessment as described in this subdivision and participants must use consultation servicesnew text end
to complete their orientation and selection of a service model.
Sec. 8.
Minnesota Statutes 2020, section 256B.85, subdivision 6, is amended to read:
Subd. 6.
Community first services and supports service delivery plan.
(a) The CFSS
service delivery plan must be developed and evaluated through a person-centered planning
process by the participant, or the participant's representative or legal representative who
may be assisted by a consultation services provider. The CFSS service delivery plan must
reflect the services and supports that are important to the participant and for the participant
to meet the needs assessed by the certified assessor and identified in the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10. The
CFSS service delivery plan must be reviewed by the participant, the consultation services
provider, and the agency-provider or FMS provider prior to starting services and at least
annually upon reassessment, or when there is a significant change in the participant's
condition, or a change in the need for services and supports.
(b) The commissioner shall establish the format and criteria for the CFSS service delivery
plan.
(c) The CFSS service delivery plan must be person-centered and:
(1) specify the consultation services provider, agency-provider, or FMS provider selected
by the participant;
(2) reflect the setting in which the participant resides that is chosen by the participant;
(3) reflect the participant's strengths and preferences;
(4) include the methods and supports used to address the needs as identified through an
assessment of functional needs;
(5) include the participant's identified goals and desired outcomes;
(6) reflect the services and supports, paid and unpaid, that will assist the participant to
achieve identified goals, including the costs of the services and supports, and the providers
of those services and supports, including natural supports;
(7) identify the amount and frequency of face-to-face supports and amount and frequency
of remote supports and technology that will be used;
(8) identify risk factors and measures in place to minimize them, including individualized
backup plans;
(9) be understandable to the participant and the individuals providing support;
(10) identify the individual or entity responsible for monitoring the plan;
(11) be finalized and agreed to in writing by the participant and signed by deleted text begin alldeleted text end individuals
and providers responsible for its implementation;
(12) be distributed to the participant and other people involved in the plan;
(13) prevent the provision of unnecessary or inappropriate care;
(14) include a detailed budget for expenditures for budget model participants or
participants under the agency-provider model if purchasing goods; and
(15) include a plan for worker training and development provided according to
subdivision 18a detailing what service components will be used, when the service components
will be used, how they will be provided, and how these service components relate to the
participant's individual needs and CFSS support worker services.
(d) new text begin The CFSS service delivery plan must describe the units or dollar amount available
to the participant. new text end The total units of agency-provider services or the service budget amount
for the budget model include both annual totals and a monthly average amount that cover
the number of months of the service agreement. The amount used each month may vary,
but additional funds must not be provided above the annual service authorization amount,
determined according to subdivision 8, unless a change in condition is assessed and
authorized by the certified assessor and documented in the coordinated service and support
plan and CFSS service delivery plan.
(e) In assisting with the development or modification of the CFSS service delivery plan
during the authorization time period, the consultation services provider shall:
(1) consult with the FMS provider on the spending budget when applicable; and
(2) consult with the participant or participant's representative, agency-provider, and case
managerdeleted text begin /deleted text end new text begin or new text end care coordinator.
(f) The CFSS service delivery plan must be approved by the consultation services provider
for participants without a case manager or care coordinator who is responsible for authorizing
services. A case manager or care coordinator must approve the plan for a waiver or alternative
care program participant.
Sec. 9.
Minnesota Statutes 2020, section 256B.85, subdivision 7, is amended to read:
Subd. 7.
Community first services and supports; covered services.
Services and
supports covered under CFSS include:
(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;
(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;
(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:
(i) relate to a need identified in a participant's CFSS service delivery plan; and
(ii) increase independence or substitute for human assistancenew text begin ,new text end to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;
(4) observation and redirection for behavior or symptoms where there is a need for
assistance;
(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;
(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;
(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;
(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. These support
workers shall notnew text begin :
new text end
new text begin (i)new text end provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and
new text begin
(ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and
new text end
(9) worker training and development services as described in subdivision 18a.
Sec. 10.
Minnesota Statutes 2020, section 256B.85, subdivision 8, is amended to read:
Subd. 8.
Determination of CFSS service authorization amount.
(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.
(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).
(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:
(1) the total number of dependencies of activities of daily living;
(2) the presence of complex health-related needs; and
(3) the presence of Level I behavior.
(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.
(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:
(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;
(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;
(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;
(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;
(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;
(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;
(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;
(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;
(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and
(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.
(f) Additional service units are provided through the assessment and identification of
the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;
(2) 30 additional minutes per day for each complex health-related need; and
(3) 30 additional minutes per day deleted text begin when thedeleted text end new text begin for eachnew text end behavior new text begin under this clause that
new text end requires assistance at least four times per week deleted text begin for one or more of the following behaviorsdeleted text end :
(i) level I behaviornew text begin that requires the immediate response of another personnew text end ;
(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
or
(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.
(g) The service budget for budget model participants shall be based on:
(1) assessed units as determined by the home care rating; and
(2) an adjustment needed for administrative expenses.
Sec. 11.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Authorization; exceptions. new text end
new text begin
All CFSS services must be authorized by the
commissioner or the commissioner's designee as described in subdivision 8 except when:
new text end
new text begin
(1) the lead agency temporarily authorizes services in the agency-provider model as
described in subdivision 5, paragraph (c);
new text end
new text begin
(2) CFSS services in the agency-provider model were required to treat an emergency
medical condition that if not immediately treated could cause a participant serious physical
or mental disability, continuation of severe pain, or death. The CFSS agency provider must
request retroactive authorization from the lead agency no later than five working days after
providing the initial emergency service. The CFSS agency provider must be able to
substantiate the emergency through documentation such as reports, notes, and admission
or discharge histories. A lead agency must follow the authorization process in subdivision
5 after the lead agency receives the request for authorization from the agency provider;
new text end
new text begin
(3) the lead agency authorizes a temporary increase to the amount of services authorized
in the agency or budget model to accommodate the participant's temporary higher need for
services. Authorization for a temporary level of CFSS services is limited to the time specified
by the commissioner, but shall not exceed 45 days. The level of services authorized under
this clause shall have no bearing on a future authorization;
new text end
new text begin
(4) a participant's medical assistance eligibility has lapsed, is then retroactively reinstated,
and an authorization for CFSS services is completed based on the date of a current
assessment, eligibility, and request for authorization;
new text end
new text begin
(5) a third-party payer for CFSS services has denied or adjusted a payment. Authorization
requests must be submitted by the provider within 20 working days of the notice of denial
or adjustment. A copy of the notice must be included with the request;
new text end
new text begin
(6) the commissioner has determined that a lead agency or state human services agency
has made an error; or
new text end
new text begin
(7) a participant enrolled in managed care experiences a temporary disenrollment from
a health plan, in which case the commissioner shall accept the current health plan
authorization for CFSS services for up to 60 days. The request must be received within the
first 30 days of the disenrollment. If the recipient's reenrollment in managed care is after
the 60 days and before 90 days, the provider shall request an additional 30-day extension
of the current health plan authorization, for a total limit of 90 days from the time of
disenrollment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.85, subdivision 9, is amended to read:
Subd. 9.
Noncovered services.
(a) Services or supports that are not eligible for payment
under this section include those that:
(1) are not authorized by the certified assessor or included in the CFSS service delivery
plan;
(2) are provided prior to the authorization of services and the approval of the CFSS
service delivery plan;
(3) are duplicative of other paid services in the CFSS service delivery plan;
(4) supplant natural unpaid supports that appropriately meet a need in the CFSS service
delivery plan, are provided voluntarily to the participant, and are selected by the participant
in lieu of other services and supports;
(5) are not effective means to meet the participant's needs; and
(6) are available through other funding sources, includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end funding
through title IV-E of the Social Security Act.
(b) Additional services, goods, or supports that are not covered include:
(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;
(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;
(3) insurance, except for insurance costs related to employee coverage;
(4) room and board costs for the participant;
(5) services, supports, or goods that are not related to the assessed needs;
(6) special education and related services provided under the Individuals with Disabilities
Education Act and vocational rehabilitation services provided under the Rehabilitation Act
of 1973;
(7) assistive technology devices and assistive technology services other than those for
back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
(8) medical supplies and equipment covered under medical assistance;
(9) environmental modifications, except as specified in subdivision 7;
(10) expenses for travel, lodging, or meals related to training the participant or the
participant's representative or legal representative;
(11) experimental treatments;
(12) any service or good covered by other state plan services, including prescription and
over-the-counter medications, compounds, and solutions and related fees, including premiums
and co-payments;
(13) membership dues or costs, except when the service is necessary and appropriate to
treat a health condition or to improve or maintain the new text begin adult new text end participant's health condition.
The condition must be identified in the participant's CFSS service delivery plan and
monitored by a Minnesota health care program enrolled physiciannew text begin , advanced practice
registered nurse, or physician's assistantnew text end ;
(14) vacation expenses other than the cost of direct services;
(15) vehicle maintenance or modifications not related to the disability, health condition,
or physical need;
(16) tickets and related costs to attend sporting or other recreational or entertainment
events;
(17) services provided and billed by a provider who is not an enrolled CFSS provider;
(18) CFSS provided by a participant's representative or paid legal guardian;
(19) services that are used solely as a child care or babysitting service;
(20) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;
(21) sterile procedures;
(22) giving of injections into veins, muscles, or skin;
(23) homemaker services that are not an integral part of the assessed CFSS service;
(24) home maintenance or chore services;
(25) home care services, including hospice services if elected by the participant, covered
by Medicare or any other insurance held by the participant;
(26) services to other members of the participant's household;
(27) services not specified as covered under medical assistance as CFSS;
(28) application of restraints or implementation of deprivation procedures;
(29) assessments by CFSS provider organizations or by independently enrolled registered
nurses;
(30) services provided in lieu of legally required staffing in a residential or child care
setting; deleted text begin and
deleted text end
(31) services provided by deleted text begin the residential or programdeleted text end new text begin a foster carenew text end license holder deleted text begin in a
residence for more than four participants.deleted text end new text begin except when the home of the person receiving
services is the licensed foster care provider's primary residence;
new text end
new text begin
(32) services that are the responsibility of the foster care provider under the terms of the
foster care placement agreement, assessment under sections 256N.24 and 260C.4411, and
administrative rules under sections 256N.24 and 260C.4411;
new text end
new text begin
(33) services in a setting that has a licensed capacity greater than six, unless all conditions
for a variance under section 245A.04, subdivision 9a, are satisfied for a sibling, as defined
in section 260C.007, subdivision 32;
new text end
new text begin
(34) services from a provider who owns or otherwise controls the living arrangement,
except when the provider of services is related by blood, marriage, or adoption or when the
provider is a licensed foster care provider who is not prohibited from providing services
under clauses (31) to (33);
new text end
new text begin
(35) instrumental activities of daily living for children younger than 18 years of age,
except when immediate attention is needed for health or hygiene reasons integral to an
assessed need for assistance with activities of daily living, health-related procedures, and
tasks or behaviors; or
new text end
new text begin
(36) services provided to a resident of a nursing facility, hospital, intermediate care
facility, or health care facility licensed by the commissioner of health.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.85, subdivision 10, is amended to read:
Subd. 10.
Agency-provider and FMS provider qualifications and duties.
(a)
Agency-providers identified in subdivision 11 and FMS providers identified in subdivision
13a shall:
(1) enroll as a medical assistance Minnesota health care programs provider and meet all
applicable provider standards and requirementsnew text begin including completion of required provider
training as determined by the commissionernew text end ;
(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;
(4) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers;
(5) not engage in any agency-initiated direct contact or marketing in person, by telephone,
or other electronic means to potential participants, guardians, family members, or participants'
representatives;
(6) directly provide services and not use a subcontractor or reporting agent;
(7) meet the financial requirements established by the commissioner for financial
solvency;
(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health care
programs provider; and
(9) have an office located in Minnesota.
(b) In conducting general duties, agency-providers and FMS providers shall:
(1) pay support workers based upon actual hours of services provided;
(2) pay for worker training and development services based upon actual hours of services
provided or the unit cost of the training session purchased;
(3) withhold and pay all applicable federal and state payroll taxes;
(4) make arrangements and pay unemployment insurance, taxes, workers' compensation,
liability insurance, and other benefits, if any;
(5) enter into a written agreement with the participant, participant's representative, or
legal representative that assigns roles and responsibilities to be performed before services,
supports, or goods are providednew text begin and that meets the requirements of subdivisions 20a, 20b,
and 20c for agency-providersnew text end ;
(6) report maltreatment as required under section 626.557 and chapter 260E;
(7) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a;
(8) comply with any data requests from the department consistent with the Minnesota
Government Data Practices Act under chapter 13; deleted text begin and
deleted text end
(9) maintain documentation for the requirements under subdivision 16, paragraph (e),
clause (2), to qualify for an enhanced rate under this sectiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) request reassessments 60 days before the end of the current authorization for CFSS
on forms provided by the commissioner.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.85, subdivision 11, is amended to read:
Subd. 11.
Agency-provider model.
(a) The agency-provider model includes services
provided by support workers and staff providing worker training and development services
who are employed by an agency-provider that meets the criteria established by the
commissioner, including required training.
(b) The agency-provider shall allow the participant to have a significant role in the
selection and dismissal of the support workers for the delivery of the services and supports
specified in the participant's CFSS service delivery plan.new text begin The agency must make a reasonable
effort to fulfill the participant's request for the participant's preferred worker.
new text end
(c) A participant may use authorized units of CFSS services as needed within a service
agreement that is not greater than 12 months. Using authorized units in a flexible manner
in either the agency-provider model or the budget model does not increase the total amount
of services and supports authorized for a participant or included in the participant's CFSS
service delivery plan.
(d) A participant may share CFSS services. Two or three CFSS participants may share
services at the same time provided by the same support worker.
(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated
by the medical assistance payment for CFSS for support worker wages and benefits, except
all of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the worker training and development services and the reasonable costs
associated with the worker training and development services must not be used in making
this calculation.
(f) The agency-provider model must be used by deleted text begin individualsdeleted text end new text begin participantsnew text end who are restricted
by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to
9505.2245.
(g) Participants purchasing goods under this model, along with support worker services,
must:
(1) specify the goods in the CFSS service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider, case manager, or
care coordinator; and
(2) use the FMS provider for the billing and payment of such goods.
Sec. 15.
Minnesota Statutes 2020, section 256B.85, subdivision 11b, is amended to read:
Subd. 11b.
Agency-provider model; support worker competency.
(a) The
agency-provider must ensure that support workers are competent to meet the participant's
assessed needs, goals, and additional requirements as written in the CFSS service delivery
plan. deleted text begin Within 30 days of any support worker beginning to provide services for a participant,deleted text end
The agency-provider must evaluate the competency of the worker through direct observation
of the support worker's performance of the job functions in a setting where the participant
is using CFSSdeleted text begin .deleted text end new text begin within 30 days of:
new text end
new text begin
(1) any support worker beginning to provide services for a participant; or
new text end
new text begin
(2) any support worker beginning to provide shared services.
new text end
(b) The agency-provider must verify and maintain evidence of support worker
competency, including documentation of the support worker's:
(1) education and experience relevant to the job responsibilities assigned to the support
worker and the needs of the participant;
(2) relevant training received from sources other than the agency-provider;
(3) orientation and instruction to implement services and supports to participant needs
and preferences as identified in the CFSS service delivery plan; deleted text begin and
deleted text end
new text begin
(4) orientation and instruction delivered by an individual competent to perform, teach,
or assign the health-related tasks for tracheostomy suctioning and services to participants
on ventilator support, including equipment operation and maintenance; and
new text end
deleted text begin (4)deleted text end new text begin (5)new text end periodic performance reviews completed by the agency-provider at least annually,
including any evaluations required under subdivision 11a, paragraph (a). If a support worker
is a minor, all evaluations of worker competency must be completed in person and in a
setting where the participant is using CFSS.
(c) The agency-provider must develop a worker training and development plan with the
participant to ensure support worker competency. The worker training and development
plan must be updated when:
(1) the support worker begins providing services;
new text begin
(2) the support worker begins providing shared services;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end there is any change in condition or a modification to the CFSS service delivery
plan; or
deleted text begin (3)deleted text end new text begin (4)new text end a performance review indicates that additional training is needed.
Sec. 16.
Minnesota Statutes 2020, section 256B.85, subdivision 12, is amended to read:
Subd. 12.
Requirements for enrollment of CFSS agency-providers.
(a) All CFSS
agency-providers must provide, at the time of enrollment, reenrollment, and revalidation
as a CFSS agency-provider in a format determined by the commissioner, information and
documentation that includesdeleted text begin ,deleted text end but is not limited todeleted text begin ,deleted text end the following:
(1) the CFSS agency-provider's current contact information including address, telephone
number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid
revenue in the previous calendar year is greater than $300,000, the agency-provider must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000new text begin per provider locationnew text end ;
(4) proof of workers' compensation insurance coverage;
(5) proof of liability insurance;
(6) a deleted text begin descriptiondeleted text end new text begin copynew text end of the CFSS agency-provider's deleted text begin organizationdeleted text end new text begin organizational chartnew text end
identifying the names new text begin and roles new text end of all owners, managing employees, staff, board of directors,
and deleted text begin thedeleted text end new text begin additional documentation reporting anynew text end affiliations of the directors and owners to
other service providers;
(7) deleted text begin a copy ofdeleted text end new text begin proof thatnew text end the CFSS deleted text begin agency-provider'sdeleted text end new text begin agency-provider hasnew text end written policies
and procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety, including the process for notification and resolution of
participant grievances, incident response, identification and prevention of communicable
diseases, and employee misconduct;
(8) deleted text begin copies of all other formsdeleted text end new text begin proof thatnew text end the CFSS agency-provider deleted text begin uses in the course of
daily business including, but not limited todeleted text end new text begin has all of the following forms and documentsnew text end :
(i) a copy of the CFSS agency-provider's time sheet; and
(ii) a copy of the participant's individual CFSS service delivery plan;
(9) a list of all training and classes that the CFSS agency-provider requires of its staff
providing CFSS services;
(10) documentation that the CFSS agency-provider and staff have successfully completed
all the training required by this section;
(11) documentation of the agency-provider's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties that
are used or could be used for providing home care services;
(13) documentation that the agency-provider will use at least the following percentages
of revenue generated from the medical assistance rate paid for CFSS services for CFSS
support worker wages and benefits: 72.5 percent of revenue from CFSS providers, except
100 percent of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The revenue generated by the worker training and development services and the
reasonable costs associated with the worker training and development services shall not be
used in making this calculation; and
(14) documentation that the agency-provider does not burden participants' free exercise
of their right to choose service providers by requiring CFSS support workers to sign an
agreement not to work with any particular CFSS participant or for another CFSS
agency-provider after leaving the agency and that the agency is not taking action on any
such agreements or requirements regardless of the date signed.
(b) CFSS agency-providers shall provide to the commissioner the information specified
in paragraph (a).
(c) All CFSS agency-providers shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day management
and operations of the agency to complete mandatory training as determined by the
commissioner. Employees in management and supervisory positions and owners who are
active in the day-to-day operations of an agency who have completed the required training
as an employee with a CFSS agency-provider do not need to repeat the required training if
they are hired by another agencydeleted text begin , ifdeleted text end new text begin andnew text end they have completed the training within the past
three years. CFSS agency-provider billing staff shall complete training about CFSS program
financial management. Any new owners or employees in management and supervisory
positions involved in the day-to-day operations are required to complete mandatory training
as a requisite of working for the agency.
deleted text begin
(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
deleted text end
deleted text begin
(1) list the materials and information the agency-provider is required to submit;
deleted text end
deleted text begin
(2) provide instructions on submitting information to the commissioner; and
deleted text end
deleted text begin
(3) provide a due date by which the commissioner must receive the requested information.
deleted text end
deleted text begin
Agency-providers shall submit all required documentation for annual review within 30 days
of notification from the commissioner. If an agency-provider fails to submit all the required
documentation, the commissioner may take action under subdivision 23a.
deleted text end
new text begin
(d) Agency-providers shall submit all required documentation in this section within 30
days of notification from the commissioner. If an agency-provider fails to submit all the
required documentation, the commissioner may take action under subdivision 23a.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.85, subdivision 12b, is amended to read:
Subd. 12b.
CFSS agency-provider requirements; notice regarding termination of
services.
(a) An agency-provider must provide written notice when it intends to terminate
services with a participant at least deleted text begin tendeleted text end new text begin 30new text end calendar days before the proposed service
termination is to become effective, except in cases where:
(1) the participant engages in conduct that significantly alters the terms of the CFSS
service delivery plan with the agency-provider;
(2) the participant or other persons at the setting where services are being provided
engage in conduct that creates an imminent risk of harm to the support worker or other
agency-provider staff; or
(3) an emergency or a significant change in the participant's condition occurs within a
24-hour period that results in the participant's service needs exceeding the participant's
identified needs in the current CFSS service delivery plan so that the agency-provider cannot
safely meet the participant's needs.
(b) When a participant initiates a request to terminate CFSS services with the
agency-provider, the agency-provider must give the participant a written deleted text begin acknowledgementdeleted text end new text begin
acknowledgmentnew text end of the participant's service termination request that includes the date the
request was received by the agency-provider and the requested date of termination.
(c) The agency-provider must participate in a coordinated transfer of the participant to
a new agency-provider to ensure continuity of care.
Sec. 18.
Minnesota Statutes 2020, section 256B.85, subdivision 13, is amended to read:
Subd. 13.
Budget model.
(a) Under the budget model participants exercise responsibility
and control over the services and supports described and budgeted within the CFSS service
delivery plan. Participants must use services specified in subdivision 13a provided by an
FMS provider. Under this model, participants may use their approved service budget
allocation to:
(1) directly employ support workers, and pay wages, federal and state payroll taxes, and
premiums for workers' compensation, liability, and health insurance coverage; and
(2) obtain supports and goods as defined in subdivision 7.
(b) Participants who are unable to fulfill any of the functions listed in paragraph (a) may
authorize a legal representative or participant's representative to do so on their behalf.
new text begin
(c) If two or more participants using the budget model live in the same household and
have the same worker, the participants must use the same FMS provider.
new text end
new text begin
(d) If the FMS provider advises that there is a joint employer in the budget model, all
participants associated with that joint employer must use the same FMS provider.
new text end
deleted text begin (c)deleted text end new text begin (e)new text end The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under, but not limited to, the following
circumstances:
(1) when a participant has been restricted by the Minnesota restricted recipient program,
in which case the participant may be excluded for a specified time period under Minnesota
Rules, parts 9505.2160 to 9505.2245;
(2) when a participant exits the budget model during the participant's service plan year.
Upon transfer, the participant shall not access the budget model for the remainder of that
service plan year; or
(3) when the department determines that the participant or participant's representative
or legal representative is unable to fulfill the responsibilities under the budget model, as
specified in subdivision 14.
deleted text begin (d)deleted text end new text begin (f)new text end A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph deleted text begin (c)deleted text end new text begin (e)new text end , clause (3), to
disenroll or exclude the participant from the budget model.
Sec. 19.
Minnesota Statutes 2020, section 256B.85, subdivision 13a, is amended to read:
Subd. 13a.
Financial management services.
(a) Services provided by an FMS provider
include but are not limited to: filing and payment of federal and state payroll taxes on behalf
of the participant; initiating and complying with background study requirements under
chapter 245C and maintaining documentation of background study requests and results;
billing for approved CFSS services with authorized funds; monitoring expenditures;
accounting for and disbursing CFSS funds; providing assistance in obtaining and filing for
liability, workers' compensation, and unemployment coverage; and providing participant
instruction and technical assistance to the participant in fulfilling employer-related
requirements in accordance with section 3504 of the Internal Revenue Code and related
regulations and interpretations, including Code of Federal Regulations, title 26, section
31.3504-1.
(b) Agency-provider services shall not be provided by the FMS provider.
(c) The FMS provider shall provide service functions as determined by the commissioner
for budget model participants that include but are not limited to:
(1) assistance with the development of the detailed budget for expenditures portion of
the CFSS service delivery plan as requested by the consultation services provider or
participant;
(2) data recording and reporting of participant spending;
(3) other duties established by the department, including with respect to providing
assistance to the participant, participant's representative, or legal representative in performing
employer responsibilities regarding support workers. The support worker shall not be
considered the employee of the FMS provider; and
(4) billing, payment, and accounting of approved expenditures for goods.
(d) The FMS provider shall obtain an assurance statement from the participant employer
agreeing to follow state and federal regulations and CFSS policies regarding employment
of support workers.
(e) The FMS provider shall:
(1) not limit or restrict the participant's choice of service or support providers or service
delivery models consistent with any applicable state and federal requirements;
(2) provide the participant, consultation services provider, and case manager or care
coordinator, if applicable, with a monthly written summary of the spending for services and
supports that were billed against the spending budget;
(3) be knowledgeable of state and federal employment regulations, including those under
the Fair Labor Standards Act of 1938, and comply with the requirements under section 3504
of the Internal Revenue Code and related regulations and interpretations, including Code
of Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability
for vendor fiscal/employer agent, and any requirements necessary to process employer and
employee deductions, provide appropriate and timely submission of employer tax liabilities,
and maintain documentation to support medical assistance claims;
(4) have current and adequate liability insurance and bonding and sufficient cash flow
as determined by the commissioner and have on staff or under contract a certified public
accountant or an individual with a baccalaureate degree in accounting;
(5) assume fiscal accountability for state funds designated for the program and be held
liable for any overpayments or violations of applicable statutes or rules, including but not
limited to the Minnesota False Claims Act, chapter 15C; deleted text begin and
deleted text end
(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support workers.
The documentation and time records must be maintained for a minimum of five years from
the claim date and be available for audit or review upon request by the commissioner. Claims
submitted by the FMS provider to the commissioner for payment must correspond with
services, amounts, and time periods as authorized in the participant's service budget and
service plan and must contain specific identifying information as determined by the
commissionerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) provide written notice to the participant or the participant's representative at least 30
calendar days before a proposed service termination becomes effective.
new text end
(f) The commissioner deleted text begin of human servicesdeleted text end shall:
(1) establish rates and payment methodology for the FMS provider;
(2) identify a process to ensure quality and performance standards for the FMS provider
and ensure statewide access to FMS providers; and
(3) establish a uniform protocol for delivering and administering CFSS services to be
used by eligible FMS providers.
Sec. 20.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 14a. new text end
new text begin Participant's representative responsibilities. new text end
new text begin
(a) If a participant is unable
to direct the participant's own care, the participant must use a participant's representative
to receive CFSS services. A participant's representative is required if:
new text end
new text begin
(1) the person is under 18 years of age;
new text end
new text begin
(2) the person has a court-appointed guardian; or
new text end
new text begin
(3) an assessment according to section 256B.0659, subdivision 3a, determines that the
participant is in need of a participant's representative.
new text end
new text begin
(b) A participant's representative must:
new text end
new text begin
(1) be at least 18 years of age;
new text end
new text begin
(2) actively participate in planning and directing CFSS services;
new text end
new text begin
(3) have sufficient knowledge of the participant's circumstances to use CFSS services
consistent with the participant's health and safety needs identified in the participant's service
delivery plan;
new text end
new text begin
(4) not have a financial interest in the provision of any services included in the
participant's CFSS service delivery plan; and
new text end
new text begin
(5) be capable of providing the support necessary to assist the participant in the use of
CFSS services.
new text end
new text begin
(c) A participant's representative must not be the:
new text end
new text begin
(1) support worker;
new text end
new text begin
(2) worker training and development service provider;
new text end
new text begin
(3) agency-provider staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(4) consultation service provider, unless related to the participant by blood, marriage,
or adoption;
new text end
new text begin
(5) FMS staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(6) FMS owner or manager; or
new text end
new text begin
(7) lead agency staff acting as part of employment.
new text end
new text begin
(d) A licensed family foster parent who lives with the participant may be the participant's
representative if the family foster parent meets the other participant's representative
requirements.
new text end
new text begin
(e) There may be two persons designated as the participant's representative, including
instances of divided households and court-ordered custodies. Each person named as the
participant's representative must meet the program criteria and responsibilities.
new text end
new text begin
(f) The participant or the participant's legal representative shall appoint a participant's
representative. The participant's representative must be identified at the time of assessment
and listed on the participant's service agreement and CFSS service delivery plan.
new text end
new text begin
(g) A participant's representative must enter into a written agreement with an
agency-provider or FMS on a form determined by the commissioner and maintained in the
participant's file, to:
new text end
new text begin
(1) be available while care is provided using a method agreed upon by the participant
or the participant's legal representative and documented in the participant's service delivery
plan;
new text end
new text begin
(2) monitor CFSS services to ensure the participant's service delivery plan is followed;
new text end
new text begin
(3) review and sign support worker time sheets after services are provided to verify the
provision of services;
new text end
new text begin
(4) review and sign vendor paperwork to verify receipt of goods; and
new text end
new text begin
(5) in the budget model, review and sign documentation to verify worker training and
development expenditures.
new text end
new text begin
(h) A participant's representative may delegate responsibility to another adult who is not
the support worker during a temporary absence of at least 24 hours but not more than six
months. To delegate responsibility, the participant's representative must:
new text end
new text begin
(1) ensure that the delegate serving as the participant's representative satisfies the
requirements of the participant's representative;
new text end
new text begin
(2) ensure that the delegate performs the functions of the participant's representative;
new text end
new text begin
(3) communicate to the CFSS agency-provider or FMS provider about the need for a
delegate by updating the written agreement to include the name of the delegate and the
delegate's contact information; and
new text end
new text begin
(4) ensure that the delegate protects the participant's privacy according to federal and
state data privacy laws.
new text end
new text begin
(i) The designation of a participant's representative remains in place until:
new text end
new text begin
(1) the participant revokes the designation;
new text end
new text begin
(2) the participant's representative withdraws the designation or becomes unable to fulfill
the duties;
new text end
new text begin
(3) the legal authority to act as a participant's representative changes; or
new text end
new text begin
(4) the participant's representative is disqualified.
new text end
new text begin
(j) A lead agency may disqualify a participant's representative who engages in conduct
that creates an imminent risk of harm to the participant, the support workers, or other staff.
A participant's representative who fails to provide support required by the participant must
be referred to the common entry point.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.85, subdivision 15, is amended to read:
Subd. 15.
Documentation of support services provided; time sheets.
(a) CFSS services
provided to a participant by a support worker employed by either an agency-provider or the
participant employer must be documented daily by each support worker, on a time sheet.
Time sheets may be created, submitted, and maintained electronically. Time sheets must
be submitted by the support worker new text begin at least once per month new text end to the:
(1) agency-provider when the participant is using the agency-provider model. The
agency-provider must maintain a record of the time sheet and provide a copy of the time
sheet to the participant; or
(2) participant and the participant's FMS provider when the participant is using the
budget model. The participant and the FMS provider must maintain a record of the time
sheet.
(b) The documentation on the time sheet must correspond to the participant's assessed
needs within the scope of CFSS covered services. The accuracy of the time sheets must be
verified by the:
(1) agency-provider when the participant is using the agency-provider model; or
(2) participant employer and the participant's FMS provider when the participant is using
the budget model.
(c) The time sheet must document the time the support worker provides services to the
participant. The following elements must be included in the time sheet:
(1) the support worker's full name and individual provider number;
(2) the agency-provider's name and telephone numbers, when responsible for the CFSS
service delivery plan;
(3) the participant's full name;
(4) the dates within the pay period established by the agency-provider or FMS provider,
including month, day, and year, and arrival and departure times with a.m. or p.m. notations
for days worked within the established pay period;
(5) the covered services provided to the participant on each date of service;
(6) deleted text begin adeleted text end new text begin thenew text end signature deleted text begin line fordeleted text end new text begin ofnew text end the participant or the participant's representative and a
statement that the participant's or participant's representative's signature is verification of
the time sheet's accuracy;
(7) the deleted text begin personaldeleted text end signature of the support worker;
(8) any shared care provided, if applicable;
(9) a statement that it is a federal crime to provide false information on CFSS billings
for medical assistance payments; and
(10) dates and location of participant stays in a hospital, care facility, or incarceration
occurring within the established pay period.
Sec. 22.
Minnesota Statutes 2020, section 256B.85, subdivision 17a, is amended to read:
Subd. 17a.
Consultation services provider qualifications and
requirements.
Consultation services providers must meet the following qualifications and
requirements:
(1) meet the requirements under subdivision 10, paragraph (a), excluding clauses (4)
and (5);
(2) are under contract with the department;
(3) are not the FMS provider, the lead agency, or the CFSS or home and community-based
services waiver vendor or agency-provider to the participant;
(4) meet the service standards as established by the commissioner;
new text begin
(5) have proof of surety bond coverage. Upon new enrollment, or if the consultation
service provider's Medicaid revenue in the previous calendar year is less than or equal to
$300,000, the consultation service provider must purchase a surety bond of $50,000. If the
agency-provider's Medicaid revenue in the previous calendar year is greater than $300,000,
the consultation service provider must purchase a surety bond of $100,000. The surety bond
must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end employ lead professional staff with a minimum of deleted text begin threedeleted text end new text begin two new text end years of experience
in providing services such as support planning, support broker, case management or care
coordination, or consultation services and consumer education to participants using a
self-directed program using FMS under medical assistance;
new text begin
(7) report maltreatment as required under chapter 260E and section 626.557;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end comply with medical assistance provider requirements;
deleted text begin (7)deleted text end new text begin (9)new text end understand the CFSS program and its policies;
deleted text begin (8)deleted text end new text begin (10)new text end are knowledgeable about self-directed principles and the application of the
person-centered planning process;
deleted text begin (9)deleted text end new text begin (11)new text end have general knowledge of the FMS provider duties and the vendor
fiscal/employer agent model, including all applicable federal, state, and local laws and
regulations regarding tax, labor, employment, and liability and workers' compensation
coverage for household workers; and
deleted text begin (10)deleted text end new text begin (12)new text end have all employees, including lead professional staff, staff in management and
supervisory positions, and owners of the agency who are active in the day-to-day management
and operations of the agency, complete training as specified in the contract with the
department.
Sec. 23.
Minnesota Statutes 2020, section 256B.85, subdivision 18a, is amended to read:
Subd. 18a.
Worker training and development services.
(a) The commissioner shall
develop the scope of tasks and functions, service standards, and service limits for worker
training and development services.
(b) Worker training and development costs are in addition to the participant's assessed
service units or service budget. Services provided according to this subdivision must:
(1) help support workers obtain and expand the skills and knowledge necessary to ensure
competency in providing quality services as needed and defined in the participant's CFSS
service delivery plan and as required under subdivisions 11b and 14;
(2) be provided or arranged for by the agency-provider under subdivision 11, or purchased
by the participant employer under the budget model as identified in subdivision 13; deleted text begin and
deleted text end
new text begin
(3) be delivered by an individual competent to perform, teach, or assign the tasks,
including health-related tasks, identified in the plan through education, training, and work
experience relevant to the person's assessed needs; and
new text end
deleted text begin (3)deleted text end new text begin (4)new text end be described in the participant's CFSS service delivery plan and documented in
the participant's file.
(c) Services covered under worker training and development shall include:
(1) support worker training on the participant's individual assessed needs and condition,
provided individually or in a group setting by a skilled and knowledgeable trainer beyond
any training the participant or participant's representative provides;
(2) tuition for professional classes and workshops for the participant's support workers
that relate to the participant's assessed needs and condition;
(3) direct observation, monitoring, coaching, and documentation of support worker job
skills and tasks, beyond any training the participant or participant's representative provides,
including supervision of health-related tasks or behavioral supports that is conducted by an
appropriate professional based on the participant's assessed needs. These services must be
provided at the start of services or the start of a new support worker except as provided in
paragraph (d) and must be specified in the participant's CFSS service delivery plan; and
(4) the activities to evaluate CFSS services and ensure support worker competency
described in subdivisions 11a and 11b.
(d) The services in paragraph (c), clause (3), are not required to be provided for a new
support worker providing services for a participant due to staffing failures, unless the support
worker is expected to provide ongoing backup staffing coverage.
(e) Worker training and development services shall not include:
(1) general agency training, worker orientation, or training on CFSS self-directed models;
(2) payment for preparation or development time for the trainer or presenter;
(3) payment of the support worker's salary or compensation during the training;
(4) training or supervision provided by the participant, the participant's support worker,
or the participant's informal supports, including the participant's representative; or
(5) services in excess of deleted text begin 96 unitsdeleted text end new text begin the rate set by the commissionernew text end per annual service
agreement, unless approved by the department.
Sec. 24.
Minnesota Statutes 2020, section 256B.85, subdivision 20b, is amended to read:
Subd. 20b.
Service-related rights under an agency-provider.
A participant receiving
CFSS from an agency-provider has service-related rights to:
(1) participate in and approve the initial development and ongoing modification and
evaluation of CFSS services provided to the participant;
(2) refuse or terminate services and be informed of the consequences of refusing or
terminating services;
(3) before services are initiated, be told the limits to the services available from the
agency-provider, including the agency-provider's knowledge, skill, and ability to meet the
participant's needs identified in the CFSS service delivery plan;
(4) a coordinated transfer of services when there will be a change in the agency-provider;
(5) before services are initiated, be told what the agency-provider charges for the services;
(6) before services are initiated, be told to what extent payment may be expected from
health insurance, public programs, or other sources, if known; and what charges the
participant may be responsible for paying;
(7) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the participant's CFSS service delivery plan;
(8) have the participant's preferences for support workers identified and documented,
and have those preferences met when possible; and
(9) before services are initiated, be told the choices that are available from the
agency-provider for meeting the participant's assessed needs identified in the CFSS service
delivery plan, including but not limited to which support worker staff will be providing
services deleted text begin anddeleted text end new text begin ,new text end the proposed frequency and schedule of visitsnew text begin , and any agreements for shared
servicesnew text end .
Sec. 25.
Minnesota Statutes 2020, section 256B.85, subdivision 23, is amended to read:
Subd. 23.
Commissioner's access.
(a) When the commissioner is investigating a possible
overpayment of Medicaid funds, the commissioner must be given immediate access without
prior notice to the agency-provider, consultation services provider, or FMS provider's office
during regular business hours and to documentation and records related to services provided
and submission of claims for services provided. deleted text begin Denying the commissioner access to records
is cause for immediate suspension of payment and terminatingdeleted text end new text begin Ifnew text end the deleted text begin agency-provider's
enrollment ordeleted text end new text begin agency-provider,new text end FMS deleted text begin provider's enrollmentdeleted text end new text begin provider, or consultation services
provider denies the commissioner access to records, the provider's payment may be
immediately suspended or the provider's enrollment may be terminatednew text end according to section
256B.064 deleted text begin or terminating the consultation services provider contractdeleted text end .
(b) The commissioner has the authority to request proof of compliance with laws, rules,
and policies from agency-providers, consultation services providers, FMS providers, and
participants.
(c) When relevant to an investigation conducted by the commissioner, the commissioner
must be given access to the business office, documents, and records of the agency-provider,
consultation services provider, or FMS provider, including records maintained in electronic
format; participants served by the program; and staff during regular business hours. The
commissioner must be given access without prior notice and as often as the commissioner
considers necessary if the commissioner is investigating an alleged violation of applicable
laws or rules. The commissioner may request and shall receive assistance from lead agencies
and other state, county, and municipal agencies and departments. The commissioner's access
includes being allowed to photocopy, photograph, and make audio and video recordings at
the commissioner's expense.
Sec. 26.
Minnesota Statutes 2020, section 256B.85, subdivision 23a, is amended to read:
Subd. 23a.
Sanctions; information for participants upon termination of services.
(a)
The commissioner may withhold payment from the provider or suspend or terminate the
provider enrollment number if the provider fails to comply fully with applicable laws or
rules. The provider has the right to appeal the decision of the commissioner under section
256B.064.
(b) Notwithstanding subdivision 13, paragraph (c), if a participant employer fails to
comply fully with applicable laws or rules, the commissioner may disenroll the participant
from the budget model. A participant may appeal in writing to the department under section
256.045, subdivision 3, to contest the department's decision to disenroll the participant from
the budget model.
(c) Agency-providers of CFSS services or FMS providers must provide each participant
with a copy of participant protections in subdivision 20c at least 30 days prior to terminating
services to a participant, if the termination results from sanctions under this subdivision or
section 256B.064, such as a payment withhold or a suspension or termination of the provider
enrollment number. If a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end determines it is unable to continue providing services to a participant because of
an action under this subdivision or section 256B.064, the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin ,
or consultation services providernew text end must notify the participant, the participant's representative,
and the commissioner 30 days prior to terminating services to the participant, and must
assist the commissioner and lead agency in supporting the participant in transitioning to
another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services providernew text end of the
participant's choice.
(d) In the event the commissioner withholds payment from a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end
FMS providernew text begin , or consultation services providernew text end , or suspends or terminates a provider
enrollment number of a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end under this subdivision or section 256B.064, the commissioner may inform the
Office of Ombudsman for Long-Term Care and the lead agencies for all participants with
active service agreements with the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . At the commissioner's request, the lead agencies must contact participants
to ensure that the participants are continuing to receive needed care, and that the participants
have been given free choice of agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end if they transfer to another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . In addition, the commissioner or the commissioner's delegate may directly
notify participants who receive care from the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or
consultation services providernew text end that payments have been new text begin or will be new text end withheld or that the
provider's participation in medical assistance has been new text begin or will be new text end suspended or terminated,
if the commissioner determines that the notification is necessary to protect the welfare of
the participants.
ARTICLE 16
MISCELLANEOUS
Section 1.
new text begin
[3.9215] OMBUDSPERSON FOR AMERICAN INDIAN FAMILIES.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
In recognition of the sovereign status of Indian Tribes and the
unique laws and standards involved in protecting Indian children, this section creates the
Office of the Ombudsperson for American Indian Families and gives the ombudsperson the
powers and duties necessary to effectively carry out the functions of the office.
new text end
new text begin Subd. 2. new text end
new text begin Creation. new text end
new text begin
The ombudsperson shall operate independently from and in
collaboration with the Indian Affairs Council and the American Indian Child Welfare
Advisory Council under section 260.835.
new text end
new text begin Subd. 3. new text end
new text begin Selection; qualifications. new text end
new text begin
The ombudsperson shall be selected by the American
Indian community-specific board established in section 3.9216. The ombudsperson serves
in the unclassified service at the pleasure of the community-specific board and may be
removed only for just cause. Each ombudsperson must be selected without regard to political
affiliation and shall be a person highly competent and qualified to analyze questions of law,
administration, and public policy regarding the protection and placement of children. In
addition, the ombudsperson must be experienced in working collaboratively with the
American Indian and Alaskan Native communities or nations and knowledgeable about the
needs of those communities, the Indian Child Welfare Act and Minnesota Indian Family
Preservation Act, and best practices regarding prevention, cultural resources, and historical
trauma. No individual may serve as the ombudsperson for American Indian families while
holding any other public office.
new text end
new text begin Subd. 4. new text end
new text begin Appropriation. new text end
new text begin
Money appropriated for the ombudsperson for American Indian
families from the general fund or the special fund authorized by section 256.01, subdivision
2, paragraph (o), is under the control of the ombudsperson. The amount necessary for the
ombudsperson to carry out the duties in this section is annually appropriated from the general
fund to the ombudsperson. This appropriation is available until expended and is in addition
to the appropriation under section 257.0769, subdivision 1, paragraph (a).
new text end
new text begin Subd. 5. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given them.
new text end
new text begin
(b) "Agency" means the local district courts or a designated county social service agency
as defined in section 256G.02, subdivision 7, engaged in providing child protection and
placement services for children. Agency also means any individual, service, organization,
or program providing child protection, placement, or adoption services in coordination with
or under contract with any other entity specified in this subdivision, including guardians ad
litem.
new text end
new text begin
(c) "American Indian" refers to individuals who are members of federally recognized
Tribes, eligible for membership in a federally recognized Tribe, or children or grandchildren
of a member of a federally recognized Tribe. American Indian is a political status established
through treaty rights between the federal government and Tribes. Each Tribe has a unique
culture and practices specific to the Tribe.
new text end
new text begin
(d) "Facility" means any entity required to be licensed under chapter 245A.
new text end
new text begin
(e) "Indian custodian" has the meaning given in United States Code, title 25, section
1903.
new text end
new text begin Subd. 6. new text end
new text begin Organization. new text end
new text begin
(a) The ombudsperson may select, appoint, and compensate
assistants and employees that the ombudsperson finds necessary to discharge responsibilities.
All employees, except the secretarial and clerical staff, serve at the pleasure of the
ombudsperson in the unclassified service. The ombudsperson and full-time staff are members
of the Minnesota State Retirement Association.
new text end
new text begin
(b) The ombudsperson may delegate to staff members or members of the American
Indian Community-Specific Board under section 3.9216 any of the ombudsperson's authority
or duties except the duty of formally making recommendations to an administrative agency
or reports to the Office of the Governor or to the legislature.
new text end
new text begin Subd. 7. new text end
new text begin Duties and powers. new text end
new text begin
(a) The ombudsperson has the duties listed in this paragraph.
new text end
new text begin
(1) The ombudsperson shall monitor agency compliance with all laws governing child
protection and placement, public education, and housing issues related to child protection
that impact American Indian children and their families. In particular, the ombudsperson
shall monitor agency compliance with sections 260.751 to 260.835; section 260C.193,
subdivision 3; and section 260C.215.
new text end
new text begin
(2) The ombudsperson shall work with local state courts to ensure that:
new text end
new text begin
(i) court officials, public policy makers, and service providers are trained in cultural
competency. The ombudsperson shall document and monitor court activities to heighten
awareness of diverse belief systems and family relationships;
new text end
new text begin
(ii) qualified expert witnesses from the appropriate American Indian community,
including Tribal advocates, are used as court advocates and are consulted in placement
decisions that involve American Indian children; and
new text end
new text begin
(iii) guardians ad litem and other individuals from American Indian communities are
recruited, trained, and used in court proceedings to advocate on behalf of American Indian
children.
new text end
new text begin
(3) The ombudsperson shall primarily work on behalf of American Indian children and
families, but shall also work on behalf of any Minnesota children and families as the
ombudsperson deems necessary and appropriate.
new text end
new text begin
(b) The ombudsperson has the authority to investigate decisions, acts, and other matters
of an agency, program, or facility providing protection or placement services to American
Indian children. In carrying out this authority and the duties in paragraph (a), the
ombudsperson has the power to:
new text end
new text begin
(1) prescribe the methods by which complaints are made, reviewed, and acted upon;
new text end
new text begin
(2) determine the scope and manner of investigations;
new text end
new text begin
(3) investigate, upon a complaint or upon personal initiative, any action of any agency;
new text end
new text begin
(4) request and be given access to any information in the possession of any agency
deemed necessary for the discharge of responsibilities. The ombudsperson is authorized to
set reasonable deadlines within which an agency must respond to requests for information.
Data obtained from any agency under this clause retains the classification that the data has
under section 13.02 and the ombudsperson shall maintain and disseminate the data according
to chapter 13;
new text end
new text begin
(5) examine the records and documents of an agency;
new text end
new text begin
(6) enter and inspect, during normal business hours, premises within the control of an
agency; and
new text end
new text begin
(7) subpoena any agency personnel to appear, testify, or produce documentation or other
evidence that the ombudsperson deems relevant to a particular matter under investigation,
and petition the appropriate state court to seek enforcement of the subpoena. Any witness
at a hearing or for an investigation has the same privileges of a witness in the courts or under
the laws of this state. The ombudsperson may compel individuals who are not agency
personnel to testify or produce evidence according to procedures developed by the advisory
board.
new text end
new text begin
(c) The ombudsperson may apply for grants and accept gifts, donations, and
appropriations for training relating to the duties of the ombudsperson. Grants, gifts, donations,
and appropriations received by the ombudsperson shall be used for training. The
ombudsperson may seek and apply for grants to develop new programs and initiatives and
to continue existing programs and initiatives. These funds may not be used for operating
expenses for the Office of the Ombudsperson for American Indian Families.
new text end
new text begin Subd. 8. new text end
new text begin Matters appropriate for review. new text end
new text begin
(a) In selecting matters for review, an
ombudsperson should give particular attention to actions of an agency, facility, or program
that:
new text end
new text begin
(1) may be contrary to law or rule;
new text end
new text begin
(2) may be unreasonable, unfair, oppressive, or inconsistent with a policy or order of an
agency, facility, or program;
new text end
new text begin
(3) may result in abuse or neglect of a child;
new text end
new text begin
(4) may disregard the rights of a child or another individual served by an agency or
facility; or
new text end
new text begin
(5) may be unclear or inadequately explained, when reasons should have been revealed.
new text end
new text begin
(b) The ombudsperson shall, in selecting matters for review, inform other interested
agencies in order to avoid duplicating other investigations or regulatory efforts, including
activities undertaken by a Tribal organization under the authority of sections 260.751 to
260.835.
new text end
new text begin Subd. 9. new text end
new text begin Complaints. new text end
new text begin
The ombudsperson may receive a complaint from any source
concerning an action of an agency, facility, or program. After completing a review, the
ombudsperson shall inform the complainant, agency, facility, or program. Services to a
child shall not be unfavorably altered as a result of an investigation or complaint. An agency,
facility, or program shall not retaliate or take adverse action, as defined in section 260E.07,
against an individual who, in good faith, makes a complaint or assists in an investigation.
new text end
new text begin Subd. 10. new text end
new text begin Recommendations to agency. new text end
new text begin
(a) If, after reviewing a complaint or conducting
an investigation and considering the response of an agency, facility, or program and any
other pertinent material, the ombudsperson determines that the complaint has merit or that
the investigation reveals a problem, the ombudsperson may recommend that the agency,
facility, or program:
new text end
new text begin
(1) consider the matter further;
new text end
new text begin
(2) modify or cancel its actions;
new text end
new text begin
(3) alter a rule, order, or internal policy;
new text end
new text begin
(4) explain more fully the action in question; or
new text end
new text begin
(5) take other action as authorized under section 257.0762.
new text end
new text begin
(b) At the ombudsperson's request, the agency, facility, or program shall, within a
reasonable time, inform the ombudsperson about the action taken on the recommendation
or the reasons for not complying with the recommendation.
new text end
new text begin
(c) Data obtained from any agency under this section retains the classification that the
data has under section 13.02, and the ombudsperson shall maintain and disseminate the data
according to chapter 13.
new text end
new text begin Subd. 11. new text end
new text begin Recommendations and public reports. new text end
new text begin
(a) The ombudsperson may send
conclusions and suggestions concerning any reviewed matter to the governor and shall
provide copies of all reports to the advisory board and to the groups specified in section
257.0768, subdivision 1. Before making public a conclusion or recommendation that
expressly or implicitly criticizes an agency, facility, program, or any person, the
ombudsperson shall inform the governor and the affected agency, facility, program, or
person concerning the conclusion or recommendation. When sending a conclusion or
recommendation to the governor that is adverse to an agency, facility, program, or any
person, the ombudsperson shall include any statement of reasonable length made by that
agency, facility, program, or person in defense or mitigation of the ombudsperson's
conclusion or recommendation.
new text end
new text begin
(b) In addition to conclusions or recommendations that the ombudsperson makes to the
governor on an ad hoc basis, the ombudsperson shall, at the end of each year, report to the
governor concerning the exercise of the ombudsperson's functions during the preceding
year.
new text end
new text begin Subd. 12. new text end
new text begin Civil actions. new text end
new text begin
The ombudsperson and designees are not civilly liable for any
action taken under this section if the action was taken in good faith, was within the scope
of the ombudsperson's authority, and did not constitute willful or reckless misconduct.
new text end
new text begin Subd. 13. new text end
new text begin Use of funds. new text end
new text begin
Any funds received by the ombudsperson from any source may
be used to compensate members of the American Indian community-specific board for
reasonable and necessary expenses incurred in aiding and assisting the ombudsperson in
programs and initiatives.
new text end
Sec. 2.
new text begin
[3.9216] AMERICAN INDIAN COMMUNITY-SPECIFIC BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin Membership. new text end
new text begin
The board consists of five members who are members of
a federally recognized Tribe or members of the American Indian community. The chair of
the Indian Affairs Council shall appoint the members of the board. In making appointments,
the chair must consult with other members of the council.
new text end
new text begin Subd. 2. new text end
new text begin Compensation. new text end
new text begin
Members do not receive compensation but are entitled to
receive reimbursement for reasonable and necessary expenses incurred doing board-related
work, including travel for meetings, trainings, and presentations. Board members may also
receive per diem payments in a manner and amount prescribed by the board.
new text end
new text begin Subd. 3. new text end
new text begin Meetings. new text end
new text begin
The board shall meet regularly at the request of the appointing chair,
board chair, or ombudsperson. The board must meet at least quarterly. The appointing chair,
board chair, or ombudsperson may also call special or emergency meetings as necessary.
new text end
new text begin Subd. 4. new text end
new text begin Removal and vacancy. new text end
new text begin
(a) A member may be removed by the appointing
authority at any time, either for cause, as described in paragraph (b), or after missing three
consecutive meetings, as described in paragraph (c).
new text end
new text begin
(b) If a removal is for cause, the member must be given notice and an opportunity for a
hearing before removal.
new text end
new text begin
(c) After a member misses two consecutive meetings, and before the next meeting, the
board chair shall notify the member in writing that the member may be removed if the
member misses the next meeting. If a member misses three consecutive meetings, the board
chair must notify the appointing authority.
new text end
new text begin
(d) If there is a vacancy on the board, the appointing authority shall appoint a person to
fill the vacancy for the remainder of the unexpired term.
new text end
new text begin Subd. 5. new text end
new text begin Duties. new text end
new text begin
(a) The board shall appoint the Ombudsperson for American Indian
Families and shall advise and assist the ombudsperson in various ways, including, but not
limited to:
new text end
new text begin
(1) selecting matters for attention;
new text end
new text begin
(2) developing policies, plans, and programs to carry out the ombudsperson's functions
and powers;
new text end
new text begin
(3) attending policy meetings when requested by the ombudsperson;
new text end
new text begin
(4) establishing protocols for working with American Indian communities;
new text end
new text begin
(5) developing procedures for the ombudsperson's use of the subpoena power to compel
testimony and evidence from individuals who are not agency personnel; and
new text end
new text begin
(6) making reports and recommendations for changes designed to improve standards of
competence, efficiency, justice, and protection of rights.
new text end
new text begin
(b) The board shall not make individual case recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Grants, gifts, donations, and appropriations. new text end
new text begin
The board may apply for grants
for the purpose of training and educating the American Indian community on child protection
issues involving American Indian families. The board may also accept gifts, donations, and
appropriations for training and education. Grants, gifts, donations, and appropriations
received by the board shall be used for training and education purposes. The board may
seek and apply for grants to develop new programs and initiatives and to continue existing
programs and initiatives. These funds may also be used to reimburse board members for
reasonable and necessary expenses incurred in aiding and assisting the Office of the
Ombudsperson for American Indian Families in Office of the Ombudsperson for American
Indian Families programs and initiatives, but may not be used for operating expenses for
the Office of Ombudsperson for American Indian Families.
new text end
new text begin Subd. 7. new text end
new text begin Terms and expiration. new text end
new text begin
The terms and expiration of board membership are
governed by section 15.0575.
new text end
Sec. 3.
new text begin
[119B.195] RETAINING EARLY EDUCATORS THROUGH ATTAINING
INCENTIVES NOW (REETAIN) GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The retaining early educators through attaining
incentives now (REETAIN) grant program is established to provide competitive grants to
incentivize well-trained child care professionals to remain in the workforce. The overall
goal of the REETAIN grant program is to create more consistent care for children over time.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
The commissioner shall administer the REETAIN grant
program through a grant to a nonprofit with the demonstrated ability to manage benefit
programs for child care professionals. Up to ten percent of grant money may be used for
administration of the grant program.
new text end
new text begin Subd. 3. new text end
new text begin Application. new text end
new text begin
Applicants must apply for the REETAIN grant program using
the forms and according to timelines established by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Eligibility. new text end
new text begin
(a) To be eligible for a grant, an applicant must:
new text end
new text begin
(1) be licensed to provide child care or work for a licensed child care program;
new text end
new text begin
(2) work directly with children at least 30 hours per week;
new text end
new text begin
(3) have worked in the applicant's current position for at least 12 months;
new text end
new text begin
(4) agree to work in the early childhood care and education field for at least 12 months
upon receiving a grant under this section;
new text end
new text begin
(5) have a career lattice step of five or higher;
new text end
new text begin
(6) have a current membership with the Minnesota quality improvement and registry
tool;
new text end
new text begin
(7) not be a current teacher education and compensation helps scholarship recipient; and
new text end
new text begin
(8) meet any other requirements determined by the commissioner.
new text end
new text begin
(b) Grant recipients must sign a contract agreeing to remain in the early childhood care
and education field for 12 months.
new text end
new text begin Subd. 5. new text end
new text begin Grant awards. new text end
new text begin
Grant awards must be made annually and may be made up to
an amount per recipient determined by the commissioner. Grant recipients may use grant
money for program supplies, training, or personal expenses.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
By January 1 each year, the commissioner must report to the legislative
committees with jurisdiction over child care about the number of grants awarded to recipients
and outcomes of the grant program since the last report.
new text end
Sec. 4.
Minnesota Statutes 2020, section 136A.128, subdivision 2, is amended to read:
Subd. 2.
Program components.
(a) The nonprofit organization must use the grant for:
(1) tuition scholarships up to deleted text begin $5,000deleted text end new text begin $10,000new text end per year for courses leading to the nationally
recognized child development associate credential or college-level courses leading to an
associate'snew text begin degreenew text end or bachelor's degree in early childhood development and school-age care;
and
(2) education incentives of a minimum of deleted text begin $100deleted text end new text begin $250new text end to participants in the tuition
scholarship program if they complete a year of working in the early care and education
field.
(b) Applicants for the scholarship must be employed by a licensed early childhood or
child care program and working directly with children, a licensed family child care provider,new text begin
employed by a public prekindergarten program,new text end or an employee in a school-age program
exempt from licensing under section 245A.03, subdivision 2, paragraph (a), clause (12).
Lower wage earners must be given priority in awarding the tuition scholarships. Scholarship
recipients must contributenew text begin at leastnew text end ten percent of the total scholarship and must be sponsored
by their employers, who must also contribute deleted text begin tendeleted text end new text begin at least fivenew text end percent of the total scholarship.
Scholarship recipients who are self-employed must contribute 20 percent of the total
scholarship.
Sec. 5.
Minnesota Statutes 2020, section 136A.128, subdivision 4, is amended to read:
Subd. 4.
Administration.
A nonprofit organization that receives a grant under this
section may use deleted text begin fivedeleted text end new text begin tennew text end percent of the grant amount to administer the program.
Sec. 6.
new text begin
[144.0503] COMPETITIVE BIDDING; REVERSE AUCTION PROCESS
REQUIRED.
new text end
new text begin
(a) The commissioner may, when not in conflict with federal law or regulation, use a
reverse auction process for all competitive bidding for contracts to procure products or
provide services, in accordance with the provisions of chapter 16C. For purposes of this
section, "reverse auction" has the meaning given in section 16C.10, subdivision 7.
new text end
new text begin
(b) The provisions of sections 13.591, subdivision 3, and 16C.06, subdivision 2, do not
apply when the commissioner uses a reverse auction purchasing process.
new text end
Sec. 7.
new text begin
[256.0113] COMPETITIVE BIDDING; REVERSE AUCTION PROCESS
REQUIRED.
new text end
new text begin
(a) The commissioner may, when not in conflict with federal law or regulation, use a
reverse auction process for all competitive bidding for contracts to procure products or
provide services, in accordance with the provisions of chapter 16C. For purposes of this
section, "reverse auction" has the meaning given in section 16C.10, subdivision 7.
new text end
new text begin
(b) The provisions of sections 13.591, subdivision 3, and 16C.06, subdivision 2, do not
apply when the commissioner uses a reverse auction purchasing process.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256.041, is amended to read:
256.041 CULTURAL AND ETHNIC COMMUNITIES LEADERSHIP COUNCIL.
Subdivision 1.
Establishment; purpose.
new text begin (a) new text end There is hereby established the Cultural
and Ethnic Communities Leadership Council for the Department of Human Services. The
purpose of the council is to advise the commissioner of human services on deleted text begin reducingdeleted text end new text begin
implementing strategies to reduce inequities andnew text end disparities that new text begin particularly new text end affect racial
and ethnic groupsnew text begin in Minnesotanew text end .
new text begin
(b) This council is comprised of racially and ethnically diverse community leaders
including American Indians who are residents of Minnesota facing the compounded
challenges of systemic inequities. Members include people who are refugees, immigrants,
and LGBTQ+; people who have disabilities; and people who live in rural Minnesota.
new text end
Subd. 2.
Members.
(a) The council must consist of:
(1) the chairs and ranking minority members of the committees in the house of
representatives and the senate with jurisdiction over human services; and
(2) no fewer than 15 and no more than 25 members appointed by and serving at the
pleasure of the commissioner of human services, in consultation with county, tribal, cultural,
and ethnic communities; diverse program participants; deleted text begin anddeleted text end parent representatives from these
communitiesnew text begin ; and cultural and ethnic communities leadership council membersnew text end .
(b) In making appointments under this section, the commissioner shall give priority
consideration to public members of the legislative councils of color established under deleted text begin chapter
3deleted text end new text begin section 15.0145new text end .
(c) Members must be appointed to allow for representation of the following groups:
(1) racial and ethnic minority groups;
(2) the American Indian community, which must be represented by two members;
(3) culturally and linguistically specific advocacy groups and service providers;
(4) human services program participants;
(5) public and private institutions;
(6) parents of human services program participants;
(7) members of the faith community;
(8) Department of Human Services employees; and
(9) any other group the commissioner deems appropriate to facilitate the goals and duties
of the council.
Subd. 3.
Guidelines.
The commissioner shall direct the development of guidelines
defining the membership of the council; setting out definitions; and developing duties of
the commissioner, the council, and council members regarding racial and ethnic disparities
reduction. The guidelines must be developed in consultation with:
(1) the chairs of relevant committees; and
(2) county, tribal, and cultural communities and program participants from these
communities.
Subd. 4.
Chair.
The commissioner shall new text begin accept recommendations from the council to
new text end appoint a chairnew text begin or chairsnew text end .
deleted text begin Subd. 5. deleted text end
deleted text begin Terms for first appointees. deleted text end
deleted text begin
The initial members appointed shall serve until
January 15, 2016.
deleted text end
Subd. 6.
Terms.
A term shall be for two years and appointees may be reappointed to
serve two additional terms. The commissioner shall make appointments to replace members
vacating their positions deleted text begin by January 15 of each yeardeleted text end new text begin in a timely manner, no more than three
months after the council reviews panel recommendationsnew text end .
Subd. 7.
Duties of commissioner.
(a) The commissioner of human services or the
commissioner's designee shall:
(1) maintain new text begin and actively engage with new text end the council established in this section;
(2) supervise and coordinate policies for persons from racial, ethnic, cultural, linguistic,
and tribal communities who experience disparities in access and outcomes;
(3) identify human services rules or statutes affecting persons from racial, ethnic, cultural,
linguistic, and tribal communities that may need to be revised;
(4) investigate and implement deleted text begin cost-effectivedeleted text end new text begin equitable and culturally responsivenew text end models
of service delivery deleted text begin such asdeleted text end new text begin includingnew text end careful deleted text begin adaptationdeleted text end new text begin adoptionnew text end of deleted text begin clinicallydeleted text end proven services
deleted text begin that constitute one strategy for increasingdeleted text end new text begin to increasenew text end the number of culturally relevant
services available to currently underserved populations; deleted text begin and
deleted text end
(5) based on recommendations of the council, review identified department policies that
maintain racial, ethnic, cultural, linguistic, and tribal disparitiesdeleted text begin , anddeleted text end new text begin ;new text end make adjustments to
ensure those disparities are not perpetuateddeleted text begin .deleted text end new text begin ; and advise the department on progress and
accountability measures for addressing inequities;
new text end
new text begin
(6) in partnership with the council, renew and implement equity policy with action plans
and resources necessary to implement the action plans;
new text end
new text begin
(7) support interagency collaboration to advance equity;
new text end
new text begin
(8) address the council at least twice annually on the state of equity within the department;
and
new text end
new text begin
(9) support member participation in the council, including participation in educational
and community engagement events across Minnesota that address equity in human services.
new text end
(b) The commissioner of human services or the commissioner's designee shall consult
with the council and receive recommendations from the council when meeting the
requirements in this subdivision.
Subd. 8.
Duties of council.
The council shall:
(1) recommend to the commissioner for review deleted text begin identified policies in thedeleted text end Department of
Human Services new text begin policy, budgetary, and operational decisions and practices new text end that deleted text begin maintaindeleted text end new text begin
impactnew text end racial, ethnic, cultural, linguistic, and tribal disparities;
(2) new text begin with community input, advance legislative proposals to improve racial and health
equity outcomes;
new text end
new text begin (3) new text end identify issues regarding new text begin inequities and new text end disparities by engaging diverse populations
in human services programs;
deleted text begin (3)deleted text end new text begin (4)new text end engage in mutual learning essential for achieving human services parity and
optimal wellness for service recipients;
deleted text begin (4)deleted text end new text begin (5)new text end raise awareness about human services disparities to the legislature and media;
deleted text begin (5)deleted text end new text begin (6)new text end provide technical assistance and consultation support to counties, private nonprofit
agencies, and other service providers to build their capacity to provide equitable human
services for persons from racial, ethnic, cultural, linguistic, and tribal communities who
experience disparities in access and outcomes;
deleted text begin (6)deleted text end new text begin (7)new text end provide technical assistance to promote statewide development of culturally and
linguistically appropriate, accessible, and cost-effective human services and related policies;
deleted text begin (7) providedeleted text end new text begin (8) recommend and monitornew text end training and outreach to facilitate access to
culturally and linguistically appropriate, accessible, and cost-effective human services to
prevent disparities;
deleted text begin
(8) facilitate culturally appropriate and culturally sensitive admissions, continued services,
discharges, and utilization review for human services agencies and institutions;
deleted text end
(9) form work groups to help carry out the duties of the council that include, but are not
limited to, persons who provide and receive services and representatives of advocacy groups,
and provide the work groups with clear guidelines, standardized parameters, and tasks for
the work groups to accomplish;
(10) promote information sharing in the human services community and statewide; and
(11) by February 15 deleted text begin each yeardeleted text end new text begin in the second year of the bienniumnew text end , prepare and submit
to the chairs and ranking minority members of the committees in the house of representatives
and the senate with jurisdiction over human services a report that summarizes the activities
of the council, identifies the major problems and issues confronting racial and ethnic groups
in accessing human services, makes recommendations to address issues, and lists the specific
objectives that the council seeks to attain during the next bienniumnew text begin , and recommendations
to strengthen equity, diversity, and inclusion within the departmentnew text end . The report must deleted text begin also
include a list of programs, groups, and grants used to reduce disparities, and statistically
valid reports of outcomes on the reduction of the disparities.deleted text end new text begin identify racial and ethnic groups'
difficulty in accessing human services and make recommendations to address the issues.
The report must include any updated Department of Human Services equity policy,
implementation plans, equity initiatives, and the council's progress.
new text end
Subd. 9.
Duties of council members.
The members of the council shall:
(1) attend deleted text begin anddeleted text end new text begin scheduled meetings with no more than three absences per year,new text end participate
in scheduled meetingsnew text begin ,new text end and be prepared by reviewing meeting notes;
(2) maintain open communication channels with respective constituencies;
(3) identify and communicate issues and risks that could impact the timely completion
of tasks;
(4) collaborate on new text begin inequity and new text end disparity reduction efforts;
(5) communicate updates of the council's work progress and status on the Department
of Human Services website; deleted text begin and
deleted text end
(6) participate in any activities the council or chair deems appropriate and necessary to
facilitate the goals and duties of the councildeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) participate in work groups to carry out council duties.
new text end
Subd. 10.
Expiration.
The council deleted text begin expires on June 30, 2022deleted text end new text begin shall expire when racial
and ethnic-based disparities no longer exist in the state of Minnesotanew text end .
new text begin Subd. 11. new text end
new text begin Compensation. new text end
new text begin
Compensation for members of the council is governed by
section 15.059, subdivision 3.
new text end
Sec. 9.
Minnesota Statutes 2020, section 257.0755, subdivision 1, is amended to read:
Subdivision 1.
Creation.
Each ombudsperson shall operate independently from but in
collaboration with the community-specific board that appointed the ombudsperson under
section 257.0768: deleted text begin the Indian Affairs Council,deleted text end the Minnesota Council on Latino Affairs, the
Council for Minnesotans of African Heritage, and the Council on Asian-Pacific Minnesotans.
Sec. 10.
Minnesota Statutes 2020, section 257.076, subdivision 3, is amended to read:
Subd. 3.
Communities of color.
"Communities of color" means the following: deleted text begin American
Indian,deleted text end Hispanic-Latino, Asian-Pacific, African, and African-American communities.
Sec. 11.
Minnesota Statutes 2020, section 257.076, subdivision 5, is amended to read:
Subd. 5.
Family of color.
"Family of color" means any family with a child under the
age of 18 who is identified by one or both parents or another trusted adult to be of deleted text begin American
Indian,deleted text end Hispanic-Latino, Asian-Pacific, African, or African-American descent.
Sec. 12.
Minnesota Statutes 2020, section 257.0768, subdivision 1, is amended to read:
Subdivision 1.
Membership.
deleted text begin Fourdeleted text end new text begin Threenew text end community-specific boards are created. Each
board consists of five members. The chair of each of the following groups shall appoint the
board for the community represented by the group: deleted text begin the Indian Affairs Council; deleted text end the Minnesota
Council on Latino Affairs; the Council for Minnesotans of African Heritage; and the Council
on Asian-Pacific Minnesotans. In making appointments, the chair must consult with other
members of the council.
Sec. 13.
Minnesota Statutes 2020, section 257.0768, subdivision 6, is amended to read:
Subd. 6.
Joint meetings.
The members of the deleted text begin fourdeleted text end new text begin threenew text end community-specific boards
shall meet jointly at least four times each year to advise the ombudspersons on overall
policies, plans, protocols, and programs for the office.
Sec. 14.
Minnesota Statutes 2020, section 257.0769, is amended to read:
257.0769 FUNDING FOR THE OMBUDSPERSON PROGRAM.
Subdivision 1.
Appropriations.
(a) deleted text begin money is appropriated fromdeleted text end new text begin $23,000 from new text end the special
fund authorized by section 256.01, subdivision 2, paragraph (o),new text begin is annually appropriatednew text end
to the deleted text begin Indian Affairs Councildeleted text end new text begin Office of Ombudsperson for American Indian Familiesnew text end for
the deleted text begin purposesdeleted text end new text begin purposenew text end of deleted text begin sections 257.0755 to 257.0768deleted text end new text begin section 3.9215new text end .
(b) deleted text begin money is appropriated fromdeleted text end new text begin $69,000 from new text end the special fund authorized by section
256.01, subdivision 2, paragraph (o),new text begin is annually appropriatednew text end to the deleted text begin Minnesota Council on
Latino Affairsdeleted text end new text begin Office of Ombudsperson for Familiesnew text end for the purposes of sections 257.0755
to 257.0768.
deleted text begin
(c) Money is appropriated from the special fund authorized by section 256.01, subdivision
2, paragraph (o), to the Council for Minnesotans of African Heritage for the purposes of
sections 257.0755 to 257.0768.
deleted text end
deleted text begin
(d) Money is appropriated from the special fund authorized by section 256.01, subdivision
2, paragraph (o), to the Council on Asian-Pacific Minnesotans for the purposes of sections
257.0755 to 257.0768.
deleted text end
Subd. 2.
Title IV-E reimbursement.
The commissioner shall obtain federal title IV-E
financial participation for eligible activity by the ombudsperson for families under section
257.0755new text begin and the ombudsperson for American Indian families under section 3.9215new text end . The
ombudsperson for familiesnew text begin and the ombudsperson for American Indian familiesnew text end shall maintain
and transmit to the Department of Human Services documentation that is necessary in order
to obtain federal funds.
Sec. 15. new text begin TRANSFER OF MONEY.
new text end
new text begin
Before the end of fiscal year 2021, the Office of the Ombudsperson for Families must
transfer to the Office of the Ombudsperson for American Indian Families any remaining
money designated for use by the Ombudsperson for American Indian Families. This section
is cost-neutral.
new text end
Sec. 16. new text begin CHILDREN WITH DISABILITIES INCLUSIVE CHILD CARE ACCESS
EXPANSION GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
(a) The commissioner of human services shall establish
a competitive grant program to expand access to licensed family child care providers or
licensed child care centers for children with disabilities including medical complexities.
The commissioner shall award grants to counties or Tribes, including at least one county
from the seven-county metropolitan area and at least one county or Tribe outside the
seven-county metropolitan area, and grant funds shall be used to enable child care providers
to develop an inclusive child care setting and offer care to children with disabilities and
children without disabilities. Grants shall be awarded to at least two applicants beginning
no later than December 1, 2021.
new text end
new text begin
(b) For purposes of this section, "child with a disability" means a child who has a
substantial delay or has an identifiable physical, medical, emotional, or mental condition
that hinders development.
new text end
new text begin
(c) For purposes of this section, "inclusive child care setting" means child care provided
in a manner that serves children with disabilities in the same setting as children without
disabilities.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
To administer the grant program, the commissioner
shall:
new text end
new text begin
(1) consult with relevant stakeholders to develop a request for proposals that at least
requires grant applicants to identify the items or services and estimated accompanying costs,
where possible, needed to expand access to inclusive child care settings for children with
disabilities;
new text end
new text begin
(2) develop procedures for data collection, qualitative and quantitative measurement of
grant program outcomes, and reporting requirements for grant recipients;
new text end
new text begin
(3) convene a working group of grant recipients, partner child care providers, and
participating families to assess progress on grant activities, share best practices, and collect
and review data on grant activities; and
new text end
new text begin
(4) by February 1, 2023, provide a report to the chairs and ranking minority members
of the legislative committees with jurisdiction over early childhood programs on the activities
and outcomes of the grant program with legislative recommendations for implementing
inclusive child care settings statewide. The report shall be made available to the public.
new text end
new text begin Subd. 3. new text end
new text begin Grant activities. new text end
new text begin
Grant recipients shall use grant funds for the cost of facility
modifications, resources, or services necessary to expand access to inclusive child care
settings for children with disabilities, including:
new text end
new text begin
(1) onetime needs to equip a child care setting to serve children with disabilities, including
but not limited to environmental modifications; accessibility modifications; sensory
adaptation; training materials and staff time for training, including for substitutes; or
equipment purchases, including durable medical equipment;
new text end
new text begin
(2) ongoing medical- or disability-related services for children with disabilities in
inclusive child care settings, including but not limited to mental health supports; inclusion
specialist services; home care nursing; behavioral supports; coaching or training for staff
and substitutes; substitute teaching time; or additional child care staff, an enhanced rate, or
another mechanism to increase staff-to-child ratio; and
new text end
new text begin
(3) other expenses determined by the grant recipient and each partner child care provider
to be necessary to establish an inclusive child care setting and serve children with disabilities
at the provider's location.
new text end
new text begin Subd. 4. new text end
new text begin Requirements for grant recipients. new text end
new text begin
Upon receipt of grant funds and throughout
the grant period, grant recipients shall:
new text end
new text begin
(1) partner with at least two but no more than five child care providers, each of which
must meet one of the following criteria:
new text end
new text begin
(i) serve 29 or fewer children, including at least two children with a disability who are
not a family member of the child care provider if the participating child care provider is a
family child care provider; or
new text end
new text begin
(ii) serve more than 30 children, including at least three children with a disability;
new text end
new text begin
(2) develop and follow a process to ensure that grant funding is used to support children
with disabilities who, without the additional supports made available through the grant,
would have difficulty accessing an inclusive child care setting;
new text end
new text begin
(3) pursue funding for ongoing services needed for children with disabilities in inclusive
child care settings, such as Medicaid or private health insurance coverage; additional grant
funding; or other funding sources;
new text end
new text begin
(4) explore and seek opportunities to use existing federal funds to provide ongoing
support to family child care providers or child care centers serving children with disabilities.
Grant recipients shall seek to minimize family financial obligations for child care for a child
with disabilities beyond what child care would cost for a child without disabilities; and
new text end
new text begin
(5) identify and utilize training resources for child care providers, where available and
applicable, for at least one of the grant recipient's partner child care providers.
new text end
new text begin Subd. 5. new text end
new text begin Reporting. new text end
new text begin
Grant recipients shall report to the commissioner every six months,
in a manner specified by the commissioner, on the following:
new text end
new text begin
(1) the number, type, and cost of additional supports needed to serve children with
disabilities in inclusive child care settings;
new text end
new text begin
(2) best practices for billing;
new text end
new text begin
(3) availability and use of funding sources other than through the grant program;
new text end
new text begin
(4) processes for identifying families of children with disabilities who could benefit
from grant activities and connecting them with a child care provider interested in serving
them;
new text end
new text begin
(5) processes and eligibility criteria used to determine whether a child is a child with a
disability and means of prioritizing grant funding to serve children with significant support
needs associated with their disability; and
new text end
new text begin
(6) any other information deemed relevant by the commissioner.
new text end
Sec. 17. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE SHARED SERVICES INNOVATION GRANTS.
new text end
new text begin
The commissioner of human services shall establish a grant program to test strategies
by which family child care providers may share services and thereby achieve economies of
scale. The commissioner shall report the results of the grant program to the legislative
committees with jurisdiction over early care and education programs.
new text end
Sec. 18. new text begin DIRECTION TO THE CHILDREN'S CABINET; EVALUATION OF THE
USE OF FEDERAL MONEY.
new text end
new text begin
(a) The Children's Cabinet, with the assistance of the commissioners of human services,
education, and employment and economic development, shall conduct an evaluation of the
use of federal money received pursuant to the American Rescue Plan Act of 2021 (Public
Law 117-2), the Coronavirus Response and Relief Supplemental Appropriations Act of
2020 (Public Law 116-260), and the Coronavirus Aid, Relief, and Economic Security Act
(Public Law 116-136) to address the state's needs in the area of early care and education.
The Children's Cabinet may arrange for consultants to assist with the evaluation.
new text end
new text begin
(b) The evaluation shall address at least the following topics with results disaggregated,
to the extent practicable, by age, race, ethnicity, and geographic areas of the state:
new text end
new text begin
(1) changes in the number of children who are able to access early care and education
programs, including children from the following categories: those from low-income families;
those who have disabilities or developmental delays; those who are English language
learners; those who are members of American Indian Tribes; and those who are migrant,
homeless, in foster care, or are in need of child protective services;
new text end
new text begin
(2) changes in the supply of early care and education, particularly in areas of the state
with shortages of early care and education;
new text end
new text begin
(3) changes in the quality of early care and education programs, as measured pursuant
to the state's quality rating and improvement system under Minnesota Statutes, section
124D.142; and
new text end
new text begin
(4) changes in the average compensation and credentials of the early care and education
workforce.
new text end
new text begin
(c) The Children's Cabinet shall submit interim findings of the evaluation to the governor
and the legislative committees with jurisdiction over early childhood programs by February
1 in each of calendar years 2022, 2023, and 2024. The Children's Cabinet shall submit a
final report to the governor and the legislative committees with jurisdiction over early
childhood programs by February 1, 2025.
new text end
Sec. 19. new text begin REPORT ON PARTICIPATION IN EARLY CHILDHOOD PROGRAMS
BY CHILDREN IN FOSTER CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Reporting requirement. new text end
new text begin
(a) The commissioner of human services shall
report on the participation in early care and education programs by children under age six
who have experienced foster care, as defined in Minnesota Statutes, section 260C.007,
subdivision 18, at any time during the reporting period.
new text end
new text begin
(b) For purposes of this section, "early care and education program" means Early Head
Start and Head Start under the federal Improving Head Start for School Readiness Act of
2007; special education programs under Minnesota Statutes, chapter 125A; early learning
scholarships under Minnesota Statutes, section 124D.165; school readiness under Minnesota
Statutes, sections 124D.15 and 124D.16; school readiness plus under Laws 2017, First
Special Session chapter 5, article 8, section 9; voluntary prekindergarten under Minnesota
Statutes, section 124D.151; child care assistance under Minnesota Statutes, chapter 119B;
and other programs as determined by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Report content. new text end
new text begin
(a) The report shall provide counts and rates of participation
in the early care and education program by each child's race, ethnicity, age, and county of
residence. The report shall use the most current administrative data and systems, including
the Early Childhood Longitudinal Data System, and include recommendations for collecting
any other administrative data listed in this paragraph that is not currently available.
new text end
new text begin
(b) The report shall include recommendations to:
new text end
new text begin
(1) provide the data described in paragraph (a) on an annual basis as part of the report
required under Minnesota Statutes, section 257.0725;
new text end
new text begin
(2) facilitate children's continued participation in early care and education programs
after reunification, adoption, or transfer of permanent legal and physical custody; and
new text end
new text begin
(3) regularly report measures of early childhood well-being for children who have
experienced foster care. "Measures of early childhood well-being" include administrative
data from developmental screenings, school readiness assessments, well-child medical visits,
and other sources as determined by the commissioner, in consultation with the commissioners
of health, education, and management and budget, county social service and public health
agencies, and school districts.
new text end
new text begin
(c) The report shall include an implementation plan to increase the rates of participation
among children and their foster families in early care and education programs, including
processes for referrals and follow-up. The plan shall be developed in collaboration with
affected communities and families, incorporating their experiences and feedback.
Representatives from county public health agencies; county social service agencies, including
child protection services; early childhood care and education providers; the judiciary; and
school districts must collaborate on the plan's development and implementation strategy.
new text end
new text begin
(d) The report shall identify barriers to be addressed to ensure that early care and
education programs are responsive to the cultural, logistical, and racial equity concerns and
needs of children's foster families and families of origin and the report shall identify methods
to ensure that the experiences and feedback from children's foster families and families of
origin are included in the ongoing implementation of early care and education programs.
new text end
new text begin Subd. 3. new text end
new text begin Submission to legislature. new text end
new text begin
By June 30, 2022, the commissioner shall submit
an interim progress report, including identification of potential administrative data sources
and barriers and a listing of plan development participants, and by December 1, 2022, the
commissioner shall submit the final report required under this section to the legislative
committees with jurisdiction over early care and education programs.
new text end
Sec. 20. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber Minnesota Statutes, section 136A.128, in Minnesota
Statutes, chapter 119B. The revisor shall also make necessary cross-reference changes
consistent with the renumbering.
new text end
ARTICLE 17
MENTAL HEALTH UNIFORM SERVICE STANDARDS
Section 1.
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[245I.01] PURPOSE AND CITATION.
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new text begin Subdivision 1. new text end
new text begin Citation. new text end
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This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
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new text begin Subd. 2. new text end
new text begin Purpose. new text end
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In accordance with sections 245.461 and 245.487, the purpose of this
chapter is to create a system of mental health care that is unified, accountable, and
comprehensive, and to promote the recovery and resiliency of Minnesotans who have mental
illnesses. The state's public policy is to support Minnesotans' access to quality outpatient
and residential mental health services. Further, the state's public policy is to protect the
health and safety, rights, and well-being of Minnesotans receiving mental health services.
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Sec. 2.
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[245I.011] APPLICABILITY.
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new text begin Subdivision 1. new text end
new text begin License requirements. new text end
new text begin
A license holder under this chapter must comply
with the requirements in chapters 245A, 245C, and 260E; section 626.557; and Minnesota
Rules, chapter 9544.
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new text begin Subd. 2. new text end
new text begin Variances. new text end
new text begin
(a) The commissioner may grant a variance to an applicant, license
holder, or certification holder as long as the variance does not affect the staff qualifications
or the health or safety of any person in a licensed or certified program and the applicant,
license holder, or certification holder meets the following conditions:
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(1) an applicant, license holder, or certification holder must request the variance on a
form approved by the commissioner and in a manner prescribed by the commissioner;
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(2) the request for a variance must include the:
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(i) reasons that the applicant, license holder, or certification holder cannot comply with
a requirement as stated in the law; and
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(ii) alternative equivalent measures that the applicant, license holder, or certification
holder will follow to comply with the intent of the law; and
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(3) the request for a variance must state the period of time when the variance is requested.
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(b) The commissioner may grant a permanent variance when the conditions under which
the applicant, license holder, or certification holder requested the variance do not affect the
health or safety of any person whom the licensed or certified program serves, and when the
conditions of the variance do not compromise the qualifications of staff who provide services
to clients. A permanent variance expires when the conditions that warranted the variance
change in any way. Any applicant, license holder, or certification holder must inform the
commissioner of any changes to the conditions that warranted the permanent variance. If
an applicant, license holder, or certification holder fails to advise the commissioner of
changes to the conditions that warranted the variance, the commissioner must revoke the
permanent variance and may impose other sanctions under sections 245A.06 and 245A.07.
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(c) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal under the provisions of chapter 14.
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new text begin Subd. 3. new text end
new text begin Certification required. new text end
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(a) An individual, organization, or government entity
that is exempt from licensure under section 245A.03, subdivision 2, paragraph (a), clause
(19), and chooses to be identified as a certified mental health clinic must:
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(1) be a mental health clinic that is certified under section 245I.20;
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(2) comply with all of the responsibilities assigned to a license holder by this chapter
except subdivision 1; and
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(3) comply with all of the responsibilities assigned to a certification holder by chapter
245A.
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(b) An individual, organization, or government entity described by this subdivision must
obtain a criminal background study for each staff person or volunteer who provides direct
contact services to clients.
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new text begin Subd. 4. new text end
new text begin License required. new text end
new text begin
An individual, organization, or government entity providing
intensive residential treatment services or residential crisis stabilization to adults must be
licensed under section 245I.23. An entity with an adult foster care license providing
residential crisis stabilization is exempt from licensure under section 245I.23.
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new text begin Subd. 5. new text end
new text begin Programs certified under chapter 256B. new text end
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(a) An individual, organization, or
government entity certified under the following sections must comply with all of the
responsibilities assigned to a license holder under this chapter except subdivision 1:
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(1) an assertive community treatment provider under section 256B.0622, subdivision
3a;
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(2) an adult rehabilitative mental health services provider under section 256B.0623;
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(3) a mobile crisis team under section 256B.0624;
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(4) a children's therapeutic services and supports provider under section 256B.0943;
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(5) an intensive treatment in foster care provider under section 256B.0946; and
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(6) an intensive nonresidential rehabilitative mental health services provider under section
256B.0947.
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(b) An individual, organization, or government entity certified under the sections listed
in paragraph (a), clauses (1) to (6), must obtain a criminal background study for each staff
person and volunteer providing direct contact services to a client.
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Sec. 3.
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[245I.02] DEFINITIONS.
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new text begin Subdivision 1. new text end
new text begin Scope. new text end
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For purposes of this chapter, the terms in this section have the
meanings given.
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new text begin Subd. 2. new text end
new text begin Approval. new text end
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"Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document. An individual may demonstrate
approval with a written signature, secure electronic signature, or documented oral approval.
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new text begin Subd. 3. new text end
new text begin Behavioral sciences or related fields. new text end
new text begin
"Behavioral sciences or related fields"
means an education from an accredited college or university in social work, psychology,
sociology, community counseling, family social science, child development, child
psychology, community mental health, addiction counseling, counseling and guidance,
special education, nursing, and other similar fields approved by the commissioner.
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new text begin Subd. 4. new text end
new text begin Business day. new text end
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"Business day" means a weekday on which government offices
are open for business. Business day does not include state or federal holidays, Saturdays,
or Sundays.
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new text begin Subd. 5. new text end
new text begin Case manager. new text end
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"Case manager" means a client's case manager according to
section 256B.0596; 256B.0621; 256B.0625, subdivision 20; 256B.092, subdivision 1a;
256B.0924; 256B.093, subdivision 3a; 256B.094; or 256B.49.
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new text begin Subd. 6. new text end
new text begin Certified rehabilitation specialist. new text end
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"Certified rehabilitation specialist" means
a staff person who meets the qualifications of section 245I.04, subdivision 8.
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new text begin Subd. 7. new text end
new text begin Child. new text end
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"Child" means a client under the age of 18.
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new text begin Subd. 8. new text end
new text begin Client. new text end
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"Client" means a person who is seeking or receiving services regulated
by this chapter. For the purpose of a client's consent to services, client includes a parent,
guardian, or other individual legally authorized to consent on behalf of a client to services.
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new text begin Subd. 9. new text end
new text begin Clinical trainee. new text end
new text begin
"Clinical trainee" means a staff person who is qualified
according to section 245I.04, subdivision 6.
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new text begin Subd. 10. new text end
new text begin Commissioner. new text end
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"Commissioner" means the commissioner of human services
or the commissioner's designee.
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new text begin Subd. 11. new text end
new text begin Co-occurring substance use disorder treatment. new text end
new text begin
"Co-occurring substance
use disorder treatment" means the treatment of a person who has a co-occurring mental
illness and substance use disorder. Co-occurring substance use disorder treatment is
characterized by stage-wise comprehensive treatment, treatment goal setting, and flexibility
for clients at each stage of treatment. Co-occurring substance use disorder treatment includes
assessing and tracking each client's stage of change readiness and treatment using a treatment
approach based on a client's stage of change, such as motivational interviewing when working
with a client at an earlier stage of change readiness and a cognitive behavioral approach
and relapse prevention to work with a client at a later stage of change; and facilitating a
client's access to community supports.
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new text begin Subd. 12. new text end
new text begin Crisis plan. new text end
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"Crisis plan" means a plan to prevent and de-escalate a client's
future crisis situation, with the goal of preventing future crises for the client and the client's
family and other natural supports. Crisis plan includes a crisis plan developed according to
section 245.4871, subdivision 9a.
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new text begin Subd. 13. new text end
new text begin Critical incident. new text end
new text begin
"Critical incident" means an occurrence involving a client
that requires a license holder to respond in a manner that is not part of the license holder's
ordinary daily routine. Critical incident includes a client's suicide, attempted suicide, or
homicide; a client's death; an injury to a client or other person that is life-threatening or
requires medical treatment; a fire that requires a fire department's response; alleged
maltreatment of a client; an assault of a client; an assault by a client; or other situation that
requires a response by law enforcement, the fire department, an ambulance, or another
emergency response provider.
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new text begin Subd. 14. new text end
new text begin Diagnostic assessment. new text end
new text begin
"Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses that a mental health professional or clinical trainee
completes under section 245I.10, subdivisions 4 to 6.
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new text begin Subd. 15. new text end
new text begin Direct contact. new text end
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"Direct contact" has the meaning given in section 245C.02,
subdivision 11.
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new text begin Subd. 16. new text end
new text begin Family and other natural supports. new text end
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"Family and other natural supports"
means the people whom a client identifies as having a high degree of importance to the
client. Family and other natural supports also means people that the client identifies as being
important to the client's mental health treatment, regardless of whether the person is related
to the client or lives in the same household as the client.
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new text begin Subd. 17. new text end
new text begin Functional assessment. new text end
new text begin
"Functional assessment" means the assessment of a
client's current level of functioning relative to functioning that is appropriate for someone
the client's age. For a client five years of age or younger, a functional assessment is the
Early Childhood Service Intensity Instrument (ESCII). For a client six to 17 years of age,
a functional assessment is the Child and Adolescent Service Intensity Instrument (CASII).
For a client 18 years of age or older, a functional assessment is the functional assessment
described in section 245I.10, subdivision 9.
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new text begin Subd. 18. new text end
new text begin Individual abuse prevention plan. new text end
new text begin
"Individual abuse prevention plan" means
a plan according to section 245A.65, subdivision 2, paragraph (b), and section 626.557,
subdivision 14.
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new text begin Subd. 19. new text end
new text begin Level of care assessment. new text end
new text begin
"Level of care assessment" means the level of care
decision support tool appropriate to the client's age. For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).
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new text begin Subd. 20. new text end
new text begin License. new text end
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"License" has the meaning given in section 245A.02, subdivision 8.
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new text begin Subd. 21. new text end
new text begin License holder. new text end
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"License holder" has the meaning given in section 245A.02,
subdivision 9.
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new text begin Subd. 22. new text end
new text begin Licensed prescriber. new text end
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"Licensed prescriber" means an individual who is
authorized to prescribe legend drugs under section 151.37.
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new text begin Subd. 23. new text end
new text begin Mental health behavioral aide. new text end
new text begin
"Mental health behavioral aide" means a
staff person who is qualified under section 245I.04, subdivision 16.
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new text begin Subd. 24. new text end
new text begin Mental health certified family peer specialist. new text end
new text begin
"Mental health certified
family peer specialist" means a staff person who is qualified under section 245I.04,
subdivision 12.
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new text begin Subd. 25. new text end
new text begin Mental health certified peer specialist. new text end
new text begin
"Mental health certified peer
specialist" means a staff person who is qualified under section 245I.04, subdivision 10.
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new text begin Subd. 26. new text end
new text begin Mental health practitioner. new text end
new text begin
"Mental health practitioner" means a staff person
who is qualified under section 245I.04, subdivision 4.
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new text begin Subd. 27. new text end
new text begin Mental health professional. new text end
new text begin
"Mental health professional" means a staff person
who is qualified under section 245I.04, subdivision 2.
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new text begin Subd. 28. new text end
new text begin Mental health rehabilitation worker. new text end
new text begin
"Mental health rehabilitation worker"
means a staff person who is qualified under section 245I.04, subdivision 14.
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new text begin Subd. 29. new text end
new text begin Mental illness. new text end
new text begin
"Mental illness" means any of the conditions included in the
most recent editions of the DC: 0-5 Diagnostic Classification of Mental Health and
Development Disorders of Infancy and Early Childhood published by Zero to Three or the
Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric
Association.
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new text begin Subd. 30. new text end
new text begin Organization. new text end
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"Organization" has the meaning given in section 245A.02,
subdivision 10c.
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new text begin Subd. 31. new text end
new text begin Personnel file. new text end
new text begin
"Personnel file" means a set of records under section 245I.07,
paragraph (a). Personnel files excludes information related to a person's employment that
is not included in section 245I.07.
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new text begin Subd. 32. new text end
new text begin Registered nurse. new text end
new text begin
"Registered nurse" means a staff person who is qualified
under section 148.171, subdivision 20.
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new text begin Subd. 33. new text end
new text begin Rehabilitative mental health services. new text end
new text begin
"Rehabilitative mental health services"
means mental health services provided to an adult client that enable the client to develop
and achieve psychiatric stability, social competencies, personal and emotional adjustment,
independent living skills, family roles, and community skills when symptoms of mental
illness has impaired any of the client's abilities in these areas.
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new text begin Subd. 34. new text end
new text begin Residential program. new text end
new text begin
"Residential program" has the meaning given in section
245A.02, subdivision 14.
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new text begin Subd. 35. new text end
new text begin Signature. new text end
new text begin
"Signature" means a written signature or an electronic signature
defined in section 325L.02, paragraph (h).
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new text begin Subd. 36. new text end
new text begin Staff person. new text end
new text begin
"Staff person" means an individual who works under a license
holder's direction or under a contract with a license holder. Staff person includes an intern,
consultant, contractor, individual who works part-time, and an individual who does not
provide direct contact services to clients. Staff person includes a volunteer who provides
treatment services to a client or a volunteer whom the license holder regards as a staff person
for the purpose of meeting staffing or service delivery requirements. A staff person must
be 18 years of age or older.
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new text begin Subd. 37. new text end
new text begin Strengths. new text end
new text begin
"Strengths" means a person's inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to a client's resilience
and core competencies. A person can build on strengths to support recovery.
new text end
new text begin Subd. 38. new text end
new text begin Trauma. new text end
new text begin
"Trauma" means an event, series of events, or set of circumstances
that is experienced by an individual as physically or emotionally harmful or life-threatening
that has lasting adverse effects on the individual's functioning and mental, physical, social,
emotional, or spiritual well-being. Trauma includes group traumatic experiences. Group
traumatic experiences are emotional or psychological harm that a group experiences. Group
traumatic experiences can be transmitted across generations within a community and are
often associated with racial and ethnic population groups who suffer major intergenerational
losses.
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new text begin Subd. 39. new text end
new text begin Treatment plan. new text end
new text begin
"Treatment plan" means services that a license holder
formulates to respond to a client's needs and goals. A treatment plan includes individual
treatment plans under section 245I.10, subdivisions 7 and 8; initial treatment plans under
section 245I.23, subdivision 7; and crisis treatment plans under sections 245I.23, subdivision
8, and 256B.0624, subdivision 11.
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new text begin Subd. 40. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means a mental health
professional's or certified rehabilitation specialist's oversight, direction, and evaluation of
a staff person providing services to a client according to section 245I.06.
new text end
new text begin Subd. 41. new text end
new text begin Volunteer. new text end
new text begin
"Volunteer" means an individual who, under the direction of the
license holder, provides services to or facilitates an activity for a client without compensation.
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Sec. 4.
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[245I.03] REQUIRED POLICIES AND PROCEDURES.
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new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must establish, enforce, and maintain policies
and procedures to comply with the requirements of this chapter and chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; and Minnesota Rules, chapter 9544. The license
holder must make all policies and procedures available in writing to each staff person. The
license holder must complete and document a review of policies and procedures every two
years and update policies and procedures as necessary. Each policy and procedure must
identify the date that it was initiated and the dates of all revisions. The license holder must
clearly communicate any policy and procedural change to each staff person and provide
necessary training to each staff person to implement any policy and procedural change.
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new text begin Subd. 2. new text end
new text begin Health and safety. new text end
new text begin
A license holder must have policies and procedures to
ensure the health and safety of each staff person and client during the provision of services,
including policies and procedures for services based in community settings.
new text end
new text begin Subd. 3. new text end
new text begin Client rights. new text end
new text begin
A license holder must have policies and procedures to ensure
that each staff person complies with the client rights and protections requirements in section
245I.12.
new text end
new text begin Subd. 4. new text end
new text begin Behavioral emergencies. new text end
new text begin
(a) A license holder must have procedures that each
staff person follows when responding to a client who exhibits behavior that threatens the
immediate safety of the client or others. A license holder's behavioral emergency procedures
must incorporate person-centered planning and trauma-informed care.
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new text begin
(b) A license holder's behavioral emergency procedures must include:
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(1) a plan designed to prevent the client from inflicting self-harm and harming others;
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(2) contact information for emergency resources that a staff person must use when the
license holder's behavioral emergency procedures are unsuccessful in controlling a client's
behavior;
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(3) the types of behavioral emergency procedures that a staff person may use;
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(4) the specific circumstances under which the program may use behavioral emergency
procedures; and
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(5) the staff persons whom the license holder authorizes to implement behavioral
emergency procedures.
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new text begin
(c) The license holder's behavioral emergency procedures must not include secluding
or restraining a client except as allowed under section 245.8261.
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new text begin
(d) Staff persons must not use behavioral emergency procedures to enforce program
rules or for the convenience of staff persons. Behavioral emergency procedures must not
be part of any client's treatment plan. A staff person may not use behavioral emergency
procedures except in response to a client's current behavior that threatens the immediate
safety of the client or others.
new text end
new text begin Subd. 5. new text end
new text begin Health services and medications. new text end
new text begin
If a license holder is licensed as a residential
program, stores or administers client medications, or observes clients self-administer
medications, the license holder must ensure that a staff person who is a registered nurse or
licensed prescriber reviews and approves of the license holder's policies and procedures to
comply with the health services and medications requirements in section 245I.11, the training
requirements in section 245I.05, subdivision 6, and the documentation requirements in
section 245I.08, subdivision 5.
new text end
new text begin Subd. 6. new text end
new text begin Reporting maltreatment. new text end
new text begin
A license holder must have policies and procedures
for reporting a staff person's suspected maltreatment, abuse, or neglect of a client according
to chapter 260E and section 626.557.
new text end
new text begin Subd. 7. new text end
new text begin Critical incidents. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must have policies and procedures for reporting and maintaining records of
critical incidents according to section 245I.13.
new text end
new text begin Subd. 8. new text end
new text begin Personnel. new text end
new text begin
A license holder must have personnel policies and procedures that:
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new text begin
(1) include a chart or description of the organizational structure of the program that
indicates positions and lines of authority;
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new text begin
(2) ensure that it will not adversely affect a staff person's retention, promotion, job
assignment, or pay when a staff person communicates in good faith with the Department
of Human Services, the Office of Ombudsman for Mental Health and Developmental
Disabilities, the Department of Health, a health-related licensing board, a law enforcement
agency, or a local agency investigating a complaint regarding a client's rights, health, or
safety;
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new text begin
(3) prohibit a staff person from having sexual contact with a client in violation of chapter
604, sections 609.344 or 609.345;
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new text begin
(4) prohibit a staff person from neglecting, abusing, or maltreating a client as described
in chapter 260E and sections 626.557 and 626.5572;
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new text begin
(5) include the drug and alcohol policy described in section 245A.04, subdivision 1,
paragraph (c);
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new text begin
(6) describe the process for disciplinary action, suspension, or dismissal of a staff person
for violating a policy provision described in clauses (3) to (5);
new text end
new text begin
(7) describe the license holder's response to a staff person who violates other program
policies or who has a behavioral problem that interferes with providing treatment services
to clients; and
new text end
new text begin
(8) describe each staff person's position that includes the staff person's responsibilities,
authority to execute the responsibilities, and qualifications for the position.
new text end
new text begin Subd. 9. new text end
new text begin Volunteers. new text end
new text begin
A license holder must have policies and procedures for using
volunteers, including when a license holder must submit a background study for a volunteer,
and the specific tasks that a volunteer may perform.
new text end
new text begin Subd. 10. new text end
new text begin Data privacy. new text end
new text begin
(a) A license holder must have policies and procedures that
comply with all applicable state and federal law. A license holder's use of electronic record
keeping or electronic signatures does not alter a license holder's obligations to comply with
applicable state and federal law.
new text end
new text begin
(b) A license holder must have policies and procedures for a staff person to promptly
document a client's revocation of consent to disclose the client's health record. The license
holder must verify that the license holder has permission to disclose a client's health record
before releasing any client data.
new text end
Sec. 5.
new text begin
[245I.04] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Tribal providers. new text end
new text begin
For purposes of this section, a tribal entity may
credential an individual according to section 256B.02, subdivision 7, paragraphs (b) and
(c).
new text end
new text begin Subd. 2. new text end
new text begin Mental health professional qualifications. new text end
new text begin
The following individuals may
provide services to a client as a mental health professional:
new text end
new text begin
(1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a: (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and
mental health nursing by a national certification organization; or (ii) nurse practitioner in
adult or family psychiatric and mental health nursing by a national nurse certification
organization;
new text end
new text begin
(2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
new text end
new text begin
(3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
new text end
new text begin
(4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
new text end
new text begin
(5) a marriage and family therapist licensed under sections 148B.29 to 148B.392; or
new text end
new text begin
(6) a licensed professional clinical counselor licensed under section 148B.5301.
new text end
new text begin Subd. 3. new text end
new text begin Mental health professional scope of practice. new text end
new text begin
A mental health professional
must maintain a valid license with the mental health professional's governing health-related
licensing board and must only provide services to a client within the scope of practice
determined by the applicable health-related licensing board.
new text end
new text begin Subd. 4. new text end
new text begin Mental health practitioner qualifications. new text end
new text begin
(a) An individual who is qualified
in at least one of the ways described in paragraph (b) to (d) may serve as a mental health
practitioner.
new text end
new text begin
(b) An individual is qualified as a mental health practitioner through relevant coursework
if the individual completes at least 30 semester hours or 45 quarter hours in behavioral
sciences or related fields and:
new text end
new text begin
(1) has at least 2,000 hours of experience providing services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to a client;
new text end
new text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, and completes the additional training described in section
245I.05, subdivision 3, paragraph (c), before providing direct contact services to a client;
new text end
new text begin
(3) is working in a day treatment program under section 256B.0671, subdivision 3, or
256B.0943; or
new text end
new text begin
(4) has completed a practicum or internship that (i) required direct interaction with adult
clients or child clients, and (ii) was focused on behavioral sciences or related fields.
new text end
new text begin
(c) An individual is qualified as a mental health practitioner through work experience
if the individual:
new text end
new text begin
(1) has at least 4,000 hours of experience in the delivery of services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients; or
new text end
new text begin
(2) receives treatment supervision at least once per week until meeting the requirement
in clause (1) of 4,000 hours of experience and has at least 2,000 hours of experience providing
services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients.
new text end
new text begin
(d) An individual is qualified as a mental health practitioner if the individual has a
master's or other graduate degree in behavioral sciences or related fields.
new text end
new text begin Subd. 5. new text end
new text begin Mental health practitioner scope of practice. new text end
new text begin
(a) A mental health practitioner
under the treatment supervision of a mental health professional or certified rehabilitation
specialist may provide an adult client with client education, rehabilitative mental health
services, functional assessments, level of care assessments, and treatment plans. A mental
health practitioner under the treatment supervision of a mental health professional may
provide skill-building services to a child client and complete treatment plans for a child
client.
new text end
new text begin
(b) A mental health practitioner must not provide treatment supervision to other staff
persons. A mental health practitioner may provide direction to mental health rehabilitation
workers and mental health behavioral aides.
new text end
new text begin
(c) A mental health practitioner who provides services to clients according to section
256B.0624 or 256B.0944 may perform crisis assessments and interventions for a client.
new text end
new text begin Subd. 6. new text end
new text begin Clinical trainee qualifications. new text end
new text begin
(a) A clinical trainee is a staff person who: (1)
is enrolled in an accredited graduate program of study to prepare the staff person for
independent licensure as a mental health professional and who is participating in a practicum
or internship with the license holder through the individual's graduate program; or (2) has
completed an accredited graduate program of study to prepare the staff person for independent
licensure as a mental health professional and who is in compliance with the requirements
of the applicable health-related licensing board, including requirements for supervised
practice.
new text end
new text begin
(b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure that the trainee meets the requirements of the health-related licensing board.
As permitted by a health-related licensing board, treatment supervision under this chapter
may be integrated into a plan to meet the supervisory requirements of the health-related
licensing board but does not supersede those requirements.
new text end
new text begin Subd. 7. new text end
new text begin Clinical trainee scope of practice. new text end
new text begin
(a) A clinical trainee under the treatment
supervision of a mental health professional may provide a client with psychotherapy, client
education, rehabilitative mental health services, diagnostic assessments, functional
assessments, level of care assessments, and treatment plans.
new text end
new text begin
(b) A clinical trainee must not provide treatment supervision to other staff persons. A
clinical trainee may provide direction to mental health behavioral aides and mental health
rehabilitation workers.
new text end
new text begin
(c) A psychological clinical trainee under the treatment supervision of a psychologist
may perform psychological testing of clients.
new text end
new text begin
(d) A clinical trainee must not provide services to clients that violate any practice act of
a health-related licensing board, including failure to obtain licensure if licensure is required.
new text end
new text begin Subd. 8. new text end
new text begin Certified rehabilitation specialist qualifications. new text end
new text begin
A certified rehabilitation
specialist must have:
new text end
new text begin
(1) a master's degree from an accredited college or university in behavioral sciences or
related fields;
new text end
new text begin
(2) at least 4,000 hours of post-master's supervised experience providing mental health
services to clients; and
new text end
new text begin
(3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
new text end
new text begin Subd. 9. new text end
new text begin Certified rehabilitation specialist scope of practice. new text end
new text begin
(a) A certified
rehabilitation specialist may provide an adult client with client education, rehabilitative
mental health services, functional assessments, level of care assessments, and treatment
plans.
new text end
new text begin
(b) A certified rehabilitation specialist may provide treatment supervision to a mental
health certified peer specialist, mental health practitioner, and mental health rehabilitation
worker.
new text end
new text begin Subd. 10. new text end
new text begin Mental health certified peer specialist qualifications. new text end
new text begin
A mental health
certified peer specialist must:
new text end
new text begin
(1) have been diagnosed with a mental illness;
new text end
new text begin
(2) be a current or former mental health services client; and
new text end
new text begin
(3) have a valid certification as a mental health certified peer specialist under section
256B.0615.
new text end
new text begin Subd. 11. new text end
new text begin Mental health certified peer specialist scope of practice. new text end
new text begin
A mental health
certified peer specialist under the treatment supervision of a mental health professional or
certified rehabilitation specialist must:
new text end
new text begin
(1) provide individualized peer support to each client;
new text end
new text begin
(2) promote a client's recovery goals, self-sufficiency, self-advocacy, and development
of natural supports; and
new text end
new text begin
(3) support a client's maintenance of skills that the client has learned from other services.
new text end
new text begin Subd. 12. new text end
new text begin Mental health certified family peer specialist qualifications. new text end
new text begin
A mental
health certified family peer specialist must:
new text end
new text begin
(1) have raised or be currently raising a child with a mental illness;
new text end
new text begin
(2) have experience navigating the children's mental health system; and
new text end
new text begin
(3) have a valid certification as a mental health certified family peer specialist under
section 256B.0616.
new text end
new text begin Subd. 13. new text end
new text begin Mental health certified family peer specialist scope of practice. new text end
new text begin
A mental
health certified family peer specialist under the treatment supervision of a mental health
professional must provide services to increase the child's ability to function in the child's
home, school, and community. The mental health certified family peer specialist must:
new text end
new text begin
(1) provide family peer support to build on a client's family's strengths and help the
family achieve desired outcomes;
new text end
new text begin
(2) provide nonadversarial advocacy to a child client and the child's family that
encourages partnership and promotes the child's positive change and growth;
new text end
new text begin
(3) support families in advocating for culturally appropriate services for a child in each
treatment setting;
new text end
new text begin
(4) promote resiliency, self-advocacy, and development of natural supports;
new text end
new text begin
(5) support maintenance of skills learned from other services;
new text end
new text begin
(6) establish and lead parent support groups;
new text end
new text begin
(7) assist parents in developing coping and problem-solving skills; and
new text end
new text begin
(8) educate parents about mental illnesses and community resources, including resources
that connect parents with similar experiences to one another.
new text end
new text begin Subd. 14. new text end
new text begin Mental health rehabilitation worker qualifications. new text end
new text begin
(a) A mental health
rehabilitation worker must:
new text end
new text begin
(1) have a high school diploma or equivalent; and
new text end
new text begin
(2) meet one of the following qualification requirements:
new text end
new text begin
(i) be fluent in the non-English language or competent in the culture of the ethnic group
to which at least 20 percent of the mental health rehabilitation worker's clients belong;
new text end
new text begin
(ii) have an associate of arts degree;
new text end
new text begin
(iii) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
new text end
new text begin
(iv) be a registered nurse;
new text end
new text begin
(v) have, within the previous ten years, three years of personal life experience with
mental illness;
new text end
new text begin
(vi) have, within the previous ten years, three years of life experience as a primary
caregiver to an adult with a mental illness, traumatic brain injury, substance use disorder,
or developmental disability; or
new text end
new text begin
(vii) have, within the previous ten years, 2,000 hours of work experience providing
health and human services to individuals.
new text end
new text begin
(b) A mental health rehabilitation worker who is scheduled as an overnight staff person
and works alone is exempt from the additional qualification requirements in paragraph (a),
clause (2).
new text end
new text begin Subd. 15. new text end
new text begin Mental health rehabilitation worker scope of practice. new text end
new text begin
A mental health
rehabilitation worker under the treatment supervision of a mental health professional or
certified rehabilitation specialist may provide rehabilitative mental health services to an
adult client according to the client's treatment plan.
new text end
new text begin Subd. 16. new text end
new text begin Mental health behavioral aide qualifications. new text end
new text begin
(a) A level 1 mental health
behavioral aide must have: (1) a high school diploma or equivalent; or (2) two years of
experience as a primary caregiver to a child with mental illness within the previous ten
years.
new text end
new text begin
(b) A level 2 mental health behavioral aide must: (1) have an associate or bachelor's
degree; or (2) be certified by a program under section 256B.0943, subdivision 8a.
new text end
new text begin Subd. 17. new text end
new text begin Mental health behavioral aide scope of practice. new text end
new text begin
While under the treatment
supervision of a mental health professional, a mental health behavioral aide may practice
psychosocial skills with a child client according to the child's treatment plan and individual
behavior plan that a mental health professional, clinical trainee, or mental health practitioner
has previously taught to the child.
new text end
Sec. 6.
new text begin
[245I.05] TRAINING REQUIRED.
new text end
new text begin Subdivision 1. new text end
new text begin Training plan. new text end
new text begin
A license holder must develop a training plan to ensure
that staff persons receive ongoing training according to this section. The training plan must
include:
new text end
new text begin
(1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation of a staff person satisfies this requirement;
new text end
new text begin
(2) a description of how the license holder conducts ongoing training of each staff person,
including whether ongoing training is based on a staff person's hire date or a specified annual
cycle determined by the program;
new text end
new text begin
(3) a description of how the license holder verifies and documents each staff person's
previous training experience. A license holder may consider a staff person to have met a
training requirement in subdivision 3, paragraph (d) or (e), if the staff person has received
equivalent postsecondary education in the previous four years or training experience in the
previous two years; and
new text end
new text begin
(4) a description of how the license holder determines when a staff person needs
additional training, including when the license holder will provide additional training.
new text end
new text begin Subd. 2. new text end
new text begin Documentation of training. new text end
new text begin
(a) The license holder must provide training to
each staff person according to the training plan and must document that the license holder
provided the training to each staff person. The license holder must document the following
information for each staff person's training:
new text end
new text begin
(1) the topics of the training;
new text end
new text begin
(2) the name of the trainee;
new text end
new text begin
(3) the name and credentials of the trainer;
new text end
new text begin
(4) the license holder's method of evaluating the trainee's competency upon completion
of training;
new text end
new text begin
(5) the date of the training; and
new text end
new text begin
(6) the length of training in hours and minutes.
new text end
new text begin
(b) Documentation of a staff person's continuing education credit accepted by the
governing health-related licensing board is sufficient to document training for purposes of
this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Initial training. new text end
new text begin
(a) A staff person must receive training about:
new text end
new text begin
(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
new text end
new text begin
(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
new text end
new text begin
(b) Before providing direct contact services to a client, a staff person must receive training
about:
new text end
new text begin
(1) client rights and protections under section 245I.12;
new text end
new text begin
(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
new text end
new text begin
(3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
new text end
new text begin
(4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
new text end
new text begin
(5) professional boundaries that the staff person must maintain; and
new text end
new text begin
(6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, physical and
mental abilities.
new text end
new text begin
(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner qualified under section
245I.04, subdivision 4, must receive 30 hours of training about:
new text end
new text begin
(1) mental illnesses;
new text end
new text begin
(2) client recovery and resiliency;
new text end
new text begin
(3) mental health de-escalation techniques;
new text end
new text begin
(4) co-occurring mental illness and substance use disorders; and
new text end
new text begin
(5) psychotropic medications and medication side effects.
new text end
new text begin
(d) Within 90 days of first providing direct contact services to an adult client, a clinical
trainee, mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
new text end
new text begin
(1) trauma-informed care and secondary trauma;
new text end
new text begin
(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
new text end
new text begin
(3) co-occurring substance use disorders; and
new text end
new text begin
(4) culturally responsive treatment practices.
new text end
new text begin
(e) Within 90 days of first providing direct contact services to a child client, a clinical
trainee, mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
new text end
new text begin
(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
new text end
new text begin
(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
new text end
new text begin
(3) mental illness and co-occurring substance use disorders in family systems;
new text end
new text begin
(4) culturally responsive treatment practices; and
new text end
new text begin
(5) child development, including cognitive functioning, and physical and mental abilities.
new text end
new text begin
(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Ongoing training. new text end
new text begin
(a) A license holder must ensure that staff persons who
provide direct contact services to clients receive annual training about the topics in
subdivision 3, paragraphs (a) and (b), clauses (1) to (3).
new text end
new text begin
(b) A license holder must ensure that each staff person who is qualified under section
245I.04 who is not a mental health professional receives 30 hours of training every two
years. The training topics must be based on the program's needs and the staff person's areas
of competency.
new text end
new text begin Subd. 5. new text end
new text begin Additional training for medication administration. new text end
new text begin
(a) Prior to administering
medications to a client under delegated authority or observing a client self-administer
medications, a staff person who is not a licensed prescriber, registered nurse, or licensed
practical nurse qualified under section 148.171, subdivision 8, must receive training about
psychotropic medications, side effects, and medication management.
new text end
new text begin
(b) Prior to administering medications to a client under delegated authority, a staff person
must successfully complete a:
new text end
new text begin
(1) medication administration training program for unlicensed personnel through an
accredited Minnesota postsecondary educational institution with completion of the course
documented in writing and placed in the staff person's personnel file; or
new text end
new text begin
(2) formalized training program taught by a registered nurse or licensed prescriber that
is offered by the license holder. A staff person's successful completion of the formalized
training program must include direct observation of the staff person to determine the staff
person's areas of competency.
new text end
Sec. 7.
new text begin
[245I.06] TREATMENT SUPERVISION.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must ensure that a mental health
professional or certified rehabilitation specialist provides treatment supervision to each staff
person who provides services to a client and who is not a mental health professional or
certified rehabilitation specialist. When providing treatment supervision, a treatment
supervisor must follow a staff person's written treatment supervision plan.
new text end
new text begin
(b) Treatment supervision must focus on each client's treatment needs and the ability of
the staff person under treatment supervision to provide services to each client, including
the following topics related to the staff person's current caseload:
new text end
new text begin
(1) a review and evaluation of the interventions that the staff person delivers to each
client;
new text end
new text begin
(2) instruction on alternative strategies if a client is not achieving treatment goals;
new text end
new text begin
(3) a review and evaluation of each client's assessments, treatment plans, and progress
notes for accuracy and appropriateness;
new text end
new text begin
(4) instruction on the cultural norms or values of the clients and communities that the
license holder serves and the impact that a client's culture has on providing treatment;
new text end
new text begin
(5) evaluation of and feedback regarding a direct service staff person's areas of
competency; and
new text end
new text begin
(6) coaching, teaching, and practicing skills with a staff person.
new text end
new text begin
(c) A treatment supervisor must provide treatment supervision to a staff person using
methods that allow for immediate feedback, including in-person, telephone, and interactive
video supervision.
new text end
new text begin
(d) A treatment supervisor's responsibility for a staff person receiving treatment
supervision is limited to the services provided by the associated license holder. If a staff
person receiving treatment supervision is employed by multiple license holders, each license
holder is responsible for providing treatment supervision related to the treatment of the
license holder's clients.
new text end
new text begin Subd. 2. new text end
new text begin Treatment supervision planning. new text end
new text begin
(a) A treatment supervisor and the staff
person supervised by the treatment supervisor must develop a written treatment supervision
plan. The license holder must ensure that a new staff person's treatment supervision plan is
completed and implemented by a treatment supervisor and the new staff person within 30
days of the new staff person's first day of employment. The license holder must review and
update each staff person's treatment supervision plan annually.
new text end
new text begin
(b) Each staff person's treatment supervision plan must include:
new text end
new text begin
(1) the name and qualifications of the staff person receiving treatment supervision;
new text end
new text begin
(2) the names and licensures of the treatment supervisors who are supervising the staff
person;
new text end
new text begin
(3) how frequently the treatment supervisors must provide treatment supervision to the
staff person; and
new text end
new text begin
(4) the staff person's authorized scope of practice, including a description of the client
population that the staff person serves, and a description of the treatment methods and
modalities that the staff person may use to provide services to clients.
new text end
new text begin Subd. 3. new text end
new text begin
Treatment supervision and direct observation of mental health
rehabilitation workers and mental health behavioral aides.
new text end
new text begin
(a) A mental health behavioral
aide or a mental health rehabilitation worker must receive direct observation from a mental
health professional, clinical trainee, certified rehabilitation specialist, or mental health
practitioner while the mental health behavioral aide or mental health rehabilitation worker
provides treatment services to clients, no less than twice per month for the first six months
of employment and once per month thereafter. The staff person performing the direct
observation must approve of the progress note for the observed treatment service.
new text end
new text begin
(b) For a mental health rehabilitation worker qualified under section 245I.04, subdivision
14, paragraph (a), clause (2), item (i), treatment supervision in the first 2,000 hours of work
must at a minimum consist of:
new text end
new text begin
(1) monthly individual supervision; and
new text end
new text begin
(2) direct observation twice per month.
new text end
Sec. 8.
new text begin
[245I.07] PERSONNEL FILES.
new text end
new text begin
(a) For each staff person, a license holder must maintain a personnel file that includes:
new text end
new text begin
(1) verification of the staff person's qualifications required for the position including
training, education, practicum or internship agreement, licensure, and any other required
qualifications;
new text end
new text begin
(2) documentation related to the staff person's background study;
new text end
new text begin
(3) the hiring date of the staff person;
new text end
new text begin
(4) a description of the staff person's job responsibilities with the license holder;
new text end
new text begin
(5) the date that the staff person's specific duties and responsibilities became effective,
including the date that the staff person began having direct contact with clients;
new text end
new text begin
(6) documentation of the staff person's training as required by section 245I.05, subdivision
2;
new text end
new text begin
(7) a verification copy of license renewals that the staff person completed during the
staff person's employment;
new text end
new text begin
(8) annual job performance evaluations; and
new text end
new text begin
(9) if applicable, the staff person's alleged and substantiated violations of the license
holder's policies under section 245I.03, subdivision 8, clauses (3) to (7), and the license
holder's response.
new text end
new text begin
(b) The license holder must ensure that all personnel files are readily accessible for the
commissioner's review. The license holder is not required to keep personnel files in a single
location.
new text end
Sec. 9.
new text begin
[245I.08] DOCUMENTATION STANDARDS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must ensure that all documentation required
by this chapter complies with this section.
new text end
new text begin Subd. 2. new text end
new text begin Documentation standards. new text end
new text begin
A license holder must ensure that all documentation
required by this chapter:
new text end
new text begin
(1) is legible;
new text end
new text begin
(2) identifies the applicable client and staff person on each page; and
new text end
new text begin
(3) is signed and dated by the staff persons who provided services to the client or
completed the documentation, including the staff persons' credentials.
new text end
new text begin Subd. 3. new text end
new text begin Documenting approval. new text end
new text begin
A license holder must ensure that all diagnostic
assessments, functional assessments, level of care assessments, and treatment plans completed
by a clinical trainee or mental health practitioner contain documentation of approval by a
treatment supervisor within five business days of initial completion by the staff person under
treatment supervision.
new text end
new text begin Subd. 4. new text end
new text begin Progress notes. new text end
new text begin
A license holder must use a progress note to document each
occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
new text end
new text begin
(1) the type of service;
new text end
new text begin
(2) the date of service;
new text end
new text begin
(3) the start and stop time of the service unless the license holder is licensed as a
residential program;
new text end
new text begin
(4) the location of the service;
new text end
new text begin
(5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention; (iv) the staff person's plan to take future
actions, including changes in treatment that the staff person will implement if the intervention
was ineffective; and (v) the service modality;
new text end
new text begin
(6) the signature, printed name, and credentials of the staff person who provided the
service to the client;
new text end
new text begin
(7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
new text end
new text begin
(8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration record. new text end
new text begin
If a license holder administers or observes
a client self-administer medications, the license holder must maintain a medication
administration record for each client that contains the following, as applicable:
new text end
new text begin
(1) the client's date of birth;
new text end
new text begin
(2) the client's allergies;
new text end
new text begin
(3) all medication orders for the client, including client-specific orders for
over-the-counter medications and approved condition-specific protocols;
new text end
new text begin
(4) the name of each ordered medication, date of each medication's expiration, each
medication's dosage frequency, method of administration, and time;
new text end
new text begin
(5) the licensed prescriber's name and telephone number;
new text end
new text begin
(6) the date of initiation;
new text end
new text begin
(7) the signature, printed name, and credentials of the staff person who administered the
medication or observed the client self-administer the medication; and
new text end
new text begin
(8) the reason that the license holder did not administer the client's prescribed medication
or observe the client self-administer the client's prescribed medication.
new text end
Sec. 10.
new text begin
[245I.09] CLIENT FILES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must maintain a file for each client that
contains the client's current and accurate records. The license holder must store each client
file on the premises where the license holder provides or coordinates services for the client.
The license holder must ensure that all client files are readily accessible for the
commissioner's review. The license holder is not required to keep client files in a single
location.
new text end
new text begin
(b) The license holder must protect client records against loss, tampering, or unauthorized
disclosure of confidential client data according to the Minnesota Government Data Practices
Act, chapter 13; the privacy provisions of the Minnesota health care programs provider
agreement; the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
Public Law 104-191; and the Minnesota Health Records Act, sections 144.291 to 144.298.
new text end
new text begin Subd. 2. new text end
new text begin Record retention. new text end
new text begin
A license holder must retain client records of a discharged
client for a minimum of five years from the date of the client's discharge. A license holder
who ceases to provide treatment services to a client must retain the client's records for a
minimum of five years from the date that the license holder stopped providing services to
the client and must notify the commissioner of the location of the client records and the
name of the individual responsible for storing and maintaining the client records.
new text end
new text begin Subd. 3. new text end
new text begin Contents. new text end
new text begin
A license holder must retain a clear and complete record of the
information that the license holder receives regarding a client, and of the services that the
license holder provides to the client. If applicable, each client's file must include the following
information:
new text end
new text begin
(1) the client's screenings, assessments, and testing;
new text end
new text begin
(2) the client's treatment plans and reviews of the client's treatment plan;
new text end
new text begin
(3) the client's individual abuse prevention plans;
new text end
new text begin
(4) the client's health care directive under section 145C.01, subdivision 5a, and the
client's emergency contacts;
new text end
new text begin
(5) the client's crisis plans;
new text end
new text begin
(6) the client's consents for releases of information and documentation of the client's
releases of information;
new text end
new text begin
(7) the client's significant medical and health-related information;
new text end
new text begin
(8) a record of each communication that a staff person has with the client's other mental
health providers and persons interested in the client, including the client's case manager,
family members, primary caregiver, legal representatives, court representatives,
representatives from the correctional system, or school administration;
new text end
new text begin
(9) written information by the client that the client requests to include in the client's file;
and
new text end
new text begin
(10) the date of the client's discharge from the license holder's program, the reason that
the license holder discontinued services for the client, and the client's discharge summaries.
new text end
Sec. 11.
new text begin
[245I.10] ASSESSMENT AND TREATMENT PLANNING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Diagnostic formulation" means a written analysis and
explanation of a client's clinical assessment to develop a hypothesis about the cause and
nature of a client's presenting problems and to identify the most suitable approach for treating
the client.
new text end
new text begin
(b) "Responsivity factors" means the factors other than the diagnostic formulation that
may modify a client's treatment needs. This includes a client's learning style, abilities,
cognitive functioning, cultural background, and personal circumstances. When documenting
a client's responsivity factors a mental health professional or clinical trainee must include
an analysis of how a client's strengths are reflected in the license holder's plan to deliver
services to the client.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
new text end
new text begin
(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
new text end
new text begin
(1) an explanation of findings;
new text end
new text begin
(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
new text end
new text begin
(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
new text end
new text begin
(4) crisis assessment services according to section 256B.0624; and
new text end
new text begin
(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245.23, subdivision 7.
new text end
new text begin
(c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
new text end
new text begin
(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
new text end
new text begin
(2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
new text end
new text begin
(d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
new text end
new text begin
(e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
new text end
new text begin
(1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
new text end
new text begin
(2) up to five days of day treatment services or partial hospitalization.
new text end
new text begin
(f) A license holder must complete a new standard diagnostic assessment of a client:
new text end
new text begin
(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
new text end
new text begin
(2) at least annually following the client's initial diagnostic assessment if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
new text end
new text begin
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
new text end
new text begin
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
new text end
new text begin
(g) For an existing client, the license holder must ensure that a new standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client, and an update regarding what information has not significantly changed,
including a discussion with the client about changes in the client's life situation, functioning,
presenting problems, and progress with achieving treatment goals since the client's last
diagnostic assessment was completed.
new text end
new text begin Subd. 3. new text end
new text begin Continuity of services. new text end
new text begin
(a) For any client with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date
of this section, the diagnostic assessment is valid for authorizing the client's treatment and
billing for one calendar year after the date that the assessment was completed.
new text end
new text begin
(b) For any client with an individual treatment plan completed under section 256B.0622,
256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts 9505.0370 to
9505.0372, the client's treatment plan is valid for authorizing treatment and billing until the
treatment plan's expiration date.
new text end
new text begin
(c) This subdivision expires July 1, 2023.
new text end
new text begin Subd. 4. new text end
new text begin Diagnostic assessment. new text end
new text begin
A client's diagnostic assessment must: (1) identify at
least one mental health diagnosis for which the client meets the diagnostic criteria and
recommend mental health services to develop the client's mental health services and treatment
plan; or (2) include a finding that the client does not meet the criteria for a mental health
disorder.
new text end
new text begin Subd. 5. new text end
new text begin Brief diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or clinical trainee may complete a brief diagnostic assessment of a client. A
license holder may only use a brief diagnostic assessment for a client who is six years of
age or older.
new text end
new text begin
(b) When conducting a brief diagnostic assessment of a client, the assessor must complete
a face-to-face interview with the client and a written evaluation of the client. The assessor
must gather and document initial components of the client's standard diagnostic assessment,
including the client's:
new text end
new text begin
(1) age;
new text end
new text begin
(2) description of symptoms, including the reason for the client's referral;
new text end
new text begin
(3) history of mental health treatment;
new text end
new text begin
(4) cultural influences on the client; and
new text end
new text begin
(5) mental status examination.
new text end
new text begin
(c) Based on the initial components of the assessment, the assessor must develop a
provisional diagnostic formulation about the client. The assessor may use the client's
provisional diagnostic formulation to address the client's immediate needs and presenting
problems.
new text end
new text begin
(d) A mental health professional or clinical trainee may use treatment sessions with the
client authorized by a brief diagnostic assessment to gather additional information about
the client to complete the client's standard diagnostic assessment if the number of sessions
will exceed the coverage limits in subdivision 2.
new text end
new text begin Subd. 6. new text end
new text begin Standard diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
new text end
new text begin
(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
new text end
new text begin
(1) the client's age;
new text end
new text begin
(2) the client's current living situation, including the client's housing status and household
members;
new text end
new text begin
(3) the status of the client's basic needs;
new text end
new text begin
(4) the client's education level and employment status;
new text end
new text begin
(5) the client's current medications;
new text end
new text begin
(6) any immediate risks to the client's health and safety;
new text end
new text begin
(7) the client's perceptions of the client's condition;
new text end
new text begin
(8) the client's description of the client's symptoms, including the reason for the client's
referral;
new text end
new text begin
(9) the client's history of mental health treatment; and
new text end
new text begin
(10) cultural influences on the client.
new text end
new text begin
(c) If the assessor cannot obtain the information that this subdivision requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:
new text end
new text begin
(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
new text end
new text begin
(2) the client's strengths and resources, including the extent and quality of the client's
social networks;
new text end
new text begin
(3) important developmental incidents in the client's life;
new text end
new text begin
(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
new text end
new text begin
(5) the client's history of or exposure to alcohol and drug usage and treatment; and
new text end
new text begin
(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
new text end
new text begin
(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
new text end
new text begin
(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
new text end
new text begin
(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
new text end
new text begin
(3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.
new text end
new text begin
(4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.
new text end
new text begin
(5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.
new text end
new text begin
(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
new text end
new text begin
(1) the client's mental status examination;
new text end
new text begin
(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
new text end
new text begin
(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
new text end
new text begin
(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
new text end
new text begin Subd. 7. new text end
new text begin Individual treatment plan. new text end
new text begin
A license holder must follow each client's written
individual treatment plan when providing services to the client with the following exceptions:
new text end
new text begin
(1) services that do not require that a license holder completes a standard diagnostic
assessment of a client before providing services to the client;
new text end
new text begin
(2) when developing a service plan; and
new text end
new text begin
(3) when a client re-engages in services under subdivision 8, paragraph (b).
new text end
new text begin Subd. 8. new text end
new text begin Individual treatment plan; required elements. new text end
new text begin
(a) After completing a client's
diagnostic assessment and before providing services to the client, the license holder must
complete the client's individual treatment plan. The license holder must:
new text end
new text begin
(1) base the client's individual treatment plan on the client's diagnostic assessment and
baseline measurements;
new text end
new text begin
(2) for a child client, use a child-centered, family-driven, and culturally appropriate
planning process that allows the child's parents and guardians to observe and participate in
the child's individual and family treatment services, assessments, and treatment planning;
new text end
new text begin
(3) for an adult client, use a person-centered, culturally appropriate planning process
that allows the client's family and other natural supports to observe and participate in the
client's treatment services, assessments, and treatment planning;
new text end
new text begin
(4) identify the client's treatment goals, measureable treatment objectives, a schedule
for accomplishing the client's treatment goals and objectives, a treatment strategy, and the
individuals responsible for providing treatment services and supports to the client. The
license holder must have a treatment strategy to engage the client in treatment if the client:
new text end
new text begin
(i) has a history of not engaging in treatment; and
new text end
new text begin
(ii) is ordered by a court to participate in treatment services or to take neuroleptic
medications;
new text end
new text begin
(5) identify the participants involved in the client's treatment planning. The client must
be a participant in the client's treatment planning. If applicable, the license holder must
document the reasons that the license holder did not involve the client's family or other
natural supports in the client's treatment planning;
new text end
new text begin
(6) review the client's individual treatment plan every 180 days and update the client's
individual treatment plan with the client's treatment progress, new treatment objectives and
goals or, if the client has not made treatment progress, changes in the license holder's
approach to treatment; and
new text end
new text begin
(7) ensure that the client approves of the client's individual treatment plan unless a court
orders the client's treatment plan under chapter 253B.
new text end
new text begin
(b) If the client disagrees with the client's treatment plan, the license holder must
document in the client file the reasons why the client does not agree with the treatment plan.
If the license holder cannot obtain the client's approval of the treatment plan, a mental health
professional must make efforts to obtain approval from a person who is authorized to consent
on the client's behalf within 30 days after the client's previous individual treatment plan
expired. A license holder may not deny a client service during this time period solely because
the license holder could not obtain the client's approval of the client's individual treatment
plan. A license holder may continue to bill for the client's otherwise eligible services when
the client re-engages in services.
new text end
new text begin Subd. 9. new text end
new text begin Functional assessment; required elements. new text end
new text begin
When a license holder is
completing a functional assessment for an adult client, the license holder must:
new text end
new text begin
(1) complete a functional assessment of the client after completing the client's diagnostic
assessment;
new text end
new text begin
(2) use a collaborative process that allows the client and the client's family and other
natural supports, the client's referral sources, and the client's providers to provide information
about how the client's symptoms of mental illness impact the client's functioning;
new text end
new text begin
(3) if applicable, document the reasons that the license holder did not contact the client's
family and other natural supports;
new text end
new text begin
(4) assess and document how the client's symptoms of mental illness impact the client's
functioning in the following areas:
new text end
new text begin
(i) the client's mental health symptoms;
new text end
new text begin
(ii) the client's mental health service needs;
new text end
new text begin
(iii) the client's substance use;
new text end
new text begin
(iv) the client's vocational and educational functioning;
new text end
new text begin
(v) the client's social functioning, including the use of leisure time;
new text end
new text begin
(vi) the client's interpersonal functioning, including relationships with the client's family
and other natural supports;
new text end
new text begin
(vii) the client's ability to provide self-care and live independently;
new text end
new text begin
(viii) the client's medical and dental health;
new text end
new text begin
(ix) the client's financial assistance needs; and
new text end
new text begin
(x) the client's housing and transportation needs;
new text end
new text begin
(5) include a narrative summarizing the client's strengths, resources, and all areas of
functional impairment;
new text end
new text begin
(6) complete the client's functional assessment before the client's initial individual
treatment plan unless a service specifies otherwise; and
new text end
new text begin
(7) update the client's functional assessment with the client's current functioning whenever
there is a significant change in the client's functioning or at least every 180 days, unless a
service specifies otherwise.
new text end
Sec. 12.
new text begin
[245I.11] HEALTH SERVICES AND MEDICATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
If a license holder is licensed as a residential program, stores
or administers client medications, or observes clients self-administer medications, the license
holder must ensure that a staff person who is a registered nurse or licensed prescriber is
responsible for overseeing storage and administration of client medications and observing
as a client self-administers medications, including training according to section 245I.05,
subdivision 6, and documenting the occurrence according to section 245I.08, subdivision
5.
new text end
new text begin Subd. 2. new text end
new text begin Health services. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must:
new text end
new text begin
(1) ensure that a client is screened for health issues within 72 hours of the client's
admission;
new text end
new text begin
(2) monitor the physical health needs of each client on an ongoing basis;
new text end
new text begin
(3) offer referrals to clients and coordinate each client's care with psychiatric and medical
services;
new text end
new text begin
(4) identify circumstances in which a staff person must notify a registered nurse or
licensed prescriber of any of a client's health concerns and the process for providing
notification of client health concerns; and
new text end
new text begin
(5) identify the circumstances in which the license holder must obtain medical care for
a client and the process for obtaining medical care for a client.
new text end
new text begin Subd. 3. new text end
new text begin Storing and accounting for medications. new text end
new text begin
(a) If a license holder stores client
medications, the license holder must:
new text end
new text begin
(1) store client medications in original containers in a locked location;
new text end
new text begin
(2) store refrigerated client medications in special trays or containers that are separate
from food;
new text end
new text begin
(3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;
new text end
new text begin
(4) store Schedule II to IV drugs listed in section 152.02, subdivisions 3 to 5, in a
compartment that is locked separately from other medications;
new text end
new text begin
(5) ensure that only authorized staff persons have access to stored client medications;
new text end
new text begin
(6) follow a documentation procedure on each shift to account for all scheduled drugs;
and
new text end
new text begin
(7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.
new text end
new text begin
(b) If a license holder is licensed as a residential program, the license holder must allow
clients who self-administer medications to keep a private medication supply. The license
holder must ensure that the client stores all private medication in a locked container in the
client's private living area, unless the private medication supply poses a health and safety
risk to any clients. A client must not maintain a private medication supply of a prescription
medication without a written medication order from a licensed prescriber and a prescription
label that includes the client's name.
new text end
new text begin Subd. 4. new text end
new text begin Medication orders. new text end
new text begin
(a) If a license holder stores, prescribes, or administers
medications or observes a client self-administer medications, the license holder must:
new text end
new text begin
(1) ensure that a licensed prescriber writes all orders to accept, administer, or discontinue
client medications;
new text end
new text begin
(2) accept nonwritten orders to administer client medications in emergency circumstances
only;
new text end
new text begin
(3) establish a timeline and process for obtaining a written order with the licensed
prescriber's signature when the license holder accepts a nonwritten order to administer client
medications;
new text end
new text begin
(4) obtain prescription medication renewals from a licensed prescriber for each client
every 90 days for psychotropic medications and annually for all other medications; and
new text end
new text begin
(5) maintain the client's right to privacy and dignity.
new text end
new text begin
(b) If a license holder employs a licensed prescriber, the license holder must inform the
client about potential medication effects and side effects and obtain and document the client's
informed consent before the licensed prescriber prescribes a medication.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration. new text end
new text begin
If a license holder is licensed as a residential
program, the license holder must:
new text end
new text begin
(1) assess and document each client's ability to self-administer medication. In the
assessment, the license holder must evaluate the client's ability to: (i) comply with prescribed
medication regimens; and (ii) store the client's medications safely and in a manner that
protects other individuals in the facility. Through the assessment process, the license holder
must assist the client in developing the skills necessary to safely self-administer medication;
new text end
new text begin
(2) monitor the effectiveness of medications, side effects of medications, and adverse
reactions to medications for each client. The license holder must address and document any
concerns about a client's medications;
new text end
new text begin
(3) ensure that no staff person or client gives a legend drug supply for one client to
another client;
new text end
new text begin
(4) have policies and procedures for: (i) keeping a record of each client's medication
orders; (ii) keeping a record of any incident of deferring a client's medications; (iii)
documenting any incident when a client's medication is omitted; and (iv) documenting when
a client refuses to take medications as prescribed; and
new text end
new text begin
(5) document and track medication errors, document whether the license holder notified
anyone about the medication error, determine if the license holder must take any follow-up
actions, and identify the staff persons who are responsible for taking follow-up actions.
new text end
Sec. 13.
new text begin
[245I.12] CLIENT RIGHTS AND PROTECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Client rights. new text end
new text begin
A license holder must ensure that all clients have the
following rights:
new text end
new text begin
(1) the rights listed in the health care bill of rights in section 144.651;
new text end
new text begin
(2) the right to be free from discrimination based on age, race, color, creed, religion,
national origin, gender, marital status, disability, sexual orientation, and status with regard
to public assistance. The license holder must follow all applicable state and federal laws
including the Minnesota Human Rights Act, chapter 363A; and
new text end
new text begin
(3) the right to be informed prior to a photograph or audio or video recording being made
of the client. The client has the right to refuse to allow any recording or photograph of the
client that is not for the purposes of identification or supervision by the license holder.
new text end
new text begin Subd. 2. new text end
new text begin Restrictions to client rights. new text end
new text begin
If the license holder restricts a client's right, the
license holder must document in the client file a mental health professional's approval of
the restriction and the reasons for the restriction.
new text end
new text begin Subd. 3. new text end
new text begin Notice of rights. new text end
new text begin
The license holder must give a copy of the client's rights
according to this section to each client on the day of the client's admission. The license
holder must document that the license holder gave a copy of the client's rights to each client
on the day of the client's admission according to this section. The license holder must post
a copy of the client rights in an area visible or accessible to all clients. The license holder
must include the client rights in Minnesota Rules, chapter 9544, for applicable clients.
new text end
new text begin Subd. 4. new text end
new text begin Client property. new text end
new text begin
(a) The license holder must meet the requirements of section
245A.04, subdivision 13.
new text end
new text begin
(b) If the license holder is unable to obtain a client's signature acknowledging the receipt
or disbursement of the client's funds or property required by section 245A.04, subdivision
13, paragraph (c), clause (1), two staff persons must sign documentation acknowledging
that the staff persons witnessed the client's receipt or disbursement of the client's funds or
property.
new text end
new text begin
(c) The license holder must return all of the client's funds and other property to the client
except for the following items:
new text end
new text begin
(1) illicit drugs, drug paraphernalia, and drug containers that are subject to forfeiture
under section 609.5316. The license holder must give illicit drugs, drug paraphernalia, and
drug containers to a local law enforcement agency or destroy the items; and
new text end
new text begin
(2) weapons, explosives, and other property that may cause serious harm to the client
or others. The license holder may give a client's weapons and explosives to a local law
enforcement agency. The license holder must notify the client that a local law enforcement
agency has the client's property and that the client has the right to reclaim the property if
the client has a legal right to possess the item.
new text end
new text begin
(d) If a client leaves the license holder's program but abandons the client's funds or
property, the license holder must retain and store the client's funds or property, including
medications, for a minimum of 30 days after the client's discharge from the program.
new text end
new text begin Subd. 5. new text end
new text begin Client grievances. new text end
new text begin
(a) The license holder must have a grievance procedure
that:
new text end
new text begin
(1) describes to clients how the license holder will meet the requirements in this
subdivision; and
new text end
new text begin
(2) contains the current public contact information of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health, Office of Health Facilities Complaints; and all
applicable health-related licensing boards.
new text end
new text begin
(b) On the day of each client's admission, the license holder must explain the grievance
procedure to the client.
new text end
new text begin
(c) The license holder must:
new text end
new text begin
(1) post the grievance procedure in a place visible to clients and provide a copy of the
grievance procedure upon request;
new text end
new text begin
(2) allow clients, former clients, and their authorized representatives to submit a grievance
to the license holder;
new text end
new text begin
(3) within three business days of receiving a client's grievance, acknowledge in writing
that the license holder received the client's grievance. If applicable, the license holder must
include a notice of the client's separate appeal rights for a managed care organization's
reduction, termination, or denial of a covered service;
new text end
new text begin
(4) within 15 business days of receiving a client's grievance, provide a written final
response to the client's grievance containing the license holder's official response to the
grievance; and
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new text begin
(5) allow the client to bring a grievance to the person with the highest level of authority
in the program.
new text end
Sec. 14.
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[245I.13] CRITICAL INCIDENTS.
new text end
new text begin
If a license holder is licensed as a residential program, the license holder must report all
critical incidents to the commissioner within ten days of learning of the incident on a form
approved by the commissioner. The license holder must keep a record of critical incidents
in a central location that is readily accessible to the commissioner for review upon the
commissioner's request for a minimum of two licensing periods.
new text end
Sec. 15.
new text begin
[245I.20] MENTAL HEALTH CLINIC.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
Certified mental health clinics provide clinical services for the
treatment of mental illnesses with a treatment team that reflects multiple disciplines and
areas of expertise.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical services" means services provided to a client to
diagnose, describe, predict, and explain the client's status relative to a condition or problem
as described in the: (1) current edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association; or (2) current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood published by Zero to Three. Where necessary, clinical services includes
services to treat a client to reduce the client's impairment due to the client's condition.
Clinical services also includes individual treatment planning, case review, record-keeping
required for a client's treatment, and treatment supervision. For the purposes of this section,
clinical services excludes services delivered to a client under a separate license and services
listed under section 245I.011, subdivision 5.
new text end
new text begin
(b) "Competent" means having professional education, training, continuing education,
consultation, supervision, experience, or a combination thereof necessary to demonstrate
sufficient knowledge of and proficiency in a specific clinical service.
new text end
new text begin
(c) "Discipline" means a branch of professional knowledge or skill acquired through a
specific course of study, training, and supervised practice. Discipline is usually documented
by a specific educational degree, licensure, or certification of proficiency. Examples of the
mental health disciplines include but are not limited to psychiatry, psychology, clinical
social work, marriage and family therapy, clinical counseling, and psychiatric nursing.
new text end
new text begin
(d) "Treatment team" means the mental health professionals, mental health practitioners,
and clinical trainees who provide clinical services to clients.
new text end
new text begin Subd. 3. new text end
new text begin Organizational structure. new text end
new text begin
(a) A mental health clinic location must be an entire
facility or a clearly identified unit within a facility that is administratively and clinically
separate from the rest of the facility. The mental health clinic location may provide services
other than clinical services to clients, including medical services, substance use disorder
services, social services, training, and education.
new text end
new text begin
(b) The certification holder must notify the commissioner of all mental health clinic
locations. If there is more than one mental health clinic location, the certification holder
must designate one location as the main location and all of the other locations as satellite
locations. The main location as a unit and the clinic as a whole must comply with the
minimum staffing standards in subdivision 4.
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new text begin
(c) The certification holder must ensure that each satellite location:
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new text begin
(1) adheres to the same policies and procedures as the main location;
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new text begin
(2) provides treatment team members with face-to-face or telephone access to a mental
health professional for the purposes of supervision whenever the satellite location is open.
The certification holder must maintain a schedule of the mental health professionals who
will be available and the contact information for each available mental health professional.
The schedule must be current and readily available to treatment team members; and
new text end
new text begin
(3) enables clients to access all of the mental health clinic's clinical services and treatment
team members, as needed.
new text end
new text begin Subd. 4. new text end
new text begin Minimum staffing standards. new text end
new text begin
(a) A certification holder's treatment team must
consist of at least four mental health professionals. At least two of the mental health
professionals must be employed by or under contract with the mental health clinic for a
minimum of 35 hours per week each. Each of the two mental health professionals must
specialize in a different mental health discipline.
new text end
new text begin
(b) The treatment team must include:
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new text begin
(1) a physician qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (4), or a nurse qualified as a mental health professional according to
section 245I.04, subdivision 2, clause (1); and
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new text begin
(2) a psychologist qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (3).
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new text begin
(c) The staff persons fulfilling the requirement in paragraph (b) must provide clinical
services at least:
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new text begin
(1) eight hours every two weeks if the mental health clinic has over 25.0 full-time
equivalent treatment team members;
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new text begin
(2) eight hours each month if the mental health clinic has 15.1 to 25.0 full-time equivalent
treatment team members;
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new text begin
(3) four hours each month if the mental health clinic has 5.1 to 15.0 full-time equivalent
treatment team members; or
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new text begin
(4) two hours each month if the mental health clinic has 2.0 to 5.0 full-time equivalent
treatment team members or only provides in-home services to clients.
new text end
new text begin
(d) The certification holder must maintain a record that demonstrates compliance with
this subdivision.
new text end
new text begin Subd. 5. new text end
new text begin Treatment supervision specified. new text end
new text begin
(a) A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
new text end
new text begin
(b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must complete a case review of each client assigned
to the mental health professional when the client is receiving clinical services from a mental
health practitioner or clinical trainee. The case review must include a consultation process
that thoroughly examines the client's condition and treatment, including: (1) a review of the
client's reason for seeking treatment, diagnoses and assessments, and the individual treatment
plan; (2) a review of the appropriateness, duration, and outcome of treatment provided to
the client; and (3) treatment recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures required by section 245I.03, the certification holder must establish, enforce,
and maintain the policies and procedures required by this subdivision.
new text end
new text begin
(b) The certification holder must have a clinical evaluation procedure to identify and
document each treatment team member's areas of competence.
new text end
new text begin
(c) The certification holder must have policies and procedures for client intake and case
assignment that:
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new text begin
(1) outline the client intake process;
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new text begin
(2) describe how the mental health clinic determines the appropriateness of accepting a
client into treatment by reviewing the client's condition and need for treatment, the clinical
services that the mental health clinic offers to clients, and other available resources; and
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new text begin
(3) contain a process for assigning a client's case to a mental health professional who is
responsible for the client's case and other treatment team members.
new text end
new text begin Subd. 7. new text end
new text begin Referrals. new text end
new text begin
If necessary treatment for a client or treatment desired by a client
is not available at the mental health clinic, the certification holder must facilitate appropriate
referrals for the client. When making a referral for a client, the treatment team member must
document a discussion with the client that includes: (1) the reason for the client's referral;
(2) potential treatment resources for the client; and (3) the client's response to receiving a
referral.
new text end
new text begin Subd. 8. new text end
new text begin Emergency service. new text end
new text begin
For the certification holder's telephone numbers that clients
regularly access, the certification holder must include the contact information for the area's
mental health crisis services as part of the certification holder's message when a live operator
is not available to answer clients' calls.
new text end
new text begin Subd. 9. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) At a minimum, a certification
holder must develop a written quality assurance and improvement plan that includes a plan
for:
new text end
new text begin
(1) encouraging ongoing consultation among members of the treatment team;
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new text begin
(2) obtaining and evaluating feedback about services from clients, family and other
natural supports, referral sources, and staff persons;
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new text begin
(3) measuring and evaluating client outcomes;
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(4) reviewing client suicide deaths and suicide attempts;
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new text begin
(5) examining the quality of clinical service delivery to clients; and
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new text begin
(6) self-monitoring of compliance with this chapter.
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new text begin
(b) At least annually, the certification holder must review, evaluate, and update the
quality assurance and improvement plan. The review must: (1) include documentation of
the actions that the certification holder will take as a result of information obtained from
monitoring activities in the plan; and (2) establish goals for improved service delivery to
clients for the next year.
new text end
new text begin Subd. 10. new text end
new text begin Application procedures. new text end
new text begin
(a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.
new text end
new text begin
(b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
new text end
new text begin
(c) The commissioner must act on an application within 90 working days of receiving
a completed application.
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new text begin
(d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
new text end
new text begin
(e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail or personal service.
In the notice of denial, the commissioner must state the reasons that the commissioner denied
the application and must inform the applicant of the applicant's right to request a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
applicant may appeal the denial by notifying the commissioner in writing by certified mail
or personal service. If mailed, the appeal must be postmarked and sent to the commissioner
within 20 calendar days after the applicant received the notice of denial. If an applicant
delivers an appeal by personal service, the commissioner must receive the appeal within 20
calendar days after the applicant received the notice of denial.
new text end
new text begin Subd. 11. new text end
new text begin Commissioner's right of access. new text end
new text begin
(a) When the commissioner is exercising
the powers conferred to the commissioner by this chapter, if the mental health clinic is in
operation and the information is relevant to the commissioner's inspection or investigation,
the certification holder must provide the commissioner access to:
new text end
new text begin
(1) the physical facility and grounds where the program is located;
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new text begin
(2) documentation and records, including electronically maintained records;
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new text begin
(3) clients served by the mental health clinic;
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new text begin
(4) staff persons of the mental health clinic; and
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new text begin
(5) personnel records of current and former staff of the mental health clinic.
new text end
new text begin
(b) The certification holder must provide the commissioner with access to the facility
and grounds, documentation and records, clients, and staff without prior notice and as often
as the commissioner considers necessary if the commissioner is investigating alleged
maltreatment or a violation of a law or rule, or conducting an inspection. When conducting
an inspection, the commissioner may request and must receive assistance from other state,
county, and municipal governmental agencies and departments. The applicant or certification
holder must allow the commissioner, at the commissioner's expense, to photocopy,
photograph, and make audio and video recordings during an inspection.
new text end
new text begin Subd. 12. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) The commissioner may conduct a certification
review of the certified mental health clinic every two years to determine the certification
holder's compliance with applicable rules and statutes.
new text end
new text begin
(b) The commissioner must offer the certification holder a choice of dates for an
announced certification review. A certification review must occur during the clinic's normal
working hours.
new text end
new text begin
(c) The commissioner must make the results of certification reviews and investigations
publicly available on the department's website.
new text end
new text begin Subd. 13. new text end
new text begin Correction orders. new text end
new text begin
(a) If the applicant or certification holder fails to comply
with a law or rule, the commissioner may issue a correction order. The correction order
must state:
new text end
new text begin
(1) the condition that constitutes a violation of the law or rule;
new text end
new text begin
(2) the specific law or rule that the applicant or certification holder has violated; and
new text end
new text begin
(3) the time that the applicant or certification holder is allowed to correct each violation.
new text end
new text begin
(b) If the applicant or certification holder believes that the commissioner's correction
order is erroneous, the applicant or certification holder may ask the commissioner to
reconsider the part of the correction order that is allegedly erroneous. An applicant or
certification holder must make a request for reconsideration in writing. The request must
be postmarked and sent to the commissioner within 20 calendar days after the applicant or
certification holder received the correction order; and the request must:
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new text begin
(1) specify the part of the correction order that is allegedly erroneous;
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new text begin
(2) explain why the specified part is erroneous; and
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new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
(c) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
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new text begin
(d) If the commissioner finds that the applicant or certification holder failed to correct
the violation specified in the correction order, the commissioner may decertify the certified
mental health clinic according to subdivision 14.
new text end
new text begin
(e) Nothing in this subdivision prohibits the commissioner from decertifying a mental
health clinic according to subdivision 14.
new text end
new text begin Subd. 14. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner may decertify a mental health clinic
if a certification holder:
new text end
new text begin
(1) failed to comply with an applicable law or rule; or
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new text begin
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, during an
investigation, or regarding compliance with applicable laws or rules.
new text end
new text begin
(b) When considering decertification of a mental health clinic, the commissioner must
consider the nature, chronicity, or severity of the violation of law or rule and the effect of
the violation on the health, safety, or rights of clients.
new text end
new text begin
(c) If the commissioner decertifies a mental health clinic, the order of decertification
must inform the certification holder of the right to have a contested case hearing under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The certification holder
may appeal the decertification. The certification holder must appeal a decertification in
writing and send or deliver the appeal to the commissioner by certified mail or personal
service. If the certification holder mails the appeal, the appeal must be postmarked and sent
to the commissioner within ten calendar days after the certification holder receives the order
of decertification. If the certification holder delivers an appeal by personal service, the
commissioner must receive the appeal within ten calendar days after the certification holder
received the order. If a certification holder submits a timely appeal of an order of
decertification, the certification holder may continue to operate the program until the
commissioner issues a final order on the decertification.
new text end
new text begin
(d) If the commissioner decertifies a mental health clinic pursuant to paragraph (a),
clause (1), based on a determination that the mental health clinic was responsible for
maltreatment, and if the certification holder appeals the decertification according to paragraph
(c), and appeals the maltreatment determination under section 260E.33, the final
decertification determination is stayed until the commissioner issues a final decision regarding
the maltreatment appeal.
new text end
new text begin Subd. 15. new text end
new text begin Transfer prohibited. new text end
new text begin
A certification issued under this section is only valid
for the premises and the individual, organization, or government entity identified by the
commissioner on the certification. A certification is not transferable or assignable.
new text end
new text begin Subd. 16. new text end
new text begin Notifications required and noncompliance. new text end
new text begin
(a) A certification holder must
notify the commissioner, in a manner prescribed by the commissioner, and obtain the
commissioner's approval before making any change to the name of the certification holder
or the location of the mental health clinic.
new text end
new text begin
(b) Changes in mental health clinic organization, staffing, treatment, or quality assurance
procedures that affect the ability of the certification holder to comply with the minimum
standards of this section must be reported in writing by the certification holder to the
commissioner within 15 days of the occurrence. Review of the change must be conducted
by the commissioner. A certification holder with changes resulting in noncompliance in
minimum standards must receive written notice and may have up to 180 days to correct the
areas of noncompliance before being decertified. Interim procedures to resolve the
noncompliance on a temporary basis must be developed and submitted in writing to the
commissioner for approval within 30 days of the commissioner's determination of the
noncompliance. Not reporting an occurrence of a change that results in noncompliance
within 15 days, failure to develop an approved interim procedure within 30 days of the
determination of the noncompliance, or nonresolution of the noncompliance within 180
days will result in immediate decertification.
new text end
new text begin
(c) The mental health clinic may be required to submit written information to the
department to document that the mental health clinic has maintained compliance with this
section and mental health clinic procedures.
new text end
Sec. 16.
new text begin
[245I.23] INTENSIVE RESIDENTIAL TREATMENT SERVICES AND
RESIDENTIAL CRISIS STABILIZATION.
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new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) Intensive residential treatment services is a community-based
medically monitored level of care for an adult client that uses established rehabilitative
principles to promote a client's recovery and to develop and achieve psychiatric stability,
personal and emotional adjustment, self-sufficiency, and other skills that help a client
transition to a more independent setting.
new text end
new text begin
(b) Residential crisis stabilization provides structure and support to an adult client in a
community living environment when a client has experienced a mental health crisis and
needs short-term services to ensure that the client can safely return to the client's home or
precrisis living environment with additional services and supports identified in the client's
crisis assessment.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Program location" means a set of rooms that are each physically
self-contained and have defining walls extending from floor to ceiling. Program location
includes bedrooms, living rooms or lounge areas, bathrooms, and connecting areas.
new text end
new text begin
(b) "Treatment team" means a group of staff persons who provide intensive residential
treatment services or residential crisis stabilization to clients. The treatment team includes
mental health professionals, mental health practitioners, clinical trainees, certified
rehabilitation specialists, mental health rehabilitation workers, and mental health certified
peer specialists.
new text end
new text begin Subd. 3. new text end
new text begin Treatment services description. new text end
new text begin
The license holder must describe in writing
all treatment services that the license holder provides. The license holder must have the
description readily available for the commissioner upon the commissioner's request.
new text end
new text begin Subd. 4. new text end
new text begin Required intensive residential treatment services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's treatment plan to provide intensive residential treatment
services to the client to improve the client's functioning.
new text end
new text begin
(b) The license holder must offer and have the capacity to directly provide the following
treatment services to each client:
new text end
new text begin
(1) rehabilitative mental health services;
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new text begin
(2) crisis prevention planning to assist a client with:
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new text begin
(i) identifying and addressing patterns in the client's history and experience of the client's
mental illness; and
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new text begin
(ii) developing crisis prevention strategies that include de-escalation strategies that have
been effective for the client in the past;
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new text begin
(3) health services and administering medication;
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new text begin
(4) co-occurring substance use disorder treatment;
new text end
new text begin
(5) engaging the client's family and other natural supports in the client's treatment and
educating the client's family and other natural supports to strengthen the client's social and
family relationships; and
new text end
new text begin
(6) making referrals for the client to other service providers in the community and
supporting the client's transition from intensive residential treatment services to another
setting.
new text end
new text begin
(c) The license holder must include Illness Management and Recovery (IMR), Enhanced
Illness Management and Recovery (E-IMR), or other similar interventions in the license
holder's programming as approved by the commissioner.
new text end
new text begin Subd. 5. new text end
new text begin Required residential crisis stabilization services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's individual crisis treatment plan to provide services to
the client in residential crisis stabilization to improve the client's functioning.
new text end
new text begin
(b) The license holder must offer and have the capacity to directly provide the following
treatment services to the client:
new text end
new text begin
(1) crisis stabilization services as described in section 256B.0624, subdivision 7;
new text end
new text begin
(2) rehabilitative mental health services;
new text end
new text begin
(3) health services and administering the client's medications; and
new text end
new text begin
(4) making referrals for the client to other service providers in the community and
supporting the client's transition from residential crisis stabilization to another setting.
new text end
new text begin Subd. 6. new text end
new text begin Optional treatment services. new text end
new text begin
(a) If the license holder offers additional treatment
services to a client, the treatment service must be:
new text end
new text begin
(1) approved by the commissioner; and
new text end
new text begin
(2)(i) a mental health evidence-based practice that the federal Department of Health and
Human Services Substance Abuse and Mental Health Service Administration has adopted;
new text end
new text begin
(ii) a nationally recognized mental health service that substantial research has validated
as effective in helping individuals with serious mental illness achieve treatment goals; or
new text end
new text begin
(iii) developed under state-sponsored research of publicly funded mental health programs
and validated to be effective for individuals, families, and communities.
new text end
new text begin
(b) Before providing an optional treatment service to a client, the license holder must
provide adequate training to a staff person about providing the optional treatment service
to a client.
new text end
new text begin Subd. 7. new text end
new text begin
Intensive residential treatment services assessment and treatment
planning.
new text end
new text begin
(a) Within 12 hours of a client's admission, the license holder must evaluate and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of the client's admission, the license holder must complete an initial
treatment plan for the client. The license holder must:
new text end
new text begin
(1) base the client's initial treatment plan on the client's referral information and an
assessment of the client's immediate needs;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the client in the past;
new text end
new text begin
(3) identify the client's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the client engage in treatment;
new text end
new text begin
(4) identify the participants involved in the client's treatment planning. The client must
be a participant; and
new text end
new text begin
(5) ensure that a treatment supervisor approves of the client's initial treatment plan if a
mental health practitioner or clinical trainee completes the client's treatment plan,
notwithstanding section 245I.08, subdivision 3.
new text end
new text begin
(c) According to section 245A.65, subdivision 2, paragraph (b), the license holder must
complete an individual abuse prevention plan as part of a client's initial treatment plan.
new text end
new text begin
(d) Within five days of the client's admission and again within 60 days after the client's
admission, the license holder must complete a level of care assessment of the client. If the
license holder determines that a client does not need a medically monitored level of service,
a treatment supervisor must document how the client's admission to and continued services
in intensive residential treatment services are medically necessary for the client.
new text end
new text begin
(e) Within ten days of a client's admission, the license holder must complete or review
and update the client's standard diagnostic assessment.
new text end
new text begin
(f) Within ten days of a client's admission, the license holder must complete the client's
individual treatment plan, notwithstanding section 245I.10, subdivision 8. Within 40 days
after the client's admission and again within 70 days after the client's admission, the license
holder must update the client's individual treatment plan. The license holder must focus the
client's treatment planning on preparing the client for a successful transition from intensive
residential treatment services to another setting. In addition to the required elements of an
individual treatment plan under section 245I.10, subdivision 8, the license holder must
identify the following information in the client's individual treatment plan: (1) the client's
referrals and resources for the client's health and safety; and (2) the staff persons who are
responsible for following up with the client's referrals and resources. If the client does not
receive a referral or resource that the client needs, the license holder must document the
reason that the license holder did not make the referral or did not connect the client to a
particular resource. The license holder is responsible for determining whether additional
follow-up is required on behalf of the client.
new text end
new text begin
(g) Within 30 days of the client's admission, the license holder must complete a functional
assessment of the client. Within 60 days after the client's admission, the license holder must
update the client's functional assessment to include any changes in the client's functioning
and symptoms.
new text end
new text begin
(h) For a client with a current substance use disorder diagnosis and for a client whose
substance use disorder screening in the client's standard diagnostic assessment indicates the
possibility that the client has a substance use disorder, the license holder must complete a
written assessment of the client's substance use within 30 days of the client's admission. In
the substance use assessment, the license holder must: (1) evaluate the client's history of
substance use, relapses, and hospitalizations related to substance use; (2) assess the effects
of the client's substance use on the client's relationships including with family member and
others; (3) identify financial problems, health issues, housing instability, and unemployment;
(4) assess the client's legal problems, past and pending incarceration, violence, and
victimization; and (5) evaluate the client's suicide attempts, noncompliance with taking
prescribed medications, and noncompliance with psychosocial treatment.
new text end
new text begin
(i) On a weekly basis, a mental health professional or certified rehabilitation specialist
must review each client's treatment plan and individual abuse prevention plan. The license
holder must document in the client's file each weekly review of the client's treatment plan
and individual abuse prevention plan.
new text end
new text begin Subd. 8. new text end
new text begin Residential crisis stabilization assessment and treatment planning. new text end
new text begin
(a)
Within 12 hours of a client's admission, the license holder must evaluate the client and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of a client's admission, the license holder must complete a crisis
treatment plan for the client under section 256B.0624, subdivision 11. The license holder
must base the client's crisis treatment plan on the client's referral information and an
assessment of the client's immediate needs.
new text end
new text begin
(c) Section 245A.65, subdivision 2, paragraph (b), requires the license holder to complete
an individual abuse prevention plan for a client as part of the client's crisis treatment plan.
new text end
new text begin Subd. 9. new text end
new text begin Key staff positions. new text end
new text begin
(a) The license holder must have a staff person assigned
to each of the following key staff positions at all times:
new text end
new text begin
(1) a program director who qualifies as a mental health practitioner. The license holder
must designate the program director as responsible for all aspects of the operation of the
program and the program's compliance with all applicable requirements. The program
director must know and understand the implications of this chapter; chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; Minnesota Rules, chapter 9544; and all other
applicable requirements. The license holder must document in the program director's
personnel file how the program director demonstrates knowledge of these requirements.
The program director may also serve as the treatment director of the program, if qualified;
new text end
new text begin
(2) a treatment director who qualifies as a mental health professional. The treatment
director must be responsible for overseeing treatment services for clients and the treatment
supervision of all staff persons; and
new text end
new text begin
(3) a registered nurse who qualifies as a mental health practitioner. The registered nurse
must:
new text end
new text begin
(i) work at the program location a minimum of eight hours per week;
new text end
new text begin
(ii) provide monitoring and supervision of staff persons as defined in section 148.171,
subdivisions 8a and 23;
new text end
new text begin
(iii) be responsible for the review and approval of health service and medication policies
and procedures under section 245I.03, subdivision 5; and
new text end
new text begin
(iv) oversee the license holder's provision of health services to clients, medication storage,
and medication administration to clients.
new text end
new text begin
(b) Within five business days of a change in a key staff position, the license holder must
notify the commissioner of the staffing change. The license holder must notify the
commissioner of the staffing change on a form approved by the commissioner and include
the name of the staff person now assigned to the key staff position and the staff person's
qualifications.
new text end
new text begin Subd. 10. new text end
new text begin Minimum treatment team staffing levels and ratios. new text end
new text begin
(a) The license holder
must maintain a treatment team staffing level sufficient to:
new text end
new text begin
(1) provide continuous daily coverage of all shifts;
new text end
new text begin
(2) follow each client's treatment plan and meet each client's needs as identified in the
client's treatment plan;
new text end
new text begin
(3) implement program requirements; and
new text end
new text begin
(4) safely monitor and guide the activities of each client, taking into account the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerabilities.
new text end
new text begin
(b) The license holder must ensure that treatment team members:
new text end
new text begin
(1) remain awake during all work hours; and
new text end
new text begin
(2) are available to monitor and guide the activities of each client whenever clients are
present in the program.
new text end
new text begin
(c) On each shift, the license holder must maintain a treatment team staffing ratio of at
least one treatment team member to nine clients. If the license holder is serving nine or
fewer clients, at least one treatment team member on the day shift must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
If the license holder is serving more than nine clients, at least one of the treatment team
members working during both the day and evening shifts must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
new text end
new text begin
(d) If the license holder provides residential crisis stabilization to clients and is serving
at least one client in residential crisis stabilization and more than four clients in residential
crisis stabilization and intensive residential treatment services, the license holder must
maintain a treatment team staffing ratio on each shift of at least two treatment team members
during the client's first 48 hours in residential crisis stabilization.
new text end
new text begin Subd. 11. new text end
new text begin Shift exchange. new text end
new text begin
A license holder must ensure that treatment team members
working on different shifts exchange information about a client as necessary to effectively
care for the client and to follow and update a client's treatment plan and individual abuse
prevention plan.
new text end
new text begin Subd. 12. new text end
new text begin Daily documentation. new text end
new text begin
(a) For each day that a client is present in the program,
the license holder must provide a daily summary in the client's file that includes observations
about the client's behavior and symptoms, including any critical incidents in which the client
was involved.
new text end
new text begin
(b) For each day that a client is not present in the program, the license holder must
document the reason for a client's absence in the client's file.
new text end
new text begin Subd. 13. new text end
new text begin
Access to a mental health professional, clinical trainee, certified
rehabilitation specialist, or mental health practitioner.
new text end
new text begin
Treatment team members must
have access in person or by telephone to a mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitioner within 30 minutes. The license
holder must maintain a schedule of mental health professionals, clinical trainees, certified
rehabilitation specialists, or mental health practitioners who will be available and contact
information to reach them. The license holder must keep the schedule current and make the
schedule readily available to treatment team members.
new text end
new text begin Subd. 14. new text end
new text begin Weekly team meetings. new text end
new text begin
(a) The license holder must hold weekly team meetings
and ancillary meetings according to this subdivision.
new text end
new text begin
(b) A mental health professional or certified rehabilitation specialist must hold at least
one team meeting each calendar week and be physically present at the team meeting. All
treatment team members, including treatment team members who work on a part-time or
intermittent basis, must participate in a minimum of one team meeting during each calendar
week when the treatment team member is working for the license holder. The license holder
must document all weekly team meetings, including the names of meeting attendees.
new text end
new text begin
(c) If a treatment team member cannot participate in a weekly team meeting, the treatment
team member must participate in an ancillary meeting. A mental health professional, certified
rehabilitation specialist, clinical trainee, or mental health practitioner who participated in
the most recent weekly team meeting may lead the ancillary meeting. During the ancillary
meeting, the treatment team member leading the ancillary meeting must review the
information that was shared at the most recent weekly team meeting, including revisions
to client treatment plans and other information that the treatment supervisors exchanged
with treatment team members. The license holder must document all ancillary meetings,
including the names of meeting attendees.
new text end
new text begin Subd. 15. new text end
new text begin Intensive residential treatment services admission criteria. new text end
new text begin
(a) An eligible
client for intensive residential treatment services is an individual who:
new text end
new text begin
(1) is age 18 or older;
new text end
new text begin
(2) is diagnosed with a mental illness;
new text end
new text begin
(3) because of a mental illness, has a substantial disability and functional impairment
in three or more areas listed in section 245I.10, subdivision 9, clause (4), that markedly
reduce the individual's self-sufficiency;
new text end
new text begin
(4) has one or more of the following: a history of recurring or prolonged inpatient
hospitalizations during the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services with poor outcomes for the
individual; and
new text end
new text begin
(5) in the written opinion of a mental health professional, needs mental health services
that available community-based services cannot provide, or is likely to experience a mental
health crisis or require a more restrictive setting if the individual does not receive intensive
rehabilitative mental health services.
new text end
new text begin
(b) The license holder must not limit or restrict intensive residential treatment services
to a client based solely on:
new text end
new text begin
(1) the client's substance use;
new text end
new text begin
(2) the county in which the client resides; or
new text end
new text begin
(3) whether the client elects to receive other services for which the client may be eligible,
including case management services.
new text end
new text begin
(c) This subdivision does not prohibit the license holder from restricting admissions of
individuals who present an imminent risk of harm or danger to themselves or others.
new text end
new text begin Subd. 16. new text end
new text begin Residential crisis stabilization services admission criteria. new text end
new text begin
An eligible client
for residential crisis stabilization is an individual who is age 18 or older and meets the
eligibility criteria in section 256B.0624, subdivision 3.
new text end
new text begin Subd. 17. new text end
new text begin Admissions referrals and determinations. new text end
new text begin
(a) The license holder must
identify the information that the license holder needs to make a determination about a
person's admission referral.
new text end
new text begin
(b) The license holder must:
new text end
new text begin
(1) always be available to receive referral information about a person seeking admission
to the license holder's program;
new text end
new text begin
(2) respond to the referral source within eight hours of receiving a referral and, within
eight hours, communicate with the referral source about what information the license holder
needs to make a determination concerning the person's admission;
new text end
new text begin
(3) consider the license holder's staffing ratio and the areas of treatment team members'
competency when determining whether the license holder is able to meet the needs of a
person seeking admission; and
new text end
new text begin
(4) determine whether to admit a person within 72 hours of receiving all necessary
information from the referral source.
new text end
new text begin Subd. 18. new text end
new text begin Discharge standards. new text end
new text begin
(a) When a license holder discharges a client from a
program, the license holder must categorize the discharge as a successful discharge,
program-initiated discharge, or non-program-initiated discharge according to the criteria in
this subdivision. The license holder must meet the standards associated with the type of
discharge according to this subdivision.
new text end
new text begin
(b) To successfully discharge a client from a program, the license holder must ensure
that the following criteria are met:
new text end
new text begin
(1) the client must substantially meet the client's documented treatment plan goals and
objectives;
new text end
new text begin
(2) the client must complete discharge planning with the treatment team; and
new text end
new text begin
(3) the client and treatment team must arrange for the client to receive continuing care
at a less intensive level of care after discharge.
new text end
new text begin
(c) Prior to successfully discharging a client from a program, the license holder must
complete the client's discharge summary and provide the client with a copy of the client's
discharge summary in plain language that includes:
new text end
new text begin
(1) a brief review of the client's problems and strengths during the period that the license
holder provided services to the client;
new text end
new text begin
(2) the client's response to the client's treatment plan;
new text end
new text begin
(3) the goals and objectives that the license holder recommends that the client addresses
during the first three months following the client's discharge from the program;
new text end
new text begin
(4) the recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting;
new text end
new text begin
(5) the client's crisis plan; and
new text end
new text begin
(6) the client's forwarding address and telephone number.
new text end
new text begin
(d) For a non-program-initiated discharge of a client from a program, the following
criteria must be met:
new text end
new text begin
(1)(i) the client has withdrawn the client's consent for treatment; (ii) the license holder
has determined that the client has the capacity to make an informed decision; and (iii) the
client does not meet the criteria for an emergency hold under section 253B.051, subdivision
2;
new text end
new text begin
(2) the client has left the program against staff person advice;
new text end
new text begin
(3) an entity with legal authority to remove the client has decided to remove the client
from the program; or
new text end
new text begin
(4) a source of payment for the services is no longer available.
new text end
new text begin
(e) Within ten days of a non-program-initiated discharge of a client from a program, the
license holder must complete the client's discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) a description of attempts by staff persons to enable the client to continue treatment
or to consent to treatment; and
new text end
new text begin
(3) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin
(f) For a program-initiated discharge of a client from a program, the following criteria
must be met:
new text end
new text begin
(1) the client is competent but has not participated in treatment or has not followed the
program rules and regulations and the client has not participated to such a degree that the
program's level of care is ineffective or unsafe for the client, despite multiple, documented
attempts that the license holder has made to address the client's lack of participation in
treatment;
new text end
new text begin
(2) the client has not made progress toward the client's treatment goals and objectives
despite the license holder's persistent efforts to engage the client in treatment, and the license
holder has no reasonable expectation that the client will make progress at the program's
level of care nor does the client require the program's level of care to maintain the current
level of functioning;
new text end
new text begin
(3) a court order or the client's legal status requires the client to participate in the program
but the client has left the program against staff person advice; or
new text end
new text begin
(4) the client meets criteria for a more intensive level of care and a more intensive level
of care is available to the client.
new text end
new text begin
(g) Prior to a program-initiated discharge of a client from a program, the license holder
must consult the client, the client's family and other natural supports, and the client's case
manager, if applicable, to review the issues involved in the program's decision to discharge
the client from the program. During the discharge review process, which must not exceed
five working days, the license holder must determine whether the license holder, treatment
team, and any interested persons can develop additional strategies to resolve the issues
leading to the client's discharge and to permit the client to have an opportunity to continue
receiving services from the license holder. The license holder may temporarily remove a
client from the program facility during the five-day discharge review period. The license
holder must document the client's discharge review in the client's file.
new text end
new text begin
(h) Prior to a program-initiated discharge of a client from the program, the license holder
must complete the client's discharge summary and provide the client with a copy of the
discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) the alternatives to discharge that the license holder considered or attempted to
implement;
new text end
new text begin
(3) the names of each individual who is involved in the decision to discharge the client
and a description of each individual's involvement; and
new text end
new text begin
(4) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin Subd. 19. new text end
new text begin Program facility. new text end
new text begin
(a) The license holder must be licensed or certified as a
board and lodging facility, supervised living facility, or a boarding care home by the
Department of Health.
new text end
new text begin
(b) The license holder must have a capacity of five to 16 beds and the program must not
be declared as an institution for mental disease.
new text end
new text begin
(c) The license holder must furnish each program location to meet the psychological,
emotional, and developmental needs of clients.
new text end
new text begin
(d) The license holder must provide one living room or lounge area per program location.
There must be space available to provide services according to each client's treatment plan,
such as an area for learning recreation time skills and areas for learning independent living
skills, such as laundering clothes and preparing meals.
new text end
new text begin
(e) The license holder must ensure that each program location allows each client to have
privacy. Each client must have privacy during assessment interviews and counseling sessions.
Each client must have a space designated for the client to see outside visitors at the program
facility.
new text end
new text begin Subd. 20. new text end
new text begin Physical separation of services. new text end
new text begin
If the license holder offers services to
individuals who are not receiving intensive residential treatment services or residential
stabilization at the program location, the license holder must inform the commissioner and
submit a plan for approval to the commissioner about how and when the license holder will
provide services. The license holder must only provide services to clients who are not
receiving intensive residential treatment services or residential crisis stabilization in an area
that is physically separated from the area in which the license holder provides clients with
intensive residential treatment services or residential crisis stabilization.
new text end
new text begin Subd. 21. new text end
new text begin Dividing staff time between locations. new text end
new text begin
A license holder must obtain approval
from the commissioner prior to providing intensive residential treatment services or
residential crisis stabilization to clients in more than one program location under one license
and dividing one staff person's time between program locations during the same work period.
new text end
new text begin Subd. 22. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures in section 245I.03, the license holder must establish, enforce, and maintain
the policies and procedures in this subdivision.
new text end
new text begin
(b) The license holder must have policies and procedures for receiving referrals and
making admissions determinations about referred persons under subdivisions 14 to 16.
new text end
new text begin
(c) The license holder must have policies and procedures for discharging clients under
subdivision 17. In the policies and procedures, the license holder must identify the staff
persons who are authorized to discharge clients from the program.
new text end
new text begin Subd. 23. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) A license holder must develop
a written quality assurance and improvement plan that includes a plan to:
new text end
new text begin
(1) encourage ongoing consultation between members of the treatment team;
new text end
new text begin
(2) obtain and evaluate feedback about services from clients, family and other natural
supports, referral sources, and staff persons;
new text end
new text begin
(3) measure and evaluate client outcomes in the program;
new text end
new text begin
(4) review critical incidents in the program;
new text end
new text begin
(5) examine the quality of clinical services in the program; and
new text end
new text begin
(6) self-monitor the license holder's compliance with this chapter.
new text end
new text begin
(b) At least annually, the license holder must review, evaluate, and update the license
holder's quality assurance and improvement plan. The license holder's review must:
new text end
new text begin
(1) document the actions that the license holder will take in response to the information
that the license holder obtains from the monitoring activities in the plan; and
new text end
new text begin
(2) establish goals for improving the license holder's services to clients during the next
year.
new text end
new text begin Subd. 24. new text end
new text begin Application. new text end
new text begin
When an applicant requests licensure to provide intensive
residential treatment services, residential crisis stabilization, or both to clients, the applicant
must submit, on forms that the commissioner provides, any documents that the commissioner
requires.
new text end
Sec. 17.
new text begin
[256B.0671] COVERED MENTAL HEALTH SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical trainee" means a staff person who is qualified
under section 245I.04, subdivision 6.
new text end
new text begin
(b) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(c) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) An individual, organization, or government entity providing
mental health services to a client under this section must obtain a criminal background study
of each staff person or volunteer who is providing direct contact services to a client.
new text end
new text begin
(b) An individual, organization, or government entity providing mental health services
to a client under this section must comply with all responsibilities that chapter 245I assigns
to a license holder, except section 245I.011, subdivision 1, unless all of the individual's,
organization's, or government entity's treatment staff are qualified as mental health
professionals.
new text end
new text begin
(c) An individual, organization, or government entity providing mental health services
to a client under this section must comply with the following requirements if all of the
license holder's treatment staff are qualified as mental health professionals:
new text end
new text begin
(1) provider qualifications and scopes of practice under section 245I.04;
new text end
new text begin
(2) maintaining and updating personnel files under section 245I.07;
new text end
new text begin
(3) documenting under section 245I.08;
new text end
new text begin
(4) maintaining and updating client files under section 245I.09;
new text end
new text begin
(5) completing client assessments and treatment planning under section 245I.10;
new text end
new text begin
(6) providing clients with health services and medications under section 245I.11; and
new text end
new text begin
(7) respecting and enforcing client rights under section 245I.12.
new text end
new text begin Subd. 3. new text end
new text begin Adult day treatment services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers adult day treatment (ADT) services that are provided under contract with
the county board. Adult day treatment payment is subject to the conditions in paragraphs
(b) to (e). The provider must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments, protocols, and forms approved by
the commissioner.
new text end
new text begin
(b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness on a client to enable the client to benefit from a lower level of
care and to live and function more independently in the community. Adult day treatment
services must be provided to a client to stabilize the client's mental health and to improve
the client's independent living and socialization skills. Adult day treatment must consist of
at least one hour of group psychotherapy and must include group time focused on
rehabilitative interventions or other therapeutic services that a multidisciplinary team provides
to each client. Adult day treatment services are not a part of inpatient or residential treatment
services. The following providers may apply to become adult day treatment providers:
new text end
new text begin
(1) a hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
new text end
new text begin
(2) a community mental health center under section 256B.0625, subdivision 5; or
new text end
new text begin
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4712, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475.
new text end
new text begin
(c) An adult day treatment (ADT) services provider must:
new text end
new text begin
(1) ensure that the commissioner has approved of the organization as an adult day
treatment provider organization;
new text end
new text begin
(2) ensure that a multidisciplinary team provides ADT services to a group of clients. A
mental health professional must supervise each multidisciplinary staff person who provides
ADT services;
new text end
new text begin
(3) make ADT services available to the client at least two days a week for at least three
consecutive hours per day. ADT services may be longer than three hours per day, but medical
assistance may not reimburse a provider for more than 15 hours per week;
new text end
new text begin
(4) provide ADT services to each client that includes group psychotherapy by a mental
health professional or clinical trainee and daily rehabilitative interventions by a mental
health professional, clinical trainee, or mental health practitioner; and
new text end
new text begin
(5) include ADT services in the client's individual treatment plan, when appropriate.
The adult day treatment provider must:
new text end
new text begin
(i) complete a functional assessment of each client under section 245I.10, subdivision
9;
new text end
new text begin
(ii) notwithstanding section 245I.10, subdivision 8, review the client's progress and
update the individual treatment plan at least every 90 days until the client is discharged
from the program; and
new text end
new text begin
(iii) include a discharge plan for the client in the client's individual treatment plan.
new text end
new text begin
(d) To be eligible for adult day treatment, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) not reside in a nursing facility, hospital, institute of mental disease, or state-operated
treatment center unless the client has an active discharge plan that indicates a move to an
independent living setting within 180 days;
new text end
new text begin
(3) have the capacity to engage in rehabilitative programming, skills activities, and
psychotherapy in the structured, therapeutic setting of an adult day treatment program and
demonstrate measurable improvements in functioning resulting from participation in the
adult day treatment program;
new text end
new text begin
(4) have a level of care assessment under section 245I.02, subdivision 19, recommending
that the client participate in services with the level of intensity and duration of an adult day
treatment program; and
new text end
new text begin
(5) have the recommendation of a mental health professional for adult day treatment
services. The mental health professional must find that adult day treatment services are
medically necessary for the client.
new text end
new text begin
(e) Medical assistance does not cover the following services as adult day treatment
services:
new text end
new text begin
(1) services that are primarily recreational or that are provided in a setting that is not
under medical supervision, including sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
new text end
new text begin
(2) social or educational services that do not have or cannot reasonably be expected to
have a therapeutic outcome related to the client's mental illness;
new text end
new text begin
(3) consultations with other providers or service agency staff persons about the care or
progress of a client;
new text end
new text begin
(4) prevention or education programs that are provided to the community;
new text end
new text begin
(5) day treatment for clients with a primary diagnosis of a substance use disorder;
new text end
new text begin
(6) day treatment provided in the client's home;
new text end
new text begin
(7) psychotherapy for more than two hours per day; and
new text end
new text begin
(8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
new text end
new text begin Subd. 4. new text end
new text begin Explanation of findings. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers an explanation of findings that a mental health professional or clinical trainee provides
when the provider has obtained the authorization from the client or the client's representative
to release the information.
new text end
new text begin
(b) A mental health professional or clinical trainee provides an explanation of findings
to assist the client or related parties in understanding the results of the client's testing or
diagnostic assessment and the client's mental illness, and provides professional insight that
the client or related parties need to carry out a client's treatment plan. Related parties may
include the client's family and other natural supports and other service providers working
with the client.
new text end
new text begin
(c) An explanation of findings is not paid for separately when a mental health professional
or clinical trainee explains the results of psychological testing or a diagnostic assessment
to the client or the client's representative as part of the client's psychological testing or a
diagnostic assessment.
new text end
new text begin Subd. 5. new text end
new text begin Family psychoeducation services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers family psychoeducation services provided to a child up to age 21 with a
diagnosed mental health condition when identified in the child's individual treatment plan
and provided by a mental health professional or a clinical trainee who has determined it
medically necessary to involve family members in the child's care.
new text end
new text begin
(b) "Family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family in understanding a child's
symptoms of mental illness, the impact on the child's development, and needed components
of treatment and skill development so that the individual, family, or group can help the child
to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental
health and long-term resilience.
new text end
new text begin Subd. 6. new text end
new text begin Dialectical behavior therapy. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers intensive mental health outpatient treatment for dialectical behavior therapy for
adults. A dialectical behavior therapy provider must make reasonable and good faith efforts
to report individual client outcomes to the commissioner using instruments and protocols
that are approved by the commissioner.
new text end
new text begin
(b) "Dialectical behavior therapy" means an evidence-based treatment approach that a
mental health professional or clinical trainee provides to a client or a group of clients in an
intensive outpatient treatment program using a combination of individualized rehabilitative
and psychotherapeutic interventions. A dialectical behavior therapy program involves:
individual dialectical behavior therapy, group skills training, telephone coaching, and team
consultation meetings.
new text end
new text begin
(c) To be eligible for dialectical behavior therapy, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) have mental health needs that available community-based services cannot meet or
that the client must receive concurrently with other community-based services;
new text end
new text begin
(3) have either:
new text end
new text begin
(i) a diagnosis of borderline personality disorder; or
new text end
new text begin
(ii) multiple mental health diagnoses, exhibit behaviors characterized by impulsivity or
intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction in multiple areas of the client's life;
new text end
new text begin
(4) be cognitively capable of participating in dialectical behavior therapy as an intensive
therapy program and be able and willing to follow program policies and rules to ensure the
safety of the client and others; and
new text end
new text begin
(5) be at significant risk of one or more of the following if the client does not receive
dialectical behavior therapy:
new text end
new text begin
(i) having a mental health crisis;
new text end
new text begin
(ii) requiring a more restrictive setting such as hospitalization;
new text end
new text begin
(iii) decompensating; or
new text end
new text begin
(iv) engaging in intentional self-harm behavior.
new text end
new text begin
(d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat a client's suicidal and other dysfunctional behaviors
and to reinforce a client's use of adaptive skillful behaviors. A mental health professional
or clinical trainee must provide individual dialectical behavior therapy to a client. A mental
health professional or clinical trainee providing dialectical behavior therapy to a client must:
new text end
new text begin
(1) identify, prioritize, and sequence the client's behavioral targets;
new text end
new text begin
(2) treat the client's behavioral targets;
new text end
new text begin
(3) assist the client in applying dialectical behavior therapy skills to the client's natural
environment through telephone coaching outside of treatment sessions;
new text end
new text begin
(4) measure the client's progress toward dialectical behavior therapy targets;
new text end
new text begin
(5) help the client manage mental health crises and life-threatening behaviors; and
new text end
new text begin
(6) help the client learn and apply effective behaviors when working with other treatment
providers.
new text end
new text begin
(e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas: (1) mindfulness; (2) interpersonal
effectiveness; (3) emotional regulation; and (4) distress tolerance.
new text end
new text begin
(f) Group skills training must be provided by two mental health professionals or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner.
Individual skills training must be provided by a mental health professional, a clinical trainee,
or a mental health practitioner.
new text end
new text begin
(g) Before a program provides dialectical behavior therapy to a client, the commissioner
must certify the program as a dialectical behavior therapy provider. To qualify for
certification as a dialectical behavior therapy provider, a provider must:
new text end
new text begin
(1) allow the commissioner to inspect the provider's program;
new text end
new text begin
(2) provide evidence to the commissioner that the program's policies, procedures, and
practices meet the requirements of this subdivision and chapter 245I;
new text end
new text begin
(3) be enrolled as a MHCP provider; and
new text end
new text begin
(4) have a manual that outlines the program's policies, procedures, and practices that
meet the requirements of this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Mental health clinical care consultation. new text end
new text begin
(a) Subject to federal approval,
medical assistance covers clinical care consultation for a person up to age 21 who is
diagnosed with a complex mental health condition or a mental health condition that co-occurs
with other complex and chronic conditions, when described in the person's individual
treatment plan and provided by a mental health professional or a clinical trainee.
new text end
new text begin
(b) "Clinical care consultation" means communication from a treating mental health
professional to other providers or educators not under the treatment supervision of the
treating mental health professional who are working with the same client to inform, inquire,
and instruct regarding the client's symptoms; strategies for effective engagement, care, and
intervention needs; and treatment expectations across service settings and to direct and
coordinate clinical service components provided to the client and family.
new text end
new text begin Subd. 8. new text end
new text begin Neuropsychological assessment. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers a client's neuropsychological assessment.
new text end
new text begin
(b) Neuropsychological assessment" means a specialized clinical assessment of the
client's underlying cognitive abilities related to thinking, reasoning, and judgment that is
conducted by a qualified neuropsychologist. A neuropsychological assessment must include
a face-to-face interview with the client, interpretation of the test results, and preparation
and completion of a report.
new text end
new text begin
(c) A client is eligible for a neuropsychological assessment if the client meets at least
one of the following criteria:
new text end
new text begin
(1) the client has a known or strongly suspected brain disorder based on the client's
medical history or the client's prior neurological evaluation, including a history of significant
head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative
disorder, significant exposure to neurotoxins, central nervous system infection, metabolic
or toxic encephalopathy, fetal alcohol syndrome, or congenital malformation of the brain;
or
new text end
new text begin
(2) the client has cognitive or behavioral symptoms that suggest that the client has an
organic condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. The client's
symptoms may include:
new text end
new text begin
(i) having a poor memory or impaired problem solving;
new text end
new text begin
(ii) experiencing change in mental status evidenced by lethargy, confusion, or
disorientation;
new text end
new text begin
(iii) experiencing a deteriorating level of functioning;
new text end
new text begin
(iv) displaying a marked change in behavior or personality;
new text end
new text begin
(v) in a child or an adolescent, having significant delays in acquiring academic skill or
poor attention relative to peers;
new text end
new text begin
(vi) in a child or an adolescent, having reached a significant plateau in expected
development of cognitive, social, emotional, or physical functioning relative to peers; and
new text end
new text begin
(vii) in a child or an adolescent, significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, emotional, or physical
demands.
new text end
new text begin
(d) The neuropsychological assessment must be completed by a neuropsychologist who:
new text end
new text begin
(1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
new text end
new text begin
(2) earned a doctoral degree in psychology from an accredited university training program
and:
new text end
new text begin
(i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
new text end
new text begin
(ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
new text end
new text begin
(iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
new text end
new text begin
(3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
new text end
new text begin
(4) was approved by the commissioner as an eligible provider of neuropsychological
assessments prior to December 31, 2010.
new text end
new text begin Subd. 9. new text end
new text begin Neuropsychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers neuropsychological testing for clients.
new text end
new text begin
(b) "Neuropsychological testing" means administering standardized tests and measures
designed to evaluate the client's ability to attend to, process, interpret, comprehend,
communicate, learn, and recall information and use problem solving and judgment.
new text end
new text begin
(c) Medical assistance covers neuropsychological testing of a client when the client:
new text end
new text begin
(1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
new text end
new text begin
(2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
new text end
new text begin
(3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, physical, or emotional
demands; or
new text end
new text begin
(4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
new text end
new text begin
(i) traumatic brain injury;
new text end
new text begin
(ii) stroke;
new text end
new text begin
(iii) brain tumor;
new text end
new text begin
(iv) substance use disorder;
new text end
new text begin
(v) cerebral anoxic or hypoxic episode;
new text end
new text begin
(vi) central nervous system infection or other infectious disease;
new text end
new text begin
(vii) neoplasms or vascular injury of the central nervous system;
new text end
new text begin
(viii) neurodegenerative disorders;
new text end
new text begin
(ix) demyelinating disease;
new text end
new text begin
(x) extrapyramidal disease;
new text end
new text begin
(xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
new text end
new text begin
(xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosus,
or celiac disease;
new text end
new text begin
(xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
new text end
new text begin
(xiv) severe or prolonged nutrition or malabsorption syndromes; or
new text end
new text begin
(xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not improved the client's neurocognitive functioning; or another disorder, including autism,
selective mutism, anxiety disorder, or reactive attachment disorder.
new text end
new text begin
(d) Neuropsychological testing must be administered or clinically supervised by a
qualified neuropsychologist under subdivision 8, paragraph (c).
new text end
new text begin
(e) Medical assistance does not cover neuropsychological testing of a client when the
testing is:
new text end
new text begin
(1) primarily for educational purposes;
new text end
new text begin
(2) primarily for vocational counseling or training;
new text end
new text begin
(3) for personnel or employment testing;
new text end
new text begin
(4) a routine battery of psychological tests given to the client at the client's inpatient
admission or during a client's continued inpatient stay; or
new text end
new text begin
(5) for legal or forensic purposes.
new text end
new text begin Subd. 10. new text end
new text begin Psychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers psychological testing of a client.
new text end
new text begin
(b) "Psychological testing" means the use of tests or other psychometric instruments to
determine the status of a client's mental, intellectual, and emotional functioning.
new text end
new text begin
(c) The psychological testing must:
new text end
new text begin
(1) be administered or supervised by a licensed psychologist qualified under section
245I.04, subdivision 2, clause (3), who is competent in the area of psychological testing;
and
new text end
new text begin
(2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical trainee in psychology under the treatment supervision of a licensed psychologist
under section 245I.06.
new text end
new text begin
(d) A licensed psychologist must supervise the administration, scoring, and interpretation
of a client's psychological tests when a clinical psychology trainee, technician, psychometrist,
or psychological assistant or a computer-assisted psychological testing program completes
the psychological testing of the client. The report resulting from the psychological testing
must be signed by the licensed psychologist who conducts the face-to-face interview with
the client. The licensed psychologist or a staff person who is under treatment supervision
must place the client's psychological testing report in the client's record and release one
copy of the report to the client and additional copies to individuals authorized by the client
to receive the report.
new text end
new text begin Subd. 11. new text end
new text begin Psychotherapy. new text end
new text begin
(a) Subject to federal approval, medical assistance covers
psychotherapy for a client.
new text end
new text begin
(b) "Psychotherapy" means treatment of a client with mental illness that applies to the
most appropriate psychological, psychiatric, psychosocial, or interpersonal method that
conforms to prevailing community standards of professional practice to meet the mental
health needs of the client. Medical assistance covers psychotherapy if a mental health
professional or a clinical trainee provides psychotherapy to a client.
new text end
new text begin
(c) "Individual psychotherapy" means psychotherapy that a mental health professional
or clinical trainee designs for a client.
new text end
new text begin
(d) "Family psychotherapy" means psychotherapy that a mental health professional or
clinical trainee designs for a client and one or more of the client's family members or primary
caregiver whose participation is necessary to accomplish the client's treatment goals. Family
members or primary caregivers participating in a therapy session do not need to be eligible
for medical assistance for medical assistance to cover family psychotherapy. For purposes
of this paragraph, "primary caregiver whose participation is necessary to accomplish the
client's treatment goals" excludes shift or facility staff persons who work at the client's
residence. Medical assistance payments for family psychotherapy are limited to face-to-face
sessions during which the client is present throughout the session, unless the mental health
professional or clinical trainee believes that the client's exclusion from the family
psychotherapy session is necessary to meet the goals of the client's individual treatment
plan. If the client is excluded from a family psychotherapy session, a mental health
professional or clinical trainee must document the reason for the client's exclusion and the
length of time that the client is excluded. The mental health professional must also document
any reason that a member of the client's family is excluded from a psychotherapy session.
new text end
new text begin
(e) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can benefit from treatment in a group
setting. For a group of three to eight clients, at least one mental health professional or clinical
trainee must provide psychotherapy to the group. For a group of nine to 12 clients, a team
of at least two mental health professionals or two clinical trainees or one mental health
professional and one clinical trainee must provide psychotherapy to the group. Medical
assistance will cover group psychotherapy for a group of no more than 12 persons.
new text end
new text begin
(f) A multiple-family group psychotherapy session is eligible for medical assistance if
a mental health professional or clinical trainee designs the psychotherapy session for at least
two but not more than five families. A mental health professional or clinical trainee must
design multiple-family group psychotherapy sessions to meet the treatment needs of each
client. If the client is excluded from a psychotherapy session, the mental health professional
or clinical trainee must document the reason for the client's exclusion and the length of time
that the client was excluded. The mental health professional or clinical trainee must document
any reason that a member of the client's family was excluded from a psychotherapy session.
new text end
new text begin Subd. 12. new text end
new text begin Partial hospitalization. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers a client's partial hospitalization.
new text end
new text begin
(b) "Partial hospitalization" means a provider's time-limited, structured program of
psychotherapy and other therapeutic services, as defined in United States Code, title 42,
chapter 7, subchapter XVIII, part E, section 1395x(ff), that a multidisciplinary staff person
provides in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services to a client.
new text end
new text begin
(c) Partial hospitalization is an appropriate alternative to inpatient hospitalization for a
client who is experiencing an acute episode of mental illness who meets the criteria for an
inpatient hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who
has family and community resources that support the client's residence in the community.
Partial hospitalization consists of multiple intensive short-term therapeutic services for a
client that a multidisciplinary staff person provides to a client to treat the client's mental
illness.
new text end
new text begin Subd. 13. new text end
new text begin Diagnostic assessments. new text end
new text begin
Subject to federal approval, medical assistance covers
a client's diagnostic assessments that a mental health professional or clinical trainee completes
under section 245I.10.
new text end
Sec. 18. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders including
counties, tribes, managed care organizations, provider organizations, advocacy groups, and
clients and clients' families, shall develop recommendations to develop a single
comprehensive licensing structure for mental health service programs, including outpatient
and residential services for adults and children. The recommendations must prioritize
program integrity, the welfare of clients and clients' families, improved integration of mental
health and substance use disorder services, and the reduction of administrative burden on
providers.
new text end
Sec. 19. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2022, or upon federal approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
ARTICLE 18
CRISIS RESPONSE SERVICES
Section 1.
Minnesota Statutes 2020, section 245.469, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
deleted text begin By July 1, 1988,deleted text end new text begin (a)new text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adultsnew text begin , children, and familiesnew text end in the county who are experiencing an emotional crisis or
mental illness. deleted text begin Clients may be required to pay a fee according to section deleted text end deleted text begin .deleted text end new text begin Emergency
service providers must not delay the timely provision of emergency services to a client
because of the unwillingness or inability of the client to pay for services. new text end Emergency services
must include assessment, crisis intervention, and appropriate case disposition. Emergency
services must:
(1) promote the safety and emotional stability of deleted text begin adults with mental illness or emotional
crisesdeleted text end new text begin each clientnew text end ;
(2) minimize further deterioration of deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each
clientnew text end ;
(3) help deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each clientnew text end to obtain ongoing care
and treatment; deleted text begin and
deleted text end
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) provide support, psychoeducation, and referrals to each client's family members,
service providers, and other third parties on behalf of the client in need of emergency
services.
new text end
new text begin
(b) If a county provides engagement services under section 253B.041, the county's
emergency service providers must refer clients to engagement services when the client
meets the criteria for engagement services.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245.469, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional, deleted text begin adeleted text end new text begin clinical trainee, ornew text end mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .
(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:
(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;
(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency
services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services deleted text begin reviewed by the state advisory
council on mental health and thendeleted text end approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services deleted text begin reviewed by
the state advisory council on mental health and thendeleted text end approved by the commissioner;
(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.
Sec. 3.
Minnesota Statutes 2020, section 245.4879, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
County boards must provide or
contract for deleted text begin enoughdeleted text end mental health emergency services deleted text begin within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition. Emergency services
must:deleted text end new text begin according to section 245.469.
new text end
deleted text begin
(1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;
deleted text end
deleted text begin
(2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;
deleted text end
deleted text begin
(3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; and
deleted text end
deleted text begin
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needs.
deleted text end
Sec. 4.
Minnesota Statutes 2020, section 256B.0624, is amended to read:
256B.0624 deleted text begin ADULTdeleted text end CRISIS RESPONSE SERVICES COVERED.
Subdivision 1.
Scope.
deleted text begin Medical assistance covers adult mental health crisis response
services as defined in subdivision 2, paragraphs (c) to (e),deleted text end new text begin (a) new text end Subject to federal approval,
deleted text begin if provided to a recipient as defined in subdivision 3 and provided by a qualified provider
entity as defined in this section and by a qualified individual provider working within the
provider's scope of practice and as defined in this subdivision and identified in the recipient's
individual crisis treatment plan as defined in subdivision 11 and if determined to be medically
necessarydeleted text end new text begin medical assistance covers medically necessary crisis response services when the
services are provided according to the standards in this sectionnew text end .
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary residential
crisis stabilization for adults when the services are provided by an entity licensed under and
meeting the standards in section 245I.23 or an entity with an adult foster care license meeting
the standards in this section.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments and protocols approved by the
commissioner.
new text end
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
deleted text begin
(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.
deleted text end
deleted text begin
(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.
deleted text end
deleted text begin
A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or crisis mental health
practitioner with input from the recipient whenever possible.
deleted text end
new text begin
(a) "Certified rehabilitation specialist" means a staff person who is qualified under section
245I.04, subdivision 8.
new text end
new text begin
(b) "Clinical trainee" means a staff person who is qualified under section 245I.04,
subdivision 6.
new text end
(c) "deleted text begin Mental healthdeleted text end Crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests that the
adult may be experiencing a mental health crisis or mental health emergency situation. It
includes, when feasible, assessing whether the person might be willing to voluntarily accept
treatment, determining whether the person has an advance directive, and obtaining
information and history from involved family members or caretakersdeleted text end new text begin a qualified member
of a crisis team, as described in subdivision 6anew text end .
(d) "deleted text begin Mental health mobiledeleted text end Crisis intervention deleted text begin servicesdeleted text end " means face-to-face, short-term
intensive mental health services initiated during a mental health crisis deleted text begin or mental health
emergencydeleted text end to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. deleted text begin The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.
deleted text end
deleted text begin
(1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.
deleted text end
deleted text begin
(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.
deleted text end
deleted text begin
(3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.
deleted text end
deleted text begin
(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.
deleted text end
deleted text begin
(5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.
deleted text end
deleted text begin
(6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.
deleted text end
new text begin
(e) "Crisis screening" means a screening of a client's potential mental health crisis
situation under subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "deleted text begin Mental healthdeleted text end Crisis stabilization deleted text begin servicesdeleted text end " means individualized mental health
services provided to a recipient deleted text begin following crisis intervention servicesdeleted text end which are designed
to restore the recipient to the recipient's prior functional level. deleted text begin Mental healthdeleted text end Crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, deleted text begin ordeleted text end a short-term supervised, licensed
residential programnew text begin , or an emergency departmentnew text end . deleted text begin Mental health crisis stabilization does
not include partial hospitalization or day treatment. Mental healthdeleted text end Crisis stabilization services
includes family psychoeducation.
new text begin
(g) "Crisis team" means the staff of a provider entity who are supervised and prepared
to provide mobile crisis services to a client in a potential mental health crisis situation.
new text end
new text begin
(h) "Mental health certified family peer specialist" means a staff person who is qualified
under section 245I.04, subdivision 12.
new text end
new text begin
(i) "Mental health certified peer specialist" means a staff person who is qualified under
section 245I.04, subdivision 10.
new text end
new text begin
(j) "Mental health crisis" is a behavioral, emotional, or psychiatric situation that, without
the provision of crisis response services, would likely result in significantly reducing the
recipient's levels of functioning in primary activities of daily living, in an emergency situation
under section 62Q.55, or in the placement of the recipient in a more restrictive setting,
including but not limited to inpatient hospitalization.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified under
section 245I.04, subdivision 14.
new text end
new text begin
(n) "Mobile crisis services" means screening, assessment, intervention, and community
based stabilization, excluding residential crisis stabilization, that is provided to a recipient.
new text end
Subd. 3.
Eligibility.
deleted text begin
An eligible recipient is an individual who:
deleted text end
deleted text begin
(1) is age 18 or older;
deleted text end
deleted text begin
(2) is screened as possibly experiencing a mental health crisis or emergency where a
mental health crisis assessment is needed; and
deleted text end
deleted text begin
(3) is assessed as experiencing a mental health crisis or emergency, and mental health
crisis intervention or crisis intervention and stabilization services are determined to be
medically necessary.
deleted text end
new text begin
(a) A recipient is eligible for crisis assessment services when the recipient has screened
positive for a potential mental health crisis during a crisis screening.
new text end
new text begin
(b) A recipient is eligible for crisis intervention services and crisis stabilization services
when the recipient has been assessed during a crisis assessment to be experiencing a mental
health crisis.
new text end
Subd. 4.
Provider entity standards.
(a) A deleted text begin provider entity is an entity that meets the
standards listed in paragraph (c) anddeleted text end new text begin mobile crisis provider must benew text end :
(1) deleted text begin isdeleted text end a county board operated entity; deleted text begin or
deleted text end
new text begin
(2) an Indian health services facility or facility owned and operated by a tribe or tribal
organization operating under United States Code, title 325, section 450f; or
new text end
deleted text begin (2) isdeleted text end new text begin (3)new text end a provider entity that is under contract with the county board in the county
where the potential crisis or emergency is occurring. To provide services under this section,
the provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.
new text begin
(b) A mobile crisis provider must meet the following standards:
new text end
new text begin
(1) must ensure that crisis screenings, crisis assessments, and crisis intervention services
are available to a recipient 24 hours a day, seven days a week;
new text end
new text begin
(2) must be able to respond to a call for services in a designated service area or according
to a written agreement with the local mental health authority for an adjacent area;
new text end
new text begin
(3) must have at least one mental health professional on staff at all times and at least
one additional staff member capable of leading a crisis response in the community; and
new text end
new text begin
(4) must provide the commissioner with information about the number of requests for
service, the number of people that the provider serves face-to-face, outcomes, and the
protocols that the provider uses when deciding when to respond in the community.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (a)deleted text begin ,
clauses (1) and (2)deleted text end new text begin to (b)new text end , but must meet all other requirements of this subdivision.
deleted text begin (c) The adult mental healthdeleted text end new text begin (d) Anew text end crisis deleted text begin responsedeleted text end services provider deleted text begin entitydeleted text end must have the
capacity to meet and carry out the new text begin standards in section 245I.011, subdivision 5, and the
new text end following standards:
(1) deleted text begin has the capacity to recruit, hire, and manage and train mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin ensures that staff persons provide support for a
recipient's family and natural supports, by enabling the recipient's family and natural supports
to observe and participate in the recipient's treatment, assessments, and planning servicesnew text end ;
(2) has adequate administrative ability to ensure availability of services;
deleted text begin
(3) is able to ensure adequate preservice and in-service training;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;
deleted text begin (5)deleted text end new text begin (4)new text end is able to ensure that staff are deleted text begin capable ofdeleted text end implementing culturally specific treatment
identified in the deleted text begin individualdeleted text end new text begin crisisnew text end treatment plan that is meaningful and appropriate as
determined by the recipient's culture, beliefs, values, and language;
deleted text begin (6)deleted text end new text begin (5)new text end is able to ensure enough flexibility to respond to the changing intervention and
care needs of a recipient as identified by the recipient new text begin or family membernew text end during the service
partnership between the recipient and providers;
deleted text begin (7)deleted text end new text begin (6)new text end is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin
staffnew text end have the communication tools and procedures to communicate and consult promptly
about crisis assessment and interventions as services occur;
deleted text begin (8)deleted text end new text begin (7)new text end is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcementnew text begin , engagement
servicesnew text end , and mental health crisis services through regularly scheduled interagency meetings;
deleted text begin
(9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;
deleted text end
deleted text begin (10)deleted text end new text begin (8)new text end is able to ensure that services are coordinated with other deleted text begin mentaldeleted text end new text begin behavioralnew text end
health service providers, county mental health authorities, or federally recognized American
Indian authorities and others as necessary, with the consent of the deleted text begin adultdeleted text end new text begin recipient or parent
or guardiannew text end . Services must also be coordinated with the recipient's case manager if the deleted text begin adultdeleted text end new text begin
recipientnew text end is receiving case management services;
deleted text begin (11)deleted text end new text begin (9)new text end is able to ensure that crisis intervention services are provided in a manner
consistent with sections 245.461 to 245.486new text begin and 245.487 to 245.4879new text end ;
deleted text begin
(12) is able to submit information as required by the state;
deleted text end
deleted text begin
(13) maintains staff training and personnel files;
deleted text end
new text begin
(10) is able to coordinate detoxification services for the recipient according to Minnesota
Rules, parts 9530.6605 to 9530.6655, or withdrawal management according to chapter 245F;
new text end
deleted text begin (14)deleted text end new text begin (11)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfaction;new text begin and
new text end
deleted text begin
(15) is able to keep records as required by applicable laws;
deleted text end
deleted text begin
(16) is able to comply with all applicable laws and statutes;
deleted text end
deleted text begin (17)deleted text end new text begin (12)new text end is an enrolled medical assistance providerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(18) develops and maintains written policies and procedures regarding service provision
and administration of the provider entity, including safety of staff and recipients in high-risk
situations.
deleted text end
Subd. 4a.
Alternative provider standards.
If a county new text begin or tribe new text end demonstrates that, due
to geographic or other barriers, it is not feasible to provide mobile crisis intervention services
according to the standards in subdivision 4, paragraph deleted text begin (c), clause (9)deleted text end new text begin (b)new text end , the commissioner
may approve deleted text begin a crisis response provider based ondeleted text end an alternative plan proposed by a county
or deleted text begin group of countiesdeleted text end new text begin tribenew text end . The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of new text begin mobile
new text end crisis services;
(2) provide mobile new text begin crisis new text end services outside of the usual nine-to-five office hours and on
weekends and holidays; and
(3) comply with standards for emergency mental health services in section 245.469.
Subd. 5.
deleted text begin Mobiledeleted text end Crisis new text begin assessment and new text end intervention staff qualifications.
deleted text begin For provision
of adult mental health mobile crisis intervention services, a mobile crisis intervention team
is comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6), or a combination of at least one mental health professional
and one mental health practitioner as defined in section 245.462, subdivision 17, with the
required mental health crisis training and under the clinical supervision of a mental health
professional on the team. The team must have at least two people with at least one member
providing on-site crisis intervention services when needed.deleted text end new text begin (a) Qualified individual staff of
a qualified provider entity must provide crisis assessment and intervention services to a
recipient. A staff member providing crisis assessment and intervention services to a recipient
must be qualified as a:
new text end
new text begin
(1) mental health professional;
new text end
new text begin
(2) clinical trainee;
new text end
new text begin
(3) mental health practitioner;
new text end
new text begin
(4) mental health certified family peer specialist; or
new text end
new text begin
(5) mental health certified peer specialist.
new text end
new text begin
(b) When crisis assessment and intervention services are provided to a recipient in the
community, a mental health professional, clinical trainee, or mental health practitioner must
lead the response.
new text end
new text begin
(c) The 30 hours of ongoing training required by section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to children and adults and include training
about evidence-based practices identified by the commissioner of health to reduce the
recipient's risk of suicide and self-injurious behavior.
new text end
new text begin (d) new text end Team members must be experienced in deleted text begin mental healthdeleted text end new text begin crisisnew text end assessment, crisis
intervention techniques, treatment engagement strategies, working with families, and clinical
decision-making under emergency conditions and have knowledge of local services and
resources. deleted text begin The team must recommend and coordinate the team's services with appropriate
local resources such as the county social services agency, mental health services, and local
law enforcement when necessary.
deleted text end
Subd. 6.
Crisis deleted text begin assessment and mobile intervention treatment planningdeleted text end new text begin screeningnew text end .
(a)
deleted text begin Prior to initiating mobile crisis intervention services, a screening of the potential crisis
situation must be conducted.deleted text end The new text begin crisis new text end screening may use the resources of deleted text begin crisis assistance
anddeleted text end emergency services as defined in deleted text begin sections 245.462, subdivision 6, anddeleted text end new text begin sectionnew text end 245.469,
subdivisions 1 and 2. The new text begin crisis new text end screening must gather information, determine whether a
new text begin mental health new text end crisis situation exists, identify parties involved, and determine an appropriate
response.
new text begin
(b) When conducting the crisis screening of a recipient, a provider must:
new text end
new text begin
(1) employ evidence-based practices to reduce the recipient's risk of suicide and
self-injurious behavior;
new text end
new text begin
(2) work with the recipient to establish a plan and time frame for responding to the
recipient's mental health crisis, including responding to the recipient's immediate need for
support by telephone or text message until the provider can respond to the recipient
face-to-face;
new text end
new text begin
(3) document significant factors in determining whether the recipient is experiencing a
mental health crisis, including prior requests for crisis services, a recipient's recent
presentation at an emergency department, known calls to 911 or law enforcement, or
information from third parties with knowledge of a recipient's history or current needs;
new text end
new text begin
(4) accept calls from interested third parties and consider the additional needs or potential
mental health crises that the third parties may be experiencing;
new text end
new text begin
(5) provide psychoeducation, including means reduction, to relevant third parties
including family members or other persons living with the recipient; and
new text end
new text begin
(6) consider other available services to determine which service intervention would best
address the recipient's needs and circumstances.
new text end
new text begin
(c) For the purposes of this section, the following situations indicate a positive screen
for a potential mental health crisis and the provider must prioritize providing a face-to-face
crisis assessment of the recipient, unless a provider documents specific evidence to show
why this was not possible, including insufficient staffing resources, concerns for staff or
recipient safety, or other clinical factors:
new text end
new text begin
(1) the recipient presents at an emergency department or urgent care setting and the
health care team at that location requested crisis services; or
new text end
new text begin
(2) a peace officer requested crisis services for a recipient who is potentially subject to
transportation under section 253B.051.
new text end
new text begin
(d) A provider is not required to have direct contact with the recipient to determine that
the recipient is experiencing a potential mental health crisis. A mobile crisis provider may
gather relevant information about the recipient from a third party to establish the recipient's
need for services and potential safety factors.
new text end
new text begin Subd. 6a. new text end
new text begin Crisis assessment. new text end
deleted text begin (b)deleted text end new text begin (a)new text end If a deleted text begin crisis existsdeleted text end new text begin recipient screens positive for
potential mental health crisisnew text end , a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which deleted text begin emergencydeleted text end services are needed and, as time
permits, the recipient's current life situation, new text begin health information, including current
medications, new text end sources of stress, mental health problems and symptoms, strengths, cultural
considerations, support network, vulnerabilities, current functioning, and the recipient's
preferences as communicated directly by the recipient, or as communicated in a health care
directive as described in chapters 145C and 253B, the new text begin crisis new text end treatment plan described under
deleted text begin paragraph (d)deleted text end new text begin subdivision 11new text end , a crisis prevention plan, or a wellness recovery action plan.
new text begin
(b) A provider must conduct a crisis assessment at the recipient's location whenever
possible.
new text end
new text begin
(c) Whenever possible, the assessor must attempt to include input from the recipient and
the recipient's family and other natural supports to assess whether a crisis exists.
new text end
new text begin
(d) A crisis assessment includes determining: (1) whether the recipient is willing to
voluntarily engage in treatment or (2) has an advance directive and (3) gathering the
recipient's information and history from involved family or other natural supports.
new text end
new text begin
(e) A crisis assessment must include coordinated response with other health care providers
if the assessment indicates that a recipient needs detoxification, withdrawal management,
or medical stabilization in addition to crisis response services. If the recipient does not need
an acute level of care, a team must serve an otherwise eligible recipient who has a
co-occurring substance use disorder.
new text end
new text begin
(f) If, after completing a crisis assessment of a recipient, a provider refers a recipient to
an intensive setting, including an emergency department, inpatient hospitalization, or
residential crisis stabilization, one of the crisis team members who completed or conferred
about the recipient's crisis assessment must immediately contact the referral entity and
consult with the triage nurse or other staff responsible for intake at the referral entity. During
the consultation, the crisis team member must convey key findings or concerns that led to
the recipient's referral. Following the immediate consultation, the provider must also send
written documentation upon completion. The provider must document if these releases
occurred with authorization by the recipient, the recipient's legal guardian, or as allowed
by section 144.293, subdivision 5.
new text end
new text begin Subd. 6b. new text end
new text begin Crisis intervention services. new text end
deleted text begin (c)deleted text end new text begin (a)new text end If the crisis assessment determines mobile
crisis intervention services are needed, the new text begin crisis new text end intervention services must be provided
promptly. As opportunity presents during the intervention, at least two members of the
mobile crisis intervention team must confer directly or by telephone about the new text begin crisis
new text end assessment, new text begin crisis new text end treatment plan, and actions taken and needed. At least one of the team
members must be deleted text begin on sitedeleted text end providing new text begin face-to-face new text end crisis intervention services. If providing
deleted text begin on-sitedeleted text end crisis intervention services, a new text begin clinical trainee or new text end mental health practitioner must seek
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required in subdivision 9.
new text begin
(b) If a provider delivers crisis intervention services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin (d)deleted text end new text begin (c)new text end The mobile crisis intervention team must develop deleted text begin an initial, briefdeleted text end new text begin anew text end crisis treatment
plan deleted text begin as soon as appropriate but no later than 24 hours after the initial face-to-face interventiondeleted text end new text begin
according to subdivision 11new text end . deleted text begin The plan must address the needs and problems noted in the
crisis assessment and include deleted text end deleted text begin measurable short-term goals, cultural considerations, and
frequency and type of services to be provided to achieve the goals and reduce or eliminate
the crisis. The treatment plan must be updated as needed to reflect current goals and services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The new text begin mobile crisis intervention new text end team must document which deleted text begin short-term goalsdeleted text end new text begin crisis
treatment plan goals and objectivesnew text end have been met and when no further crisis intervention
services are required.
deleted text begin (f)deleted text end new text begin (e)new text end If the recipient's new text begin mental health new text end crisis is stabilized, but the recipient needs a referral
to other services, the team must provide referrals to these services. If the recipient has a
case manager, planning for other services must be coordinated with the case manager. If
the recipient is unable to follow up on the referral, the team must link the recipient to the
service and follow up to ensure the recipient is receiving the service.
deleted text begin (g)deleted text end new text begin (f)new text end If the recipient's new text begin mental health new text end crisis is stabilized and the recipient does not have
an advance directive, the case manager or crisis team shall offer to work with the recipient
to develop one.
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis deleted text begin stabilizationdeleted text end treatment plan must be developed deleted text begin whichdeleted text end new text begin thatnew text end meets the criteria
in subdivision 11;
(2) staff must be qualified as defined in subdivision 8; deleted text begin and
deleted text end
(3) new text begin crisis stabilization new text end services must be delivered according to the new text begin crisis new text end treatment plan
and include face-to-face contact with the recipient by qualified staff for further assessment,
help with referrals, updating of the crisis deleted text begin stabilizationdeleted text end treatment plan, deleted text begin supportive counseling,deleted text end
skills training, and collaboration with other service providers in the communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) if a provider delivers crisis stabilization services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end If crisis stabilization services are provided in a supervised, licensed residential
setting that serves no more than four adult residents, and one or more individuals are present
at the setting to receive residential crisis stabilization deleted text begin servicesdeleted text end , the residential staff must
include, for at least eight hours per day, at least one deleted text begin individual who meets the qualifications
in subdivision 8, paragraph (a), clause (1) or (2)deleted text end new text begin mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end .
deleted text begin
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
deleted text end
Subd. 8.
deleted text begin Adultdeleted text end Crisis stabilization staff qualifications.
(a) deleted text begin Adultdeleted text end Mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. deleted text begin Individual provider staff must have the following qualificationsdeleted text end new text begin A staff member
providing crisis stabilization services to a recipient must be qualified as anew text end :
(1) deleted text begin be adeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;
(2) deleted text begin be adeleted text end new text begin certified rehabilitation specialist;
new text end
new text begin
(3) clinical trainee;
new text end
new text begin (4)new text end mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end ;
new text begin
(5) mental health certified family peer specialist;
new text end
deleted text begin (3) be adeleted text end new text begin (6) mental healthnew text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or
deleted text begin (4) be adeleted text end new text begin (7)new text end mental health rehabilitation worker deleted text begin who meets the criteria in section
256B.0623, subdivision 5, paragraph (a), clause (4); works under the direction of a mental
health practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professionaldeleted text end .
(b) deleted text begin Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during the
past two years.deleted text end new text begin The 30 hours of ongoing training required in section 245I.05, subdivision
4, paragraph (b), must be specific to providing crisis services to children and adults and
include training about evidence-based practices identified by the commissioner of health
to reduce a recipient's risk of suicide and self-injurious behavior.
new text end
Subd. 9.
Supervision.
new text begin Clinical trainees and new text end mental health practitioners may provide
crisis assessment and deleted text begin mobiledeleted text end crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services
provided;
(2) the mental health professional of the provider entitydeleted text begin , who is an employee or under
contract with the provider entity,deleted text end must be immediately available by phone or in person for
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;
(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a new text begin clinical trainee or new text end mental health practitioner provides deleted text begin on-site servicedeleted text end new text begin
crisis assessment or crisis intervention servicesnew text end ;new text begin and
new text end
(4) the mental health professional must:
(i) review and approvenew text begin , as defined in section 245I.02, subdivision 2,new text end of the tentative
crisis assessment and crisis treatment plannew text begin within 24 hours of first providing services to the
recipient, notwithstanding section 245I.08, subdivision 3new text end ;new text begin and
new text end
(ii) document the consultationnew text begin required in clause (3).new text end deleted text begin ; and
deleted text end
deleted text begin
(iii) sign the crisis assessment and treatment plan within the next business day;
deleted text end
deleted text begin
(5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
deleted text end
deleted text begin
(6) the on-site observation must be documented in the recipient's record and signed by
the mental health professional.
deleted text end
deleted text begin Subd. 10. deleted text end
deleted text begin Recipient file. deleted text end
deleted text begin
Providers of mobile crisis intervention or crisis stabilization
services must maintain a file for each recipient containing the following information:
deleted text end
deleted text begin
(1) individual crisis treatment plans signed by the recipient, mental health professional,
and mental health practitioner who developed the crisis treatment plan, or if the recipient
refused to sign the plan, the date and reason stated by the recipient as to why the recipient
would not sign the plan;
deleted text end
deleted text begin
(2) signed release forms;
deleted text end
deleted text begin
(3) recipient health information and current medications;
deleted text end
deleted text begin
(4) emergency contacts for the recipient;
deleted text end
deleted text begin
(5) case records which document the date of service, place of service delivery, signature
of the person providing the service, and the nature, extent, and units of service. Direct or
telephone contact with the recipient's family or others should be documented;
deleted text end
deleted text begin
(6) required clinical supervision by mental health professionals;
deleted text end
deleted text begin
(7) summary of the recipient's case reviews by staff;
deleted text end
deleted text begin
(8) any written information by the recipient that the recipient wants in the file; and
deleted text end
deleted text begin
(9) an advance directive, if there is one available.
deleted text end
deleted text begin
Documentation in the file must comply with all requirements of the commissioner.
deleted text end
Subd. 11.
new text begin Crisis new text end treatment plan.
deleted text begin
The individual crisis stabilization treatment plan must
include, at a minimum:
deleted text end
deleted text begin
(1) a list of problems identified in the assessment;
deleted text end
deleted text begin
(2) a list of the recipient's strengths and resources;
deleted text end
deleted text begin
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;
deleted text end
deleted text begin
(4) specific objectives directed toward the achievement of each one of the goals;
deleted text end
deleted text begin
(5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;
deleted text end
deleted text begin
(6) planned frequency and type of services initiated;
deleted text end
deleted text begin
(7) a crisis response action plan if a crisis should occur;
deleted text end
deleted text begin
(8) clear progress notes on outcome of goals;
deleted text end
deleted text begin
(9) a written plan must be completed within 24 hours of beginning services with the
recipient; and
deleted text end
deleted text begin
(10) a treatment plan must be developed by a mental health professional or mental health
practitioner under the clinical supervision of a mental health professional. The mental health
professional must approve and sign all treatment plans.
deleted text end
new text begin
(a) Within 24 hours of the recipient's admission, the provider entity must complete the
recipient's crisis treatment plan. The provider entity must:
new text end
new text begin
(1) base the recipient's crisis treatment plan on the recipient's crisis assessment;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the recipient in the
past;
new text end
new text begin
(3) for a child recipient, use a child-centered, family-driven, and culturally appropriate
planning process that allows the recipient's parents and guardians to observe or participate
in the recipient's individual and family treatment services, assessment, and treatment
planning;
new text end
new text begin
(4) for an adult recipient, use a person-centered, culturally appropriate planning process
that allows the recipient's family and other natural supports to observe or participate in
treatment services, assessment, and treatment planning;
new text end
new text begin
(5) identify the participants involved in the recipient's treatment planning. The recipient,
if possible, must be a participant;
new text end
new text begin
(6) identify the recipient's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the recipient engage in treatment;
new text end
new text begin
(7) include documentation of referral to and scheduling of services, including specific
providers where applicable;
new text end
new text begin
(8) ensure that the recipient or the recipient's legal guardian approves under section
245I.02, subdivision 2, of the recipient's crisis treatment plan unless a court orders the
recipient's treatment plan under chapter 253B. If the recipient or the recipient's legal guardian
disagrees with the crisis treatment plan, the license holder must document in the client file
the reasons why the recipient disagrees with the crisis treatment plan; and
new text end
new text begin
(9) ensure that a treatment supervisor approves under section 245I.02, subdivision 2, of
the recipient's treatment plan within 24 hours of the recipient's admission if a mental health
practitioner or clinical trainee completes the crisis treatment plan, notwithstanding section
245I.08, subdivision 3.
new text end
new text begin
(b) The provider entity must provide the recipient and the recipient's legal guardian with
a copy of the recipient's crisis treatment plan.
new text end
Subd. 12.
Excluded services.
The following services are excluded from reimbursement
under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) recipient transportation costs may be covered under other medical assistance
provisions, but transportation services are not an adult mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical
assistance to provide adult mental health crisis response services;
(5) services performed by volunteers;
(6) direct billing of time spent "on call" when not delivering services to a recipient;
(7) provider service time included in case management reimbursement. When a provider
is eligible to provide more than one type of medical assistance service, the recipient must
have a choice of provider for each service, unless otherwise provided for by law;
(8) outreach services to potential recipients; deleted text begin and
deleted text end
(9) a mental health service that is not medically necessarydeleted text begin .deleted text end new text begin ;
new text end
new text begin
(10) services that a residential treatment center licensed under Minnesota Rules, chapter
2960, provides to a client;
new text end
new text begin
(11) partial hospitalization or day treatment; and
new text end
new text begin
(12) a crisis assessment that a residential provider completes when a daily rate is paid
for the recipient's crisis stabilization.
new text end
Sec. 5. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2022, or upon federal approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
ARTICLE 19
MENTAL HEALTH UNIFORM SERVICE STANDARDS; CONFORMING
CHANGES
Section 1.
Minnesota Statutes 2020, section 62A.152, subdivision 3, is amended to read:
Subd. 3.
Provider discrimination prohibited.
All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professionaldeleted text begin ,
as defined in sections 245.462, subdivision 18, clauses (1) to (5); and 245.4871, subdivision
27, clauses (1) to (5)deleted text end new text begin qualified according to section 245I.04, subdivision 2new text end , to the extent that
the services and treatment are within the scope of mental health professional licensure.
This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.
Sec. 2.
Minnesota Statutes 2020, section 62A.3094, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.
(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.
(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.
(d) "Mental health professional" means a mental health professional deleted text begin as defined in section
245.4871, subdivision 27deleted text end new text begin who is qualified according to section 245I.04, subdivision 2new text end ,
clause (1), (2), (3), (4), or (6), who has training and expertise in autism spectrum disorder
and child development.
Sec. 3.
Minnesota Statutes 2020, section 62Q.096, is amended to read:
62Q.096 CREDENTIALING OF PROVIDERS.
If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:
(1) is authorized to bill under section 256B.0625, subdivision 5;
(2) deleted text begin meets the requirements of Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin is a mental
health clinic certified under section 245I.20new text end ;
(3) is designated an essential community provider under section 62Q.19; and
(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.
A health plan company shall not refuse to credential these providers on the grounds that
their provider network has a sufficient number of providers of that type.
Sec. 4.
Minnesota Statutes 2020, section 144.651, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For the purposes of this section, "patient" means a person who is
admitted to an acute care inpatient facility for a continuous period longer than 24 hours, for
the purpose of diagnosis or treatment bearing on the physical or mental health of that person.
For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a
person who receives health care services at an outpatient surgical center or at a birth center
licensed under section 144.615. "Patient" also means a minor who is admitted to a residential
program as defined in section 253C.01. For purposes of subdivisions 1, 3 to 16, 18, 20 and
30, "patient" also means any person who is receiving mental health treatment on an outpatient
basis or in a community support program or other community-based program. "Resident"
means a person who is admitted to a nonacute care facility including extended care facilities,
nursing homes, and boarding care homes for care required because of prolonged mental or
physical illness or disability, recovery from injury or disease, or advancing age. For purposes
of all subdivisions except subdivisions 28 and 29, "resident" also means a person who is
admitted to a facility licensed as a board and lodging facility under Minnesota Rules, parts
4625.0100 to 4625.2355, new text begin a boarding care home under sections 144.50 to 144.56, new text end or a
supervised living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which
operates a rehabilitation program licensed under chapter 245G new text begin or 245I, new text end or Minnesota Rules,
parts 9530.6510 to 9530.6590.
Sec. 5.
Minnesota Statutes 2020, section 144D.01, subdivision 4, is amended to read:
Subd. 4.
Housing with services establishment or establishment.
(a) "Housing with
services establishment" or "establishment" means:
(1) an establishment providing sleeping accommodations to one or more adult residents,
at least 80 percent of which are 55 years of age or older, and offering or providing, for a
fee, one or more regularly scheduled health-related services or two or more regularly
scheduled supportive services, whether offered or provided directly by the establishment
or by another entity arranged for by the establishment; or
(2) an establishment that registers under section 144D.025.
(b) Housing with services establishment does not include:
(1) a nursing home licensed under chapter 144A;
(2) a hospital, certified boarding care home, or supervised living facility licensed under
sections 144.50 to 144.56;
(3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules,
parts 9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(4) a board and lodging establishment which serves as a shelter for battered women or
other similar purpose;
(5) a family adult foster care home licensed by the Department of Human Services;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) residential settings for persons with developmental disabilities in which the services
are licensed under chapter 245D;
(8) a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person in
exchange for services or rent, or both;
(9) a duly organized condominium, cooperative, common interest community, or owners'
association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units;
(10) services for persons with developmental disabilities that are provided under a license
under chapter 245D; or
(11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593.
Sec. 6.
Minnesota Statutes 2020, section 144G.08, subdivision 7, as amended by Laws
2020, Seventh Special Session chapter 1, article 6, section 5, is amended to read:
Subd. 7.
Assisted living facility.
"Assisted living facility" means a facility that provides
sleeping accommodations and assisted living services to one or more adults. Assisted living
facility includes assisted living facility with dementia care, and does not include:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) a private home in which the residents are related by kinship, law, or affinity with the
provider of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593;
(9) a setting offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011;
(14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b); or
(15) any establishment that exclusively or primarily serves as a shelter or temporary
shelter for victims of domestic or any other form of violence.
Sec. 7.
Minnesota Statutes 2020, section 148B.5301, subdivision 2, is amended to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional deleted text begin as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2new text end , or by a board-approved supervisor, who has at
least two years of postlicensure experience in the delivery of clinical services in the diagnosis
and treatment of mental illnesses and disorders. All supervisors must meet the supervisor
requirements in Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
Sec. 8.
Minnesota Statutes 2020, section 148E.120, subdivision 2, is amended to read:
Subd. 2.
Alternate supervisors.
(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a deleted text begin licenseddeleted text end mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:
(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;
(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;
(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or
(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or
(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.
(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:
(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and
(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.
Sec. 9.
Minnesota Statutes 2020, section 148F.11, subdivision 1, is amended to read:
Subdivision 1.
Other professionals.
(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, paragraph
(a), clauses (1) deleted text begin and (2)deleted text end new text begin to (6)new text end , providing deleted text begin integrated dual diagnosisdeleted text end new text begin co-occurring substance
use disordernew text end treatment in adult mental health rehabilitative programs certified new text begin or licensed
new text end by the Department of Human Services under section new text begin 245I.23, new text end 256B.0622new text begin ,new text end or 256B.0623.
(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).
Sec. 10.
Minnesota Statutes 2020, section 245.462, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
The definitions in this section apply to sections 245.461 to
deleted text begin 245.486deleted text end new text begin 245.4863new text end .
Sec. 11.
Minnesota Statutes 2020, section 245.462, subdivision 6, is amended to read:
Subd. 6.
Community support services program.
"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.
Sec. 12.
Minnesota Statutes 2020, section 245.462, subdivision 8, is amended to read:
Subd. 8.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a hospital accredited by the joint commission on accreditation of health
organizations and licensed under sections 144.50 to 144.55; (2) a community mental health
center under section 245.62; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week by a multidisciplinary staff under the clinical supervision of a mental health
professional. Day treatment may include education and consultation provided to families
and other individuals as part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described by section
256B.0671, subdivision 3new text end .
Sec. 13.
Minnesota Statutes 2020, section 245.462, subdivision 9, is amended to read:
Subd. 9.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given in
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
deleted text begin
(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
deleted text end
Sec. 14.
Minnesota Statutes 2020, section 245.462, subdivision 14, is amended to read:
Subd. 14.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the formulation
of planned services that are responsive to the needs and goals of a client. An individual
treatment plan must be completed according to section 245I.10, subdivisions 7 and 8new text end .
Sec. 15.
Minnesota Statutes 2020, section 245.462, subdivision 16, is amended to read:
Subd. 16.
Mental health funds.
"Mental health funds" are funds expended under sections
245.73 and 256E.12, federal mental health block grant funds, and funds expended under
section 256D.06 to facilities licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670.
Sec. 16.
Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
deleted text begin (a)deleted text end "Mental health practitioner" means a new text begin staff
new text end person deleted text begin providing services to adults with mental illness or children with emotional disturbance
who is qualified in at least one of the ways described in paragraphs (b) to (g). A mental
health practitioner for a child client must have training working with children. A mental
health practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end .
deleted text begin
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
deleted text end
deleted text begin
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
deleted text end
deleted text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
deleted text end
deleted text begin
(3) is working in a day treatment program under section 245.4712, subdivision 2; or
deleted text end
deleted text begin
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
deleted text end
deleted text begin
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
deleted text end
deleted text begin
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
deleted text end
deleted text begin
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
deleted text end
deleted text begin
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
deleted text end
deleted text begin
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
deleted text end
deleted text begin
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
deleted text end
deleted text begin
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
deleted text end
deleted text begin
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
deleted text end
deleted text begin
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
deleted text end
deleted text begin
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
deleted text end
deleted text begin
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 245.462, subdivision 18, is amended to read:
Subd. 18.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin who is qualified according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
deleted text end
deleted text begin
(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
deleted text end
deleted text begin
(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
deleted text end
deleted text begin
(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
deleted text end
deleted text begin
(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
deleted text end
deleted text begin
(4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry, or an
osteopathic physician licensed under chapter 147 and certified by the American Osteopathic
Board of Neurology and Psychiatry or eligible for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness; or
deleted text end
deleted text begin
(7) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
deleted text end
Sec. 18.
Minnesota Statutes 2020, section 245.462, subdivision 21, is amended to read:
Subd. 21.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.
Sec. 19.
Minnesota Statutes 2020, section 245.462, subdivision 23, is amended to read:
Subd. 23.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under new text begin chapter 245I, new text end Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted
by the commissioner.
Sec. 20.
Minnesota Statutes 2020, section 245.462, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245.4661, subdivision 5, is amended to read:
Subd. 5.
Planning for pilot projects.
(a) Each local plan for a pilot project, with the
exception of the placement of a Minnesota specialty treatment facility as defined in paragraph
(c), must be developed under the direction of the county board, or multiple county boards
acting jointly, as the local mental health authority. The planning process for each pilot shall
include, but not be limited to, mental health consumers, families, advocates, local mental
health advisory councils, local and state providers, representatives of state and local public
employee bargaining units, and the department of human services. As part of the planning
process, the county board or boards shall designate a managing entity responsible for receipt
of funds and management of the pilot project.
(b) For Minnesota specialty treatment facilities, the commissioner shall issue a request
for proposal for regions in which a need has been identified for services.
(c) For purposes of this section, "Minnesota specialty treatment facility" is defined as
an intensive residential treatment service new text begin licensed new text end under deleted text begin section 256B.0622, subdivision 2,
paragraph (b)deleted text end new text begin chapter 245Inew text end .
Sec. 22.
Minnesota Statutes 2020, section 245.4662, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given them.
(b) "Community partnership" means a project involving the collaboration of two or more
eligible applicants.
(c) "Eligible applicant" means an eligible county, Indian tribe, mental health service
provider, hospital, or community partnership. Eligible applicant does not include a
state-operated direct care and treatment facility or program under chapter 246.
(d) "Intensive residential treatment services" has the meaning given in section 256B.0622deleted text begin ,
subdivision 2deleted text end .
(e) "Metropolitan area" means the seven-county metropolitan area, as defined in section
473.121, subdivision 2.
Sec. 23.
Minnesota Statutes 2020, section 245.467, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services
governed by this section must complete a diagnostic assessment according to the standards
of section 245I.10, subdivisions 4 to 6.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245.467, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. Providers of day treatment services must develop the individual
treatment plan before the completion of five working days in which service is provided or
within 30 days after the diagnostic assessment is completed or obtained, whichever occurs
first. Providers of outpatient services must develop the individual treatment plan within 30
days after the diagnostic assessment is completed or obtained or by the end of the second
session of an outpatient service, not including the session in which the diagnostic assessment
was provided, whichever occurs first. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services
governed by this section must complete an individual treatment plan according to the
standards of section 245I.10, subdivisions 7 and 8.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245.470, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved by the
commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter 245Inew text end ;
by contract with privately operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved
by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter
245Inew text end ; by contract with hospital mental health outpatient programs certified by the Joint
Commission on Accreditation of Hospital Organizations; or by contract with a deleted text begin licenseddeleted text end
mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6)deleted text end .
Clients may be required to pay a fee according to section 245.481. Outpatient services
include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating an adult's mental health needs through therapy;
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and
(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.
Sec. 26.
Minnesota Statutes 2020, section 245.4712, subdivision 2, is amended to read:
Subd. 2.
Day treatment services provided.
(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:
(1) provide a structured environment for treatment;
(2) provide support for residing in the community;
(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;
(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and
(5) operate on a continuous basis throughout the year.
(b) deleted text begin For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of clinical supervision specified in
Minnesota Rules, part 9505.0371, subpart 4. The clinical supervision must be performed
by a qualified supervisor who satisfies the requirements of Minnesota Rules, part 9505.0371,
subpart 5.deleted text end new text begin An adult day treatment program must comply with medical assistance requirements
in section 256B.0671, subdivision 3.
new text end
deleted text begin
A day treatment program must demonstrate compliance with this clinical supervision
requirement by the commissioner's review and approval of the program according to
Minnesota Rules, part 9505.0372, subpart 8.
deleted text end
(c) County boards may request a waiver from including day treatment services if they
can document that:
(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;
(2) day treatment, if included, would be duplicative of other components of the
community support services; and
(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.
Sec. 27.
Minnesota Statutes 2020, section 245.472, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
Providers of residential services must be licensed under
new text begin chapter 245I or new text end applicable rules adopted by the commissioner deleted text begin and must be clinically
supervised by a mental health professional. Persons employed in facilities licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director as of
July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may be
allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670deleted text end .new text begin Residential services must be provided under treatment supervision.
new text end
Sec. 28.
Minnesota Statutes 2020, section 245.4863, is amended to read:
245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.
(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.
(b) Notwithstanding paragraph (a), screening is not required when:
(1) the presence of co-occurring disorders was documented for the client in the past 12
months;
(2) the client is currently receiving co-occurring disorders treatment;
(3) the client is being referred for co-occurring disorders treatment; or
(4) a mental health professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0370, subpart
18,deleted text end who is competent to perform diagnostic assessments of co-occurring disorders is
performing a diagnostic assessment deleted text begin that meets the requirements in Minnesota Rules, part
9533.0090, subpart 5,deleted text end to identify whether the client may have co-occurring mental health
and chemical dependency disorders. If an individual is identified to have co-occurring
mental health and substance use disorders, the assessing mental health professional must
document what actions will be taken to address the client's co-occurring disorders.
(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.
(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.
Sec. 29.
Minnesota Statutes 2020, section 245.4871, subdivision 9a, is amended to read:
Subd. 9a.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .
"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatmentdeleted text end new text begin the development of a written plan to assist a child and the child's family in
preventing and addressing a potential crisis and is distinct from mobile crisis services defined
in section 256B.0624. The plan must address prevention, deescalation, and intervention
strategies to be used in a crisis. The plan identifies factors that might precipitate a crisis,
behaviors or symptoms related to the emergence of a crisis, and the resources available to
resolve a crisis. The plan must address the following potential needs: (1) acute carenew text end ; (2)
crisis placement; (3) community resources for follow-up; and (4) emotional support to the
family during crisis. new text begin When appropriate for the child's needs, the plan must include strategies
to reduce the child's risk of suicide and self-injurious behavior.new text end Crisis deleted text begin assistancedeleted text end new text begin planningnew text end
does not include services designed to secure the safety of a child who is at risk of abuse or
neglect or necessary emergency services.
Sec. 30.
Minnesota Statutes 2020, section 245.4871, subdivision 10, is amended to read:
Subd. 10.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to a child
in:
(1) an outpatient hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
(2) a community mental health center under section 245.62;
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475; deleted text begin or
deleted text end
(4) an entity that operates a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is under contract
with an entity that is under contract with a county boarddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) a program certified under section 256B.0943.
new text end
Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. Day treatment may include
education and consultation provided to families and other individuals as an extension of the
treatment process. The services are aimed at stabilizing the child's mental health status, and
developing and improving the child's daily independent living and socialization skills. Day
treatment services are distinguished from day care by their structured therapeutic program
of psychotherapy services. Day treatment services are not a part of inpatient hospital or
residential treatment services.
A day treatment service must be available to a child up to 15 hours a week throughout
the year and must be coordinated with, integrated with, or part of an education program
offered by the child's school.
Sec. 31.
Minnesota Statutes 2020, section 245.4871, subdivision 11a, is amended to read:
Subd. 11a.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given
in deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
Sec. 32.
Minnesota Statutes 2020, section 245.4871, subdivision 17, is amended to read:
Subd. 17.
Family community support services.
"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:
(1) client outreach to each child with severe emotional disturbance and the child's family;
(2) medication monitoring where necessary;
(3) assistance in developing independent living skills;
(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;
(5) assistance with leisure and recreational activities;
(6) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis placement and respite care;
(7) professional home-based family treatment;
(8) foster care with therapeutic supports;
(9) day treatment;
(10) assistance in locating respite care and special needs day care; and
(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.
Sec. 33.
Minnesota Statutes 2020, section 245.4871, subdivision 21, is amended to read:
Subd. 21.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the formulation of planned services that are responsive to
the needs and goals of a client. An individual treatment plan must be completed according
to section 245I.10, subdivisions 7 and 8new text end .
Sec. 34.
Minnesota Statutes 2020, section 245.4871, subdivision 26, is amended to read:
Subd. 26.
Mental health practitioner.
"Mental health practitioner" deleted text begin has the meaning
given in section 245.462, subdivision 17deleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
Sec. 35.
Minnesota Statutes 2020, section 245.4871, subdivision 27, is amended to read:
Subd. 27.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing, the mental health professional must be a registered nurse who
is licensed under sections 148.171 to 148.285 and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences or
related fields from an accredited college or university or its equivalent, with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
deleted text end
deleted text begin
(2) in clinical social work, the mental health professional must be a person licensed as
an independent clinical social worker under chapter 148D, or a person with a master's degree
in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders;
deleted text end
deleted text begin
(3) in psychology, the mental health professional must be an individual licensed by the
board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
deleted text end
deleted text begin
(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatry or an osteopathic physician licensed under chapter 147
and certified by the American Osteopathic Board of Neurology and Psychiatry or eligible
for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders or emotional disturbances;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders or emotional disturbances; or
deleted text end
deleted text begin
(7) in allied fields, the mental health professional must be a person with a master's degree
from an accredited college or university in one of the behavioral sciences or related fields,
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of emotional disturbances.
deleted text end
Sec. 36.
Minnesota Statutes 2020, section 245.4871, subdivision 29, is amended to read:
Subd. 29.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.
Sec. 37.
Minnesota Statutes 2020, section 245.4871, subdivision 31, is amended to read:
Subd. 31.
Professional home-based family treatment.
"Professional home-based family
treatment" means intensive mental health services provided to children because of an
emotional disturbance (1) who are at risk of out-of-home placement; (2) who are in
out-of-home placement; or (3) who are returning from out-of-home placement. Services
are provided to the child and the child's family primarily in the child's home environment.
Services may also be provided in the child's school, child care setting, or other community
setting appropriate to the child. Services must be provided on an individual family basis,
must be child-oriented and family-oriented, and must be designed using information from
diagnostic and functional assessments to meet the specific mental health needs of the child
and the child's family. Examples of services are: (1) individual therapy; (2) family therapy;
(3) client outreach; (4) assistance in developing individual living skills; (5) assistance in
developing parenting skills necessary to address the needs of the child; (6) assistance with
leisure and recreational services; (7) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis respite care
and arranging for crisis placement; and (8) assistance in locating respite and child care.
Services must be coordinated with other services provided to the child and family.
Sec. 38.
Minnesota Statutes 2020, section 245.4871, subdivision 32, is amended to read:
Subd. 32.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.
Sec. 39.
Minnesota Statutes 2020, section 245.4871, subdivision 34, is amended to read:
Subd. 34.
Therapeutic support of foster care.
"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end
Sec. 40.
Minnesota Statutes 2020, section 245.4871, is amended by adding a subdivision
to read:
new text begin Subd. 36. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 41.
Minnesota Statutes 2020, section 245.4876, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 245I.10, subdivisions
4 to 6.
new text end
Sec. 42.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intake, except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9.
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
245I.10, subdivisions 7 and 8.
new text end
Sec. 43.
Minnesota Statutes 2020, section 245.488, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated deleted text begin mental health centers ordeleted text end mental
health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting
the standards of chapter 245Inew text end ; by contract with privately operated deleted text begin mental health centers ordeleted text end
mental health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin
meeting the standards of chapter 245Inew text end ; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.4871,
subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to pay a fee
based in accordance with section 245.481. Outpatient services include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating the child's mental health needs through therapy; and
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.
(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.
Sec. 44.
Minnesota Statutes 2020, section 245.4901, subdivision 2, is amended to read:
Subd. 2.
Eligible applicants.
An eligible applicant for school-linked mental health grants
is an entity that is:
(1) new text begin a mental health clinic new text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
section 245I.20new text end ;
(2) a community mental health center under section 256B.0625, subdivision 5;
(3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
(4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
(5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section deleted text begin 245I.16deleted text end new text begin 245I.04new text end , subdivision 2, or two alcohol and drug counselors
licensed or exempt from licensure under chapter 148F who are qualified to provide clinical
services to children and families.
Sec. 45.
Minnesota Statutes 2020, section 245.62, subdivision 2, is amended to read:
Subd. 2.
Definition.
A community mental health center is a private nonprofit corporation
or public agency approved under the deleted text begin rules promulgated by the commissioner pursuant to
subdivision 4deleted text end new text begin standards of section 256B.0625, subdivision 5new text end .
Sec. 46.
Minnesota Statutes 2020, section 245A.04, subdivision 5, is amended to read:
Subd. 5.
Commissioner's right of access.
(a) When the commissioner is exercising the
powers conferred by this chapter, deleted text begin sections 245.69 anddeleted text end new text begin sectionnew text end 626.557, and chapter 260E,
the commissioner must be given access to:
(1) the physical plant and grounds where the program is provided;
(2) documents and records, including records maintained in electronic format;
(3) persons served by the program; and
(4) staff and personnel records of current and former staff whenever the program is in
operation and the information is relevant to inspections or investigations conducted by the
commissioner. Upon request, the license holder must provide the commissioner verification
of documentation of staff work experience, training, or educational requirements.
The commissioner must be given access without prior notice and as often as the
commissioner considers necessary if the commissioner is investigating alleged maltreatment,
conducting a licensing inspection, or investigating an alleged violation of applicable laws
or rules. In conducting inspections, the commissioner may request and shall receive assistance
from other state, county, and municipal governmental agencies and departments. The
applicant or license holder shall allow the commissioner to photocopy, photograph, and
make audio and video tape recordings during the inspection of the program at the
commissioner's expense. The commissioner shall obtain a court order or the consent of the
subject of the records or the parents or legal guardian of the subject before photocopying
hospital medical records.
(b) Persons served by the program have the right to refuse to consent to be interviewed,
photographed, or audio or videotaped. Failure or refusal of an applicant or license holder
to fully comply with this subdivision is reasonable cause for the commissioner to deny the
application or immediately suspend or revoke the license.
Sec. 47.
Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
$200 |
|
| greater than $10,000 but less than or equal to $25,000 |
$300 |
|
| greater than $25,000 but less than or equal to $50,000 |
$400 |
|
| greater than $50,000 but less than or equal to $100,000 |
$500 |
|
| greater than $100,000 but less than or equal to $150,000 |
$600 |
|
| greater than $150,000 but less than or equal to $200,000 |
$800 |
|
| greater than $200,000 but less than or equal to $250,000 |
$1,000 |
|
| greater than $250,000 but less than or equal to $300,000 |
$1,200 |
|
| greater than $300,000 but less than or equal to $350,000 |
$1,400 |
|
| greater than $350,000 but less than or equal to $400,000 |
$1,600 |
|
| greater than $400,000 but less than or equal to $450,000 |
$1,800 |
|
| greater than $450,000 but less than or equal to $500,000 |
$2,000 |
|
| greater than $500,000 but less than or equal to $600,000 |
$2,250 |
|
| greater than $600,000 but less than or equal to $700,000 |
$2,500 |
|
| greater than $700,000 but less than or equal to $800,000 |
$2,750 |
|
| greater than $800,000 but less than or equal to $900,000 |
$3,000 |
|
| greater than $900,000 but less than or equal to $1,000,000 |
$3,250 |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
$3,500 |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
$3,750 |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
$4,000 |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
$4,250 |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
$4,500 |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
$4,750 |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
$5,000 |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
$5,500 |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
$6,000 |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
$6,500 |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
$7,000 |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
$8,500 |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
$10,000 |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
$14,000 |
|
| greater than $15,000,000 |
$18,000 |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670, to serve persons with mental illness shall pay an annual
nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A deleted text begin mental health center ordeleted text end mental health clinic deleted text begin requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin certified under section 245I.20new text end , shall pay deleted text begin adeleted text end new text begin an annual nonrefundablenew text end certification
fee of $1,550 deleted text begin per yeardeleted text end . If the deleted text begin mental health center ordeleted text end mental health clinic provides services
at a primary location with satellite facilities, the satellite facilities shall be certified with the
primary location without an additional charge.
Sec. 48.
Minnesota Statutes 2020, section 245A.65, subdivision 2, is amended to read:
Subd. 2.
Abuse prevention plans.
All license holders shall establish and enforce ongoing
written program abuse prevention plans and individual abuse prevention plans as required
under section 626.557, subdivision 14.
(a) The scope of the program abuse prevention plan is limited to the population, physical
plant, and environment within the control of the license holder and the location where
licensed services are provided. In addition to the requirements in section 626.557, subdivision
14, the program abuse prevention plan shall meet the requirements in clauses (1) to (5).
(1) The assessment of the population shall include an evaluation of the following factors:
age, gender, mental functioning, physical and emotional health or behavior of the client;
the need for specialized programs of care for clients; the need for training of staff to meet
identified individual needs; and the knowledge a license holder may have regarding previous
abuse that is relevant to minimizing risk of abuse for clients.
(2) The assessment of the physical plant where the licensed services are provided shall
include an evaluation of the following factors: the condition and design of the building as
it relates to the safety of the clients; and the existence of areas in the building which are
difficult to supervise.
(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following factors:
the location of the program in a particular neighborhood or community; the type of grounds
and terrain surrounding the building; the type of internal programming; and the program's
staffing patterns.
(4) The license holder shall provide an orientation to the program abuse prevention plan
for clients receiving services. If applicable, the client's legal representative must be notified
of the orientation. The license holder shall provide this orientation for each new person
within 24 hours of admission, or for persons who would benefit more from a later orientation,
the orientation may take place within 72 hours.
(5) The license holder's governing body or the governing body's delegated representative
shall review the plan at least annually using the assessment factors in the plan and any
substantiated maltreatment findings that occurred since the last review. The governing body
or the governing body's delegated representative shall revise the plan, if necessary, to reflect
the review results.
(6) A copy of the program abuse prevention plan shall be posted in a prominent location
in the program and be available upon request to mandated reporters, persons receiving
services, and legal representatives.
(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).
(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within the
scope of the licensed services, and will identify referrals made when the vulnerable adult
is susceptible to abuse outside the scope or control of the licensed services. When the
assessment indicates that the vulnerable adult does not need specific risk reduction measures
in addition to those identified in the program abuse prevention plan, the individual abuse
prevention plan shall document this determination.
(2) An individual abuse prevention plan shall be developed for each new person as part
of the initial individual program plan or service plan required under the applicable licensing
rulenew text begin or statutenew text end . The review and evaluation of the individual abuse prevention plan shall be
done as part of the review of the program plan deleted text begin ordeleted text end new text begin ,new text end service plannew text begin , or treatment plannew text end . The person
receiving services shall participate in the development of the individual abuse prevention
plan to the full extent of the person's abilities. If applicable, the person's legal representative
shall be given the opportunity to participate with or for the person in the development of
the plan. The interdisciplinary team shall document the review of all abuse prevention plans
at least annually, using the individual assessment and any reports of abuse relating to the
person. The plan shall be revised to reflect the results of this review.
Sec. 49.
Minnesota Statutes 2020, section 245D.02, subdivision 20, is amended to read:
Subd. 20.
Mental health crisis intervention team.
"Mental health crisis intervention
team" means a mental health crisis response provider as identified in section 256B.0624deleted text begin ,
subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision 1, paragraph
(d), for childrendeleted text end .
Sec. 50.
Minnesota Statutes 2020, section 256B.0615, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified peer specialist
services, as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
are provided by a new text begin mental health new text end certified peer specialist who has completed the training
under subdivision 5new text begin and is qualified according to section 245I.04, subdivision 10new text end .
Sec. 51.
Minnesota Statutes 2020, section 256B.0615, subdivision 5, is amended to read:
Subd. 5.
Certified peer specialist training and certification.
The commissioner of
human services shall develop a training and certification process for certified peer specialistsdeleted text begin ,
who must be at least 21 years of agedeleted text end . The candidates must have had a primary diagnosis of
mental illness, be a current or former consumer of mental health services, and must
demonstrate leadership and advocacy skills and a strong dedication to recovery. The training
curriculum must teach participating consumers specific skills relevant to providing peer
support to other consumers. In addition to initial training and certification, the commissioner
shall develop ongoing continuing educational workshops on pertinent issues related to peer
support counseling.
Sec. 52.
Minnesota Statutes 2020, section 256B.0616, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified family peer
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245, and are provided by a new text begin mental health new text end certified family peer specialist who has
completed the training under subdivision 5new text begin and is qualified according to section 245I.04,
subdivision 12new text end . A family peer specialist cannot provide services to the peer specialist's
family.
Sec. 53.
Minnesota Statutes 2020, section 256B.0616, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment, new text begin intensive new text end treatment
new text begin in new text end foster care, day treatment, children's therapeutic services and supports, or crisis services.
Sec. 54.
Minnesota Statutes 2020, section 256B.0616, subdivision 5, is amended to read:
Subd. 5.
Certified family peer specialist training and certification.
The commissioner
shall develop a training and certification process for certified family peer specialists deleted text begin who
must be at least 21 years of agedeleted text end . The candidates must have raised or be currently raising a
child with a mental illness, have had experience navigating the children's mental health
system, and must demonstrate leadership and advocacy skills and a strong dedication to
family-driven and family-focused services. The training curriculum must teach participating
family peer specialists specific skills relevant to providing peer support to other parents. In
addition to initial training and certification, the commissioner shall develop ongoing
continuing educational workshops on pertinent issues related to family peer support
counseling.
Sec. 55.
Minnesota Statutes 2020, section 256B.0622, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin (a) new text end Subject to federal approval, medical assistance covers medically
necessary, assertive community treatment deleted text begin for clients as defined in subdivision 2a and
intensive residential treatment services for clients as defined in subdivision 3,deleted text end when the
services are provided by an entity new text begin certified under and new text end meeting the standards in this section.
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary, intensive
residential treatment services when the services are provided by an entity licensed under
and meeting the standards in section 245I.23.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner, using instruments and protocols approved by the
commissioner.
new text end
Sec. 56.
Minnesota Statutes 2020, section 256B.0622, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them.
(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.
(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.
(d) "Individual treatment plan" means deleted text begin the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomesdeleted text end new text begin a plan described by section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(e) "Assertive engagement" means the use of collaborative strategies to engage clients
to receive services.
deleted text end
deleted text begin
(f) "Benefits and finance support" means assisting clients in capably managing financial
affairs. Services include, but are not limited to, assisting clients in applying for benefits;
assisting with redetermination of benefits; providing financial crisis management; teaching
and supporting budgeting skills and asset development; and coordinating with a client's
representative payee, if applicable.
deleted text end
deleted text begin
(g) "Co-occurring disorder treatment" means the treatment of co-occurring mental illness
and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages of
change, such as outreach and motivational interviewing techniques to work with clients in
earlier stages of change readiness and cognitive behavioral approaches and relapse prevention
to work with clients in later stages of change; and facilitating access to community supports.
deleted text end
deleted text begin (h)deleted text end new text begin (e)new text end "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2deleted text begin , paragraphs (c) to (e)deleted text end .
deleted text begin
(i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing individual
client preferences and strengths; ensuring employment services are integrated with mental
health services; conducting rapid job searches and systematic job development according
to client preferences and choices; providing benefits counseling; and offering all services
in an individualized and time-unlimited manner. Services shall also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the work place, and managing work relationships.
deleted text end
deleted text begin
(j) "Family psychoeducation and support" means services provided to the client's family
and other natural supports to restore and strengthen the client's unique social and family
relationships. Services include, but are not limited to, individualized psychoeducation about
the client's illness and the role of the family and other significant people in the therapeutic
process; family intervention to restore contact, resolve conflict, and maintain relationships
with family and other significant people in the client's life; ongoing communication and
collaboration between the ACT team and the family; introduction and referral to family
self-help programs and advocacy organizations that promote recovery and family
engagement, individual supportive counseling, parenting training, and service coordination
to help clients fulfill parenting responsibilities; coordinating services for the child and
restoring relationships with children who are not in the client's custody; and coordinating
with child welfare and family agencies, if applicable. These services must be provided with
the client's agreement and consent.
deleted text end
deleted text begin
(k) "Housing access support" means assisting clients to find, obtain, retain, and move
to safe and adequate housing of their choice. Housing access support includes, but is not
limited to, locating housing options with a focus on integrated independent settings; applying
for housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation.
deleted text end
deleted text begin (l)deleted text end new text begin (f)new text end "Individual treatment team" means a minimum of three members of the ACT team
who are responsible for consistently carrying out most of a client's assertive community
treatment services.
deleted text begin
(m) "Intensive residential treatment services treatment team" means all staff who provide
intensive residential treatment services under this section to clients. At a minimum, this
includes the clinical supervisor; mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6); mental health practitioners as defined in section 245.462,
subdivision 17; mental health rehabilitation workers under section 256B.0623, subdivision
5, paragraph (a), clause (4); and mental health certified peer specialists under section
256B.0615.
deleted text end
deleted text begin
(n) "Intensive residential treatment services" means short-term, time-limited services
provided in a residential setting to clients who are in need of more restrictive settings and
are at risk of significant functional deterioration if they do not receive these services. Services
are designed to develop and enhance psychiatric stability, personal and emotional adjustment,
self-sufficiency, and skills to live in a more independent setting. Services must be directed
toward a targeted discharge date with specified client outcomes.
deleted text end
deleted text begin
(o) "Medication assistance and support" means assisting clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. This includes the prescription, administration, and order of medication
by appropriate medical staff.
deleted text end
deleted text begin
(p) "Medication education" means educating clients on the role and effects of medications
in treating symptoms of mental illness and the side effects of medications.
deleted text end
deleted text begin
(q) "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.
deleted text end
deleted text begin
(r) "Mental health certified peer specialist services" has the meaning given in section
256B.0615.
deleted text end
deleted text begin
(s) "Physical health services" means any service or treatment to meet the physical health
needs of the client to support the client's mental health recovery. Services include, but are
not limited to, education on primary health issues, including wellness education; medication
administration and monitoring; providing and coordinating medical screening and follow-up;
scheduling routine and acute medical and dental care visits; tobacco cessation strategies;
assisting clients in attending appointments; communicating with other providers; and
integrating all physical and mental health treatment.
deleted text end
deleted text begin (t)deleted text end new text begin (g)new text end "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.
deleted text begin
(u) "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text end
deleted text begin
(v) "Symptom management" means supporting clients in identifying and targeting the
symptoms and occurrence patterns of their mental illness and developing strategies to reduce
the impact of those symptoms.
deleted text end
deleted text begin
(w) "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure therapy,
acceptance and commitment therapy, interpersonal therapy, and motivational interviewing.
deleted text end
deleted text begin
(x) "Wellness self-management and prevention" means a combination of approaches to
working with the client to build and apply skills related to recovery, and to support the client
in participating in leisure and recreational activities, civic participation, and meaningful
structure.
deleted text end
new text begin
(h) "Certified rehabilitation specialist" means a staff person who is qualified according
to section 245I.04, subdivision 8.
new text end
new text begin
(i) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
new text begin
(j) "Mental health certified peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 10.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified according
to section 245I.04, subdivision 14.
new text end
Sec. 57.
Minnesota Statutes 2020, section 256B.0622, subdivision 3a, is amended to read:
Subd. 3a.
Provider certification and contract requirements for assertive community
treatment.
(a) The assertive community treatment provider must:
(1) have a contract with the host county to provide assertive community treatment
services; and
(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , the standards in chapter 245I as required in section 245I.011, subdivision 5, andnew text end
minimum program fidelity standards as measured by a nationally recognized fidelity tool
approved by the commissioner. Recertification must occur at least every three years.
(b) An ACT team certified under this subdivision must meet the following standards:
(1) have capacity to recruit, hire, manage, and train required ACT team members;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and ongoing training for staff;
deleted text end
deleted text begin
(4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;
deleted text begin
(6) develop and maintain client files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(7) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(8) submit information as required by the state;
deleted text end
deleted text begin (9)deleted text end new text begin (4)new text end keep all necessary records required by law;
deleted text begin
(10) comply with all applicable laws;
deleted text end
deleted text begin (11)deleted text end new text begin (5)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (12)deleted text end new text begin (6)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(13) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.
Sec. 58.
Minnesota Statutes 2020, section 256B.0622, subdivision 4, is amended to read:
Subd. 4.
Provider entity licensure and contract requirements for intensive residential
treatment services.
deleted text begin
(a) The intensive residential treatment services provider entity must:
deleted text end
deleted text begin
(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
deleted text end
deleted text begin
(2) not exceed 16 beds per site; and
deleted text end
deleted text begin
(3) comply with the additional standards in this section.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end The commissioner shall develop procedures for counties and providers to submit
other documentation as needed to allow the commissioner to determine whether the standards
in this section are met.
deleted text begin (c)deleted text end new text begin (b)new text end A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.
deleted text begin (d)deleted text end new text begin (c)new text end A provider entity must submit documentation that the provider entity requested
a statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.
Sec. 59.
Minnesota Statutes 2020, section 256B.0622, subdivision 7, is amended to read:
Subd. 7.
Assertive community treatment service standards.
(a) ACT teams must offer
and have the capacity to directly provide the following services:
(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;
(2) benefits and finance supportnew text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicablenew text end ;
(3) co-occurring new text begin substance use new text end disorder treatmentnew text begin as defined in section 245I.02,
subdivision 11new text end ;
(4) crisis assessment and intervention;
(5) employment servicesnew text begin that assist clients to work at jobs of the clients' choosing.
Services must follow the principles of the individual placement and support employment
model, including focusing on competitive employment, emphasizing individual client
preferences and strengths, ensuring employment services are integrated with mental health
services, conducting rapid job searches and systematic job development according to client
preferences and choices, providing benefits counseling, and offering all services in an
individualized and time-unlimited manner. Services must also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the workplace, workplace accommodations, and managing work
relationshipsnew text end ;
(6) family psychoeducation and supportnew text begin provided to the client's family and other natural
supports to restore and strengthen the client's unique social and family relationships. Services
include but are not limited to individualized psychoeducation about the client's illness and
the role of the family and other significant people in the therapeutic process; family
intervention to restore contact, resolve conflict, and maintain relationships with family and
other significant people in the client's life; ongoing communication and collaboration between
the ACT team and the family; introduction and referral to family self-help programs and
advocacy organizations that promote recovery and family engagement, individual supportive
counseling, parenting training, and service coordination to help clients fulfill parenting
responsibilities; coordinating services for the child and restoring relationships with children
who are not in the client's custody; and coordinating with child welfare and family agencies,
if applicable. These services must be provided with the client's agreement and consentnew text end ;
(7) housing access supportnew text begin that assists clients to find, obtain, retain, and move to safe
and adequate housing of their choice. Housing access support includes but is not limited to
locating housing options with a focus on integrated independent settings; applying for
housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocationnew text end ;
(8) medication assistance and supportnew text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staffnew text end ;
(9) medication educationnew text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medicationsnew text end ;
(10) mental health certified peer specialists servicesnew text begin according to section 256B.0615new text end ;
(11) physical health servicesnew text begin to meet the physical health needs of the client to support
the client's mental health recovery. Services include but are not limited to education on
primary health and wellness issues, medication administration and monitoring, providing
and coordinating medical screening and follow-up, scheduling routine and acute medical
and dental care visits, tobacco cessation strategies, assisting clients in attending appointments,
communicating with other providers, and integrating all physical and mental health treatmentnew text end ;
(12) rehabilitative mental health servicesnew text begin as defined in section 245I.02, subdivision 33new text end ;
(13) symptom managementnew text begin that supports clients in identifying and targeting the symptoms
and occurrence patterns of their mental illness and developing strategies to reduce the impact
of those symptomsnew text end ;
(14) therapeutic interventionsnew text begin to address specific symptoms and behaviors such as
anxiety, psychotic symptoms, emotional dysregulation, and trauma symptoms. Interventions
include empirically supported psychotherapies including but not limited to cognitive
behavioral therapy, exposure therapy, acceptance and commitment therapy, interpersonal
therapy, and motivational interviewingnew text end ;
(15) wellness self-management and preventionnew text begin that includes a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structurenew text end ; and
(16) other services based on client needs as identified in a client's assertive community
treatment individual treatment plan.
(b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.
Sec. 60.
Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end of services in conjunction with the psychiatrist or psychiatric
care provider, and supervising team members to ensure delivery of best and ethical practices;
and
(iv) must be available to provide overall deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end to the
ACT team after regular business hours and on weekends and holidays. The team leader may
delegate this duty to another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a deleted text begin licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item Adeleted text end new text begin mental health
professional permitted to prescribe psychiatric medications as part of the mental health
professional's scope of practicenew text end . The psychiatric care provider must have demonstrated
clinical experience working with individuals with serious and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may not provide specific roles and responsibilities by telemedicine unless approved
by the commissioner; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) deleted text begin shoulddeleted text end new text begin mustnew text end not refer individuals to receive any type of vocational services or linkage
by providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; new text begin clinical trainees; certified rehabilitation specialists; new text end mental health practitioners deleted text begin as defined
in section 245.462, subdivision 17; a mental health practitioner working as a clinical trainee
according to Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end ; or mental health
rehabilitation workers deleted text begin as defined in section 256B.0623, subdivision 5, paragraph (a), clause
(4)deleted text end . These individuals shall have the knowledge, skills, and abilities required by the
population served to carry out rehabilitation and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 61.
Minnesota Statutes 2020, section 256B.0622, subdivision 7b, is amended to read:
Subd. 7b.
Assertive community treatment program size and opportunities.
(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:
(1) a small ACT team must:
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
(ii) serve an annual average maximum of no more than 50 clients;
(iii) ensure at least one full-time equivalent position for every eight clients served;
(iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least one additional full-time ACT team member
who has mental health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or
new text begin mental health new text end practitioner status; and
(2) a midsize ACT team shall:
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end
specialist, one full-time equivalent mental health certified peer specialist, one full-time
vocational specialist, one full-time program assistant, and at least 1.5 to two additional
full-time equivalent ACT members, with at least one dedicated full-time staff member with
mental health professional status. Remaining team members may have mental health
professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or new text begin mental health new text end practitioner
status;
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
(iii) serve an annual average maximum caseload of 51 to 74 clients;
(iv) ensure at least one full-time equivalent position for every nine clients served;
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
(3) a large ACT team must:
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one full-time equivalent
mental health certified peer specialist, one full-time vocational specialist, one full-time
program assistant, and at least two additional full-time equivalent ACT team members, with
at least one dedicated full-time staff member with mental health professional status.
Remaining team members may have mental health professional or mental health practitioner
status;
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
(iii) serve an annual average maximum caseload of 75 to 100 clients;
(iv) ensure at least one full-time equivalent position for every nine individuals served;
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
Sec. 62.
Minnesota Statutes 2020, section 256B.0622, subdivision 7d, is amended to read:
Subd. 7d.
Assertive community treatment assessment and individual treatment
plan.
(a) An initial assessmentdeleted text begin , including a diagnostic assessment that meets the requirements
of Minnesota Rules, part 9505.0372, subpart 1, and a 30-day treatment plandeleted text end shall be
completed the day of the client's admission to assertive community treatment by the ACT
team leader or the psychiatric care provider, with participation by designated ACT team
members and the client. new text begin The initial assessment must include obtaining or completing a
standard diagnostic assessment according to section 245I.10, subdivision 6, and completing
a 30-day individual treatment plan. new text end The team leader, psychiatric care provider, or other
mental health professional designated by the team leader or psychiatric care provider, must
update the client's diagnostic assessment at least annually.
(b) deleted text begin An initialdeleted text end new text begin Anew text end functional assessment must be completed deleted text begin within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes firstdeleted text end new text begin according to section 245I.10, subdivision 9new text end .
deleted text begin
(c) Within 30 days of the client's assertive community treatment admission, the ACT
team shall complete an in-depth assessment of the domains listed under section 245.462,
subdivision 11a.
deleted text end
deleted text begin (d)deleted text end Each part of the deleted text begin in-depthdeleted text end new text begin functionalnew text end assessment areas shall be completed by each
respective team specialist or an ACT team member with skill and knowledge in the area
being assessed. deleted text begin The assessments are based upon all available information, including that
from client interview family and identified natural supports, and written summaries from
other agencies, including police, courts, county social service agencies, outpatient facilities,
and inpatient facilities, where applicable.
deleted text end
deleted text begin (e)deleted text end new text begin (c)new text end Between 30 and 45 days after the client's admission to assertive community
treatment, the entire ACT team must hold a comprehensive case conference, where all team
members, including the psychiatric provider, present information discovered from the
completed deleted text begin in-depthdeleted text end assessments and provide treatment recommendations. The conference
must serve as the basis for the first deleted text begin six-monthdeleted text end new text begin individualnew text end treatment plan, which must be
written by the primary team member.
deleted text begin (f)deleted text end new text begin (d)new text end The client's psychiatric care provider, primary team member, and individual
treatment team members shall assume responsibility for preparing the written narrative of
the results from the psychiatric and social functioning history timeline and the comprehensive
assessment.
deleted text begin (g)deleted text end new text begin (e)new text end The primary team member and individual treatment team members shall be
assigned by the team leader in collaboration with the psychiatric care provider by the time
of the first treatment planning meeting or 30 days after admission, whichever occurs first.
deleted text begin (h)deleted text end new text begin (f)new text end Individual treatment plans must be developed through the following treatment
planning process:
(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.
(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.
(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.
(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.
(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.
(6) The individual treatment plan and review must be deleted text begin signeddeleted text end new text begin approvednew text end or acknowledged
by the client, the primary team member, the team leader, the psychiatric care provider, and
all individual treatment team members. A copy of the deleted text begin signeddeleted text end new text begin approvednew text end individual treatment
plan deleted text begin isdeleted text end new text begin must benew text end made available to the client.
Sec. 63.
Minnesota Statutes 2020, section 256B.0623, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin Subject to federal approval, new text end medical assistance covers new text begin medically
necessary new text end adult rehabilitative mental health services deleted text begin as defined in subdivision 2, subject to
federal approval, if provided to recipients as defined in subdivision 3 and provided by a
qualified provider entity meeting the standards in this section and by a qualified individual
provider working within the provider's scope of practice and identified in the recipient's
individual treatment plan as defined in section 245.462, subdivision 14, and if determined
to be medically necessary according to section 62Q.53deleted text end new text begin when the services are provided by
an entity meeting the standards in this sectionnew text end .new text begin The provider entity must make reasonable
and good faith efforts to report individual client outcomes to the commissioner, using
instruments and protocols approved by the commissioner.
new text end
Sec. 64.
Minnesota Statutes 2020, section 256B.0623, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Adult rehabilitative mental health services" means deleted text begin mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these servicesdeleted text end new text begin the
services described in section 245I.02, subdivision 33new text end .
deleted text begin
(1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
deleted text end
deleted text begin
(2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
deleted text end
(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians, advanced
practice registered nurses, pharmacists, physician assistants, or registered nurses.
(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program deleted text begin under Minnesota Rules, chapter
9505deleted text end , board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.
Sec. 65.
Minnesota Statutes 2020, section 256B.0623, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is age 18 or older;
(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;
(3) has substantial disability and functional impairment in three or more of the areas
listed in section deleted text begin 245.462, subdivision 11adeleted text end new text begin 245I.10, subdivision 9, clause (4)new text end , so that
self-sufficiency is markedly reduced; and
(4) has had a recent new text begin standard new text end diagnostic assessment deleted text begin or an adult diagnostic assessment
updatedeleted text end by a qualified professional that documents adult rehabilitative mental health services
are medically necessary to address identified disability and functional impairments and
individual recipient goals.
Sec. 66.
Minnesota Statutes 2020, section 256B.0623, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.
(b) The certification process is a determination as to whether the entity meets the standards
in this deleted text begin subdivisiondeleted text end new text begin section and chapter 245I, as required in section 245I.011, subdivision 5new text end .
The certification must specify which adult rehabilitative mental health services the entity
is qualified to provide.
(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.
(d) new text begin State-level new text end recertification must occur at least every three years.
(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.
(f) The adult rehabilitative mental health services provider entity must meet the following
standards:
(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and inservice and ongoing training for staff;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staffnew text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;
deleted text begin
(5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;
deleted text begin
(7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;
deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;
deleted text begin
(10) develop and maintain recipient files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(11) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(12) submit information as required by the state;
deleted text end
deleted text begin
(13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
deleted text end
deleted text begin (14)deleted text end new text begin (7)new text end keep all necessary records required by law;
deleted text begin (15)deleted text end new text begin (8)new text end deliver services as required by section 245.461;
deleted text begin
(16) comply with all applicable laws;
deleted text end
deleted text begin (17)deleted text end new text begin (9)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (18)deleted text end new text begin (10)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(19) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
Sec. 67.
Minnesota Statutes 2020, section 256B.0623, subdivision 5, is amended to read:
Subd. 5.
Qualifications of provider staff.
deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin under one of the following criteriadeleted text end new text begin asnew text end :
(1) a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitionerdeleted text end new text begin
who is qualified according to section 245I.04, subdivision 2new text end ;
(2)new text begin a certified rehabilitation specialist who is qualified according to section 245I.04,
subdivision 8;
new text end
new text begin
(3) a clinical trainee who is qualified according to section 245I.04, subdivision 6;
new text end
new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.04, subdivision 4new text end ;
deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin who
is qualified according to section 245I.04, subdivision 10new text end ; or
deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin who is qualified according to section 245I.04,
subdivision 14new text end . deleted text begin A mental health rehabilitation worker means a staff person working under
the direction of a mental health practitioner or mental health professional and under the
clinical supervision of a mental health professional in the implementation of rehabilitative
mental health services as identified in the recipient's individual treatment plan who:
deleted text end
deleted text begin
(i) is at least 21 years of age;
deleted text end
deleted text begin
(ii) has a high school diploma or equivalent;
deleted text end
deleted text begin
(iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and
deleted text end
deleted text begin
(iv) meets the qualifications in paragraph (b).
deleted text end
deleted text begin
(b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):
deleted text end
deleted text begin
(1) has an associates of arts degree, two years of full-time postsecondary education, or
a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields; is
a registered nurse; or within the previous ten years has:
deleted text end
deleted text begin
(i) three years of personal life experience with serious mental illness;
deleted text end
deleted text begin
(ii) three years of life experience as a primary caregiver to an adult with a serious mental
illness, traumatic brain injury, substance use disorder, or developmental disability; or
deleted text end
deleted text begin
(iii) 2,000 hours of supervised work experience in the delivery of mental health services
to adults with a serious mental illness, traumatic brain injury, substance use disorder, or
developmental disability;
deleted text end
deleted text begin
(2)(i) is fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
deleted text end
deleted text begin
(ii) receives during the first 2,000 hours of work, monthly documented individual clinical
supervision by a mental health professional;
deleted text end
deleted text begin
(iii) has 18 hours of documented field supervision by a mental health professional or
mental health practitioner during the first 160 hours of contact work with recipients, and at
least six hours of field supervision quarterly during the following year;
deleted text end
deleted text begin
(iv) has review and cosignature of charting of recipient contacts during field supervision
by a mental health professional or mental health practitioner; and
deleted text end
deleted text begin
(v) has 15 hours of additional continuing education on mental health topics during the
first year of employment and 15 hours during every additional year of employment; or
deleted text end
deleted text begin
(3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:
deleted text end
deleted text begin
(i) satisfies clause (2), items (ii) to (iv); and
deleted text end
deleted text begin
(ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.
deleted text end
deleted text begin
(c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).
deleted text end
deleted text begin
(d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.
deleted text end
Sec. 68.
Minnesota Statutes 2020, section 256B.0623, subdivision 6, is amended to read:
Subd. 6.
Required deleted text begin training anddeleted text end supervision.
deleted text begin
(a) Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d).
deleted text end
deleted text begin
(b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
deleted text end
deleted text begin
(c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.
A mental health professional providing clinical supervision of staff delivering adult
rehabilitative mental health services must provide the following guidance:
deleted text end
deleted text begin
(1) review the information in the recipient's file;
deleted text end
deleted text begin
(2) review and approve initial and updates of individual treatment plans;
deleted text end
new text begin
(a) A treatment supervisor providing treatment supervision required by section 245I.06
must:
new text end
deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving treatment supervisionnew text end at least monthly to discuss treatment
topics of interest deleted text begin to the workers and practitioners;
deleted text end
deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly to discussdeleted text end new text begin andnew text end treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;new text begin and
new text end
deleted text begin (5)deleted text end new text begin (2)new text end meet at least monthly with the directing new text begin clinical trainee or new text end mental health
practitioner, if there is one, to review needs of the adult rehabilitative mental health services
program, review staff on-site observations and evaluate mental health rehabilitation workers,
plan staff training, review program evaluation and development, and consult with the
directing new text begin clinical trainee or mental health new text end practitionerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end An adult rehabilitative mental health services provider entity must have a treatment
director who is a deleted text begin mental health practitioner ordeleted text end mental health professionalnew text begin clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end . The treatment director must
deleted text begin ensure the followingdeleted text end :
(1) deleted text begin while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker worksdeleted text end new text begin ensure the direct
observation of mental health rehabilitation workers required by section 245I.06, subdivision
3, is providednew text end ;
deleted text begin
(2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
deleted text end
deleted text begin
(3) progress notes are reviewed from on-site service observation prepared by the mental
health rehabilitation worker and mental health practitioner for accuracy and consistency
with actual recipient contact and the individual treatment plan and goals;
deleted text end
deleted text begin (4)deleted text end new text begin (2) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or a mental health
practitioner to the mental health rehabilitation deleted text begin servicesdeleted text end worker during service provision;
deleted text begin
(5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
deleted text end
deleted text begin (6)deleted text end new text begin (3)new text end model service practices which: respect the recipient, include the recipient in
planning and implementation of the individual treatment plan, recognize the recipient's
strengths, collaborate and coordinate with other involved parties and providers;
deleted text begin (7)deleted text end new text begin (4)new text end ensure that new text begin clinical trainees, new text end mental health practitionersnew text begin ,new text end and mental health
rehabilitation workers are able to effectively communicate with the recipients, significant
others, and providers; and
deleted text begin (8)deleted text end new text begin (5)new text end oversee the record of the results of deleted text begin on-sitedeleted text end new text begin directnew text end observation deleted text begin and chartingdeleted text end new text begin , progress
notenew text end evaluationnew text begin ,new text end and corrective actions taken to modify the work of the new text begin clinical trainees,
new text end mental health practitionersnew text begin ,new text end and mental health rehabilitation workers.
deleted text begin (e)deleted text end new text begin (c)new text end A new text begin clinical trainee or new text end mental health practitioner who is providing treatment direction
for a provider entity must receive new text begin treatment new text end supervision at least monthly deleted text begin from a mental
health professionaldeleted text end to:
(1) identify and plan for general needs of the recipient population served;
(2) identify and plan to address provider entity program needs and effectiveness;
(3) identify and plan provider entity staff training and personnel needs and issues; and
(4) plan, implement, and evaluate provider entity quality improvement programs.
Sec. 69.
Minnesota Statutes 2020, section 256B.0623, subdivision 9, is amended to read:
Subd. 9.
Functional assessment.
new text begin (a) new text end Providers of adult rehabilitative mental health
services must complete a written functional assessment deleted text begin as defined in section 245.462,
subdivision 11adeleted text end new text begin according to section 245I.10, subdivision 9new text end , for each recipient. deleted text begin The functional
assessment must be completed within 30 days of intake, and reviewed and updated at least
every six months after it is developed, unless there is a significant change in the functioning
of the recipient. If there is a significant change in functioning, the assessment must be
updated. A single functional assessment can meet case management and adult rehabilitative
mental health services requirements if agreed to by the recipient. Unless the recipient refuses,
the recipient must have significant participation in the development of the functional
assessment.
deleted text end
new text begin
(b) When a provider of adult rehabilitative mental health services completes a written
functional assessment, the provider must also complete a level of care assessment as defined
in section 245I.02, subdivision 19, for the recipient.
new text end
Sec. 70.
Minnesota Statutes 2020, section 256B.0623, subdivision 12, is amended to read:
Subd. 12.
Additional requirements.
(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.
(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36)new text begin , or section
245I.23new text end , or an acute care hospital.
(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and new text begin individual new text end treatment plan. A group
is defined as two to ten clients, at least one of whom is a recipient, who is concurrently
receiving a service which is identified in this section. The service and group must be specified
in the recipient's new text begin individual new text end treatment plan. No more than two qualified staff may bill
Medicaid for services provided to the same group of recipients. If two adult rehabilitative
mental health workers bill for recipients in the same group session, they must each bill for
different recipients.
new text begin
(d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
new text end
new text begin
(e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
new text end
new text begin
(f) Community intervention, including consultation with relatives, guardians, friends,
employers, treatment providers, and other significant individuals, is appropriate when
directed exclusively to the treatment of the client.
new text end
Sec. 71.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
Telemedicine services.
(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f). Telemedicine services shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, a community paramedic as defined
under section 144E.001, subdivision 5f, deleted text begin ordeleted text end new text begin a clinical trainee who is qualified according to
section 245I.04, subdivision 6,new text end a mental health practitioner deleted text begin defined under section 245.462,
subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a
mental health professionaldeleted text end new text begin qualified according to section 245I.04, subdivision 4new text end , and a
community health worker who meets the criteria under subdivision 49, paragraph (a); "health
care provider" is defined under section 62A.671, subdivision 3; and "originating site" is
defined under section 62A.671, subdivision 7.
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
Sec. 72.
Minnesota Statutes 2020, section 256B.0625, subdivision 5, is amended to read:
Subd. 5.
Community mental health center services.
Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).
(a) The provider deleted text begin is licensed under Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin must
be certified as a mental health clinic under section 245I.20new text end .
(b) deleted text begin The provider provides mental health services under the clinical supervision of a
mental health professional who is licensed for independent practice at the doctoral level or
by a board-certified psychiatristdeleted text end new text begin In addition to the policies and procedures required by
section 245I.03, the provider must establish, enforce, and maintain the policies and procedures
for oversight of clinical services by a doctoral level psychologistnew text end or a new text begin board certified or
board eligiblenew text end psychiatrist deleted text begin who is eligible for board certificationdeleted text end . deleted text begin Clinical supervision has
the meaning given in Minnesota Rules, part 9505.0370, subpart 6.deleted text end new text begin These policies and
procedures must be developed with the involvement of a doctoral level psychologist and a
board certified or board eligible psychiatrist, and must include:
new text end
new text begin
(1) requirements for when to seek clinical consultation by doctoral level psychologist
or a board certified or board eligible psychiatrist;
new text end
new text begin
(2) requirements for the involvement of a doctoral level psychologist or a board certified
or board eligible psychiatrist in the direction of clinical services; and
new text end
new text begin
(3) involvement of a doctoral level psychologist or a board certified or board eligible
psychiatrist in quality improvement initiatives and review as part of a multidisciplinary care
team.
new text end
(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.
(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.
(e) At a minimum, the provider must provide the following outpatient mental health
services: diagnostic assessment; explanation of findings; family, group, and individual
psychotherapy, including crisis intervention psychotherapy services, deleted text begin multiple family group
psychotherapydeleted text end , psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.
(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are deleted text begin diagnosed with bothdeleted text end new text begin dually diagnosed withnew text end mental illness or emotional
disturbance, and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individualsnew text begin who arenew text end
dually diagnosed with a mental illness or emotional disturbance and developmental disability.
(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.
(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).
(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.
(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.
new text begin
(k) The commissioner may require the provider to annually attest that the provider meets
the requirements in this subdivision using a form that the commissioner provides.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (b), (e), (f), and (k) are effective the day following
final enactment.
new text end
Sec. 73.
Minnesota Statutes 2020, section 256B.0625, subdivision 19c, is amended to
read:
Subd. 19c.
Personal care.
Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.
"Qualified professional" means a mental health professional deleted text begin as defined in section 245.462,
subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.
Sec. 74.
Minnesota Statutes 2020, section 256B.0625, subdivision 28a, is amended to
read:
Subd. 28a.
Licensed physician assistant services.
(a) Medical assistance covers services
performed by a licensed physician assistant if the service is otherwise covered under this
chapter as a physician service and if the service is within the scope of practice of a licensed
physician assistant as defined in section 147A.09.
(b) Licensed physician assistants, who are supervised by a physician certified by the
American Board of Psychiatry and Neurology or eligible for board certification in psychiatry,
may bill for medication management and evaluation and management services provided to
medical assistance enrollees in inpatient hospital settings, and in outpatient settings after
the licensed physician assistant completes 2,000 hours of clinical experience in the evaluation
and treatment of mental health, consistent with their authorized scope of practice, as defined
in section 147A.09, with the exception of performing psychotherapy or diagnostic
assessments or providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision.
Sec. 75.
Minnesota Statutes 2020, section 256B.0625, subdivision 42, is amended to read:
Subd. 42.
Mental health professional.
Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional deleted text begin shall include a person
who isdeleted text end qualified deleted text begin as specified indeleted text end new text begin according tonew text end section deleted text begin 245.462, subdivision 18, clauses (1) to
(6); or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end , for the purpose
of this section and Minnesota Rules, parts 9505.0170 to 9505.0475.
Sec. 76.
Minnesota Statutes 2020, section 256B.0625, subdivision 48, is amended to read:
Subd. 48.
Psychiatric consultation to primary care practitioners.
Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5)deleted text end new text begin mental health professional
who is qualified according to section 245I.04, subdivision 2, except a licensed professional
clinical counselor licensed under section 148B.5301new text end , via telephone, e-mail, facsimile, or
other means of communication to primary care practitioners, including pediatricians. The
need for consultation and the receipt of the consultation must be documented in the patient
record maintained by the primary care practitioner. If the patient consents, and subject to
federal limitations and data privacy provisions, the consultation may be provided without
the patient present.
Sec. 77.
Minnesota Statutes 2020, section 256B.0625, subdivision 49, is amended to read:
Subd. 49.
Community health worker.
(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin :
deleted text end
deleted text begin (1)deleted text end received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
deleted text end
deleted text begin
Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
deleted text end
(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6), and section
245.4871, subdivision 27, clauses (1) to (5)deleted text end , or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.
(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.
Sec. 78.
Minnesota Statutes 2020, section 256B.0625, subdivision 56a, is amended to
read:
Subd. 56a.
Officer-involved community-based care coordination.
(a) Medical
assistance covers officer-involved community-based care coordination for an individual
who:
(1) has screened positive for benefiting from treatment for a mental illness or substance
use disorder using a tool approved by the commissioner;
(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;
(3) meets the eligibility requirements in section 256B.056; and
(4) has agreed to participate in officer-involved community-based care coordination.
(b) Officer-involved community-based care coordination means navigating services to
address a client's mental health, chemical health, social, economic, and housing needs, or
any other activity targeted at reducing the incidence of jail utilization and connecting
individuals with existing covered services available to them, including, but not limited to,
targeted case management, waiver case management, or care coordination.
(c) Officer-involved community-based care coordination must be provided by an
individual who is an employee of or is under contract with a county, or is an employee of
or under contract with an Indian health service facility or facility owned and operated by a
tribe or a tribal organization operating under Public Law 93-638 as a 638 facility to provide
officer-involved community-based care coordination and is qualified under one of the
following criteria:
(1) a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18,
clauses (1) to (6)deleted text end ;
(2)new text begin a clinical trainee who is qualified according to section 245I.04, subdivision 6, working
under the treatment supervision of a mental health professional according to section 245I.06;
new text end
new text begin (3)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17deleted text end new text begin who is
qualified according to section 245I.04, subdivision 4new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision of a mental health professionalnew text begin according to section 245I.06new text end ;
deleted text begin (3)deleted text end new text begin (4)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615deleted text end new text begin who is qualified
according to section 245I.04, subdivision 10new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;
(4) an individual qualified as an alcohol and drug counselor under section 245G.11,
subdivision 5; or
(5) a recovery peer qualified under section 245G.11, subdivision 8, working under the
supervision of an individual qualified as an alcohol and drug counselor under section
245G.11, subdivision 5.
(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.
(e) Providers of officer-involved community-based care coordination shall annually
report to the commissioner on the number of individuals served, and number of the
community-based services that were accessed by recipients. The commissioner shall ensure
that services and payments provided under officer-involved community-based care
coordination do not duplicate services or payments provided under section 256B.0625,
subdivision 20, 256B.0753, 256B.0755, or 256B.0757.
(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
officer-involved community-based care coordination services shall be provided by the
county providing the services, from sources other than federal funds or funds used to match
other federal funds.
Sec. 79.
Minnesota Statutes 2020, section 256B.0757, subdivision 4c, is amended to read:
Subd. 4c.
Behavioral health home services staff qualifications.
(a) A behavioral health
home services provider must maintain staff with required professional qualifications
appropriate to the setting.
(b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.
(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1)
to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner deleted text begin as defined
indeleted text end new text begin who is qualified according tonew text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.04, subdivision 4new text end , or
a community health worker as defined in section 256B.0625, subdivision 49.
(e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
(1) a new text begin mental health certified new text end peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0615deleted text end new text begin 245I.04, subdivision 10new text end ;
(2) a new text begin mental health certified new text end family peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0616deleted text end new text begin 245I.04, subdivision 12new text end ;
(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
(4) a mental health rehabilitation worker deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 256B.0623, subdivision 5, clause (4)deleted text end new text begin 245I.04, subdivision 14new text end ;
(5) a community paramedic as defined in section 144E.28, subdivision 9;
(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
(7) a community health worker as defined in section 256B.0625, subdivision 49.
Sec. 80.
Minnesota Statutes 2020, section 256B.0941, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:
(1) before admission, services are determined to be medically necessary according to
Code of Federal Regulations, title 42, section 441.152;
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
(7) was referred for treatment in a psychiatric residential treatment facility by a deleted text begin qualifieddeleted text end
mental health professional deleted text begin licensed as defined indeleted text end new text begin who is qualified according tonew text end section
deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The commissioner shall provide oversight and review the use of referrals for clients
admitted to psychiatric residential treatment facilities to ensure that eligibility criteria,
clinical services, and treatment planning reflect clinical, state, and federal standards for
psychiatric residential treatment facility level of care. The commissioner shall coordinate
the production of a statewide list of children and youth who meet the medical necessity
criteria for psychiatric residential treatment facility level of care and who are awaiting
admission. The commissioner and any recipient of the list shall not use the statewide list to
direct admission of children and youth to specific facilities.
Sec. 81.
Minnesota Statutes 2020, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
deleted text begin
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" means a deleted text begin mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin staff person who is qualified
according to section 245I.04, subdivision 6new text end .
deleted text begin (d)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a. deleted text begin Crisis assistance entails the development of a written plan to assist a child's family to
contend with a potential crisis and is distinct from the immediate provision of crisis
intervention services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
deleted text begin (f)deleted text end new text begin (e)new text end "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a deleted text begin multidisciplinarydeleted text end team, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professional.
deleted text begin (g)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described in 245I.10, subdivision 6new text end .
deleted text begin (h)deleted text end new text begin (g)new text end "Direct service time" means the time that a mental health professional, clinical
trainee, mental health practitioner, or mental health behavioral aide spends face-to-face with
a client and the client's family or providing covered telemedicine services. Direct service
time includes time in which the provider obtains a client's history, develops a client's
treatment plan, records individual treatment outcomes, or provides service components of
children's therapeutic services and supports. Direct service time does not include time doing
work before and after providing direct services, including scheduling or maintaining clinical
records.
deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end or mental health practitioner in guiding the mental
health behavioral aide in providing services to a client. The direction of a mental health
behavioral aide must be based on the client's deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan and
meet the requirements in subdivision 6, paragraph (b), clause (5).
deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.
deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional new text begin or a clinical trainee new text end or mental health
practitionerdeleted text begin ,deleted text end under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, to
guide the work of the mental health behavioral aide. The individual behavioral plan may
be incorporated into the child's individual treatment plan so long as the behavioral plan is
separately communicable to the mental health behavioral aide.
deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a deleted text begin trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3)deleted text end new text begin mental health behavioral aide qualified according to section 245I.04,
subdivision 16new text end , to assist a child retain or generalize psychosocial skills as previously trained
by a mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner and as described
in the child's individual treatment plan and individual behavior plan. Activities involve
working directly with the child or child's family as provided in subdivision 9, paragraph
(b), clause (4).
new text begin
(m) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
(n) "Mental health practitioner" deleted text begin has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
deleted text end deleted text begin services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experiencedeleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7,deleted text end including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and
(2) administering new text begin and reporting the new text end standardized outcome deleted text begin measurement instruments,
determined and updated by the commissionerdeleted text end new text begin measurements in section 245I.10, subdivision
6, paragraph (d), clauses (3) and (4), and other standardized outcome measurements approved
by the commissionernew text end , as periodically needed to evaluate the effectiveness of treatment deleted text begin for
children receiving clinical services and reporting outcome measures, as required by the
commissionerdeleted text end .
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment deleted text begin of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plandeleted text end new text begin described in section 256B.0671, subdivision 11new text end .
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
new text begin coordinated new text end psychotherapy to address internal psychological, emotional, and intellectual
processing deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
new text begin
(u) "Treatment supervision" means the supervision described in section 245I.06.
new text end
Sec. 82.
Minnesota Statutes 2020, section 256B.0943, subdivision 2, is amended to read:
Subd. 2.
Covered service components of children's therapeutic services and
supports.
(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports deleted text begin as defined in this section thatdeleted text end new text begin when the services
are provided bynew text end an eligible provider entity certified under deleted text begin subdivision 4 provides to a client
eligible under subdivision 3deleted text end new text begin and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) The service components of children's therapeutic services and supports are:
(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;
(2) individual, family, or group skills training provided by a mental health professionalnew text begin ,
clinical trainee,new text end or mental health practitioner;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;
(4) mental health behavioral aide services;
(5) direction of a mental health behavioral aide;
(6) mental health service plan development; and
(7) children's day treatment.
Sec. 83.
Minnesota Statutes 2020, section 256B.0943, subdivision 3, is amended to read:
Subd. 3.
Determination of client eligibility.
new text begin (a) new text end A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a new text begin standard
new text end diagnostic assessment by a mental health professional or a deleted text begin mental health practitioner who
meets the requirements of a clinical trainee as defined in Minnesota Rules, part 9505.0371,
subpart 5, item C,deleted text end new text begin clinical traineenew text end that is performed within one year before the initial start
of service. The new text begin standard new text end diagnostic assessment must deleted text begin meet the requirements for a standard
or extended diagnostic assessment as defined in Minnesota Rules, part 9505.0372, subpart
1, items B and C, anddeleted text end :
deleted text begin
(1) include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or, for
children under age five, as specified in the current edition of the Diagnostic Classification
of Mental Health Disorders of Infancy and Early Childhood;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a child under age 18 has a diagnosis of emotional disturbance
or, if the person is between the ages of 18 and 21, whether the person has a mental illness;
deleted text begin (3)deleted text end new text begin (2)new text end document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals;new text begin and
new text end
deleted text begin (4)deleted text end new text begin (3)new text end be used in the development of the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plandeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) be completed annually until age 18. For individuals between age 18 and 21, unless
a client's mental health condition has changed markedly since the client's most recent
diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
deleted text end
new text begin
(b) Notwithstanding paragraph (a), a client may be determined to be eligible for up to
five days of day treatment under this section based on a hospital's medical history and
presentation examination of the client.
new text end
Sec. 84.
Minnesota Statutes 2020, section 256B.0943, subdivision 4, is amended to read:
Subd. 4.
Provider entity certification.
(a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity and shall require corrective
action, medical assistance repayment, or decertification of a provider entity that no longer
meets the requirements in this section or that fails to meet the clinical quality standards or
administrative standards provided by the commissioner in the application and certification
process.
(b) For purposes of this section, a provider entity must new text begin meet the standards in this section
and chapter 245I, as required by section 245I.011, subdivision 5, and new text end be:
(1) an Indian health services facility or a facility owned and operated by a tribe or tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;
(2) a county-operated entity certified by the state; or
(3) a noncounty entity certified by the state.
Sec. 85.
Minnesota Statutes 2020, section 256B.0943, subdivision 5, is amended to read:
Subd. 5.
Provider entity administrative infrastructure requirements.
(a) deleted text begin To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement.deleted text end An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. deleted text begin The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.
deleted text end
(b) deleted text begin The administrative infrastructure writtendeleted text end new text begin In addition to the policies and procedures
required in section 245I.03, thenew text end policies and procedures must include:
deleted text begin
(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteria, training criteria under subdivision 8, and clinical
supervision or direction of a mental health behavioral aide requirements under subdivision
6;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end fiscal procedures, including internal fiscal control practices and a process for
collecting revenue that is compliant with federal and state laws;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (2)new text end a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017, to be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and
deleted text end
deleted text begin
(4) a process to establish and maintain individual client records. The client's records
must include:
deleted text end
deleted text begin
(i) the client's personal information;
deleted text end
deleted text begin
(ii) forms applicable to data privacy;
deleted text end
deleted text begin
(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
deleted text end
deleted text begin
(iv) documentation of service delivery as specified under subdivision 6;
deleted text end
deleted text begin
(v) telephone contacts;
deleted text end
deleted text begin
(vi) discharge plan; and
deleted text end
deleted text begin
(vii) if applicable, insurance information.
deleted text end
(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.
Sec. 86.
Minnesota Statutes 2020, section 256B.0943, subdivision 5a, is amended to read:
Subd. 5a.
Background studies.
The requirements for background studies under deleted text begin thisdeleted text end
section new text begin 245I.011, subdivision 4, paragraph (d), new text end may be met by a children's therapeutic
services and supports services agency through the commissioner's NETStudy system as
provided under sections 245C.03, subdivision 7, and 245C.10, subdivision 8.
Sec. 87.
Minnesota Statutes 2020, section 256B.0943, subdivision 6, is amended to read:
Subd. 6.
Provider entity clinical infrastructure requirements.
(a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plans, service delivery,
and individual treatment plan review that are culturally competent, child-centered, and
family-driven to achieve maximum benefit for the client. The provider entity must review,
and update as necessary, the clinical policies and procedures every three years, must distribute
the policies and procedures to staff initially and upon each subsequent update, and must
train staff accordingly.
(b) The clinical infrastructure written policies and procedures must include policies and
procedures fornew text begin meeting the requirements in this subdivisionnew text end :
(1) providing or obtaining a client's new text begin standard new text end diagnostic assessment, including a new text begin standard
new text end diagnostic assessment deleted text begin performed by an outside or independent clinician, that identifies acute
and chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.deleted text end
When required components of the new text begin standard new text end diagnostic assessmentdeleted text begin , such as baseline measures,deleted text end
are not provided in an outside or independent assessment or deleted text begin when baseline measuresdeleted text end cannot
be attained deleted text begin in a one-session standard diagnostic assessmentdeleted text end new text begin immediatelynew text end , the provider entity
must determine the missing information within 30 days and amend the child's new text begin standard
new text end diagnostic assessment or incorporate the deleted text begin baselinesdeleted text end new text begin informationnew text end into the child's individual
treatment plan;
(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin ;
new text end
deleted text begin
(i) is based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(iii) is developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
deleted text end
deleted text begin
(iv) is developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessment, and treatment planning;
deleted text end
deleted text begin
(v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
deleted text end
deleted text begin
(vi) is signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
deleted text end
(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:
(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;
(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;
(iii) methods of documenting the child's behavior;
(iv) methods of monitoring the child's progress in reaching objectives; and
(v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;
(4) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans for deleted text begin mental health practitioners and
mental health behavioral aides. A mental health professional must document the clinical
supervision the professional provides by cosigning individual treatment plans and making
entries in the client's record on supervisory activities. The clinical supervisor also shall
document supervisee-specific supervision in the supervisee's personnel file. Clinicaldeleted text end new text begin staff
according to section 245I.06. Treatmentnew text end supervision does not include the authority to make
or terminate court-ordered placements of the child. A deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be
available for urgent consultation as required by the individual client's needs or the situationdeleted text begin .
Clinical supervision may occur individually or in a small group to discuss treatment and
review progress toward goals. The focus of clinical supervision must be the client's treatment
needs and progress and the mental health practitioner's or behavioral aide's ability to provide
servicesdeleted text end ;
(4a) meeting day treatment program conditions in items (i) deleted text begin to (iii)deleted text end new text begin and (ii)new text end :
(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;new text begin and
new text end
deleted text begin
(ii) the diagnosis and the client's individual treatment plan or a change in the diagnosis
or individual treatment plan must be made by or reviewed, approved, and signed by the
clinical supervisor; and
deleted text end
deleted text begin (iii)deleted text end new text begin (ii)new text end every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;
(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:
deleted text begin
(i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
deleted text end
deleted text begin
(ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
deleted text end
deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the new text begin clinical trainee, new text end mental health
practitionernew text begin ,new text end or mental health behavioral aide is providing CTSS services; and
deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;
(5) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan, and instruct the mental health
behavioral aide on how to implement therapeutic activities and interventions that will lead
to goal attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end giving direction must also instruct
the mental health behavioral aide about the client's diagnosis, functional status, and other
characteristics that are likely to affect service delivery. Direction must also include
determining that the mental health behavioral aide has the skills to interact with the client
and the client's family in ways that convey personal and cultural respect and that the aide
actively solicits information relevant to treatment from the family. The aide must be able
to clearly explain or demonstrate the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision and
requires the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the deleted text begin individualizeddeleted text end new text begin individualnew text end
treatment plan and the deleted text begin individualizeddeleted text end new text begin individualnew text end behavior plan. When providing direction,
the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must:
(i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the
deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must approve and sign the progress notes;
(ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;
(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;
(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; deleted text begin and
deleted text end
(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;new text begin and
new text end
new text begin
(vi) ensure the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
new text end
(6) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and
(7) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. deleted text begin Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's parent
or other person authorized by statute to give consent to the mental health services for the
child.
deleted text end
Sec. 88.
Minnesota Statutes 2020, section 256B.0943, subdivision 7, is amended to read:
Subd. 7.
Qualifications of individual and team providers.
(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.
(b) An individual provider must be qualified asnew text begin anew text end :
(1) deleted text begin adeleted text end mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end
(2) deleted text begin adeleted text end new text begin clinical trainee;
new text end
new text begin (3)new text end mental health practitioner deleted text begin or clinical trainee. The mental health practitioner or clinical
trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end
new text begin
(4) mental health certified family peer specialist; or
new text end
deleted text begin (3) adeleted text end new text begin (5)new text end mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.
deleted text end
deleted text begin
(A) A level I mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements under subdivision 8.
deleted text end
deleted text begin
(B) A level II mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements in subdivision 8.
deleted text end
(c) A day treatment deleted text begin multidisciplinarydeleted text end team must include at least one mental health
professional or clinical trainee and one mental health practitioner.
Sec. 89.
Minnesota Statutes 2020, section 256B.0943, subdivision 9, is amended to read:
Subd. 9.
Service delivery criteria.
(a) In delivering services under this section, a certified
provider entity must ensure that:
(1) deleted text begin each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs.deleted text end the provider's
caseload size should reasonably enable the provider to play an active role in service planning,
monitoring, and delivering services to meet the client's and client's family's needs, as specified
in each client's individual treatment plan;
(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and
(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day
treatment program must stabilize the client's mental health status while developing and
improving the client's independent living and socialization skills. The goal of the day
treatment program must be to reduce or relieve the effects of mental illness and provide
training to enable the client to live in the community. The program must be available
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.
(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
(1) deleted text begin patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6.deleted text end psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;
(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:
(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;
(iv) skills training delivered to the child's family must teach skills needed by parents to
enhance the child's skill development, to help the child utilize daily life skills taught by a
mental health professional, clinical trainee, or mental health practitioner, and to develop or
maintain a home environment that supports the child's progressive use of skills;
(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(A) one mental health professional deleted text begin or onedeleted text end new text begin ,new text end clinical traineenew text begin ,new text end or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or
(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;
(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;
(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3),deleted text end and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;new text begin and
new text end
deleted text begin
(5) direction of a mental health behavioral aide must include the following:
deleted text end
deleted text begin
(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
deleted text end
deleted text begin
(ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end mental health service plan development must be performed in consultation with
the child's family and, when appropriate, with other key participants in the child's life by
the child's treating mental health professional or clinical trainee or by a mental health
practitioner and approved by the treating mental health professional. Treatment plan drafting
consists of development, review, and revision by face-to-face or electronic communication.
The provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7,deleted text end Medical assistance
covers service plan development before completion of the child's individual treatment plan.
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
deleted text end
Sec. 90.
Minnesota Statutes 2020, section 256B.0943, subdivision 11, is amended to read:
Subd. 11.
Documentation and billing.
deleted text begin (a)deleted text end A provider entity must document the services
it provides under this section. The provider entity must ensure that documentation complies
with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section
that are not documented according to this subdivision shall be subject to monetary recovery
by the commissioner. Billing for covered service components under subdivision 2, paragraph
(b), must not include anything other than direct service time.
deleted text begin
(b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
deleted text end
deleted text begin
(1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
deleted text end
deleted text begin
(2) the name, dated signature, and credentials of the person who delivered the service;
deleted text end
deleted text begin
(3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
deleted text end
deleted text begin
(4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
deleted text end
deleted text begin
(5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
deleted text end
deleted text begin
(6) the date when services are discontinued and reasons for discontinuation of services.
deleted text end
Sec. 91.
Minnesota Statutes 2020, section 256B.0946, subdivision 1, is amended to read:
Subdivision 1.
Required covered service components.
(a) deleted text begin Effective May 23, 2013,
anddeleted text end Subject to federal approval, medical assistance covers medically necessary intensive
treatment services deleted text begin described under paragraph (b) thatdeleted text end new text begin when the servicesnew text end are provided by a
provider entity deleted text begin eligible under subdivision 3 to a client eligible under subdivision 2 who is
placed in a foster home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or
placed in a foster home licensed under the regulations established by a federally recognized
Minnesota tribedeleted text end new text begin certified under and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (5)
are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;
(2) crisis deleted text begin assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943deleted text end new text begin planningnew text end ;
(3) individual, family, and group psychoeducation servicesdeleted text begin , defined in subdivision 1a,
paragraph (q),deleted text end provided by a mental health professional or a clinical trainee;
(4) clinical care consultationdeleted text begin , as defined in subdivision 1a, anddeleted text end provided by a mental
health professional or a clinical trainee; and
(5) service delivery payment requirements as provided under subdivision 4.
Sec. 92.
Minnesota Statutes 2020, section 256B.0946, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For the purposes of this section, the following terms have the
meanings given them.
(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.
deleted text begin
(b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.
deleted text end
deleted text begin
(c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item C;deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9adeleted text begin , including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis interventiondeleted text end .
deleted text begin (f)deleted text end new text begin (d)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influencesdeleted text begin , as defined in Minnesota Rules, part 9505.0370,
subpart 9,deleted text end into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
deleted text begin (g)deleted text end new text begin (e)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.
deleted text begin (h)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means the assessment described in section 245I.10, subdivision 6new text end .
deleted text begin (i)deleted text end new text begin (g)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.
deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(m) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, and a mental health practitioner working as a clinical trainee according to Minnesota
Rules, part 9505.0371, subpart 5, item C.
deleted text end
new text begin
(k) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
deleted text begin (n)deleted text end new text begin (l)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245I.02, subdivision 29new text end .
deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.
deleted text begin (q)deleted text end new text begin (o)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.
deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" deleted text begin has the meaning given in Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin means the treatment described in section 256B.0671, subdivision 11new text end .
deleted text begin (s)deleted text end new text begin (q)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.
new text begin
(r) "Trauma" has the meaning given in section 245I.02, subdivision 38.
new text end
new text begin
(s) "Treatment supervision" means the supervision described under section 245I.06.
new text end
Sec. 93.
Minnesota Statutes 2020, section 256B.0946, subdivision 2, is amended to read:
Subd. 2.
Determination of client eligibility.
An eligible recipient is an individual, from
birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, new text begin or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota tribe, new text end and has receivednew text begin : (1)new text end a
new text begin standard new text end diagnostic assessment deleted text begin and an evaluation of level of care needed, as defined in
paragraphs (a) and (b).deleted text end new text begin within 180 days before the start of service that documents that
intensive treatment services are medically necessary within a foster family setting to
ameliorate identified symptoms and functional impairments; and (2) a level of care
assessment as defined in section 245I.02, subdivision 19, that demonstrates that the individual
requires intensive intervention without 24-hour medical monitoring, and a functional
assessment as defined in section 245I.02, subdivision 17. The level of care assessment and
the functional assessment must include information gathered from the placing county, tribe,
or case manager.
new text end
deleted text begin
(a) The diagnostic assessment must:
deleted text end
deleted text begin
(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
deleted text end
deleted text begin
(2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
deleted text end
deleted text begin
(3) document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;
deleted text end
deleted text begin
(4) be performed within 180 days before the start of service; and
deleted text end
deleted text begin
(5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
deleted text end
deleted text begin
(b) The evaluation of level of care must be conducted by the placing county, tribe, or
case manager in conjunction with the diagnostic assessment as described by Minnesota
Rules, part 9505.0372, subpart 1, item B, using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.
deleted text end
Sec. 94.
Minnesota Statutes 2020, section 256B.0946, subdivision 3, is amended to read:
Subd. 3.
Eligible mental health services providers.
(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the standards in chapter 245I, as required in section 245I.011, subdivision 5new text end .
(b) For purposes of this section, a provider agency must be:
(1) a county-operated entity certified by the state;
(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
(3) a noncounty entity.
(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.
Sec. 95.
Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (l)new text end .
deleted text begin
(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
deleted text end
deleted text begin
(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
new text begin standard new text end diagnostic assessment and team consultation and treatment planning review process.
deleted text begin (e)deleted text end new text begin (c)new text end Each client receiving treatment must be assessed for a trauma history, and the
client's treatment plan must document how the results of the assessment will be incorporated
into treatment.
new text begin
(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.
new text end
deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning processdeleted text begin , as defined in subdivision 1a, paragraph (s)deleted text end .
deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultationdeleted text begin , as defined in subdivision 1a, paragraph (a),deleted text end must be
provided in accordance with the client's individual treatment plan.
deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.
deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end Location of service delivery must be in the client's home, day care setting, school,
or other community-based setting that is specified on the client's individualized treatment
plan.
deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.
deleted text begin (l)deleted text end new text begin (k)new text end Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.
deleted text begin (m)deleted text end new text begin (l)new text end Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.
deleted text begin (n)deleted text end new text begin (m)new text end Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's permanency
plan and postdischarge mental health service needs.
Sec. 96.
Minnesota Statutes 2020, section 256B.0946, subdivision 6, is amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ; deleted text begin and
deleted text end
(7) transportationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) mental health certified family peer specialist services under section 256B.0616.
new text end
(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section deleted text begin 256B.0625, subdivision 35bdeleted text end new text begin 256B.0943new text end ;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5) room and board costs as defined in section 256I.03, subdivision 6.
Sec. 97.
Minnesota Statutes 2020, section 256B.0947, subdivision 1, is amended to read:
Subdivision 1.
Scope.
deleted text begin Effective November 1, 2011, anddeleted text end Subject to federal approval,
medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services deleted text begin as defined in subdivision 2, for recipients as defined in subdivision 3,deleted text end when
the services are provided by an entity meeting the standards in this section.new text begin The provider
entity must make reasonable and good faith efforts to report individual client outcomes to
the commissioner, using instruments and protocols approved by the commissioner.
new text end
Sec. 98.
Minnesota Statutes 2020, section 256B.0947, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20 with a serious mental illness or co-occurring mental illness and
substance abuse addictiondeleted text end who require intensive services to prevent admission to an inpatient
psychiatric hospital or placement in a residential treatment facility or who require intensive
services to step down from inpatient or residential care to community-based care.
(b) "Co-occurring mental illness and substance deleted text begin abuse addictiondeleted text end new text begin use disordernew text end " means a
dual diagnosis of at least one form of mental illness and at least one substance use disorder.
Substance use disorders include alcohol or drug abuse or dependence, excluding nicotine
use.
(c) "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given to it in Minnesota Rules,
part 9505.0370, subpart 11. A diagnostic assessment must be provided according to
Minnesota Rules, part 9505.0372, subpart 1, and for this section must incorporate a
determination of the youth's necessary level of care using a standardized functional
assessment instrument approved and periodically updated by the commissionerdeleted text end new text begin means the
assessment described in section 245I.10, subdivision 6new text end .
deleted text begin
(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.
deleted text end
deleted text begin
(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
deleted text end
deleted text begin
(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.
deleted text end
deleted text begin (g)deleted text end new text begin (d)new text end "Medication education services" means services provided individually or in
groups, which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
deleted text begin
(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer who:
deleted text end
deleted text begin
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
deleted text end
deleted text begin
(2) assists younger peers to identify and achieve specific life goals;
deleted text end
deleted text begin
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
deleted text end
deleted text begin
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
deleted text end
deleted text begin
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
deleted text end
deleted text begin
(6) meets the following criteria:
deleted text end
deleted text begin
(i) is at least 22 years of age;
deleted text end
deleted text begin
(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;
deleted text end
deleted text begin
(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;
deleted text end
deleted text begin
(iv) has at least a high school diploma or equivalent;
deleted text end
deleted text begin
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
deleted text end
deleted text begin
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
deleted text end
deleted text begin
(vii) must be free of substance use problems for at least one year.
deleted text end
new text begin
(e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
deleted text begin (i)deleted text end new text begin (f)new text end "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
deleted text begin (j)deleted text end new text begin (g)new text end "Substance use disorders" means one or more of the disorders defined in the
diagnostic and statistical manual of mental disorders, current edition.
deleted text begin (k)deleted text end new text begin (h)new text end "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
deleted text begin (l)deleted text end new text begin (i)new text end "Treatment team" means all staff who provide services to recipients under this
section.
deleted text begin (m)deleted text end new text begin (j)new text end "Family peer specialist" means a staff person new text begin who is new text end qualified under section
256B.0616.
Sec. 99.
Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is age 16, 17, 18, 19, or 20; and
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
deleted text begin abuse addictiondeleted text end new text begin use disordernew text end , for which intensive nonresidential rehabilitative mental health
services are needed;
(3) has received a deleted text begin level-of-care determination, using an instrument approved by the
commissionerdeleted text end new text begin level of care assessment as defined in section 245I.02, subdivision 19new text end , that
indicates a need for intensive integrated intervention without 24-hour medical monitoring
and a need for extensive collaboration among multiple providers;
(4) hasnew text begin receivednew text end anew text begin functional assessment as defined in section 245I.02, subdivision 17,
that indicatesnew text end functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system within the next two years; and
(5) has had a recent new text begin standard new text end diagnostic assessmentdeleted text begin , as provided in Minnesota Rules,
part 9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.
Sec. 100.
Minnesota Statutes 2020, section 256B.0947, subdivision 3a, is amended to
read:
Subd. 3a.
Required service components.
deleted text begin
(a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities new text begin are new text end covered by deleted text begin thedeleted text end new text begin anew text end single daily rate per client must include the following,
as needed by the individual client:
(1) individual, family, and group psychotherapy;
(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section 245.4871, subdivision 9adeleted text begin , which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end ;
(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;
(5) mental health case management as provided in section 256B.0625, subdivision 20;
(6) medication education services as defined in this section;
(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;
(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;
(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;
(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ;
deleted text begin
(11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
deleted text end
deleted text begin (12)deleted text end new text begin (11)new text end transition services deleted text begin as defined in this sectiondeleted text end ;
deleted text begin (13) integrated dual disorders treatment as defined in this sectiondeleted text end new text begin (12) co-occurring
substance use disorder treatment as defined in section 245I.02, subdivision 11new text end ; and
deleted text begin (14)deleted text end new text begin (13)new text end housing access supportnew text begin that assists clients to find, obtain, retain, and move to
safe and adequate housing. Housing access support does not provide monetary assistance
for rent, damage deposits, or application feesnew text end .
deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:
deleted text begin (1)deleted text end client access to crisis intervention services, as defined in section deleted text begin 256B.0944deleted text end new text begin
256B.0624new text end , and available 24 hours per day and seven days per weekdeleted text begin ;deleted text end new text begin .
new text end
deleted text begin
(2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
deleted text end
deleted text begin
(3) determination of the client's needed level of care using an instrument approved and
periodically updated by the commissioner.
deleted text end
Sec. 101.
Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must deleted text begin be provided by a provider entity as provided in subdivision 4deleted text end new text begin meet the standards in
this section and chapter 245I as required in section 245I.011, subdivision 5new text end .
(b) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:
(1) deleted text begin The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients.deleted text end Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must new text begin minimally new text end includedeleted text begin , but is not limited todeleted text end :
(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a new text begin mental health certified new text end peer specialist deleted text begin as defined in subdivision 2, paragraph (h)deleted text end new text begin
who is qualified according to section 245I.04, subdivision 10, and is also a former children's
mental health consumernew text end .
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialistnew text begin with knowledge and experience working with youth on
special education requirements and goals, special education plans, and coordination of
educational activities with health care activitiesnew text end ;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v)new text begin a clinical trainee who is qualified according to section 245I.04, subdivision 6;
new text end
new text begin (vi)new text end a mental health practitionerdeleted text begin , as defined in section 245.4871, subdivision 26deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end ;
deleted text begin (vi)deleted text end new text begin (vii)new text end a case management service provider, as defined in section 245.4871, subdivision
4;
deleted text begin (vii)deleted text end new text begin (viii)new text end a housing access specialist; and
deleted text begin (viii)deleted text end new text begin (ix)new text end a family peer specialist as defined in subdivision 2, paragraph (m).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance deleted text begin abusedeleted text end new text begin usenew text end counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor shall be an active member of the treatment team
and shall function as a practicing clinician at least on a part-time basis. The treatment team
shall meet with the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor at least weekly to discuss recipients' progress
and make rapid adjustments to meet recipients' needs. The team meeting must include
client-specific case reviews and general treatment discussions among team members.
Client-specific case reviews and planning must be documented in the individual client's
treatment record.
(d) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(e) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
(f) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitionernew text begin , clinical trainee,new text end or mental health professional. The provider shall have
the capacity to promptly and appropriately respond to emergent needs and make any
necessary staffing adjustments to ensure the health and safety of clients.
(g) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
(h) A regional treatment team may serve multiple counties.
Sec. 102.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The deleted text begin initial functional assessment must be completed within ten days of intake anddeleted text end new text begin
level of care assessment as defined in section 245I.02, subdivision 19, and functional
assessment as defined in section 245I.02, subdivision 17, must benew text end updated at least every deleted text begin six
monthsdeleted text end new text begin 90 days new text end or prior to discharge from the service, whichever comes first.
(e) new text begin The treatment team must complete new text end an individual treatment plan deleted text begin mustdeleted text end new text begin for each client,
according to section 245I.10, subdivisions 7 and 8, and the individual treatment plan mustnew text end :
deleted text begin
(1) be based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
deleted text end
deleted text begin
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
deleted text end
deleted text begin
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
deleted text end
deleted text begin
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
deleted text end
deleted text begin (7)deleted text end new text begin (1)new text end be completed in consultation with the client's current therapist and key providers
and provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
deleted text begin (8)deleted text end new text begin (2)new text end if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment;
new text begin (ii)new text end develop a schedule for accomplishingnew text begin substance use disordernew text end treatment goals and
objectives; and
new text begin (iii)new text end identify the individuals responsible for providingnew text begin substance use disordernew text end treatment
services and supports;
deleted text begin
(ii) be reviewed at least once every 90 days and revised, if necessary;
deleted text end
deleted text begin
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
deleted text end
deleted text begin (10)deleted text end new text begin (3)new text end provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" servicesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) notwithstanding section 245I.10, subdivision 8, be reviewed at least every 90 days
and revised to document treatment progress or, if progress is not documented, to document
changes in treatment.
new text end
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 103.
Minnesota Statutes 2020, section 256B.0947, subdivision 7, is amended to read:
Subd. 7.
Medical assistance payment and rate setting.
(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end .
(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.
(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:
(1) the cost for similar services in the health care trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each client;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.
Sec. 104.
Minnesota Statutes 2020, section 256B.0949, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) The terms used in this section have the meanings given in this
subdivision.
(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
(1) is severe and chronic;
(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
(3) requires treatment or services similar to those required for a person with ASD; and
(4) results in substantial functional limitations in three core developmental deficits of
ASD: social or interpersonal interaction; functional communication, including nonverbal
or social communication; and restrictive or repetitive behaviors or hyperreactivity or
hyporeactivity to sensory input; and may include deficits or a high level of support in one
or more of the following domains:
(i) behavioral challenges and self-regulation;
(ii) cognition;
(iii) learning and play;
(iv) self-care; or
(v) safety.
(d) "Person" means a person under 21 years of age.
(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.
(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
(h) "Department" means the Department of Human Services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved and
published by the commissioner that are based in behavioral and developmental science
consistent with best practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.
(k) "Incident" means when any of the following occur:
(1) an illness, accident, or injury that requires first aid treatment;
(2) a bump or blow to the head; or
(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
(n) "Mental health professional" deleted text begin has the meaning given indeleted text end new text begin means a staff person who is
qualified according tonew text end section deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04,
subdivision 2new text end .
(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
Sec. 105.
Minnesota Statutes 2020, section 256B.0949, subdivision 4, is amended to read:
Subd. 4.
Diagnosis.
(a) A diagnosis of ASD or a related condition must:
(1) be based upon current DSM criteria including direct observations of the person and
information from the person's legal representative or primary caregivers;
(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and
(3) meet the requirements of deleted text begin Minnesota Rules, part 9505.0372, subpart 1, items B and
Cdeleted text end new text begin a standard diagnostic assessment according to section 245I.10, subdivision 6new text end .
(b) Additional assessment information may be considered to complete a diagnostic
assessment including specialized tests administered through special education evaluations
and licensed school personnel, and from professionals licensed in the fields of medicine,
speech and language, psychology, occupational therapy, and physical therapy. A diagnostic
assessment may include treatment recommendations.
Sec. 106.
Minnesota Statutes 2020, section 256B.0949, subdivision 5a, is amended to
read:
Subd. 5a.
Comprehensive multidisciplinary evaluation provider qualification.
A
CMDE provider must:
(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a deleted text begin mental health practitioner who meets the requirements of adeleted text end clinical trainee
deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin who is qualified according
to section 245I.04, subdivision 6new text end ;
(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and
(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.
Sec. 107.
Minnesota Statutes 2020, section 256B.25, subdivision 3, is amended to read:
Subd. 3.
Payment exceptions.
The limitation in subdivision 2 shall not apply to:
(1) payment of Minnesota supplemental assistance funds to recipients who reside in
facilities which are involved in litigation contesting their designation as an institution for
treatment of mental disease;
(2) payment or grants to a boarding care home or supervised living facility licensed by
the Department of Human Services under Minnesota Rules, parts 2960.0130 to 2960.0220
deleted text begin ordeleted text end new text begin ,new text end 2960.0580 to 2960.0700,new text begin ornew text end 9520.0500 to 9520.0670, or new text begin under new text end chapter 245Gnew text begin or 245Inew text end ,
or payment to recipients who reside in these facilities;
(3) payments or grants to a boarding care home or supervised living facility which are
ineligible for certification under United States Code, title 42, sections 1396-1396p;
(4) payments or grants otherwise specifically authorized by statute or rule.
Sec. 108.
Minnesota Statutes 2020, section 256B.761, is amended to read:
256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.
(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.
deleted text begin
(c) The commissioner shall establish three levels of payment for mental health diagnostic
assessment, based on three levels of complexity. The aggregate payment under the tiered
rates must not exceed the projected aggregate payments for mental health diagnostic
assessment under the previous single rate. The new rate structure is effective January 1,
2011, or upon federal approval, whichever is later.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.
deleted text begin (e)deleted text end new text begin (d)new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
Sec. 109.
Minnesota Statutes 2020, section 256B.763, is amended to read:
256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment
rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:
(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
(2) community mental health centers under section 256B.0625, subdivision 5; and
(3) mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin section 245I.20new text end , or hospital outpatient psychiatric departments that are
designated as essential community providers under section 62Q.19.
(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.
(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated
with the county, rates that are established by the federal government, or rates that increased
between January 1, 2004, and January 1, 2005.
(d) The commissioner shall adjust rates paid to prepaid health plans under contract with
the commissioner to reflect the rate increases provided in paragraphs (a), (e), and (f). The
prepaid health plan must pass this rate increase to the providers identified in paragraphs (a),
(e), (f), and (g).
(e) Payment rates shall be increased by 23.7 percent over the rates in effect on December
31, 2007, for:
(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and
(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943 and
not already included in paragraph (a), payment rates shall be increased by 23.7 percent over
the rates in effect on December 31, 2007.
(g) Payment rates shall be increased by 2.3 percent over the rates in effect on December
31, 2007, for individual and family skills training provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(h) For services described in paragraphs (b), (e), and (g) and rendered on or after July
1, 2017, payment rates for mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules,
parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end , that are not designated as essential community
providers under section 62Q.19 shall be equal to payment rates for mental health clinics
deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end ,
that are designated as essential community providers under section 62Q.19. In order to
receive increased payment rates under this paragraph, a provider must demonstrate a
commitment to serve low-income and underserved populations by:
(1) charging for services on a sliding-fee schedule based on current poverty income
guidelines; and
(2) not restricting access or services because of a client's financial limitation.
Sec. 110.
Minnesota Statutes 2020, section 256P.01, subdivision 6a, is amended to read:
Subd. 6a.
Qualified professional.
(a) For illness, injury, or incapacity, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, physical therapist, occupational therapist, or licensed chiropractor, according to their
scope of practice.
(b) For developmental disability, learning disability, and intelligence testing, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, licensed independent clinical social worker, licensed psychologist, certified school
psychologist, or certified psychometrist working under the supervision of a licensed
psychologist.
(c) For mental health, a "qualified professional" means a licensed physician, advanced
practice registered nurse, or qualified mental health professional under section deleted text begin 245.462,
subdivision 18, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(d) For substance use disorder, a "qualified professional" means a licensed physician, a
qualified mental health professional under section 245.462, subdivision 18, clauses (1) to
(6), or an individual as defined in section 245G.11, subdivision 3, 4, or 5.
Sec. 111.
Minnesota Statutes 2020, section 295.50, subdivision 9b, is amended to read:
Subd. 9b.
Patient services.
(a) "Patient services" means inpatient and outpatient services
and other goods and services provided by hospitals, surgical centers, or health care providers.
They include the following health care goods and services provided to a patient or consumer:
(1) bed and board;
(2) nursing services and other related services;
(3) use of hospitals, surgical centers, or health care provider facilities;
(4) medical social services;
(5) drugs, biologicals, supplies, appliances, and equipment;
(6) other diagnostic or therapeutic items or services;
(7) medical or surgical services;
(8) items and services furnished to ambulatory patients not requiring emergency care;
and
(9) emergency services.
(b) "Patient services" does not include:
(1) services provided to nursing homes licensed under chapter 144A;
(2) examinations for purposes of utilization reviews, insurance claims or eligibility,
litigation, and employment, including reviews of medical records for those purposes;
(3) services provided to and by community residential mental health facilities licensed
under new text begin section 245I.23 or new text end Minnesota Rules, parts 9520.0500 to 9520.0670, and to and by
residential treatment programs for children with severe emotional disturbance licensed or
certified under chapter 245A;
(4) services provided under the following programs: day treatment services as defined
in section 245.462, subdivision 8; assertive community treatment as described in section
256B.0622; adult rehabilitative mental health services as described in section 256B.0623;
deleted text begin adultdeleted text end crisis response services as described in section 256B.0624; new text begin and new text end children's therapeutic
services and supports as described in section 256B.0943; deleted text begin and children's mental health crisis
response services as described in section 256B.0944;
deleted text end
(5) services provided to and by community mental health centers as defined in section
245.62, subdivision 2;
(6) services provided to and by assisted living programs and congregate housing
programs;
(7) hospice care services;
(8) home and community-based waivered services under chapter 256S and sections
256B.49 and 256B.501;
(9) targeted case management services under sections 256B.0621; 256B.0625,
subdivisions 20, 20a, 33, and 44; and 256B.094; and
(10) services provided to the following: supervised living facilities for persons with
developmental disabilities licensed under Minnesota Rules, parts 4665.0100 to 4665.9900;
housing with services establishments required to be registered under chapter 144D; board
and lodging establishments providing only custodial services that are licensed under chapter
157 and registered under section 157.17 to provide supportive services or health supervision
services; adult foster homes as defined in Minnesota Rules, part 9555.5105; day training
and habilitation services for adults with developmental disabilities as defined in section
252.41, subdivision 3; boarding care homes as defined in Minnesota Rules, part 4655.0100;
adult day care services as defined in section 245A.02, subdivision 2a; and home health
agencies as defined in Minnesota Rules, part 9505.0175, subpart 15, or licensed under
chapter 144A.
Sec. 112.
Minnesota Statutes 2020, section 325F.721, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given them.
(b) "Covered setting" means an unlicensed setting providing sleeping accommodations
to one or more adult residents, at least 80 percent of which are 55 years of age or older, and
offering or providing, for a fee, supportive services. For the purposes of this section, covered
setting does not mean:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) temporary family health care dwellings as defined in sections 394.307 and 462.3593;
(9) settings offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011; or
(14) an assisted living facility licensed under chapter 144G.
(c) "'I'm okay' check services" means providing a service to, by any means, check on
the safety of a resident.
(d) "Resident" means a person entering into written contract for housing and services
with a covered setting.
(e) "Supportive services" means:
(1) assistance with laundry, shopping, and household chores;
(2) housekeeping services;
(3) provision of meals or assistance with meals or food preparation;
(4) help with arranging, or arranging transportation to, medical, social, recreational,
personal, or social services appointments; or
(5) provision of social or recreational services.
Arranging for services does not include making referrals or contacting a service provider
in an emergency.
Sec. 113. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 245.462, subdivision 4a; 245.4879, subdivision
2; 245.62, subdivisions 3 and 4; 245.69, subdivision 2; 256B.0615, subdivision 2; 256B.0616,
subdivision 2; 256B.0622, subdivisions 3 and 5a; 256B.0623, subdivisions 7, 8, 10, and 11;
256B.0625, subdivisions 5l, 35a, 35b, 61, 62, and 65; 256B.0943, subdivisions 8 and 10;
256B.0944; and 256B.0946, subdivision 5,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750;
9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820;
9520.0830; 9520.0840; 9520.0850; 9520.0860; and 9520.0870,
new text end
new text begin
are repealed.
new text end
Sec. 114. new text begin EFFECTIVE DATE.
new text end
new text begin
Unless otherwise stated, this article is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
ARTICLE 20
FORECAST ADJUSTMENTS
Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2019, First Special
Session chapter 9, article 14, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2021" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2021.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2021 new text end |
||||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(816,996,000) new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(745,266,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
(36,893,000) new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,837,000) new text end |
|
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
|||||
|
new text begin
(a) Minnesota Family Investment Program (MFIP)/Diversionary Work Program (DWP) new text end |
|||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
59,004,000 new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,843,000) new text end |
|
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(54,158,000) new text end |
|||||
|
new text begin
(c) General Assistance new text end |
new text begin
3,925,000 new text end |
|||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
3,849,000 new text end |
|||||
|
new text begin
(e) Housing Support new text end |
new text begin
3,022,000 new text end |
|||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(8,639,000) new text end |
|||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(36,893,000) new text end |
|||||
new text begin
This appropriation is from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(694,938,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
|
|
new text begin
(i) Alternative Care new text end |
new text begin
247,000 new text end |
|||||
|
new text begin
(j) Consolidated Chemical Dependency Treatment Fund (CCDTF) Entitlement new text end |
new text begin
(57,578,000) new text end |
|||||
new text begin Subd. 3. new text end
new text begin
Technical Activities
|
new text begin
6,000 new text end |
|||||
new text begin
This appropriation is from the federal TANF
fund.
new text end
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
Sections 1 and 2 are effective the day following final enactment.
new text end
ARTICLE 21
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2022" and "2023" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2022, or June 30, 2023, respectively.
"The first year" is fiscal year 2022. "The second year" is fiscal year 2023. "The biennium"
is fiscal years 2022 and 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
9,011,308,000 new text end |
new text begin
$ new text end |
new text begin
9,578,488,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
7,927,777,000 new text end |
new text begin
8,453,146,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,299,000 new text end |
new text begin
4,299,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
792,153,000 new text end |
new text begin
837,210,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
282,623,000 new text end |
new text begin
278,803,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,896,000 new text end |
new text begin
1,896,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,560,000 new text end |
new text begin
2,560,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
TANF Maintenance of Effort
|
||||||
new text begin
(a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
new text end
new text begin
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end
new text begin
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end
new text begin
(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end
new text begin
(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
new text end
new text begin
(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end
new text begin
(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
new text end
new text begin
(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end
new text begin
(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end
new text begin
(b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end
new text begin
(c) Certain Expenditures Required. The
commissioner shall ensure that the MOE used
by the commissioner of management and
budget for the February and November
forecasts required under Minnesota Statutes,
section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 16
percent of the total required under Code of
Federal Regulations, title 45, section 263.1.
new text end
new text begin
(d) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
new text end
new text begin
(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end
new text begin
(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end
new text begin
(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section
261.43(a)(2).
new text end
new text begin
(e) Supplemental Expenditures. For the
purposes of paragraph (d), the commissioner
may supplement the MOE claim with working
family credit expenditures or other qualified
expenditures to the extent such expenditures
are otherwise available after considering the
expenditures allowed in this subdivision.
new text end
new text begin
(f) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
new text end
new text begin
(g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
new text end
new text begin
(i) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2022 and 2023 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
171,957,000 new text end |
new text begin
167,757,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,174,000 new text end |
new text begin
4,174,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
16,966,000 new text end |
new text begin
16,966,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
100,000 new text end |
new text begin
100,000 new text end |
new text begin
(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end
new text begin
(1) Minnesota Statutes, section 125A.744,
subdivision 3;
new text end
new text begin
(2) Minnesota Statutes, section 245.495,
paragraph (b);
new text end
new text begin
(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end
new text begin
(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end
new text begin
(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
new text end
new text begin
(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end
new text begin
(b) Background Studies. (1) $2,074,000 in
fiscal year 2022 is from the general fund to
provide a credit to providers who paid for
emergency background studies in NETStudy
2.0.
new text end
new text begin
(2) $2,061,000 in fiscal year 2022 is from the
general fund to cover the costs of reprocessing
emergency studies conducted under
interagency agreements with other agencies.
new text end
new text begin
(c) Personal Care Assistance Compensation
for Services Provided by a Parent or
Spouse. $349,000 in fiscal year 2022 is from
the general fund for compensation for personal
care assistance services provided by a parent
or spouse under Laws 2020, Fifth Special
Session chapter 3, article 10, section 3, as
amended.
new text end
new text begin
(d) Family Foster Setting Background
Studies. $338,000 in fiscal year 2022 and
$349,000 in fiscal year 2023 are from the
general fund for costs related to implementing
and administering licensed family foster
setting background study requirements.
new text end
new text begin
(e) Cultural and Ethnic Communities
Leadership Council. $18,000 in fiscal year
2022 and $62,000 in fiscal year 2023 are from
the general fund for the Cultural and Ethnic
Communities Leadership Council.
new text end
new text begin
(f) Ombudsperson for Child Care
Providers. $120,000 in fiscal year 2022 and
$126,000 in fiscal year 2023 are for an
ombudsperson for child care providers under
Minnesota Statutes, section 119B.27.
new text end
new text begin
(g) Base Level Adjustment. The general fund
base is $164,210,000 in fiscal year 2024 and
$163,029,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Children and Families
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,382,000 new text end |
new text begin
18,407,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
2,582,000 new text end |
new text begin
2,582,000 new text end |
new text begin
(a) Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 in fiscal
year 2022 and $310,000 in fiscal year 2023
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $18,677,000 in fiscal year 2024 and
$18,677,000 in fiscal year 2025.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
26,282,000 new text end |
new text begin
24,142,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
30,168,000 new text end |
new text begin
28,168,000 new text end |
new text begin
(a) new text begin Case Management Benefit Study for
American Indians.new text end $200,000 in fiscal year
2022 is from the general fund for a contract
to conduct fiscal analysis and development of
standards for a targeted case management
benefit for American Indians. The
commissioner of human services must consult
the Minnesota Indian Affairs Council in the
development of any request for proposal and
in the evaluation of responses. This is a
onetime appropriation. Any unencumbered
balance remaining from the first year does not
cancel and is available for the second year of
the biennium.
new text end
new text begin
(b) Integrated Care for High-Risk Pregnant
Women Grant Program. $106,000 in fiscal
year 2022 and $122,000 in fiscal year 2023
are from the general fund for administration
of the integrated care for high-risk pregnant
women grant program under Minnesota
Statutes, section 256B.79.
new text end
new text begin
(c) Studies on Health Care Delivery.
$700,000 in fiscal year 2022 and $300,000 in
fiscal year 2023 are from the general fund for
the commissioner of human services to
develop a legislative proposal for a public
option program and to compare and report to
the legislature on delivery and payment system
models to deliver services to MinnesotaCare
enrollees and certain medical assistance
enrollees.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is $24,186,000 in fiscal year 2024 and
$24,184,000 in fiscal year 2025.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Continuing Care for
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,873,000 new text end |
new text begin
18,900,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
125,000 new text end |
new text begin
125,000 new text end |
new text begin
(a) Assisted Living Survey. $2,593,000 in
fiscal year 2022 and $2,593,000 in fiscal year
2023 are from the general fund for
development and administration of a resident
experience survey and family survey for all
assisted living facilities according to
Minnesota Statutes, section 256B.439,
subdivision 3c. These appropriations are
available in either year of the biennium.
new text end
new text begin
(b) new text begin Base Level Adjustment.new text end The general fund
base is $18,859,000 in fiscal year 2024 and
$18,900,000 in fiscal year 2025.
new text end
new text begin Subd. 7. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
36,794,000 new text end |
new text begin
36,346,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
163,000 new text end |
new text begin
163,000 new text end |
|
new text begin
Opioid Epidemic Response new text end |
new text begin
60,000 new text end |
new text begin
60,000 new text end |
new text begin
(a) Study of Self Directed Tiered Wage
Structure. $25,000 in fiscal year 2022 is from
the general fund for a study of the feasibility
of a tiered wage structure for individual
providers. This is a onetime appropriation.
This appropriation is available only if the labor
agreement between the state of Minnesota and
the Service Employees International Union
Healthcare Minnesota under Minnesota
Statutes, section 179A.54, is approved under
Minnesota Statutes, section 3.855.
new text end
new text begin
(b) Substance Use Disorder Treatment
Paperwork Reduction. $234,000 in fiscal
year 2022 and $201,000 in fiscal year 2023
are from the general fund for a contract with
a vendor to develop, assess, and recommend
systems improvements to minimize regulatory
paperwork and improve systems for licensed
substance use disorder programs. This is a
onetime appropriation.
new text end
new text begin
(c) Case Management and Substance Use
Disorder Treatment Rate Methodology
Analysis. $500,000 in fiscal year 2022 and
$200,000 in fiscal year 2023 are from the
general fund for the fiscal analysis needed to
establish federally compliant payment
methodologies for all medical
assistance-funded case management services,
including substance use disorder treatment
rates. This is a onetime appropriation.
new text end
new text begin
(d) Substance Use Disorder Community of
Practice. $250,000 in fiscal year 2022 and
$250,000 in fiscal year 2023 are from the
general fund for the commissioner of human
services to establish and administer the
substance use disorder community of practice,
including providing compensation for
community of practice participants.
new text end
new text begin
(e) Sober Housing Program
Recommendations Development. $90,000
in fiscal year 2022 is from the general fund
for developing recommendations related to
sober housing programs and completing and
submitting a report on the recommendations
to the legislature.
new text end
new text begin
(f) new text begin Base Level Adjustment.new text end The general fund
base is $34,257,000 in fiscal year 2024 and
$34,289,000 in fiscal year 2025. The opiate
epidemic response fund base is $60,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
92,588,000 new text end |
new text begin
91,668,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
104,285,000 new text end |
new text begin
101,410,000 new text end |
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; MFIP Child Care
|
new text begin
103,347,000 new text end |
new text begin
110,788,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; General
|
new text begin
53,574,000 new text end |
new text begin
52,835,000 new text end |
||||
new text begin
(a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
new text end
new text begin
(b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2022 and $6,729,812
in fiscal year 2023. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
new text end
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
51,779,000 new text end |
new text begin
52,486,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
184,005,000 new text end |
new text begin
191,966,000 new text end |
||||
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Northstar Care
|
new text begin
110,583,000 new text end |
new text begin
121,246,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
113,474,000 new text end |
new text begin
159,610,000 new text end |
||||
new text begin
new text begin Generally.new text end This appropriation is from the
health care access fund.
new text end
new text begin Subd. 15. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
6,041,715,000 new text end |
new text begin
6,553,284,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
628,080,000 new text end |
new text begin
629,001,000 new text end |
new text begin
(a) Behavioral Health Services. $1,000,000
in fiscal year 2022 and $1,000,000 in fiscal
year 2023 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
new text end
new text begin
(b) Base Level Adjustment. The health care
access fund base is $604,758,000 in fiscal year
2024 and $604,758,000 in fiscal year 2025.
new text end
new text begin Subd. 16. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
45,669,000 new text end |
new text begin
45,656,000 new text end |
||||
new text begin
new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end
new text begin Subd. 17. new text end
new text begin
Forecasted Programs; Behavioral
|
new text begin
132,377,000 new text end |
new text begin
116,706,000 new text end |
||||
new text begin
(a) Grants to Tribal Governments.
$28,873,377 in fiscal year 2022 is from the
general fund to satisfy the value of
overpayments owed by the Leech Lake Band
of Ojibwe and White Earth Band of Chippewa
to repay overpayments for medication-assisted
treatment services between fiscal year 2014
and fiscal year 2019. The grant to the Leech
Lake Band of Ojibwe shall be $14,666,122
and the grant to the White Earth Band of
Chippewa shall be $14,207,215. This is a
onetime appropriation.
new text end
new text begin
(b) Institutions for Mental Disease
Payments. $8,328,000 in fiscal year 2022 is
from the general fund for the commissioner
of human services to reimburse counties for
the amount identified by the commissioner for
the statewide county share of costs for which
federal funds were claimed, but were not
eligible for federal funding for substance use
disorder services provided in institutions for
mental disease, for claims paid between
January 1, 2014, and June 30, 2019. The
commissioner of human services shall allocate
this appropriation between counties in the
amount identified by the department that is
owed by each county. Prior to a county
receiving reimbursement, the county must pay
in full any unpaid consolidated chemical
dependency treatment fund invoiced county
share. This is a onetime appropriation.
new text end
new text begin Subd. 18. new text end
new text begin
Grant Programs; Support Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
8,715,000 new text end |
new text begin
8,715,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
96,312,000 new text end |
new text begin
96,311,000 new text end |
new text begin Subd. 19. new text end
new text begin
Grant Programs; BSF Child Care
|
new text begin
53,350,000 new text end |
new text begin
53,362,000 new text end |
||||
new text begin
Base Level Adjustment. The general fund
base is $53,366,000 in fiscal year 2024 and
$53,366,000 in fiscal year 2025.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Child Care
|
new text begin
2,317,000 new text end |
new text begin
2,257,000 new text end |
||||
new text begin
(a) TEACH Grant Program. $500,000 in
fiscal year 2022 and $500,000 in fiscal year
2023 are for TEACH program grants under
Minnesota Statutes, section 136A.128.
new text end
new text begin
(b) Peer Mentoring Program for Licensed
Family Child Care Providers. $30,000 in
fiscal year 2022 and $20,000 in fiscal year
2023 are for a grant to the Minnesota Child
Care Provider Information Network for
establishing a peer mentoring program for
licensed family child care providers in the
state. The grant money must be used to revise
and update peer mentoring program curricula,
recruit and train mentors and program
participants, and support mentors and active
mentoring. The Minnesota Child Care
Provider Information Network must submit
to the commissioner an initial report
describing the program's implementation
progress and financial accounting by
September 1, 2022, and a final report must be
submitted by June 30, 2023. Any unexpended
balance in the first year does not cancel and
is available in the second year. This is a
onetime appropriation.
new text end
new text begin
(c) Report on Foster Children Participation
in Early Childhood Programs. $50,000 in
fiscal year 2022 is for interim and final reports
on foster children's participation in early
childhood programs. This is a onetime
appropriation and is available until June 30,
2023.
new text end
new text begin
(d) Child Care Center Regulation
Modernization. $577,000 in fiscal year 2022
and $741,000 in fiscal year 2023 are for the
child care center regulation modernization
project. This is a onetime appropriation and
remains available until June 30, 2024.
new text end
new text begin
(e) Family Child Care Regulation
Modernization. $478,000 in fiscal year 2022
and $642,000 in fiscal year 2023 are for the
family child care regulation modernization
project. This is a onetime appropriation and
remains available until June 30, 2024.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is $2,237,000 in fiscal year 2024 and
$2,237,000 in fiscal year 2025.
new text end
new text begin Subd. 21. new text end
new text begin
Grant Programs; Child Support
|
new text begin
50,000 new text end |
new text begin
50,000 new text end |
||||
new text begin Subd. 22. new text end
new text begin
Grant Programs; Children's Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
52,133,000 new text end |
new text begin
51,848,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
140,000 new text end |
new text begin
140,000 new text end |
new text begin
(a) new text begin Title IV-E Adoption Assistance.new text end The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
new text end
new text begin
(b) Indian Child Welfare Training.
$1,012,000 in fiscal year 2022 and $993,000
in fiscal year 2023 are from the general fund
for the establishment and operation of the
Tribal Training and Certification Partnership
at the University of Minnesota-Duluth to
provide training, establish federal Indian Child
Welfare Act and Minnesota Family
Preservation Act training requirements for
county child welfare workers, and develop
indigenous child welfare training for American
Indian Tribes. The base for this appropriation
is $1,053,000 in fiscal year 2024 and
$1,053,000 in fiscal year 2025.
new text end
new text begin
(c) Parent Support for Better Outcomes
Grants. $150,000 in fiscal year 2022 and
$150,000 in fiscal year 2023 are from the
general fund for grants to Minnesota One-Stop
for Communities to provide mentoring,
guidance, and support services to parents
navigating the child welfare system in
Minnesota, in order to promote the
development of safe, stable, and healthy
families. Grant money may be used for parent
mentoring, peer-to-peer support groups,
housing support services, training, staffing,
and administrative costs.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Children and
|
new text begin
60,251,000 new text end |
new text begin
60,856,000 new text end |
||||
new text begin Subd. 24. new text end
new text begin
Grant Programs; Children and
|
new text begin
34,040,000 new text end |
new text begin
34,040,000 new text end |
||||
new text begin
(a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2022 do not
cancel but are available for this purpose in
fiscal year 2023.
new text end
new text begin
(b) Emergency Shelters. $2,500,000 in fiscal
year 2022 and $2,500,000 in fiscal year 2023
are for short-term housing facilities to increase
the supply and improve the condition of
shelters for individuals and families without
a permanent residence. The commissioner
shall ensure that a portion of the funds are
expended to provide for short-term housing
facilities for tribes and shall ensure equitable
geographic distribution of funds. This
appropriation is available until June 30, 2026.
new text end
new text begin
(c) Emergency Services Grants. $9,000,000
in fiscal year 2022 and $9,000,000 in fiscal
year 2023 are to provide emergency services
grants under Minnesota Statutes, section
256E.36.
new text end
new text begin Subd. 25. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
4,811,000 new text end |
new text begin
4,811,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
3,465,000 new text end |
new text begin
3,465,000 new text end |
new text begin
Integrated Care for High Risk Pregnancies
Initiative. $1,100,000 in fiscal year 2022 and
$1,100,000 in fiscal year 2023 are from the
general fund for the commissioner of human
services to enter into a contract with the
Integrated Care for High Risk Pregnancies
(ICHRP) initiative to provide support to the
integrated care for high-risk pregnant women
grant program under Minnesota Statutes,
section 256B.79.
new text end
new text begin Subd. 26. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
1,925,000 new text end |
new text begin
1,925,000 new text end |
||||
new text begin Subd. 27. new text end
new text begin
Grant Programs; Aging and Adult
|
new text begin
32,495,000 new text end |
new text begin
32,495,000 new text end |
||||
new text begin Subd. 28. new text end
new text begin
Grant Programs; Deaf and
|
new text begin
2,886,000 new text end |
new text begin
2,886,000 new text end |
||||
new text begin Subd. 29. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
20,251,000 new text end |
new text begin
18,863,000 new text end |
||||
new text begin
Training Stipends for Direct Support
Services Providers. $1,000,000 in fiscal year
2022 is from the general fund for stipends for
individual providers of direct support services
as defined in Minnesota Statutes, section
256B.0711, subdivision 1. These stipends are
available to individual providers who have
completed designated voluntary trainings
made available through the State-Provider
Cooperation Committee formed by the State
of Minnesota and the Service Employees
International Union Healthcare Minnesota.
Any unspent appropriation in fiscal year 2022
is available in fiscal year 2023. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
new text end
new text begin Subd. 30. new text end
new text begin
Grant Programs; Housing Support
|
new text begin
11,364,000 new text end |
new text begin
11,364,000 new text end |
||||
new text begin
Long-Term Homeless Supportive Services.
$1,000,000 in fiscal year 2022 and $1,000,000
in fiscal year 2023 are for long-term homeless
supportive services under Minnesota Statutes,
section 256K.26.
new text end
new text begin Subd. 31. new text end
new text begin
Grant Programs; Adult Mental Health
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
84,073,000 new text end |
new text begin
84,074,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,000,000 new text end |
new text begin
2,000,000 new text end |
new text begin
(a) Culturally and Linguistically
Appropriate Services Implementation
Grants. $750,000 in fiscal year 2022 and
$750,000 in fiscal year 2023 are from the
general fund for grants to substance use
disorder treatment providers to implement
culturally and linguistically appropriate
services standards, according to the
implementation and transition plan developed
by the commissioner. This is a onetime
appropriation.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $83,324,000 in fiscal year 2024 and
$83,324,000 in fiscal year 2025. The opiate
epidemic response fund base is $2,000,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 32. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
28,700,000 new text end |
new text begin
28,680,000 new text end |
||||
new text begin
(a) Children's Residential Facilities.
$2,997,000 in fiscal year 2022 and $2,977,000
in fiscal year 2023 are to reimburse counties
and Tribal governments for a portion of the
costs of treatment in children's residential
facilities. The commissioner shall distribute
the appropriation on an annual basis to
counties and Tribal governments
proportionally based on a methodology
developed by the commissioner. Of this
appropriation, $100,000 in fiscal year 2022
and $100,000 in fiscal year 2023 are available
to the commissioner for administrative
expenses and $70,000 in fiscal year 2022 is
available to the commissioner for the
children's mental health residential treatment
work group.
new text end
new text begin
(b) new text begin Base Level Adjustment.new text end The general fund
base is $28,702,000 in fiscal year 2024 and
$28,702,000 in fiscal year 2025.
new text end
new text begin Subd. 33. new text end
new text begin
Grant Programs; Chemical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
2,846,000 new text end |
new text begin
2,845,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,733,000 new text end |
new text begin
1,733,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
500,000 new text end |
new text begin
500,000 new text end |
new text begin
(a) Problem Gambling. $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
new text end
new text begin
(b) Recovery Community Organization
Grants. $573,000 in fiscal year 2022 and
$571,000 in fiscal year 2023 are from the
general fund for grants to recovery community
organizations, as defined in Minnesota
Statutes, section 254B.01, subdivision 8, to
provide for costs and community-based peer
recovery support services that are not
otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05, as part
of the continuum of care for substance use
disorders.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $2,636,000 in fiscal year 2024 and
$2,636,000 in fiscal year 2025. The opiate
epidemic response fund base is $500,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 34. new text end
new text begin
Direct Care and Treatment -
|
||||||
new text begin
new text begin Transfer Authority.new text end Money appropriated to
budget activities under this subdivision and
subdivisions 35 to 39 may be transferred
between budget activities and between years
of the biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 35. new text end
new text begin
Direct Care and Treatment - Mental
|
new text begin
139,946,000 new text end |
new text begin
144,103,000 new text end |
||||
new text begin
(a) Transfer Authority. Money appropriated
to support the continued operations of the
Community Addiction Recovery Enterprise
(C.A.R.E.) program may be transferred to the
enterprise fund for C.A.R.E.
new text end
new text begin
(b) Operating Adjustment. $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 are for the Community Addiction
Recovery Enterprise program. The
commissioner may transfer $2,307,000 in
fiscal year 2022 and $2,453,000 in fiscal year
2023 to the enterprise fund for Community
Addiction Recovery Enterprise.
new text end
new text begin Subd. 36. new text end
new text begin
Direct Care and Treatment -
|
new text begin
18,771,000 new text end |
new text begin
19,752,000 new text end |
||||
new text begin
(a) Transfer Authority. Money appropriated
to support the continued operations of the
Minnesota State Operated Community
Services (MSOCS) program may be
transferred to the enterprise fund for MSOCS.
new text end
new text begin
(b) Operating Adjustment. $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 are for the Minnesota State Operated
Community Services program. The
commissioner may transfer $1,519,000 in
fiscal year 2022 and $2,541,000 in fiscal year
2023 to the enterprise fund for Minnesota State
Operated Community Services.
new text end
new text begin Subd. 37. new text end
new text begin
Direct Care and Treatment - Forensic
|
new text begin
119,854,000 new text end |
new text begin
122,206,000 new text end |
||||
new text begin Subd. 38. new text end
new text begin
Direct Care and Treatment - Sex
|
new text begin
97,570,000 new text end |
new text begin
99,917,000 new text end |
||||
new text begin
new text begin Transfer Authority.new text end Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 39. new text end
new text begin
Direct Care and Treatment -
|
new text begin
63,504,000 new text end |
new text begin
65,910,000 new text end |
||||
new text begin Subd. 40. new text end
new text begin
Technical Activities
|
new text begin
79,204,000 new text end |
new text begin
78,260,000 new text end |
||||
new text begin
(a) Generally. This appropriation is from the
federal TANF fund.
new text end
new text begin
(b) Base Level Adjustment. The TANF fund
base is $71,493,000 in fiscal year 2024 and
$71,493,000 in fiscal year 2025.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
269,395,000 new text end |
new text begin
$ new text end |
new text begin
261,903,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
166,359,000 new text end |
new text begin
160,576,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
54,465,000 new text end |
new text begin
53,356,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,858,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
123,719,000 new text end |
new text begin
122,714,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
9,103,000 new text end |
new text begin
7,777,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,858,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2022 and $3,579,000 in fiscal year
2023 are from the TANF fund for home
visiting and nutritional services listed under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
new text end
new text begin
(2) $2,000,000 in fiscal year 2022 and
$2,000,000 in fiscal year 2023 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
new text end
new text begin
(3) $4,978,000 in fiscal year 2022 and
$4,978,000 in fiscal year 2023 are from the
TANF fund for the family home visiting grant
program according to Minnesota Statutes,
section 145A.17. $4,000,000 of the funding
in each fiscal year must be distributed to
community health boards according to
Minnesota Statutes, section 145A.131,
subdivision 1. $978,000 of the funding in each
fiscal year must be distributed to tribal
governments according to Minnesota Statutes,
section 145A.14, subdivision 2a;
new text end
new text begin
(4) $1,156,000 in fiscal year 2022 and
$1,156,000 in fiscal year 2023 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
new text end
new text begin
(5) the commissioner may use up to 6.23
percent of the funds appropriated from the
TANF fund each fiscal year to conduct the
ongoing evaluations required under Minnesota
Statutes, section 145A.17, subdivision 7, and
training and technical assistance as required
under Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end
new text begin
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
new text end
new text begin
(c) Maternal Death Studies. $198,000 in
fiscal year 2022 and $198,000 in fiscal year
2023 are from the general fund to be used to
conduct maternal death studies under
Minnesota Statutes, section 145.901.
new text end
new text begin
(d) Comprehensive Advanced Life Support
Educational Program. $100,000 in fiscal
year 2022 and $100,000 in fiscal year 2023
are from the general fund for the
comprehensive advanced life support
educational program under Minnesota Statutes,
section 144.6062. This is a onetime
appropriation.
new text end
new text begin
(e) Local Public Health Grants. $7,500,000
in fiscal year 2022 and $7,500,000 in fiscal
year 2023 are from the general fund for local
public health grants under Minnesota Statutes,
section 145A.131.
new text end
new text begin
(f) Public Health Infrastructure and Health
Equity and Outreach. $7,500,000 in fiscal
year 2022 and $7,500,000 in fiscal year 2023
are from the general fund for purposes of
Minnesota Statutes, sections 144.0661 to
144.0663, and to build public health
infrastructure at the state and local levels to
address current and future public health
emergencies, conduct outreach to underserved
communities in the state experiencing health
disparities, and build systems at the state and
local levels with the goals of reducing and
eliminating health disparities in these
communities. A community health board or
local unit of government must use any funds
provided under this paragraph to supplement
and not supplant local funds being used for
public health purposes.
new text end
new text begin
(g) Mental Health Cultural Community
Continuing Education. $500,000 in fiscal
year 2022 and $500,000 in fiscal year 2023
are from the general fund for the mental health
cultural community continuing education grant
program.
new text end
new text begin
(h) Health Professional Education Loan
Forgiveness Program. $3,000,000 in fiscal
year 2022 and $3,000,000 in fiscal year 2023
are from the general fund for loan forgiveness
under the health professional education loan
forgiveness program under Minnesota Statutes,
section 144.1501, for individuals who: (1) are
eligible alcohol and drug counselors or eligible
mental health professionals, as defined in
Minnesota Statutes, section 144.1501,
subdivision 1; and (2) are Black, indigenous,
or people of color, or members of an
underrepresented community as defined in
Minnesota Statutes, section 148E.010,
subdivision 20. Loan forgiveness shall be
provided according to this paragraph
notwithstanding the priorities and distribution
requirements for loan forgiveness in
Minnesota Statutes, section 144.1501.
new text end
new text begin
(i) Birth Records; Homeless Youth. $72,000
in fiscal year 2022 and $32,000 in fiscal year
2023 are from the general fund for
administration and issuance of certified birth
records and statements of no vital record found
to homeless youth under Minnesota Statutes,
section 144.2255.
new text end
new text begin
(j) Trauma-Informed Gun Violence
Reduction Pilot Program. $100,000 in fiscal
year 2022 is from the general fund for the
trauma-informed gun violence reduction pilot
program.
new text end
new text begin
(k) Home Visiting for Pregnant Women and
Families with Young Children. $5,000,000
in fiscal year 2022 and $5,000,000 in fiscal
year 2023 are from the general fund for grants
for home visiting services under Minnesota
Statutes, section 145.87.
new text end
new text begin
(l) Supporting Healthy Development of
Babies During Pregnancy and Postpartum.
$279,000 in fiscal year 2022 and $279,000 in
fiscal year 2023 are from the general fund for
a grant to the Amherst H. Wilder Foundation
for the African American Babies Coalition
initiative for community-driven training and
education on best practices to support healthy
development of babies during pregnancy and
postpartum. Grant funds must be used to build
capacity in, train, educate, or improve
practices among individuals, from youth to
elders, serving families with members who
are Black, indigenous, or people of color,
during pregnancy and postpartum. Of this
appropriation, $19,000 in fiscal year 2022 and
$19,000 in fiscal year 2023 are for the
commissioner to use for administration. This
is a onetime appropriation. Any unexpended
balance in the first year of the biennium does
not cancel and is available in the second year
of the biennium.
new text end
new text begin
(m) Dignity in Pregnancy and Childbirth.
$1,695,000 in fiscal year 2022 and $908,000
in fiscal year 2023 are from the general fund
for purposes of Minnesota Statutes, section
144.1461, subdivision 2. Of this appropriation,
$845,000 in fiscal year 2022 is for a grant to
the University of Minnesota School of Public
Health's Center for Antiracism Research for
Health Equity, to develop a model curriculum
on anti-racism and implicit bias for use by
hospitals with obstetric care and birth centers
to provide continuing education to staff caring
for pregnant or postpartum women. The model
curriculum must be evidence-based and must
meet the criteria in Minnesota Statutes, section
144.1461, subdivision 2, paragraph (a). The
base for this appropriation is $907,000 in fiscal
year 2024 and $860,000 in fiscal year 2025.
new text end
new text begin
(n) Midwife and Doula Care. $500,000 in
fiscal year 2022 and $500,000 in fiscal year
2023 are from the general fund for purposes
of Minnesota Statutes, section 144.1461,
subdivision 3.
new text end
new text begin
(o) Recommendations to Expand Access to
Data from the All-Payer Claims Database.
$55,000 in fiscal year 2022 is from the general
fund for the commissioner to develop
recommendations to expand access to data
from the all-payer claims database under
Minnesota Statutes, section 62U.04, to
additional outside entities for public health or
research purposes.
new text end
new text begin
(p) Base Level Adjustments. The general
fund base is $120,834,000 in fiscal year 2024
and $120,787,000 in fiscal year 2025. The
state government special revenue fund base is
$7,777,000 in fiscal year 2024 and $7,777,000
in fiscal year 2025. The health care access
fund base is $36,858,000 in fiscal year 2024
and $36,258,000 in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
31,070,000 new text end |
new text begin
26,283,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
45,362,000 new text end |
new text begin
45,579,000 new text end |
new text begin
(a) Lead Risk Assessments and Lead
Orders. $1,530,000 in fiscal year 2022 and
$1,314,000 in fiscal year 2023 are from the
general fund for implementation of the
requirements for conducting lead risk
assessments under Minnesota Statutes, section
144.9504, subdivision 2, and for issuance of
lead orders under Minnesota Statutes, section
144.9504, subdivision 5.
new text end
new text begin
(b) Hospital Closure or Curtailment of
Operations. $10,000 in fiscal year 2022 and
$1,000 in fiscal year 2023 are from the general
fund for purposes of Minnesota Statutes,
section 144.555, subdivisions 1a, 1b, and 2.
new text end
new text begin
(c) Transfer; Public Health Response
Contingency Account. The commissioner
shall transfer $4,343,000 in fiscal year 2022
from the general fund to the public health
response contingency account established in
Minnesota Statutes, section 144.4199. This is
a onetime transfer.
new text end
new text begin
(d) Skin Lightening Products Public
Awareness and Education Grant Program.
$100,000 in fiscal year 2022 and $100,000 in
fiscal year 2023 are from the general fund for
a skin lightening products public awareness
and education grant program. This is a onetime
appropriation.
new text end
new text begin
(e) Base Level Adjustments. The general
fund base is $26,183,000 in fiscal year 2024
and $26,183,000 in fiscal year 2025. The state
government special revenue fund base is
$45,579,000 in fiscal year 2024 and
$45,579,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Health Operations
|
new text begin
11,570,000 new text end |
new text begin
11,579,000 new text end |
||||
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
27,535,000 new text end |
new text begin
$ new text end |
new text begin
26,960,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
State Government Special Revenue new text end |
new text begin
27,459,000 new text end |
new text begin
26,884,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Behavioral Health and
|
new text begin
877,000 new text end |
new text begin
875,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Chiropractic Examiners
|
new text begin
666,000 new text end |
new text begin
666,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Dentistry
|
new text begin
4,228,000 new text end |
new text begin
3,753,000 new text end |
||||
new text begin
(a) Administrative Services Unit - Operating
Costs. Of this appropriation, $2,738,000 in
fiscal year 2022 and $2,263,000 in fiscal year
2023 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end
new text begin
(b) Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2022
and $150,000 in fiscal year 2023 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end
new text begin
(c) Administrative Services Unit -
Retirement Costs. Of this appropriation,
$475,000 in fiscal year 2022 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.
new text end
new text begin
(d) Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2022
and $200,000 in fiscal year 2023 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
new text end
new text begin Subd. 5. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
164,000 new text end |
new text begin
164,000 new text end |
||||
new text begin Subd. 6. new text end
new text begin
Board of Executives for Long Term
|
new text begin
693,000 new text end |
new text begin
635,000 new text end |
||||
new text begin Subd. 7. new text end
new text begin
Board of Marriage and Family Therapy
|
new text begin
413,000 new text end |
new text begin
410,000 new text end |
||||
new text begin Subd. 8. new text end
new text begin
Board of Medical Practice
|
new text begin
5,912,000 new text end |
new text begin
5,868,000 new text end |
||||
new text begin
Health Professional Services Program. This
appropriation includes $1,002,000 in fiscal
year 2022 and $1,002,000 in fiscal year 2023
for the health professional services program.
new text end
new text begin Subd. 9. new text end
new text begin
Board of Nursing
|
new text begin
5,345,000 new text end |
new text begin
5,355,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Board of Occupational Therapy
|
new text begin
456,000 new text end |
new text begin
456,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Board of Optometry
|
new text begin
238,000 new text end |
new text begin
238,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Board of Pharmacy
|
new text begin
4,479,000 new text end |
new text begin
4,479,000 new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
State Government Special Revenue new text end |
new text begin
4,403,000 new text end |
new text begin
4,403,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
Base Level Adjustment. The health care
access fund base is $76,000 in fiscal year
2024, $38,000 in fiscal year 2025, and $0 in
fiscal year 2026.
new text end
new text begin Subd. 13. new text end
new text begin
Board of Physical Therapy
|
new text begin
564,000 new text end |
new text begin
564,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Board of Podiatric Medicine
|
new text begin
214,000 new text end |
new text begin
214,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Board of Psychology
|
new text begin
1,362,000 new text end |
new text begin
1,360,000 new text end |
||||
new text begin Subd. 16. new text end
new text begin
Board of Social Work
|
new text begin
1,561,000 new text end |
new text begin
1,560,000 new text end |
||||
new text begin Subd. 17. new text end
new text begin
Board of Veterinary Medicine
|
new text begin
363,000 new text end |
new text begin
363,000 new text end |
||||
Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
4,453,000 new text end |
new text begin
$ new text end |
new text begin
3,829,000 new text end |
||
new text begin
(a) Cooper/Sams Volunteer Ambulance
Program. $950,000 in fiscal year 2022 and
$950,000 in fiscal year 2023 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
new text end
new text begin
(1) Of this amount, $861,000 in fiscal year
2022 and $861,000 in fiscal year 2023 are for
the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40.
new text end
new text begin
(2) Of this amount, $89,000 in fiscal year 2022
and $89,000 in fiscal year 2023 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
new text end
new text begin
(b) EMSRB Operations. $1,880,000 in fiscal
year 2022 and $1,880,000 in fiscal year 2023
are for board operations.
new text end
new text begin
(c) Regional Grants. $1,235,000 in fiscal year
2022 and $585,000 in fiscal year 2023 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.
new text end
new text begin
(d) Ambulance Training Grants. $361,000
in fiscal year 2022 and $361,000 in fiscal year
2023 are for training grants under Minnesota
Statutes, section 144E.35.
new text end
Sec. 6. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
1,022,000 new text end |
new text begin
$ new text end |
new text begin
1,038,000 new text end |
||
Sec. 7. new text begin OMBUDSMAN FOR MENTAL
|
new text begin
$ new text end |
new text begin
2,487,000 new text end |
new text begin
$ new text end |
new text begin
2,536,000 new text end |
||
new text begin
Department of Psychiatry Monitoring.
$100,000 in fiscal year 2022 and $100,000 in
fiscal year 2023 are for monitoring the
Department of Psychiatry at the University of
Minnesota.
new text end
Sec. 8. new text begin OMBUDSPERSONS FOR FAMILIES
|
new text begin
$ new text end |
new text begin
968,000 new text end |
new text begin
$ new text end |
new text begin
992,000 new text end |
||
Sec. 9. new text begin ATTORNEY GENERAL
|
new text begin
$ new text end |
new text begin
200,000 new text end |
new text begin
$ new text end |
new text begin
200,000 new text end |
||
new text begin
Excessive Drug Price Increases. This
appropriation is for costs of expert witnesses
and investigations under Minnesota Statutes,
section 62J.844. This is a onetime
appropriation.
new text end
Sec. 10.
Laws 2019, First Special Session chapter 9, article 14, section 3, as amended by
Laws 2019, First Special Session chapter 12, section 6, is amended to read:
Sec. 3. COMMISSIONER OF HEALTH
|
||||||
Subdivision 1.Total Appropriation
|
$ |
231,829,000 |
$ |
deleted text begin
236,188,000
deleted text end
new text begin
233,584,000 new text end |
||
| Appropriations by Fund |
||
| 2020 |
2021 |
|
| General |
124,381,000 |
deleted text begin 126,276,000deleted text end new text begin 125,881,000 new text end |
| State Government Special Revenue |
58,450,000 |
deleted text begin
61,367,000
deleted text end
new text begin
59,158,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
Subd. 2.Health Improvement
|
||||||
| Appropriations by Fund |
||
| General |
94,980,000 |
deleted text begin 96,117,000deleted text end new text begin 95,722,000 new text end |
| State Government Special Revenue |
7,614,000 |
deleted text begin
7,558,000
deleted text end
new text begin
6,924,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2020 and $3,579,000 in fiscal year
2021 are from the TANF fund for home
visiting and nutritional services under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
(2) $2,000,000 in fiscal year 2020 and
$2,000,000 in fiscal year 2021 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
(3) $4,978,000 in fiscal year 2020 and
$4,978,000 in fiscal year 2021 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 of the funding in each
fiscal year must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding in each fiscal year must be
distributed to tribal governments according to
Minnesota Statutes, section 145A.14,
subdivision 2a;
(4) $1,156,000 in fiscal year 2020 and
$1,156,000 in fiscal year 2021 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
(5) The commissioner may use up to 6.23
percent of the amounts appropriated from the
TANF fund each year to conduct the ongoing
evaluations required under Minnesota Statutes,
section 145A.17, subdivision 7, and training
and technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
(c) Comprehensive Suicide Prevention.
$2,730,000 in fiscal year 2020 and $2,730,000
in fiscal year 2021 are from the general fund
for a comprehensive, community-based suicide
prevention strategy. The funds are allocated
as follows:
(1) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are for community-based
suicide prevention grants authorized in
Minnesota Statutes, section 145.56,
subdivision 2. Specific emphasis must be
placed on those communities with the greatest
disparities. The base for this appropriation is
$1,291,000 in fiscal year 2022 and $1,291,000
in fiscal year 2023;
(2) $683,000 in fiscal year 2020 and $683,000
in fiscal year 2021 are to support
evidence-based training for educators and
school staff and purchase suicide prevention
curriculum for student use statewide, as
authorized in Minnesota Statutes, section
145.56, subdivision 2. The base for this
appropriation is $913,000 in fiscal year 2022
and $913,000 in fiscal year 2023;
(3) $137,000 in fiscal year 2020 and $137,000
in fiscal year 2021 are to implement the Zero
Suicide framework with up to 20 behavioral
and health care organizations each year to treat
individuals at risk for suicide and support
those individuals across systems of care upon
discharge. The base for this appropriation is
$205,000 in fiscal year 2022 and $205,000 in
fiscal year 2023;
(4) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are to develop and fund a
Minnesota-based network of National Suicide
Prevention Lifeline, providing statewide
coverage. The base for this appropriation is
$1,321,000 in fiscal year 2022 and $1,321,000
in fiscal year 2023; and
(5) the commissioner may retain up to 18.23
percent of the appropriation under this
paragraph to administer the comprehensive
suicide prevention strategy.
(d) Statewide Tobacco Cessation. $1,598,000
in fiscal year 2020 and $2,748,000 in fiscal
year 2021 are from the general fund for
statewide tobacco cessation services under
Minnesota Statutes, section 144.397. The base
for this appropriation is $2,878,000 in fiscal
year 2022 and $2,878,000 in fiscal year 2023.
(e) Health Care Access Survey. $225,000 in
fiscal year 2020 and $225,000 in fiscal year
2021 are from the health care access fund to
continue and improve the Minnesota Health
Care Access Survey. These appropriations
may be used in either year of the biennium.
(f) Community Solutions for Healthy Child
Development Grant Program. $1,000,000
in fiscal year 2020 and $1,000,000 in fiscal
year 2021 are for the community solutions for
healthy child development grant program to
promote health and racial equity for young
children and their families under article 11,
section 107. The commissioner may use up to
23.5 percent of the total appropriation for
administration. The base for this appropriation
is $1,000,000 in fiscal year 2022, $1,000,000
in fiscal year 2023, and $0 in fiscal year 2024.
(g) Domestic Violence and Sexual Assault
Prevention Program. $375,000 in fiscal year
2020 and $375,000 in fiscal year 2021 are
from the general fund for the domestic
violence and sexual assault prevention
program under article 11, section 108. This is
a onetime appropriation.
(h) Skin Lightening Products Public
Awareness Grant Program. $100,000 in
fiscal year 2020 and $100,000 in fiscal year
2021 are from the general fund for a skin
lightening products public awareness and
education grant program. This is a onetime
appropriation.
(i) Cannabinoid Products Workgroup.
$8,000 in fiscal year 2020 is from the state
government special revenue fund for the
cannabinoid products workgroup. This is a
onetime appropriation.
(j) Base Level Adjustments. The general fund
base is $96,742,000 in fiscal year 2022 and
$96,742,000 in fiscal year 2023. The health
care access fund base is $37,432,000 in fiscal
year 2022 and $36,832,000 in fiscal year 2023.
Subd. 3.Health Protection
|
||||||
| Appropriations by Fund |
||
| General |
18,803,000 |
19,774,000 |
| State Government Special Revenue |
50,836,000 |
deleted text begin
53,809,000
deleted text end
new text begin
52,234,000 new text end |
(a) Public Health Laboratory Equipment.
$840,000 in fiscal year 2020 and $655,000 in
fiscal year 2021 are from the general fund for
equipment for the public health laboratory.
This is a onetime appropriation and is
available until June 30, 2023.
(b) Base Level Adjustment. The general fund
base is $19,119,000 in fiscal year 2022 and
$19,119,000 in fiscal year 2023. The state
government special revenue fund base is
$53,782,000 in fiscal year 2022 and
$53,782,000 in fiscal year 2023.
Subd. 4.Health Operations
|
10,598,000 |
10,385,000 |
||||
Base Level Adjustment. The general fund
base is $10,912,000 in fiscal year 2022 and
$10,912,000 in fiscal year 2023.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
the reductions in subdivisions 1 to 3 are onetime reductions.
new text end
Sec. 11. new text begin APPROPRIATION; MINNESOTA FAMILY INVESTMENT PROGRAM
SUPPLEMENTAL PAYMENT.
new text end
new text begin
$24,235,000 in fiscal year 2021 is appropriated from the TANF fund to the commissioner
of human services to provide a onetime cash benefit of up to $750 for each household
enrolled in the Minnesota family investment program or diversionary work program under
Minnesota Statutes, chapter 256J, at the time that the cash benefit is distributed. The
commissioner shall distribute these funds through existing systems and in a manner that
minimizes the burden to families. This is a onetime appropriation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12. new text begin APPROPRIATION; MINNESOTACARE PREMIUMS.
new text end
new text begin
$108,000 in fiscal year 2021 is appropriated from the general fund and $44,000 in fiscal
year 2021 is appropriated from the health care access fund to the commissioner of human
services to implement changes to MinnesotaCare premiums.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13. new text begin APPROPRIATION; PERSONAL CARE ASSISTANCE PROGRAM
INTEGRITY.
new text end
new text begin
The cost of the personal care assistance program integrity changes under Minnesota
Statutes, section 256B.0659, subdivisions 11b, 14a, 21, and 24, are paid for by reducing
the Department of Human Services operating adjustment in section 2, subdivision 3, by
$1,500,000 in each year of the 2022-2023 biennium.
new text end
Sec. 14. new text begin APPROPRIATION; REFINANCING OF EMERGENCY CHILD CARE
GRANTS; CANCELLATION.
new text end
new text begin
$26,622,626 in fiscal year 2021 is appropriated from the coronavirus relief federal fund
to the commissioner of human services for fiscal year 2020 to replace a portion of the general
fund appropriation in Laws 2020, chapter 71, article 1, section 2, subdivision 9. The general
fund appropriation that is replaced by coronavirus relief funds under this section is canceled
to the general fund. This is a onetime appropriation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15. new text begin CANCELLATION; TRANSFER FROM STATE GOVERNMENT SPECIAL
REVENUE FUND TO GENERAL FUND.
new text end
new text begin
The $77,000 transfer each year from the state government special revenue fund to the
general fund under Laws 2008, chapter 364, section 17, paragraph (b), is canceled. This
section does not expire.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 30, 2021.
new text end
Sec. 16. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; CHILD
CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION.
new text end
new text begin
(a) The commissioner of human services shall allocate $212,400,000 from the child care
and development block grant amount in the federal fund as follows:
new text end
new text begin
(1) $1,435,000 for the quality rating and improvement system's evaluation and equity
report under Minnesota Statutes, section 124D.142, subdivisions 3 and 4; and
new text end
new text begin
(2) the remaining amount to reprioritize the basic sliding fee program waiting list under
Minnesota Statutes, section 119B.03, to increase child care assistance rates for legal,
nonlicensed family child care providers under Minnesota Statutes, section 119B.13,
subdivision 1a, and to increase child care assistance rates under Minnesota Statutes, section
119B.13, subdivision 1, paragraph (a), to the 50th percentile of the most recent market rate
survey. The commissioner may not increase the rate differential percentage established
under Minnesota Statutes, section 119B.13, subdivision 3a or 3b.
new text end
new text begin
(b) Each year, an amount equal to at least 88 percent of the federal discretionary funding
in the Child Care and Development Block Grant of 2014, Public Law 113-186, in federal
fiscal year 2018 above the amounts authorized in federal fiscal year 2017, not to exceed the
cost of rate adjustments, shall be allocated to pay the cost of rate adjustments based on the
most recent market survey.
new text end
new text begin
(c) When increased federal discretionary child care and development block grant funding
is used to pay for the rate increase under paragraph (a), the commissioner, in consultation
with the commissioner of management and budget, may adjust the amount of working family
credit expenditures as needed to meet the state's maintenance of effort requirements for the
TANF block grant.
new text end
Sec. 17. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; CHILD
CARE STABILIZATION.
new text end
new text begin
The commissioner shall allocate $325,000,000 from the child care and development
block grant amount in the federal fund for the following purposes:
new text end
new text begin
(1) $1,500,000 for the Children's Cabinet to conduct an evaluation of the use of federal
money on early care and learning programs;
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new text begin
(2) $500,000 to award grants to community-based organizations working with family,
friend, and neighbor caregivers, with a particular emphasis on such caregivers serving
children from low-income families, families of color, Tribal communities, or families with
limited English language proficiency, to promote healthy development, social-emotional
learning, early literacy, and school readiness;
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new text begin
(3) $100,000 for a grant program to test strategies by which family child care providers
could share services;
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new text begin
(4) $500,000 for competitive grants to expand access to child care for children with
disabilities;
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new text begin
(5) $5,000,000 for child care improvement grants under Minnesota Statutes, section
119B.25;
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new text begin
(6) $5,000,000 for administering the monthly grants under clause (7); and
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new text begin
(7) the remaining amount to award monthly grants, between July 1, 2021, and June 30,
2023, to providers of early care and education to support the stability of the sector with
providers required to direct 75 percent of such grants to employees or other individuals
providing early care and education services.
new text end
Sec. 18. new text begin FEDERAL FUNDS FOR VACCINE ACTIVITIES.
new text end
new text begin
To the extent that federal funds are available for vaccine activities, the commissioner
of health may use those funds to support work under Minnesota Statutes, sections 144.067
to 144.069.
new text end
Sec. 19. new text begin FEDERAL FUNDS REPLACEMENT; APPROPRIATION.
new text end
new text begin
Notwithstanding any law to the contrary, the commissioner of management and budget
must determine whether the expenditures authorized under this act are eligible uses of federal
funding received under the Coronavirus State Fiscal Recovery Fund or any other federal
funds received by the state under the American Rescue Plan Act, Public Law 117-2. If the
commissioner of management and budget determines an expenditure is eligible for funding
under Public Law 117-2, the amount of the eligible expenditure is appropriated from the
account where those amounts have been deposited and the corresponding general fund
amounts appropriated under this act are canceled to the general fund.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20. new text begin TRANSFERS; HUMAN SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Grants. new text end
new text begin
The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2023, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid program, group residential housing
program, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health Finance and Policy Committee and Human Services
Finance and Policy Committee quarterly about transfers made under this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
Positions, salary money, and nonsalary administrative money
may be transferred within the Department of Human Services as the commissioners consider
necessary, with the advance approval of the commissioner of management and budget. The
commissioner shall inform the chairs and ranking minority members of the senate Health
and Human Services Finance Division and the house of representatives Health Finance and
Policy Committee and Human Services Finance and Policy Committee quarterly about
transfers made under this subdivision.
new text end
Sec. 21. new text begin TRANSFERS; HEALTH.
new text end
new text begin
Positions, salary money, and nonsalary administrative money may be transferred within
the Department of Health as the commissioner considers necessary, with the advance
approval of the commissioner of management and budget. The commissioner shall inform
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services finance quarterly about transfers made under this section.
new text end
Sec. 22. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end
new text begin
The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
new text end
Sec. 23. new text begin APPROPRIATION ENACTED MORE THAN ONCE.
new text end
new text begin
If an appropriation in this act is enacted more than once in the 2021 legislative session,
the appropriation must be given effect only once.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2023, unless a
different expiration date is explicit.
new text end
Sec. 25. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 16A.724, subdivision 2,
new text end
new text begin
is repealed effective June 30,
2025.
new text end
Sec. 26. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2021, unless a different effective date is specified.
new text end
APPENDIX
Repealed Minnesota Statutes: H2128-4
16A.724 HEALTH CARE ACCESS FUND.
Subd. 2.
Transfers.
(a) Notwithstanding section 295.581, to the extent available resources in the health care access fund exceed expenditures in that fund, effective for the biennium beginning July 1, 2007, the commissioner of management and budget shall transfer the excess funds from the health care access fund to the general fund on June 30 of each year, provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet the rate increase required under section 256B.04, subdivision 25.
(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if necessary, the commissioner shall reduce these transfers from the health care access fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer sufficient funds from the general fund to the health care access fund to meet annual MinnesotaCare expenditures.
62A.67 SHORT TITLE.
Sections 62A.67 to 62A.672 may be cited as the "Minnesota Telemedicine Act."
62A.671 DEFINITIONS.
Subdivision 1.
Applicability.
For purposes of sections 62A.67 to 62A.672, the terms defined in this section have the meanings given.
Subd. 2.
Distant site.
"Distant site" means a site at which a licensed health care provider is located while providing health care services or consultations by means of telemedicine.
Subd. 3.
Health care provider.
"Health care provider" has the meaning provided in section 62A.63, subdivision 2.
Subd. 4.
Health carrier.
"Health carrier" has the meaning provided in section 62A.011, subdivision 2.
Subd. 5.
Health plan.
"Health plan" means a health plan as defined in section 62A.011, subdivision 3, and includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental plans that provide indemnity-based benefits, regardless of expenses incurred and are designed to pay benefits directly to the policyholder.
Subd. 6.
Licensed health care provider.
"Licensed health care provider" means a health care provider who is:
(1) licensed under chapter 147, 147A, 148, 148B, 148E, 148F, 150A, or 153; a mental health professional as defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; or vendor of medical care defined in section 256B.02, subdivision 7; and
(2) authorized within their respective scope of practice to provide the particular service with no supervision or under general supervision.
Subd. 7.
Originating site.
"Originating site" means a site including, but not limited to, a health care facility at which a patient is located at the time health care services are provided to the patient by means of telemedicine.
Subd. 8.
Store-and-forward technology.
"Store-and-forward technology" means the transmission of a patient's medical information from an originating site to a health care provider at a distant site without the patient being present, or the delivery of telemedicine that does not occur in real time via synchronous transmissions.
Subd. 9.
Telemedicine.
"Telemedicine" means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. A communication between a licensed health care provider and a patient that consists solely of an e-mail or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care.
62A.672 COVERAGE OF TELEMEDICINE SERVICES.
Subdivision 1.
Coverage of telemedicine.
(a) A health plan sold, issued, or renewed by a health carrier for which coverage of benefits begins on or after January 1, 2017, shall include coverage for telemedicine benefits in the same manner as any other benefits covered under the policy, plan, or contract, and shall comply with the regulations of this section.
(b) Nothing in this section shall be construed to:
(1) require a health carrier to provide coverage for services that are not medically necessary;
(2) prohibit a health carrier from establishing criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service via telemedicine for which the health carrier does not already reimburse other health care providers for delivering via telemedicine, so long as the criteria are not unduly burdensome or unreasonable for the particular service; or
(3) prevent a health carrier from requiring a health care provider to agree to certain documentation or billing practices designed to protect the health carrier or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular service.
Subd. 2.
Parity between telemedicine and in-person services.
A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and a patient.
Subd. 3.
Reimbursement for telemedicine services.
(a) A health carrier shall reimburse the distant site licensed health care provider for covered services delivered via telemedicine on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered in person by the distant site licensed health care provider.
(b) It is not a violation of this subdivision for a health carrier to include a deductible, co-payment, or coinsurance requirement for a health care service provided via telemedicine, provided that the deductible, co-payment, or coinsurance is not in addition to, and does not exceed, the deductible, co-payment, or coinsurance applicable if the same services were provided through in-person contact.
62J.63 CENTER FOR HEALTH CARE PURCHASING IMPROVEMENT.
Subd. 3.
Report.
The commissioner of health must report annually to the legislature and the governor on the operations, activities, and impacts of the center. The report must be posted on the Department of Health website and must be available to the public. The report must include a description of the state's efforts to develop and use more common strategies for health care performance measurement and health care purchasing. The report must also include an assessment of the impacts of these efforts, especially in promoting greater transparency of health care costs and quality, and greater accountability for health care results and improvement.
119B.125 PROVIDER REQUIREMENTS.
Subd. 5.
Provisional payment.
After a county receives a completed application from a provider, the county may issue provisional authorization and payment to the provider during the time needed to determine whether to give final authorization to the provider.
144.0721 ASSESSMENTS OF CARE AND SERVICES TO NURSING HOME RESIDENTS.
Subdivision 1.
Appropriateness and quality.
Until the date of implementation of the revised case mix system based on the minimum data set, the commissioner of health shall assess the appropriateness and quality of care and services furnished to private paying residents in nursing homes and boarding care homes that are certified for participation in the medical assistance program under United States Code, title 42, sections 1396-1396p. These assessments shall be conducted until the date of implementation of the revised case mix system with the exception of provisions requiring recommendations for changes in the level of care provided to the private paying residents.
144.0722 RESIDENT REIMBURSEMENT CLASSIFICATIONS.
Subdivision 1.
Resident reimbursement classifications.
The commissioner of health shall establish resident reimbursement classifications based upon the assessments of residents of nursing homes and boarding care homes conducted under section 144.0721, or under rules established by the commissioner of human services under chapter 256R. The reimbursement classifications established by the commissioner must conform to the rules established by the commissioner of human services.
Subd. 2.
Notice of resident reimbursement classification.
The commissioner of health shall notify each resident, and the nursing home or boarding care home in which the resident resides, of the reimbursement classification established under subdivision 1. The notice must inform the resident of the classification that was assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the commissioner, and the opportunity to request a reconsideration of the classification. The notice of resident classification must be sent by first-class mail. The individual resident notices may be sent to the resident's nursing home or boarding care home for distribution to the resident. The nursing home or boarding care home is responsible for the distribution of the notice to each resident, to the person responsible for the payment of the resident's nursing home expenses, or to another person designated by the resident. This notice must be distributed within three working days after the facility's receipt of the notices from the department.
Subd. 2a.
Semiannual assessment by nursing facilities.
Notwithstanding Minnesota Rules, part 9549.0059, subpart 2, item B, the individual dependencies items 21 to 24 and 28 are required to be completed in accordance with the Facility Manual for Completing Case Mix Requests for Classification, July 1987, issued by the Minnesota Department of Health.
Subd. 3.
Request for reconsideration.
The resident or the nursing home or boarding care home may request that the commissioner reconsider the assigned reimbursement classification. The request for reconsideration must be submitted in writing to the commissioner within 30 days of the receipt of the notice of resident classification. For reconsideration requests submitted by or on behalf of the resident, the time period for submission of the request begins as of the date the resident or the resident's representative receives the classification notice. The request for reconsideration must include the name of the resident, the name and address of the facility in which the resident resides, the reasons for the reconsideration, the requested classification changes, and documentation supporting the requested classification. The documentation accompanying the reconsideration request is limited to documentation establishing that the needs of the resident at the time of the assessment resulting in the disputed classification justify a change of classification.
Subd. 3a.
Access to information.
Upon written request, the nursing home or boarding care home must give the resident or the resident's representative a copy of the assessment form and the other documentation that was given to the department to support the assessment findings. The nursing home or boarding care home shall also provide access to and a copy of other information from the resident's record that has been requested by or on behalf of the resident to support a resident's reconsideration request. A copy of any requested material must be provided within three working days of receipt of a written request for the information. If a facility fails to provide the material within this time, it is subject to the issuance of a correction order and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order issued under this subdivision must require that the facility immediately comply with the request for information and that as of the date of the issuance of the correction order, the facility shall forfeit to the state a $100 fine the first day of noncompliance, and an increase in the $100 fine by $50 increments for each day the noncompliance continues. For the purposes of this section, "representative" includes the resident's guardian or conservator, the person authorized to pay the nursing home expenses of the resident, a representative of the nursing home ombudsman's office whose assistance has been requested, or any other individual designated by the resident.
Subd. 3b.
Facility's request for reconsideration.
In addition to the information required in subdivision 3, a reconsideration request from a nursing home or boarding care home must contain the following information: the date the resident reimbursement classification notices were received by the facility; the date the classification notices were distributed to the resident or the resident's representative; and a copy of a notice sent to the resident or to the resident's representative. This notice must tell the resident or the resident's representative that a reconsideration of the resident's classification is being requested, the reason for the request, that the resident's rate will change if the request is approved by the department and the extent of the change, that copies of the facility's request and supporting documentation are available for review, and that the resident also has the right to request a reconsideration. If the facility fails to provide this information with the reconsideration request, the request must be denied, and the facility may not make further reconsideration requests on that specific reimbursement classification.
Subd. 4.
Reconsideration.
The commissioner's reconsideration must be made by individuals not involved in reviewing the assessment that established the disputed classification. The reconsideration must be based upon the initial assessment and upon the information provided to the commissioner under subdivision 3. If necessary for evaluating the reconsideration request, the commissioner may conduct on-site reviews. In its discretion, the commissioner may review the reimbursement classifications assigned to all residents in the facility. Within 15 working days of receiving the request for reconsideration, the commissioner shall affirm or modify the original resident classification. The original classification must be modified if the commissioner determines that the assessment resulting in the classification did not accurately reflect the needs of the resident at the time of the assessment. The resident and the nursing home or boarding care home shall be notified within five working days after the decision is made. The commissioner's decision under this subdivision is the final administrative decision of the agency.
Subd. 5.
Audit authority.
The Department of Health may audit assessments of nursing home and boarding care home residents. These audits may be in addition to the assessments completed by the department under section 144.0721. The audits may be conducted at the facility, and the department may conduct the audits on an unannounced basis.
144.0724 RESIDENT REIMBURSEMENT CLASSIFICATION.
Subd. 10.
Transition.
After implementation of this section, reconsiderations requested for classifications made under section 144.0722, subdivision 1, shall be determined under section 144.0722, subdivision 3.
144.693 MEDICAL MALPRACTICE CLAIMS; REPORTS.
Subdivision 1.
Insurers' reports to commissioner.
On or before September 1, 1976, and on or before March 1 and September 1 of each year thereafter, each insurer providing professional liability insurance to one or more hospitals, outpatient surgery centers, or health maintenance organizations, shall submit to the state commissioner of health a report listing by facility or organization all claims which have been closed by or filed with the insurer during the period ending December 31 of the previous year or June 30 of the current year. The report shall contain, but not be limited to, the following information:
(1) the total number of claims made against each facility or organization which were filed or closed during the reporting period;
(2) the date each new claim was filed with the insurer;
(3) the allegations contained in each claim filed during the reporting period;
(4) the disposition and closing date of each claim closed during the reporting period;
(5) the dollar amount of the award or settlement for each claim closed during the reporting period; and
(6) any other information the commissioner of health may, by rule, require.
Any hospital, outpatient surgery center, or health maintenance organization which is self insured shall be considered to be an insurer for the purposes of this section and shall comply with the reporting provisions of this section.
A report from an insurer submitted pursuant to this section is private data, as defined in section 13.02, subdivision 12, accessible to the facility or organization which is the subject of the data, and to its authorized agents. Any data relating to patient records which is reported to the state commissioner of health pursuant to this section shall be reported in the form of summary data, as defined in section 13.02, subdivision 19.
Subd. 2.
Report to legislature.
The state commissioner of health shall collect and review the data reported pursuant to subdivision 1. On December 1, 1976, and on January 2 of each year thereafter, the state commissioner of health shall report to the legislature the findings related to the incidence and size of malpractice claims against hospitals, outpatient surgery centers, and health maintenance organizations, and shall make any appropriate recommendations to reduce the incidence and size of the claims. Data published by the state commissioner of health pursuant to this subdivision with respect to malpractice claims information shall be summary data within the meaning of section 13.02, subdivision 19.
Subd. 3.
Access to insurers' records.
The state commissioner of health shall have access to the records of any insurer relating to malpractice claims made against hospitals, outpatient surgery centers, and health maintenance organizations in years prior to 1976 if the commissioner determines the records are necessary to fulfill the duties of the commissioner under Laws 1976, chapter 325.
245.462 DEFINITIONS.
Subd. 4a.
Clinical supervision.
"Clinical supervision" means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager. Clinical supervision must be accomplished by full or part-time employment of or contracts with mental health professionals. Clinical supervision must be documented by the mental health professional cosigning individual treatment plans and by entries in the client's record regarding supervisory activities.
245.4871 DEFINITIONS.
Subd. 32a.
Responsible social services agency.
"Responsible social services agency" is defined in section 260C.007, subdivision 27a.
245.4879 EMERGENCY SERVICES.
Subd. 2.
Specific requirements.
(a) The county board shall require that all service providers of emergency services to the child with an emotional disturbance provide immediate direct access to a mental health professional during regular business hours. For evenings, weekends, and holidays, the service may be by direct toll-free telephone access to a mental health professional, a mental health practitioner, or until January 1, 1991, a designated person with training in human services who receives clinical supervision from a mental health professional.
(b) The commissioner may waive the requirement in paragraph (a) that the evening, weekend, and holiday service be provided by a mental health professional or mental health practitioner after January 1, 1991, if the county documents that:
(1) mental health professionals or mental health practitioners are unavailable to provide this service;
(2) services are provided by a designated person with training in human services who receives clinical supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the evening, weekend, and holiday service not be provided by the provider of fire and public safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least eight hours of training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive at least four hours of continued training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(3) the local social service agency has provided public education about available emergency mental health services and can assure potential users of emergency services that their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) When emergency service during nonbusiness hours is provided by anyone other than a mental health professional, a mental health professional must be available on call for an emergency assessment and crisis intervention services, and must be available for at least telephone consultation within 30 minutes.
245.62 COMMUNITY MENTAL HEALTH CENTER.
Subd. 3.
Clinical supervisor.
All community mental health center services shall be provided under the clinical supervision of a licensed psychologist licensed under sections 148.88 to 148.98, or a physician who is board certified or eligible for board certification in psychiatry, and who is licensed under section 147.02.
Subd. 4.
Rules.
The commissioner shall promulgate rules to establish standards for the designation of an agency as a community mental health center. These standards shall include, but are not limited to:
(1) provision of mental health services in the prevention, identification, treatment and aftercare of emotional disorders, chronic and acute mental illness, developmental disabilities, and alcohol and drug abuse and dependency, including the services listed in section 245.61 except detoxification services;
(2) establishment of a community mental health center board pursuant to section 245.66; and
(3) approval pursuant to section 245.69, subdivision 2.
245.69 ADDITIONAL DUTIES OF COMMISSIONER.
Subd. 2.
Approval of centers and clinics.
The commissioner of human services has the authority to approve or disapprove public and private mental health centers and public and private mental health clinics for the purposes of section 62A.152, subdivision 2. For the purposes of this subdivision the commissioner shall promulgate rules in accordance with sections 14.001 to 14.69. The rules shall require each applicant to pay a fee to cover costs of processing applications and determining compliance with the rules and this subdivision. The commissioner may contract with any state agency, individual, corporation or association to which the commissioner shall delegate all but final approval and disapproval authority to determine compliance or noncompliance.
(a) Each approved mental health center and each approved mental health clinic shall have a multidisciplinary team of professional staff persons as required by rule. A mental health center or mental health clinic may provide the staffing required by rule by means of written contracts with professional persons or with other health care providers. Any personnel qualifications developed by rule shall be consistent with any personnel standards developed pursuant to chapter 214.
(b) Each approved mental health clinic and each approved mental health center shall establish a written treatment plan for each outpatient for whom services are reimbursable through insurance or public assistance. The treatment plan shall be developed in accordance with the rules and shall include a patient history, treatment goals, a statement of diagnosis and a treatment strategy. The clinic or center shall provide access to hospital admission as a bed patient as needed by any outpatient. The clinic or center shall ensure ongoing consultation among and availability of all members of the multidisciplinary team.
(c) As part of the required consultation, members of the multidisciplinary team shall meet at least twice monthly to conduct case reviews, peer consultations, treatment plan development and in-depth case discussion. Written minutes of these meetings shall be kept at the clinic or center for three years.
(d) Each approved center or clinic shall establish mechanisms for quality assurance and submit documentation concerning the mechanisms to the commissioner as required by rule, including:
(1) continuing education of each professional staff person;
(2) an ongoing internal utilization and peer review plan and procedures;
(3) mechanisms of staff supervision; and
(4) procedures for review by the commissioner or a delegate.
(e) The commissioner shall disapprove an applicant, or withdraw approval of a clinic or center, which the commissioner finds does not comply with the requirements of the rules or this subdivision. A clinic or center which is disapproved or whose approval is withdrawn is entitled to a contested case hearing and judicial review pursuant to sections 14.01 to 14.69.
(f) Data on individuals collected by approved clinics and centers, including written minutes of team meetings, is private data on individuals within the welfare system as provided in chapter 13.
(g) Each center or clinic that is approved and in compliance with the commissioner's existing rule on July 1, 1980, is approved for purposes of section 62A.152, subdivision 2, until rules are promulgated to implement this section.
245.735 EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROJECT.
Subdivision 1.
Excellence in Mental Health demonstration project.
The commissioner shall develop and execute projects to reform the mental health system by participating in the Excellence in Mental Health demonstration project.
Subd. 2.
Federal proposal.
The commissioner shall develop and submit to the United States Department of Health and Human Services a proposal for the Excellence in Mental Health demonstration project. The proposal shall include any necessary state plan amendments, waivers, requests for new funding, realignment of existing funding, and other authority necessary to implement the projects specified in subdivision 3.
Subd. 4.
Public participation.
In developing and implementing CCBHCs under subdivision 3, the commissioner shall consult, collaborate, and partner with stakeholders, including but not limited to mental health providers, substance use disorder treatment providers, advocacy organizations, licensed mental health professionals, counties, tribes, hospitals, other health care providers, and Minnesota public health care program enrollees who receive mental health services and their families.
245C.10 BACKGROUND STUDY; FEES.
Subd. 2.
Supplemental nursing services agencies.
The commissioner shall recover the cost of the background studies initiated by supplemental nursing services agencies registered under section 144A.71, subdivision 1, through a fee of no more than $20 per study charged to the agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 2a.
Occupations regulated by commissioner of health.
The commissioner shall set fees to recover the cost of combined background studies and criminal background checks initiated by applicants, licensees, and certified practitioners regulated under sections 148.511 to 148.5198 and chapter 153A. The fees collected under this subdivision shall be deposited in the special revenue fund and are appropriated to the commissioner for the purpose of conducting background studies and criminal background checks.
Subd. 3.
Personal care provider organizations.
The commissioner shall recover the cost of background studies initiated by a personal care provider organization under sections 256B.0651 to 256B.0654 and 256B.0659 through a fee of no more than $20 per study charged to the organization responsible for submitting the background study form. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 4.
Temporary personnel agencies, educational programs, and professional services agencies.
The commissioner shall recover the cost of the background studies initiated by temporary personnel agencies, educational programs, and professional services agencies that initiate background studies under section 245C.03, subdivision 4, through a fee of no more than $20 per study charged to the agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 5.
Adult foster care and family adult day services.
The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 1, for the purposes of adult foster care and family adult day services licensing, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 6.
Unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities.
The commissioner shall recover the cost of background studies initiated by unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities under section 256B.4912 through a fee of no more than $20 per study.
Subd. 7.
Private agencies.
The commissioner shall recover the cost of conducting background studies under section 245C.33 for studies initiated by private agencies for the purpose of adoption through a fee of no more than $70 per study charged to the private agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 8.
Children's therapeutic services and supports providers.
The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 7, for the purposes of children's therapeutic services and supports under section 256B.0943, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 9.
Human services licensed programs.
The commissioner shall recover the cost of background studies required under section 245C.03, subdivision 1, for all programs that are licensed by the commissioner, except child foster care when the applicant or license holder resides in the home where child foster care services are provided, family child care, child care centers, certified license-exempt child care centers, and legal nonlicensed child care authorized under chapter 119B, through a fee of no more than $20 per study charged to the license holder. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 9a.
Child care programs.
The commissioner shall recover the cost of a background study required for family child care, certified license-exempt child care centers, licensed child care centers, and legal nonlicensed child care providers authorized under chapter 119B through a fee of no more than $40 per study charged to the license holder. A fee of no more than $20 per study shall be charged for studies conducted under section 245C.05, subdivision 5a, paragraph (a). The fees collected under this subdivision are appropriated to the commissioner to conduct background studies.
Subd. 10.
Community first services and supports organizations.
The commissioner shall recover the cost of background studies initiated by an agency-provider delivering services under section 256B.85, subdivision 11, or a financial management services provider providing service functions under section 256B.85, subdivision 13, through a fee of no more than $20 per study, charged to the organization responsible for submitting the background study form. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 11.
Providers of housing support.
The commissioner shall recover the cost of background studies initiated by providers of housing support under section 256I.04 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 12.
Child protection workers or social services staff having responsibility for child protective duties.
The commissioner shall recover the cost of background studies initiated by county social services agencies and local welfare agencies for individuals who are required to have a background study under section 626.559, subdivision 1b, through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 13.
Providers of special transportation service.
The commissioner shall recover the cost of background studies initiated by providers of special transportation service under section 174.30 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
Subd. 14.
Children's residential facilities.
The commissioner shall recover the cost of background studies initiated by a licensed children's residential facility through a fee of no more than $51 per study. Fees collected under this subdivision are appropriated to the commissioner for purposes of conducting background studies.
Subd. 16.
Providers of housing support services.
The commissioner shall recover the cost of background studies initiated by providers of housing support services under section 256B.051 through a fee of no more than $20 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.
256B.0596 MENTAL HEALTH CASE MANAGEMENT.
256B.0596 MENTAL HEALTH CASE MANAGEMENT.
Counties shall contract with eligible providers willing to provide mental health case management services under section 256B.0625, subdivision 20. In order to be eligible, in addition to general provider requirements under this chapter, the provider must:
(1) be willing to provide the mental health case management services; and
(2) have a minimum of at least one contact with the client per week. This section is not intended to limit the ability of a county to provide its own mental health case management services.
256B.0596 MENTAL HEALTH CASE MANAGEMENT.
Counties shall contract with eligible providers willing to provide mental health case management services under section 256B.0625, subdivision 20. In order to be eligible, in addition to general provider requirements under this chapter, the provider must:
(1) be willing to provide the mental health case management services; and
(2) have a minimum of at least one contact with the client per week. This section is not intended to limit the ability of a county to provide its own mental health case management services.
256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified peer specialist program model, which:
(1) provides nonclinical peer support counseling by certified peer specialists;
(2) provides a part of a wraparound continuum of services in conjunction with other community mental health services;
(3) is individualized to the consumer; and
(4) promotes socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.
256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified family peer specialists program model which:
(1) provides nonclinical family peer support counseling, building on the strengths of families and helping them achieve desired outcomes;
(2) collaborates with others providing care or support to the family;
(3) provides nonadversarial advocacy;
(4) promotes the individual family culture in the treatment milieu;
(5) links parents to other parents in the community;
(6) offers support and encouragement;
(7) assists parents in developing coping mechanisms and problem-solving skills;
(8) promotes resiliency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services;
(9) establishes and provides peer-led parent support groups; and
(10) increases the child's ability to function better within the child's home, school, and community by educating parents on community resources, assisting with problem solving, and educating parents on mental illnesses.
256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.
Subd. 3.
Eligibility for intensive residential treatment services.
An eligible client for intensive residential treatment services is an individual who:
(1) is age 18 or older;
(2) is eligible for medical assistance;
(3) is diagnosed with a mental illness;
(4) because of a mental illness, has substantial disability and functional impairment in three or more of the areas listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced;
(5) has one or more of the following: a history of recurring or prolonged inpatient hospitalizations in the past year, significant independent living instability, homelessness, or very frequent use of mental health and related services yielding poor outcomes; and
(6) in the written opinion of a licensed mental health professional, has the need for mental health services that cannot be met with other available community-based services, or is likely to experience a mental health crisis or require a more restrictive setting if intensive rehabilitative mental health services are not provided.
Subd. 5a.
Standards for intensive residential rehabilitative mental health services.
(a) The standards in this subdivision apply to intensive residential mental health services.
(b) The provider of intensive residential treatment services must have sufficient staff to provide 24-hour-per-day coverage to deliver the rehabilitative services described in the treatment plan and to safely supervise and direct the activities of clients, given the client's level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider must have the capacity within the facility to provide integrated services for chemical dependency, illness management services, and family education, when appropriate.
(c) At a minimum:
(1) staff must provide direction and supervision whenever clients are present in the facility;
(2) staff must remain awake during all work hours;
(3) there must be a staffing ratio of at least one to nine clients for each day and evening shift. If more than nine clients are present at the residential site, there must be a minimum of two staff during day and evening shifts, one of whom must be a mental health practitioner or mental health professional;
(4) if services are provided to clients who need the services of a medical professional, the provider shall ensure that these services are provided either by the provider's own medical staff or through referral to a medical professional; and
(5) the provider must ensure the timely availability of a licensed registered nurse, either directly employed or under contract, who is responsible for ensuring the effectiveness and safety of medication administration in the facility and assessing clients for medication side effects and drug interactions.
(d) Services must be provided by qualified staff as defined in section 256B.0623, subdivision 5, who are trained and supervised according to section 256B.0623, subdivision 6, except that mental health rehabilitation workers acting as overnight staff are not required to comply with section 256B.0623, subdivision 5, paragraph (a), clause (4), item (iv).
(e) The clinical supervisor must be an active member of the intensive residential services treatment team. The team must meet with the clinical supervisor at least weekly to discuss clients' progress and make rapid adjustments to meet clients' needs. The team meeting shall include client-specific case reviews and general treatment discussions among team members. Client-specific case reviews and planning must be documented in the client's treatment record.
(f) Treatment staff must have prompt access in person or by telephone to a mental health practitioner or mental health professional. The provider must have the capacity to promptly and appropriately respond to emergent needs and make any necessary staffing adjustments to ensure the health and safety of clients.
(g) The initial functional assessment must be completed within ten days of intake and updated at least every 30 days, or prior to discharge from the service, whichever comes first.
(h) The initial individual treatment plan must be completed within 24 hours of admission. Within ten days of admission, the initial treatment plan must be refined and further developed, except for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180. The individual treatment plan must be reviewed with the client and updated at least monthly.
256B.0623 ADULT REHABILITATIVE MENTAL HEALTH SERVICES COVERED.
Subd. 7.
Personnel file.
The adult rehabilitative mental health services provider entity must maintain a personnel file on each staff. Each file must contain:
(1) an annual performance review;
(2) a summary of on-site service observations and charting review;
(3) a criminal background check of all direct service staff;
(4) evidence of academic degree and qualifications;
(5) a copy of professional license;
(6) any job performance recognition and disciplinary actions;
(7) any individual staff written input into own personnel file;
(8) all clinical supervision provided; and
(9) documentation of compliance with continuing education requirements.
Subd. 8.
Diagnostic assessment.
Providers of adult rehabilitative mental health services must complete a diagnostic assessment as defined in section 245.462, subdivision 9, within five days after the recipient's second visit or within 30 days after intake, whichever occurs first. In cases where a diagnostic assessment is available that reflects the recipient's current status, and has been completed within three years preceding admission, an adult diagnostic assessment update must be completed. An update shall include a face-to-face interview with the recipient and a written summary by a mental health professional of the recipient's current mental health status and service needs. If the recipient's mental health status has changed significantly since the adult's most recent diagnostic assessment, a new diagnostic assessment is required.
Subd. 10.
Individual treatment plan.
All providers of adult rehabilitative mental health services must develop and implement an individual treatment plan for each recipient. The provisions in clauses (1) and (2) apply:
(1) Individual treatment plan means a plan of intervention, treatment, and services for an individual recipient written by a mental health professional or by a mental health practitioner under the clinical supervision of a mental health professional. The individual treatment plan must be based on diagnostic and functional assessments. To the extent possible, the development and implementation of a treatment plan must be a collaborative process involving the recipient, and with the permission of the recipient, the recipient's family and others in the recipient's support system. Providers of adult rehabilitative mental health services must develop the individual treatment plan within 30 calendar days of intake. The treatment plan must be updated at least every six months thereafter, or more often when there is significant change in the recipient's situation or functioning, or in services or service methods to be used, or at the request of the recipient or the recipient's legal guardian.
(2) The individual treatment plan must include:
(i) a list of problems identified in the assessment;
(ii) the recipient's strengths and resources;
(iii) concrete, measurable goals to be achieved, including time frames for achievement;
(iv) specific objectives directed toward the achievement of each one of the goals;
(v) documentation of participants in the treatment planning. The recipient, if possible, must be a participant. The recipient or the recipient's legal guardian must sign the treatment plan, or documentation must be provided why this was not possible. A copy of the plan must be given to the recipient or legal guardian. Referral to formal services must be arranged, including specific providers where applicable;
(vi) cultural considerations, resources, and needs of the recipient must be included;
(vii) planned frequency and type of services must be initiated; and
(viii) clear progress notes on outcome of goals.
(3) The individual community support plan defined in section 245.462, subdivision 12, may serve as the individual treatment plan if there is involvement of a mental health case manager, and with the approval of the recipient. The individual community support plan must include the criteria in clause (2).
Subd. 11.
Recipient file.
Providers of adult rehabilitative mental health services must maintain a file for each recipient that contains the following information:
(1) diagnostic assessment or verification of its location that is current and that was reviewed by a mental health professional who is employed by or under contract with the provider entity;
(2) functional assessments;
(3) individual treatment plans signed by the recipient and the mental health professional, or if the recipient refused to sign the plan, the date and reason stated by the recipient as to why the recipient would not sign the plan;
(4) recipient history;
(5) signed release forms;
(6) recipient health information and current medications;
(7) emergency contacts for the recipient;
(8) case records which document the date of service, the place of service delivery, signature of the person providing the service, nature, extent and units of service, and place of service delivery;
(9) contacts, direct or by telephone, with recipient's family or others, other providers, or other resources for service coordination;
(10) summary of recipient case reviews by staff; and
(11) written information by the recipient that the recipient requests be included in the file.
256B.0625 COVERED SERVICES.
Subd. 5l.
Intensive mental health outpatient treatment.
Medical assistance covers intensive mental health outpatient treatment for dialectical behavioral therapy. The commissioner shall establish:
(1) certification procedures to ensure that providers of these services are qualified; and
(2) treatment protocols including required service components and criteria for admission, continued treatment, and discharge.
Subd. 18c.
Nonemergency Medical Transportation Advisory Committee.
(a) The Nonemergency Medical Transportation Advisory Committee shall advise the commissioner on the administration of nonemergency medical transportation covered under medical assistance. The advisory committee shall meet at least quarterly the first year following January 1, 2015, and at least biannually thereafter and may meet more frequently as required by the commissioner. The advisory committee shall annually elect a chair from among its members, who shall work with the commissioner or the commissioner's designee to establish the agenda for each meeting. The commissioner, or the commissioner's designee, shall attend all advisory committee meetings.
(b) The Nonemergency Medical Transportation Advisory Committee shall advise and make recommendations to the commissioner on:
(1) updates to the nonemergency medical transportation policy manual;
(2) other aspects of the nonemergency medical transportation system, as requested by the commissioner; and
(3) other aspects of the nonemergency medical transportation system, as requested by:
(i) a committee member, who may request an item to be placed on the agenda for a future meeting. The request may be considered by the committee and voted upon. If the motion carries, the meeting agenda item may be developed for presentation to the committee; and
(ii) a member of the public, who may approach the committee by letter or e-mail requesting that an item be placed on a future meeting agenda. The request may be considered by the committee and voted upon. If the motion carries, the agenda item may be developed for presentation to the committee.
(c) The Nonemergency Medical Transportation Advisory Committee shall coordinate its activities with the Minnesota Council on Transportation Access established under section 174.285. The chair of the advisory committee, or the chair's designee, shall attend all meetings of the Minnesota Council on Transportation Access.
(d) The Nonemergency Medical Transportation Advisory Committee shall expire December 1, 2019.
Subd. 18d.
Advisory committee members.
(a) The Nonemergency Medical Transportation Advisory Committee consists of:
(1) four voting members who represent counties, utilizing the rural urban commuting area classification system. As defined in subdivision 17, these members shall be designated as follows:
(i) two counties within the 11-county metropolitan area;
(ii) one county representing the rural area of the state; and
(iii) one county representing the super rural area of the state.
The Association of Minnesota Counties shall appoint one county within the 11-county metropolitan area and one county representing the super rural area of the state. The Minnesota Inter-County Association shall appoint one county within the 11-county metropolitan area and one county representing the rural area of the state;
(2) three voting members who represent medical assistance recipients, including persons with physical and developmental disabilities, persons with mental illness, seniors, children, and low-income individuals;
(3) five voting members who represent providers that deliver nonemergency medical transportation services to medical assistance enrollees, one of whom is a taxicab owner or operator;
(4) two voting members of the house of representatives, one from the majority party and one from the minority party, appointed by the speaker of the house, and two voting members from the senate, one from the majority party and one from the minority party, appointed by the Subcommittee on Committees of the Committee on Rules and Administration;
(5) one voting member who represents demonstration providers as defined in section 256B.69, subdivision 2;
(6) one voting member who represents an organization that contracts with state or local governments to coordinate transportation services for medical assistance enrollees;
(7) one voting member who represents the Minnesota State Council on Disability;
(8) the commissioner of transportation or the commissioner's designee, who shall serve as a voting member;
(9) one voting member appointed by the Minnesota Ambulance Association; and
(10) one voting member appointed by the Minnesota Hospital Association.
(b) Members of the advisory committee shall not be employed by the Department of Human Services. Members of the advisory committee shall receive no compensation.
Subd. 18e.
Single administrative structure and delivery system.
The commissioner, in coordination with the commissioner of transportation, shall implement a single administrative structure and delivery system for nonemergency medical transportation, beginning the latter of the date the single administrative assessment tool required in this subdivision is available for use, as determined by the commissioner or by July 1, 2016.
In coordination with the Department of Transportation, the commissioner shall develop and authorize a web-based single administrative structure and assessment tool, which must operate 24 hours a day, seven days a week, to facilitate the enrollee assessment process for nonemergency medical transportation services. The web-based tool shall facilitate the transportation eligibility determination process initiated by clients and client advocates; shall include an accessible automated intake and assessment process and real-time identification of level of service eligibility; and shall authorize an appropriate and auditable mode of transportation authorization. The tool shall provide a single framework for reconciling trip information with claiming and collecting complaints regarding inappropriate level of need determinations, inappropriate transportation modes utilized, and interference with accessing nonemergency medical transportation. The web-based single administrative structure shall operate on a trial basis for one year from implementation and, if approved by the commissioner, shall be permanent thereafter. The commissioner shall seek input from the Nonemergency Medical Transportation Advisory Committee to ensure the software is effective and user-friendly and make recommendations regarding funding of the single administrative system.
Subd. 18h.
Managed care.
(a) The following subdivisions apply to managed care plans and county-based purchasing plans:
(1) subdivision 17, paragraphs (a), (b), (i), and (n);
(2) subdivision 18; and
(3) subdivision 18a.
(b) A nonemergency medical transportation provider must comply with the operating standards for special transportation service specified in sections 174.29 to 174.30 and Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire vehicles are exempt from the requirements in this paragraph.
Subd. 35a.
Children's mental health crisis response services.
Medical assistance covers children's mental health crisis response services according to section 256B.0944.
Subd. 35b.
Children's therapeutic services and supports.
Medical assistance covers children's therapeutic services and supports according to section 256B.0943.
Subd. 61.
Family psychoeducation services.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers family psychoeducation services provided to a child up to age 21 with a diagnosed mental health condition when identified in the child's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who has determined it medically necessary to involve family members in the child's care. For the purposes of this subdivision, "family psychoeducation services" means information or demonstration provided to an individual or family as part of an individual, family, multifamily group, or peer group session to explain, educate, and support the child and family in understanding a child's symptoms of mental illness, the impact on the child's development, and needed components of treatment and skill development so that the individual, family, or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental health and long-term resilience.
Subd. 62.
Mental health clinical care consultation.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers clinical care consultation for a person up to age 21 who is diagnosed with a complex mental health condition or a mental health condition that co-occurs with other complex and chronic conditions, when described in the person's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the purposes of this subdivision, "clinical care consultation" means communication from a treating mental health professional to other providers or educators not under the clinical supervision of the treating mental health professional who are working with the same client to inform, inquire, and instruct regarding the client's symptoms; strategies for effective engagement, care, and intervention needs; and treatment expectations across service settings; and to direct and coordinate clinical service components provided to the client and family.
Subd. 65.
Outpatient mental health services.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy according to Minnesota Rules, part 9505.0372, when the mental health services are performed by a mental health practitioner working as a clinical trainee according to section 245.462, subdivision 17, paragraph (g).
256B.0916 EXPANSION OF HOME AND COMMUNITY-BASED SERVICES.
Subd. 2.
Distribution of funds; partnerships.
(a) Beginning with fiscal year 2000, the commissioner shall distribute all funding available for home and community-based waiver services for persons with developmental disabilities to individual counties or to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals. The commissioner shall encourage counties to form partnerships that have a sufficient number of recipients and funding to adequately manage the risk and maximize use of available resources.
(b) Counties must submit a request for funds and a plan for administering the program as required by the commissioner. The plan must identify the number of clients to be served, their ages, and their priority listing based on:
(1) requirements in Minnesota Rules, part 9525.1880; and
(2) statewide priorities identified in section 256B.092, subdivision 12.
The plan must also identify changes made to improve services to eligible persons and to improve program management.
(c) In allocating resources to counties, priority must be given to groups of counties that form partnerships to jointly plan, administer, and authorize funding for eligible individuals and to counties determined by the commissioner to have sufficient waiver capacity to maximize resource use.
(d) Within 30 days after receiving the county request for funds and plans, the commissioner shall provide a written response to the plan that includes the level of resources available to serve additional persons.
(e) Counties are eligible to receive medical assistance administrative reimbursement for administrative costs under criteria established by the commissioner.
(f) The commissioner shall manage waiver allocations in such a manner as to fully use available state and federal waiver appropriations.
Subd. 3.
Failure to develop partnerships or submit a plan.
(a) By October 1 of each year the commissioner shall notify the county board if any county determined by the commissioner to have insufficient capacity to maximize use of available resources fails to develop a partnership with other counties or fails to submit a plan as required in subdivision 2. The commissioner shall provide needed technical assistance to a county or group of counties that fails to form a partnership or submit a plan. If a county has not joined a county partnership or submitted a plan within 30 days following the notice by the commissioner of its failure, the commissioner shall require and assist that county to develop a plan or contract with another county or group of counties to plan and administer the waiver services program in that county.
(b) Counties may request technical assistance, management information, and administrative support from the commissioner at any time. The commissioner shall respond to county requests within 30 days. Priority shall be given to activities that support the administrative needs of newly formed county partnerships.
Subd. 4.
Allowed reserve.
Counties or groups of counties participating in partnerships that have submitted a plan under this section may develop an allowed reserve amount to meet crises and other unmet needs of current home and community-based waiver recipients. The amount of the allowed reserve shall be a county specific amount based upon documented past experience and projected need for the coming year described in an allowed reserve plan submitted for approval to the commissioner with the allocation request for the fiscal year.
Subd. 5.
Allocation of new diversions and priorities for reassignment of resources for developmental disabilities.
(a) The commissioner shall monitor county utilization of allocated resources and, as appropriate, reassign resources not utilized.
(b) Effective July 1, 2002, the commissioner shall authorize the spending of new diversion resources beginning January 1 of each year.
(c) Effective July 1, 2002, the commissioner shall manage the reassignment of waiver resources that occur from persons who have left the waiver in a manner that results in the cost reduction equivalent to delaying the reuse of those waiver resources by 180 days.
(d) Priority consideration for reassignment of resources shall be given to counties that form partnerships. In addition to the priorities listed in Minnesota Rules, part 9525.1880, the commissioner shall also give priority consideration to persons whose living situations are unstable due to the age or incapacity of the primary caregiver and to children to avoid out-of-home placement.
Subd. 8.
Financial and wait-list data reporting.
(a) The commissioner shall make available financial and waiting list information on the department's website.
(b) The financial information must include:
(1) the most recent end of session forecast available for the disability home and community-based waiver programs authorized under sections 256B.092 and 256B.49; and
(2) the most current financial information, updated at least monthly for the disability home and community-based waiver program authorized under section 256B.092 and three disability home and community-based waiver programs authorized under section 256B.49 for each county and tribal agency, including:
(i) the amount of resources allocated;
(ii) the amount of resources authorized for participants; and
(iii) the amount of allocated resources not authorized and the amount not used as provided in subdivision 12, and section 256B.49, subdivision 27.
(c) The waiting list information must be provided quarterly beginning August 1, 2016, and must include at least:
(1) the number of persons screened and waiting for services listed by urgency category, the number of months on the wait list, age group, and the type of services requested by those waiting;
(2) the number of persons beginning waiver services who were on the waiting list, and the number of persons beginning waiver services who were not on the waiting list;
(3) the number of persons who left the waiting list but did not begin waiver services; and
(4) the number of persons on the waiting list with approved funding but without a waiver service agreement and the number of days from funding approval until a service agreement is effective for each person.
(d) By December 1 of each year, the commissioner shall compile a report posted on the department's website that includes:
(1) the financial information listed in paragraph (b) for the most recently completed allocation period;
(2) for the previous four quarters, the waiting list information listed in paragraph (c);
(3) for a 12-month period ending October 31, a list of county and tribal agencies required to submit a corrective action plan under subdivisions 11 and 12, and section 256B.49, subdivisions 26 and 27; and
(4) for a 12-month period ending October 31, a list of the county and tribal agencies from which resources were moved as authorized in section 256B.092, subdivision 12, and section 256B.49, subdivision 11a, the amount of resources taken from each agency, the counties that were given increased resources as a result, and the amounts provided.
Subd. 11.
Excess spending.
County and tribal agencies are responsible for spending in excess of the allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, they must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct their overspending for the two years following the period when the overspending occurred. The commissioner shall recoup spending in excess of the allocation only in cases where statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to them for that purpose.
Subd. 12.
Use of waiver allocations.
County and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services. If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county's or tribe's available allocation and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.
256B.0924 TARGETED CASE MANAGEMENT SERVICES.
Subd. 4a.
Targeted case management through interactive video.
(a) Subject to federal approval, contact made for targeted case management by interactive video shall be eligible for payment under subdivision 6 if:
(1) the person receiving targeted case management services is residing in:
(i) a hospital;
(ii) a nursing facility; or
(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging establishment or lodging establishment that provides supportive services or health supervision services according to section 157.17 that is staffed 24 hours a day, seven days a week;
(2) interactive video is in the best interests of the person and is deemed appropriate by the person receiving targeted case management or the person's legal guardian, the case management provider, and the provider operating the setting where the person is residing;
(3) the use of interactive video is approved as part of the person's written personal service or case plan; and
(4) interactive video is used for up to, but not more than, 50 percent of the minimum required face-to-face contact.
(b) The person receiving targeted case management or the person's legal guardian has the right to choose and consent to the use of interactive video under this subdivision and has the right to refuse the use of interactive video at any time.
(c) The commissioner shall establish criteria that a targeted case management provider must attest to in order to demonstrate the safety or efficacy of delivering the service via interactive video. The attestation may include that the case management provider has:
(1) written policies and procedures specific to interactive video services that are regularly reviewed and updated;
(2) policies and procedures that adequately address client safety before, during, and after the interactive video services are rendered;
(3) established protocols addressing how and when to discontinue interactive video services; and
(4) established a quality assurance process related to interactive video services.
(d) As a condition of payment, the targeted case management provider must document the following for each occurrence of targeted case management provided by interactive video:
(1) the time the service began and the time the service ended, including an a.m. and p.m. designation;
(2) the basis for determining that interactive video is an appropriate and effective means for delivering the service to the person receiving case management services;
(3) the mode of transmission of the interactive video services and records evidencing that a particular mode of transmission was utilized;
(4) the location of the originating site and the distant site; and
(5) compliance with the criteria attested to by the targeted case management provider as provided in paragraph (c).
256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.
Subd. 8.
Required preservice and continuing education.
(a) A provider entity shall establish a plan to provide preservice and continuing education for staff. The plan must clearly describe the type of training necessary to maintain current skills and obtain new skills and that relates to the provider entity's goals and objectives for services offered.
(b) A provider that employs a mental health behavioral aide under this section must require the mental health behavioral aide to complete 30 hours of preservice training. The preservice training must include parent team training. The preservice training must include 15 hours of in-person training of a mental health behavioral aide in mental health services delivery and eight hours of parent team training. Curricula for parent team training must be approved in advance by the commissioner. Components of parent team training include:
(1) partnering with parents;
(2) fundamentals of family support;
(3) fundamentals of policy and decision making;
(4) defining equal partnership;
(5) complexities of the parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses;
(6) sibling impacts;
(7) support networks; and
(8) community resources.
(c) A provider entity that employs a mental health practitioner and a mental health behavioral aide to provide children's therapeutic services and supports under this section must require the mental health practitioner and mental health behavioral aide to complete 20 hours of continuing education every two calendar years. The continuing education must be related to serving the needs of a child with emotional disturbance in the child's home environment and the child's family.
(d) The provider entity must document the mental health practitioner's or mental health behavioral aide's annual completion of the required continuing education. The documentation must include the date, subject, and number of hours of the continuing education, and attendance records, as verified by the staff member's signature, job title, and the instructor's name. The provider entity must keep documentation for each employee, including records of attendance at professional workshops and conferences, at a central location and in the employee's personnel file.
Subd. 10.
Service authorization.
Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.
256B.0944 CHILDREN'S MENTAL HEALTH CRISIS RESPONSE SERVICES.
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the meanings given them.
(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation that, but for the provision of crisis response services to the child, would likely result in significantly reduced levels of functioning in primary activities of daily living, an emergency situation, or the child's placement in a more restrictive setting, including, but not limited to, inpatient hospitalization.
(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric situation that causes an immediate need for mental health services and is consistent with section 62Q.55. A physician, mental health professional, or crisis mental health practitioner determines a mental health crisis or emergency for medical assistance reimbursement with input from the client and the client's family, if possible.
(c) "Mental health crisis assessment" means an immediate face-to-face assessment by a physician, mental health professional, or mental health practitioner under the clinical supervision of a mental health professional, following a screening that suggests the child may be experiencing a mental health crisis or mental health emergency situation.
(d) "Mental health mobile crisis intervention services" means face-to-face, short-term intensive mental health services initiated during a mental health crisis or mental health emergency. Mental health mobile crisis services must help the recipient cope with immediate stressors, identify and utilize available resources and strengths, and begin to return to the recipient's baseline level of functioning. Mental health mobile services must be provided on site by a mobile crisis intervention team outside of an inpatient hospital setting.
(e) "Mental health crisis stabilization services" means individualized mental health services provided to a recipient following crisis intervention services that are designed to restore the recipient to the recipient's prior functional level. The individual treatment plan recommending mental health crisis stabilization must be completed by the intervention team or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services may be provided in the recipient's home, the home of a family member or friend of the recipient, schools, another community setting, or a short-term supervised, licensed residential program if the service is not included in the facility's cost pool or per diem. Mental health crisis stabilization is not reimbursable when provided as part of a partial hospitalization or day treatment program.
Subd. 2.
Medical assistance coverage.
Medical assistance covers medically necessary children's mental health crisis response services, subject to federal approval, if provided to an eligible recipient under subdivision 3, by a qualified provider entity under subdivision 4 or a qualified individual provider working within the provider's scope of practice, and identified in the recipient's individual crisis treatment plan under subdivision 8.
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is eligible for medical assistance;
(2) is under age 18 or between the ages of 18 and 21;
(3) is screened as possibly experiencing a mental health crisis or mental health emergency where a mental health crisis assessment is needed;
(4) is assessed as experiencing a mental health crisis or mental health emergency, and mental health mobile crisis intervention or mental health crisis stabilization services are determined to be medically necessary; and
(5) meets the criteria for emotional disturbance or mental illness.
Subd. 4.
Provider entity standards.
(a) A crisis intervention and crisis stabilization provider entity must meet the administrative and clinical standards specified in section 256B.0943, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:
(1) an Indian health service facility or facility owned and operated by a tribe or a tribal organization operating under Public Law 93-638 as a 638 facility;
(2) a county board-operated entity; or
(3) a provider entity that is under contract with the county board in the county where the potential crisis or emergency is occurring.
(b) The children's mental health crisis response services provider entity must:
(1) ensure that mental health crisis assessment and mobile crisis intervention services are available 24 hours a day, seven days a week;
(2) directly provide the services or, if services are subcontracted, the provider entity must maintain clinical responsibility for services and billing;
(3) ensure that crisis intervention services are provided in a manner consistent with sections 245.487 to 245.4889; and
(4) develop and maintain written policies and procedures regarding service provision that include safety of staff and recipients in high-risk situations.
Subd. 4a.
Alternative provider standards.
If a provider entity demonstrates that, due to geographic or other barriers, it is not feasible to provide mobile crisis intervention services 24 hours a day, seven days a week, according to the standards in subdivision 4, paragraph (b), clause (1), the commissioner may approve a crisis response provider based on an alternative plan proposed by a provider entity. The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of crisis services; and
(2) provide mobile services outside of the usual nine-to-five office hours and on weekends and holidays.
Subd. 5.
Mobile crisis intervention staff qualifications.
(a) To provide children's mental health mobile crisis intervention services, a mobile crisis intervention team must include:
(1) at least two mental health professionals as defined in section 256B.0943, subdivision 1, paragraph (o); or
(2) a combination of at least one mental health professional and one mental health practitioner as defined in section 245.4871, subdivision 26, with the required mental health crisis training and under the clinical supervision of a mental health professional on the team.
(b) The team must have at least two people with at least one member providing on-site crisis intervention services when needed. Team members must be experienced in mental health assessment, crisis intervention techniques, and clinical decision making under emergency conditions and have knowledge of local services and resources. The team must recommend and coordinate the team's services with appropriate local resources, including the county social services agency, mental health service providers, and local law enforcement, if necessary.
Subd. 6.
Initial screening and crisis assessment planning.
(a) Before initiating mobile crisis intervention services, a screening of the potential crisis situation must be conducted. The screening may use the resources of crisis assistance and emergency services as defined in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The screening must gather information, determine whether a crisis situation exists, identify the parties involved, and determine an appropriate response.
(b) If a crisis exists, a crisis assessment must be completed. A crisis assessment must evaluate any immediate needs for which emergency services are needed and, as time permits, the recipient's current life situation, sources of stress, mental health problems and symptoms, strengths, cultural considerations, support network, vulnerabilities, and current functioning.
(c) If the crisis assessment determines mobile crisis intervention services are needed, the intervention services must be provided promptly. As the opportunity presents itself during the intervention, at least two members of the mobile crisis intervention team must confer directly or by telephone about the assessment, treatment plan, and actions taken and needed. At least one of the team members must be on site providing crisis intervention services. If providing on-site crisis intervention services, a mental health practitioner must seek clinical supervision as required under subdivision 9.
(d) The mobile crisis intervention team must develop an initial, brief crisis treatment plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention. The plan must address the needs and problems noted in the crisis assessment and include measurable short-term goals, cultural considerations, and frequency and type of services to be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan must be updated as needed to reflect current goals and services. The team must involve the client and the client's family in developing and implementing the plan.
(e) The team must document in progress notes which short-term goals have been met and when no further crisis intervention services are required.
(f) If the client's crisis is stabilized, but the client needs a referral for mental health crisis stabilization services or to other services, the team must provide a referral to these services. If the recipient has a case manager, planning for other services must be coordinated with the case manager.
Subd. 7.
Crisis stabilization services.
Crisis stabilization services must be provided by a mental health professional or a mental health practitioner, as defined in section 245.462, subdivision 17, who works under the clinical supervision of a mental health professional and for a crisis stabilization services provider entity and must meet the following standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in subdivision 8;
(2) services must be delivered according to the treatment plan and include face-to-face contact with the recipient by qualified staff for further assessment, help with referrals, updating the crisis stabilization treatment plan, supportive counseling, skills training, and collaboration with other service providers in the community; and
(3) mental health practitioners must have completed at least 30 hours of training in crisis intervention and stabilization during the past two years.
Subd. 8.
Treatment plan.
(a) The individual crisis stabilization treatment plan must include, at a minimum:
(1) a list of problems identified in the assessment;
(2) a list of the recipient's strengths and resources;
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames for achievement of the goals;
(4) specific objectives directed toward the achievement of each goal;
(5) documentation of the participants involved in the service planning;
(6) planned frequency and type of services initiated;
(7) a crisis response action plan if a crisis should occur; and
(8) clear progress notes on the outcome of goals.
(b) The client, if clinically appropriate, must be a participant in the development of the crisis stabilization treatment plan. The client or the client's legal guardian must sign the service plan or documentation must be provided why this was not possible. A copy of the plan must be given to the client and the client's legal guardian. The plan should include services arranged, including specific providers where applicable.
(c) A treatment plan must be developed by a mental health professional or mental health practitioner under the clinical supervision of a mental health professional. A written plan must be completed within 24 hours of beginning services with the client.
Subd. 9.
Supervision.
(a) A mental health practitioner may provide crisis assessment and mobile crisis intervention services if the following clinical supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services provided;
(2) the mental health professional of the provider entity, who is an employee or under contract with the provider entity, must be immediately available by telephone or in person for clinical supervision;
(3) the mental health professional is consulted, in person or by telephone, during the first three hours when a mental health practitioner provides on-site service; and
(4) the mental health professional must review and approve the tentative crisis assessment and crisis treatment plan, document the consultation, and sign the crisis assessment and treatment plan within the next business day.
(b) If the mobile crisis intervention services continue into a second calendar day, a mental health professional must contact the client face-to-face on the second day to provide services and update the crisis treatment plan. The on-site observation must be documented in the client's record and signed by the mental health professional.
Subd. 10.
Client record.
The provider must maintain a file for each client that complies with the requirements under section 256B.0943, subdivision 11, and contains the following information:
(1) individual crisis treatment plans signed by the recipient, mental health professional, and mental health practitioner who developed the crisis treatment plan, or if the recipient refused to sign the plan, the date and reason stated by the recipient for not signing the plan;
(2) signed release of information forms;
(3) recipient health information and current medications;
(4) emergency contacts for the recipient;
(5) case records that document the date of service, place of service delivery, signature of the person providing the service, and the nature, extent, and units of service. Direct or telephone contact with the recipient's family or others should be documented;
(6) required clinical supervision by mental health professionals;
(7) summary of the recipient's case reviews by staff; and
(8) any written information by the recipient that the recipient wants in the file.
Subd. 11.
Excluded services.
The following services are excluded from reimbursement under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) transportation services under children's mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical assistance to provide children's mental health crisis response services;
(5) crisis response services provided by a residential treatment center to clients in their facility;
(6) services performed by volunteers;
(7) direct billing of time spent "on call" when not delivering services to a recipient;
(8) provider service time included in case management reimbursement;
(9) outreach services to potential recipients; and
(10) a mental health service that is not medically necessary.
256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
Subd. 5.
Service authorization.
The commissioner will administer authorizations for services under this section in compliance with section 256B.0625, subdivision 25.
256B.097 STATE QUALITY ASSURANCE, QUALITY IMPROVEMENT, AND LICENSING SYSTEM.
Subdivision 1.
Scope.
(a) In order to improve the quality of services provided to Minnesotans with disabilities and to meet the requirements of the federally approved home and community-based waivers under section 1915c of the Social Security Act, a State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving disability services is enacted. This system is a partnership between the Department of Human Services and the State Quality Council established under subdivision 3.
(b) This system is a result of the recommendations from the Department of Human Services' licensing and alternative quality assurance study mandated under Laws 2005, First Special Session chapter 4, article 7, section 57, and presented to the legislature in February 2007.
(c) The disability services eligible under this section include:
(1) the home and community-based services waiver programs for persons with developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, including brain injuries and services for those who qualify for nursing facility level of care or hospital facility level of care and any other services licensed under chapter 245D;
(2) home care services under section 256B.0651;
(3) family support grants under section 252.32;
(4) consumer support grants under section 256.476;
(5) semi-independent living services under section 252.275; and
(6) services provided through an intermediate care facility for the developmentally disabled.
(d) For purposes of this section, the following definitions apply:
(1) "commissioner" means the commissioner of human services;
(2) "council" means the State Quality Council under subdivision 3;
(3) "Quality Assurance Commission" means the commission under section 256B.0951; and
(4) "system" means the State Quality Assurance, Quality Improvement and Licensing System under this section.
Subd. 2.
Duties of commissioner of human services.
(a) The commissioner of human services shall establish the State Quality Council under subdivision 3.
(b) The commissioner shall initially delegate authority to perform licensing functions and activities according to section 245A.16 to a host county in Region 10. The commissioner must not license or reimburse a participating facility, program, or service located in Region 10 if the commissioner has received notification from the host county that the facility, program, or service has failed to qualify for licensure.
(c) The commissioner may conduct random licensing inspections based on outcomes adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services eligible under this section. The role of the random inspections is to verify that the system protects the safety and well-being of persons served and maintains the availability of high-quality services for persons with disabilities.
(d) The commissioner shall ensure that the federal home and community-based waiver requirements are met and that incidents that may have jeopardized safety and health or violated services-related assurances, civil and human rights, and other protections designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and acted upon in a timely manner.
(e) The commissioner shall seek a federal waiver by July 1, 2012, to allow intermediate care facilities for persons with developmental disabilities to participate in this system.
Subd. 3.
State Quality Council.
(a) There is hereby created a State Quality Council which must define regional quality councils, and carry out a community-based, person-directed quality review component, and a comprehensive system for effective incident reporting, investigation, analysis, and follow-up.
(b) By August 1, 2011, the commissioner of human services shall appoint the members of the initial State Quality Council. Members shall include representatives from the following groups:
(1) disability service recipients and their family members;
(2) during the first four years of the State Quality Council, there must be at least three members from the Region 10 stakeholders. As regional quality councils are formed under subdivision 4, each regional quality council shall appoint one member;
(3) disability service providers;
(4) disability advocacy groups; and
(5) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(c) Members of the council who do not receive a salary or wages from an employer for time spent on council duties may receive a per diem payment when performing council duties and functions.
(d) The State Quality Council shall:
(1) assist the Department of Human Services in fulfilling federally mandated obligations by monitoring disability service quality and quality assurance and improvement practices in Minnesota;
(2) establish state quality improvement priorities with methods for achieving results and provide an annual report to the legislative committees with jurisdiction over policy and funding of disability services on the outcomes, improvement priorities, and activities undertaken by the commission during the previous state fiscal year;
(3) identify issues pertaining to financial and personal risk that impede Minnesotans with disabilities from optimizing choice of community-based services; and
(4) recommend to the chairs and ranking minority members of the legislative committees with jurisdiction over human services and civil law by January 15, 2014, statutory and rule changes related to the findings under clause (3) that promote individualized service and housing choices balanced with appropriate individualized protection.
(e) The State Quality Council, in partnership with the commissioner, shall:
(1) approve and direct implementation of the community-based, person-directed system established in this section;
(2) recommend an appropriate method of funding this system, and determine the feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
(3) approve measurable outcomes in the areas of health and safety, consumer evaluation, education and training, providers, and systems;
(4) establish variable licensure periods not to exceed three years based on outcomes achieved; and
(5) in cooperation with the Quality Assurance Commission, design a transition plan for licensed providers from Region 10 into the alternative licensing system.
(f) The State Quality Council shall notify the commissioner of human services that a facility, program, or service has been reviewed by quality assurance team members under subdivision 4, paragraph (b), clause (13), and qualifies for a license.
(g) The State Quality Council, in partnership with the commissioner, shall establish an ongoing review process for the system. The review shall take into account the comprehensive nature of the system which is designed to evaluate the broad spectrum of licensed and unlicensed entities that provide services to persons with disabilities. The review shall address efficiencies and effectiveness of the system.
(h) The State Quality Council may recommend to the commissioner certain variances from the standards governing licensure of programs for persons with disabilities in order to improve the quality of services so long as the recommended variances do not adversely affect the health or safety of persons being served or compromise the qualifications of staff to provide services.
(i) The safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make recommendations to the commissioner or to the legislature in the report required under paragraph (c) regarding alternatives or modifications to the safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c).
(j) The State Quality Council may hire staff to perform the duties assigned in this subdivision.
Subd. 4.
Regional quality councils.
(a) The commissioner shall establish, as selected by the State Quality Council, regional quality councils of key stakeholders, including regional representatives of:
(1) disability service recipients and their family members;
(2) disability service providers;
(3) disability advocacy groups; and
(4) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(b) Each regional quality council shall:
(1) direct and monitor the community-based, person-directed quality assurance system in this section;
(2) approve a training program for quality assurance team members under clause (13);
(3) review summary reports from quality assurance team reviews and make recommendations to the State Quality Council regarding program licensure;
(4) make recommendations to the State Quality Council regarding the system;
(5) resolve complaints between the quality assurance teams, counties, providers, persons receiving services, their families, and legal representatives;
(6) analyze and review quality outcomes and critical incident data reporting incidents of life safety concerns immediately to the Department of Human Services licensing division;
(7) provide information and training programs for persons with disabilities and their families and legal representatives on service options and quality expectations;
(8) disseminate information and resources developed to other regional quality councils;
(9) respond to state-level priorities;
(10) establish regional priorities for quality improvement;
(11) submit an annual report to the State Quality Council on the status, outcomes, improvement priorities, and activities in the region;
(12) choose a representative to participate on the State Quality Council and assume other responsibilities consistent with the priorities of the State Quality Council; and
(13) recruit, train, and assign duties to members of quality assurance teams, taking into account the size of the service provider, the number of services to be reviewed, the skills necessary for the team members to complete the process, and ensure that no team member has a financial, personal, or family relationship with the facility, program, or service being reviewed or with anyone served at the facility, program, or service. Quality assurance teams must be comprised of county staff, persons receiving services or the person's families, legal representatives, members of advocacy organizations, providers, and other involved community members. Team members must complete the training program approved by the regional quality council and must demonstrate performance-based competency. Team members may be paid a per diem and reimbursed for expenses related to their participation in the quality assurance process.
(c) The commissioner shall monitor the safety standards, rights, and procedural protections for the monitoring of psychotropic medications and those identified under sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause (7); and 626.557; and chapter 260E.
(d) The regional quality councils may hire staff to perform the duties assigned in this subdivision.
(e) The regional quality councils may charge fees for their services.
(f) The quality assurance process undertaken by a regional quality council consists of an evaluation by a quality assurance team of the facility, program, or service. The process must include an evaluation of a random sample of persons served. The sample must be representative of each service provided. The sample size must be at least five percent but not less than two persons served. All persons must be given the opportunity to be included in the quality assurance process in addition to those chosen for the random sample.
(g) A facility, program, or service may contest a licensing decision of the regional quality council as permitted under chapter 245A.
Subd. 5.
Annual survey of service recipients.
The commissioner, in consultation with the State Quality Council, shall conduct an annual independent statewide survey of service recipients, randomly selected, to determine the effectiveness and quality of disability services. The survey must be consistent with the system performance expectations of the Centers for Medicare and Medicaid Services (CMS) Quality Framework. The survey must analyze whether desired outcomes for persons with different demographic, diagnostic, health, and functional needs, who are receiving different types of services in different settings and with different costs, have been achieved. Annual statewide and regional reports of the results must be published and used to assist regions, counties, and providers to plan and measure the impact of quality improvement activities.
Subd. 6.
Mandated reporters.
Members of the State Quality Council under subdivision 3, the regional quality councils under subdivision 4, and quality assurance team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as defined in sections 260E.06, subdivision 1, and 626.5572, subdivision 16.
256B.49 HOME AND COMMUNITY-BASED SERVICE WAIVERS FOR PERSONS WITH DISABILITIES.
Subd. 26.
Excess allocations.
Effective July 1, 2018, county and tribal agencies will be responsible for spending in excess of the annual allocation made by the commissioner. In the event a county or tribal agency spends in excess of the allocation made by the commissioner for a given allocation period, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The plan must state the actions the agency will take to correct its overspending for the two years following the period when the overspending occurred. The commissioner shall recoup funds spent in excess of the allocation only in cases when statewide spending exceeds the appropriation designated for the home and community-based services waivers. Nothing in this subdivision shall be construed as reducing the county or tribe's responsibility to offer and make available feasible home and community-based options to eligible waiver recipients within the resources allocated to it for that purpose.
Subd. 27.
Use of waiver allocations.
(a) Effective until June 30, 2018, county and tribal agencies are responsible for authorizing the annual allocation made by the commissioner. In the event a county or tribal agency authorizes less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.
(b) Effective July 1, 2018, county and tribal agencies are responsible for spending the annual allocation made by the commissioner. In the event a county or tribal agency spends less than 97 percent of the allocation, while maintaining a list of persons waiting for waiver services, the county or tribal agency must submit a corrective action plan to the commissioner for approval. The commissioner may determine a plan is unnecessary given the size of the allocation and capacity for new enrollment. The plan must state the actions the agency will take to assure reasonable and timely access to home and community-based waiver services for persons waiting for services.
(c) If a county or tribe does not submit a plan when required or implement the changes required, the commissioner shall assure access to waiver services within the county or tribe's available allocation, and take other actions needed to assure that all waiver participants in that county or tribe are receiving appropriate waiver services to meet their needs.
256D.051 SNAP EMPLOYMENT AND TRAINING PROGRAM.
Subdivision 1.
SNAP employment and training program.
The commissioner shall implement a SNAP employment and training program in order to meet the SNAP employment and training participation requirements of the United States Department of Agriculture. Unless exempt under subdivision 3a, each adult recipient in the unit must participate in the SNAP employment and training program each month that the person is eligible for SNAP benefits. The person's participation in SNAP employment and training services must begin no later than the first day of the calendar month following the determination of eligibility for SNAP benefits. With the county agency's consent, and to the extent of available resources, the person may voluntarily continue to participate in SNAP employment and training services for up to three additional consecutive months immediately following termination of SNAP benefits in order to complete the provisions of the person's employability development plan.
Subd. 1a.
Notices and sanctions.
(a) At the time the county agency notifies the household that it is eligible for SNAP benefits, the county agency must inform all mandatory employment and training services participants as identified in subdivision 1 in the household that they must comply with all SNAP employment and training program requirements each month, including the requirement to attend an initial orientation to the SNAP employment and training program and that SNAP eligibility will end unless the participants comply with the requirements specified in the notice.
(b) A participant who fails without good cause to comply with SNAP employment and training program requirements of this section, including attendance at orientation, will lose SNAP eligibility for the following periods:
(1) for the first occurrence, for one month or until the person complies with the requirements not previously complied with, whichever is longer;
(2) for the second occurrence, for three months or until the person complies with the requirements not previously complied with, whichever is longer; or
(3) for the third and any subsequent occurrence, for six months or until the person complies with the requirements not previously complied with, whichever is longer.
If the participant is not the SNAP head of household, the person shall be considered an ineligible household member for SNAP purposes. If the participant is the SNAP head of household, the entire household is ineligible for SNAP as provided in Code of Federal Regulations, title 7, section 273.7(g). "Good cause" means circumstances beyond the control of the participant, such as illness or injury, illness or injury of another household member requiring the participant's presence, a household emergency, or the inability to obtain child care for children between the ages of six and 12 or to obtain transportation needed in order for the participant to meet the SNAP employment and training program participation requirements.
(c) The county agency shall mail or hand deliver a notice to the participant not later than five days after determining that the participant has failed without good cause to comply with SNAP employment and training program requirements which specifies the requirements that were not complied with, the factual basis for the determination of noncompliance, and the right to reinstate eligibility upon a showing of good cause for failure to meet the requirements. The notice must ask the reason for the noncompliance and identify the participant's appeal rights. The notice must request that the participant inform the county agency if the participant believes that good cause existed for the failure to comply and must state that the county agency intends to terminate eligibility for SNAP benefits due to failure to comply with SNAP employment and training program requirements.
(d) If the county agency determines that the participant did not comply during the month with all SNAP employment and training program requirements that were in effect, and if the county agency determines that good cause was not present, the county must provide a ten-day notice of termination of SNAP benefits. The amount of SNAP benefits that are withheld from the household and determination of the impact of the sanction on other household members is governed by Code of Federal Regulations, title 7, section 273.7.
(e) The participant may appeal the termination of SNAP benefits under the provisions of section 256.045.
Subd. 2.
County agency duties.
(a) The county agency shall provide to SNAP benefit recipients a SNAP employment and training program. The program must include:
(1) orientation to the SNAP employment and training program;
(2) an individualized employability assessment and an individualized employability development plan that includes assessment of literacy, ability to communicate in the English language, educational and employment history, and that estimates the length of time it will take the participant to obtain employment. The employability assessment and development plan must be completed in consultation with the participant, must assess the participant's assets, barriers, and strengths, and must identify steps necessary to overcome barriers to employment. A copy of the employability development plan must be provided to the registrant;
(3) referral to available accredited remedial or skills training programs designed to address participant's barriers to employment;
(4) referral to available programs that provide subsidized or unsubsidized employment as necessary;
(5) a job search program, including job seeking skills training; and
(6) other activities, to the extent of available resources designed by the county agency to prepare the participant for permanent employment.
In order to allow time for job search, the county agency may not require an individual to participate in the SNAP employment and training program for more than 32 hours a week. The county agency shall require an individual to spend at least eight hours a week in job search or other SNAP employment and training program activities.
(b) The county agency shall prepare an annual plan for the operation of its SNAP employment and training program. The plan must be submitted to and approved by the commissioner of employment and economic development. The plan must include:
(1) a description of the services to be offered by the county agency;
(2) a plan to coordinate the activities of all public entities providing employment-related services in order to avoid duplication of effort and to provide services more efficiently;
(3) a description of the factors that will be taken into account when determining a client's employability development plan; and
(4) provisions to ensure that the county agency's employment and training service provider provides each recipient with an orientation, employability assessment, and employability development plan as specified in paragraph (a), clauses (1) and (2), within 30 days of the recipient's eligibility for assistance.
Subd. 2a.
Duties of commissioner.
In addition to any other duties imposed by law, the commissioner shall:
(1) based on this section and section 256D.052 and Code of Federal Regulations, title 7, section 273.7, supervise the administration of SNAP employment and training services to county agencies;
(2) disburse money appropriated for SNAP employment and training services to county agencies based upon the county's costs as specified in section 256D.051, subdivision 6c;
(3) accept and supervise the disbursement of any funds that may be provided by the federal government or from other sources for use in this state for SNAP employment and training services;
(4) cooperate with other agencies including any agency of the United States or of another state in all matters concerning the powers and duties of the commissioner under this section and section 256D.052; and
(5) in cooperation with the commissioner of employment and economic development, ensure that each component of an employment and training program carried out under this section is delivered through a statewide workforce development system, unless the component is not available locally through such a system.
Subd. 3.
Participant duties.
In order to receive SNAP assistance, a registrant shall: (1) cooperate with the county agency in all aspects of the SNAP employment and training program; (2) accept any suitable employment, including employment offered through the Job Training Partnership Act, and other employment and training options; and (3) participate in SNAP employment and training activities assigned by the county agency. The county agency may terminate assistance to a registrant who fails to cooperate in the SNAP employment and training program, as provided in subdivision 1a.
Subd. 3a.
Requirement to register work.
(a) To the extent required under Code of Federal Regulations, title 7, section 273.7(a), each applicant for and recipient of SNAP benefits is required to register for work as a condition of eligibility for SNAP benefits. Applicants and recipients are registered by signing an application or annual reapplication for SNAP benefits, and must be informed that they are registering for work by signing the form.
(b) The commissioner shall determine, within federal requirements, persons required to participate in the SNAP employment and training program.
(c) The following SNAP benefit recipients are exempt from mandatory participation in SNAP employment and training services:
(1) recipients of benefits under the Minnesota family investment program, Minnesota supplemental aid program, or the general assistance program;
(2) a child;
(3) a recipient over age 55;
(4) a recipient who has a mental or physical illness, injury, or incapacity which is expected to continue for at least 30 days and which impairs the recipient's ability to obtain or retain employment as evidenced by professional certification or the receipt of temporary or permanent disability benefits issued by a private or government source;
(5) a parent or other household member responsible for the care of either a dependent child in the household who is under age six or a person in the household who is professionally certified as having a physical or mental illness, injury, or incapacity. Only one parent or other household member may claim exemption under this provision;
(6) a recipient receiving unemployment insurance or who has applied for unemployment insurance and has been required to register for work with the Department of Employment and Economic Development as part of the unemployment insurance application process;
(7) a recipient participating each week in a drug addiction or alcohol abuse treatment and rehabilitation program, provided the operators of the treatment and rehabilitation program, in consultation with the county agency, recommend that the recipient not participate in the SNAP employment and training program;
(8) a recipient employed or self-employed for 30 or more hours per week at employment paying at least minimum wage, or who earns wages from employment equal to or exceeding 30 hours multiplied by the federal minimum wage; or
(9) a student enrolled at least half time in any school, training program, or institution of higher education. When determining if a student meets this criteria, the school's, program's or institution's criteria for being enrolled half time shall be used.
Subd. 3b.
Orientation.
The county agency or its employment and training service provider must provide an orientation to SNAP employment and training services to each nonexempt SNAP benefit recipient within 30 days of the date that SNAP eligibility is determined. The orientation must inform the participant of the requirement to participate in services, the date, time, and address to report to for services, the name and telephone number of the SNAP employment and training service provider, the consequences for failure without good cause to comply, the services and support services available through SNAP employment and training services and other providers of similar services, and must encourage the participant to view the SNAP benefits program as a temporary means of supplementing the family's food needs until the family achieves self-sufficiency through employment. The orientation may be provided through audio-visual methods, but the participant must have the opportunity for face-to-face interaction with county agency staff.
Subd. 6b.
Federal reimbursement.
(a) Federal financial participation from the United States Department of Agriculture for SNAP employment and training expenditures that are eligible for reimbursement through the SNAP employment and training program are dedicated funds and are annually appropriated to the commissioner of human services for the operation of the SNAP employment and training program.
(b) The appropriation must be used for skill attainment through employment, training, and support services for SNAP participants.
(c) Federal financial participation for the nonstate portion of SNAP employment and training costs must be paid to the county agency or service provider that incurred the costs.
Subd. 6c.
Program funding.
Within the limits of available resources, the commissioner shall reimburse the actual costs of county agencies and their employment and training service providers for the provision of SNAP employment and training services, including participant support services, direct program services, and program administrative activities. The cost of services for each county's SNAP employment and training program shall not exceed the annual allocated amount. No more than 15 percent of program funds may be used for administrative activities. The county agency may expend county funds in excess of the limits of this subdivision without state reimbursement.
Program funds shall be allocated based on the county's average number of SNAP eligible cases as compared to the statewide total number of such cases. The average number of cases shall be based on counts of cases as of March 31, June 30, September 30, and December 31 of the previous calendar year. The commissioner may reallocate unexpended money appropriated under this section to those county agencies that demonstrate a need for additional funds.
Subd. 7.
Registrant status.
A registrant under this section is not an employee for the purposes of workers' compensation, unemployment benefits, retirement, or civil service laws, and shall not perform work ordinarily performed by a regular public employee.
Subd. 8.
Voluntary quit.
A person who is required to participate in SNAP employment and training services is not eligible for SNAP benefits if, without good cause, the person refuses a legitimate offer of, or quits, suitable employment within 60 days before the date of application. A person who is required to participate in SNAP employment and training services and, without good cause, voluntarily quits suitable employment or refuses a legitimate offer of suitable employment while receiving SNAP benefits shall be terminated from the SNAP program as specified in subdivision 1a.
Subd. 9.
Subcontractors.
A county agency may, at its option, subcontract any or all of the duties under this section to a public or private entity approved by the commissioner of employment and economic development.
Subd. 18.
Work experience placements.
(a) To the extent of available resources, each county agency must establish and operate a work experience component in the SNAP employment and training program for recipients who are subject to a federal limit of three months of SNAP eligibility in any 36-month period. The purpose of the work experience component is to enhance the participant's employability, self-sufficiency, and to provide meaningful, productive work activities.
(b) The commissioner shall assist counties in the design and implementation of these components. The commissioner must ensure that job placements under a work experience component comply with section 256J.72. Written or oral concurrence with job duties of persons placed under the community work experience program shall be obtained from the appropriate exclusive bargaining representative.
(c) Worksites developed under this section are limited to projects that serve a useful public service such as health, social service, environmental protection, education, urban and rural development and redevelopment, welfare, recreation, public facilities, public safety, community service, services to aged citizens or citizens with a disability, and child care. To the extent possible, the prior training, skills, and experience of a recipient must be used in making appropriate work experience assignments.
(d) Structured, supervised volunteer work with an agency or organization that is monitored by the county service provider may, with the approval of the county agency, be used as a work experience placement.
(e) As a condition of placing a person receiving SNAP benefits in a program under this subdivision, the county agency shall first provide the recipient the opportunity:
(1) for placement in suitable subsidized or unsubsidized employment through participation in job search under section 256D.051; or
(2) for placement in suitable employment through participation in on-the-job training, if such employment is available.
(f) The county agency shall limit the maximum monthly number of hours that any participant may work in a work experience placement to a number equal to the amount of the family's monthly SNAP benefit allotment divided by the greater of the federal minimum wage or the applicable state minimum wage.
After a participant has been assigned to a position for nine months, the participant may not continue in that assignment unless the maximum number of hours a participant works is no greater than the amount of the SNAP benefit divided by the rate of pay for individuals employed in the same or similar occupations by the same employer at the same site.
(g) The participant's employability development plan must include the length of time needed in the work experience program, the need to continue job seeking activities while participating in work experience, and the participant's employment goals.
(h) After each six months of a recipient's participation in a work experience job placement, and at the conclusion of each work experience assignment under this section, the county agency shall reassess and revise, as appropriate, the participant's employability development plan.
(i) A participant has good cause for failure to cooperate with a work experience job placement if, in the judgment of the employment and training service provider, the reason for failure is reasonable and justified. Good cause for purposes of this section is defined in subdivision 1a, paragraph (b).
(j) A recipient who has failed without good cause to participate in or comply with the work experience job placement shall be terminated from participation in work experience job activities. If the recipient is not exempt from mandatory SNAP employment and training program participation under subdivision 3a, the recipient will be assigned to other mandatory program activities. If the recipient is exempt from mandatory participation but is participating as a volunteer, the person shall be terminated from the SNAP employment and training program.
256D.052 LITERACY TRAINING FOR RECIPIENTS.
Subd. 3.
Participant literacy transportation costs.
Within the limits of the state appropriation the county agency must provide transportation to enable Supplemental Nutrition Assistance Program (SNAP) employment and training participants to participate in literacy training under this section. The state shall reimburse county agencies for the costs of providing transportation under this section up to the amount of the state appropriation. Counties must make every effort to ensure that child care is available as needed by recipients who are pursuing literacy training.
256J.08 DEFINITIONS.
Subd. 10.
Budget month.
"Budget month" means the calendar month which the county agency uses to determine the income or circumstances of an assistance unit to calculate the amount of the assistance payment in the payment month.
Subd. 61.
Monthly income test.
"Monthly income test" means the test used to determine ongoing eligibility and the assistance payment amount according to section 256J.21.
Subd. 62.
Nonrecurring income.
"Nonrecurring income" means a form of income which is received:
(1) only one time or is not of a continuous nature; or
(2) in a prospective payment month but is no longer received in the corresponding retrospective payment month.
Subd. 81.
Retrospective budgeting.
"Retrospective budgeting" means a method of determining the amount of the assistance payment in which the payment month is the second month after the budget month.
Subd. 83.
Significant change.
"Significant change" means a decline in gross income of the amount of the disregard as defined in section 256P.03 or more from the income used to determine the grant for the current month.
256J.21 INCOME LIMITATIONS.
Subdivision 1.
Income inclusions.
To determine MFIP eligibility, the county agency must evaluate income received by members of an assistance unit, or by other persons whose income is considered available to the assistance unit, and only count income that is available to the member of the assistance unit. Income is available if the individual has legal access to the income. All payments, unless specifically excluded in subdivision 2, must be counted as income. The county agency shall verify the income of all MFIP recipients and applicants.
Subd. 2.
Income exclusions.
The following must be excluded in determining a family's available income:
(1) payments for basic care, difficulty of care, and clothing allowances received for providing family foster care to children or adults under Minnesota Rules, parts 9555.5050 to 9555.6265, 9560.0521, and 9560.0650 to 9560.0654, payments for family foster care for children under section 260C.4411 or chapter 256N, and payments received and used for care and maintenance of a third-party beneficiary who is not a household member;
(2) reimbursements for employment training received through the Workforce Investment Act of 1998, United States Code, title 20, chapter 73, section 9201;
(3) reimbursement for out-of-pocket expenses incurred while performing volunteer services, jury duty, employment, or informal carpooling arrangements directly related to employment;
(4) all educational assistance, except the county agency must count graduate student teaching assistantships, fellowships, and other similar paid work as earned income and, after allowing deductions for any unmet and necessary educational expenses, shall count scholarships or grants awarded to graduate students that do not require teaching or research as unearned income;
(5) loans, regardless of purpose, from public or private lending institutions, governmental lending institutions, or governmental agencies;
(6) loans from private individuals, regardless of purpose, provided an applicant or participant documents that the lender expects repayment;
(7)(i) state income tax refunds; and
(ii) federal income tax refunds;
(8)(i) federal earned income credits;
(ii) Minnesota working family credits;
(iii) state homeowners and renters credits under chapter 290A; and
(iv) federal or state tax rebates;
(9) funds received for reimbursement, replacement, or rebate of personal or real property when these payments are made by public agencies, awarded by a court, solicited through public appeal, or made as a grant by a federal agency, state or local government, or disaster assistance organizations, subsequent to a presidential declaration of disaster;
(10) the portion of an insurance settlement that is used to pay medical, funeral, and burial expenses, or to repair or replace insured property;
(11) reimbursements for medical expenses that cannot be paid by medical assistance;
(12) payments by a vocational rehabilitation program administered by the state under chapter 268A, except those payments that are for current living expenses;
(13) in-kind income, including any payments directly made by a third party to a provider of goods and services;
(14) assistance payments to correct underpayments, but only for the month in which the payment is received;
(15) payments for short-term emergency needs under section 256J.626, subdivision 2;
(16) funeral and cemetery payments as provided by section 256.935;
(17) nonrecurring cash gifts of $30 or less, not exceeding $30 per participant in a calendar month;
(18) any form of energy assistance payment made through Public Law 97-35, Low-Income Home Energy Assistance Act of 1981, payments made directly to energy providers by other public and private agencies, and any form of credit or rebate payment issued by energy providers;
(19) Supplemental Security Income (SSI), including retroactive SSI payments and other income of an SSI recipient;
(20) Minnesota supplemental aid, including retroactive payments;
(21) proceeds from the sale of real or personal property;
(22) adoption or kinship assistance payments under chapter 256N or 259A and Minnesota permanency demonstration title IV-E waiver payments;
(23) state-funded family subsidy program payments made under section 252.32 to help families care for children with developmental disabilities, consumer support grant funds under section 256.476, and resources and services for a disabled household member under one of the home and community-based waiver services programs under chapter 256B;
(24) interest payments and dividends from property that is not excluded from and that does not exceed the asset limit;
(25) rent rebates;
(26) income earned by a minor caregiver, minor child through age 6, or a minor child who is at least a half-time student in an approved elementary or secondary education program;
(27) income earned by a caregiver under age 20 who is at least a half-time student in an approved elementary or secondary education program;
(28) MFIP child care payments under section 119B.05;
(29) all other payments made through MFIP to support a caregiver's pursuit of greater economic stability;
(30) income a participant receives related to shared living expenses;
(31) reverse mortgages;
(32) benefits provided by the Child Nutrition Act of 1966, United States Code, title 42, chapter 13A, sections 1771 to 1790;
(33) benefits provided by the women, infants, and children (WIC) nutrition program, United States Code, title 42, chapter 13A, section 1786;
(34) benefits from the National School Lunch Act, United States Code, title 42, chapter 13, sections 1751 to 1769e;
(35) relocation assistance for displaced persons under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, United States Code, title 42, chapter 61, subchapter II, section 4636, or the National Housing Act, United States Code, title 12, chapter 13, sections 1701 to 1750jj;
(36) benefits from the Trade Act of 1974, United States Code, title 19, chapter 12, part 2, sections 2271 to 2322;
(37) war reparations payments to Japanese Americans and Aleuts under United States Code, title 50, sections 1989 to 1989d;
(38) payments to veterans or their dependents as a result of legal settlements regarding Agent Orange or other chemical exposure under Public Law 101-239, section 10405, paragraph (a)(2)(E);
(39) income that is otherwise specifically excluded from MFIP consideration in federal law, state law, or federal regulation;
(40) security and utility deposit refunds;
(41) American Indian tribal land settlements excluded under Public Laws 98-123, 98-124, and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech Lake, and Mille Lacs reservations and payments to members of the White Earth Band, under United States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;
(42) all income of the minor parent's parents and stepparents when determining the grant for the minor parent in households that include a minor parent living with parents or stepparents on MFIP with other children;
(43) income of the minor parent's parents and stepparents equal to 200 percent of the federal poverty guideline for a family size not including the minor parent and the minor parent's child in households that include a minor parent living with parents or stepparents not on MFIP when determining the grant for the minor parent. The remainder of income is deemed as specified in section 256J.37, subdivision 1b;
(44) payments made to children eligible for relative custody assistance under section 257.85;
(45) vendor payments for goods and services made on behalf of a client unless the client has the option of receiving the payment in cash;
(46) the principal portion of a contract for deed payment;
(47) cash payments to individuals enrolled for full-time service as a volunteer under AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps National, and AmeriCorps NCCC;
(48) housing assistance grants under section 256J.35, paragraph (a); and
(49) child support payments of up to $100 for an assistance unit with one child and up to $200 for an assistance unit with two or more children.
256J.30 APPLICANT AND PARTICIPANT REQUIREMENTS AND RESPONSIBILITIES.
Subd. 5.
Monthly MFIP household reports.
Each assistance unit with a member who has earned income or a recent work history, and each assistance unit that has income deemed to it from a financially responsible person must complete a monthly MFIP household report form. "Recent work history" means the individual received earned income in the report month or any of the previous three calendar months even if the earnings are excluded. To be complete, the MFIP household report form must be signed and dated by the caregivers no earlier than the last day of the reporting period. All questions required to determine assistance payment eligibility must be answered, and documentation of earned income must be included.
Subd. 7.
Due date of MFIP household report form.
An MFIP household report form must be received by the county agency by the eighth calendar day of the month following the reporting period covered by the form. When the eighth calendar day of the month falls on a weekend or holiday, the MFIP household report form must be received by the county agency the first working day that follows the eighth calendar day.
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the county agency must immediately return the incomplete form and clearly state what the caregiver must do for the form to be complete.
(c) The automated eligibility system must send a notice of proposed termination of assistance to the assistance unit if a complete MFIP household report form is not received by a county agency. The automated notice must be mailed to the caregiver by approximately the 16th of the month. When a caregiver submits an incomplete form on or after the date a notice of proposed termination has been sent, the termination is valid unless the caregiver submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered to have continued its application for assistance if a complete MFIP household report form is received within a calendar month after the month in which the form was due and assistance shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements under subdivision 5 when any of the following factors cause a caregiver to fail to provide the county agency with a completed MFIP household report form before the end of the month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable care which prevents the caregiver from providing a completed MFIP household report form before the end of the month in which the form is due.
256J.33 PROSPECTIVE AND RETROSPECTIVE MFIP ELIGIBILITY.
Subd. 3.
Retrospective eligibility.
After the first two months of MFIP eligibility, a county agency must continue to determine whether an assistance unit is prospectively eligible for the payment month by looking at all factors other than income and then determine whether the assistance unit is retrospectively income eligible by applying the monthly income test to the income from the budget month. When the monthly income test is not satisfied, the assistance payment must be suspended when ineligibility exists for one month or ended when ineligibility exists for more than one month.
Subd. 4.
Monthly income test.
A county agency must apply the monthly income test retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when the countable income equals or exceeds the MFIP standard of need or the family wage level for the assistance unit. The income applied against the monthly income test must include:
(1) gross earned income from employment, prior to mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36, unless the employment income is specifically excluded under section 256J.21, subdivision 2;
(2) gross earned income from self-employment less deductions for self-employment expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or business state and federal income taxes, personal FICA, personal health and life insurance, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36;
(3) unearned income after deductions for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36, unless the income has been specifically excluded in section 256J.21, subdivision 2;
(4) gross earned income from employment as determined under clause (1) which is received by a member of an assistance unit who is a minor child or minor caregiver and less than a half-time student;
(5) child support received by an assistance unit, excluded under section 256J.21, subdivision 2, clause (49), or section 256P.06, subdivision 3, clause (2), item (xvi);
(6) spousal support received by an assistance unit;
(7) the income of a parent when that parent is not included in the assistance unit;
(8) the income of an eligible relative and spouse who seek to be included in the assistance unit; and
(9) the unearned income of a minor child included in the assistance unit.
Subd. 5.
When to terminate assistance.
When an assistance unit is ineligible for MFIP assistance for two consecutive months, the county agency must terminate MFIP assistance.
256J.34 CALCULATING ASSISTANCE PAYMENTS.
Subdivision 1.
Prospective budgeting.
A county agency must use prospective budgeting to calculate the assistance payment amount for the first two months for an applicant who has not received assistance in this state for at least one payment month preceding the first month of payment under a current application. Notwithstanding subdivision 3, paragraph (a), clause (2), a county agency must use prospective budgeting for the first two months for a person who applies to be added to an assistance unit. Prospective budgeting is not subject to overpayments or underpayments unless fraud is determined under section 256.98.
(a) The county agency must apply the income received or anticipated in the first month of MFIP eligibility against the need of the first month. The county agency must apply the income received or anticipated in the second month against the need of the second month.
(b) When the assistance payment for any part of the first two months is based on anticipated income, the county agency must base the initial assistance payment amount on the information available at the time the initial assistance payment is made.
(c) The county agency must determine the assistance payment amount for the first two months of MFIP eligibility by budgeting both recurring and nonrecurring income for those two months.
Subd. 2.
Retrospective budgeting.
The county agency must use retrospective budgeting to calculate the monthly assistance payment amount after the payment for the first two months has been made under subdivision 1.
Subd. 3.
Additional uses of retrospective budgeting.
Notwithstanding subdivision 1, the county agency must use retrospective budgeting to calculate the monthly assistance payment amount for the first two months under paragraphs (a) and (b).
(a) The county agency must use retrospective budgeting to determine the amount of the assistance payment in the first two months of MFIP eligibility:
(1) when an assistance unit applies for assistance for the same month for which assistance has been interrupted, the interruption in eligibility is less than one payment month, the assistance payment for the preceding month was issued in this state, and the assistance payment for the immediately preceding month was determined retrospectively; or
(2) when a person applies in order to be added to an assistance unit, that assistance unit has received assistance in this state for at least the two preceding months, and that person has been living with and has been financially responsible for one or more members of that assistance unit for at least the two preceding months.
(b) Except as provided in clauses (1) to (4), the county agency must use retrospective budgeting and apply income received in the budget month by an assistance unit and by a financially responsible household member who is not included in the assistance unit against the MFIP standard of need or family wage level to determine the assistance payment to be issued for the payment month.
(1) When a source of income ends prior to the third payment month, that income is not considered in calculating the assistance payment for that month. When a source of income ends prior to the fourth payment month, that income is not considered when determining the assistance payment for that month.
(2) When a member of an assistance unit or a financially responsible household member leaves the household of the assistance unit, the income of that departed household member is not budgeted retrospectively for any full payment month in which that household member does not live with that household and is not included in the assistance unit.
(3) When an individual is removed from an assistance unit because the individual is no longer a minor child, the income of that individual is not budgeted retrospectively for payment months in which that individual is not a member of the assistance unit, except that income of an ineligible child in the household must continue to be budgeted retrospectively against the child's needs when the parent or parents of that child request allocation of their income against any unmet needs of that ineligible child.
(4) When a person ceases to have financial responsibility for one or more members of an assistance unit, the income of that person is not budgeted retrospectively for the payment months which follow the month in which financial responsibility ends.
Subd. 4.
Significant change in gross income.
The county agency must recalculate the assistance payment when an assistance unit experiences a significant change, as defined in section 256J.08, resulting in a reduction in the gross income received in the payment month from the gross income received in the budget month. The county agency must issue a supplemental assistance payment based on the county agency's best estimate of the assistance unit's income and circumstances for the payment month. Supplemental assistance payments that result from significant changes are limited to two in a 12-month period regardless of the reason for the change. Notwithstanding any other statute or rule of law, supplementary assistance payments shall not be made when the significant change in income is the result of receipt of a lump sum, receipt of an extra paycheck, business fluctuation in self-employment income, or an assistance unit member's participation in a strike or other labor action.
256J.37 TREATMENT OF INCOME AND LUMP SUMS.
Subd. 10.
Treatment of lump sums.
(a) The agency must treat lump-sum payments as earned or unearned income. If the lump-sum payment is included in the category of income identified in subdivision 9, it must be treated as unearned income. A lump sum is counted as income in the month received and budgeted either prospectively or retrospectively depending on the budget cycle at the time of receipt. When an individual receives a lump-sum payment, that lump sum must be combined with all other earned and unearned income received in the same budget month, and it must be applied according to paragraphs (a) to (c). A lump sum may not be carried over into subsequent months. Any funds that remain in the third month after the month of receipt are counted in the asset limit.
(b) For a lump sum received by an applicant during the first two months, prospective budgeting is used to determine the payment and the lump sum must be combined with other earned or unearned income received and budgeted in that prospective month.
(c) For a lump sum received by a participant after the first two months of MFIP eligibility, the lump sum must be combined with other income received in that budget month, and the combined amount must be applied retrospectively against the applicable payment month.
(d) When a lump sum, combined with other income under paragraphs (b) and (c), is less than the MFIP transitional standard for the appropriate payment month, the assistance payment must be reduced according to the amount of the countable income. When the countable income is greater than the MFIP standard or family wage level, the assistance payment must be suspended for the payment month.
256S.20 CUSTOMIZED LIVING SERVICES; POLICY.
Subd. 2.
Customized living services requirements.
Customized living services and 24-hour customized living services may only be provided in a building that is registered as a housing with services establishment under chapter 144D.
Repealed Minnesota Rule: H2128-4
9505.0275 EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT.
Subpart 1.
Definition.
"Early and periodic screening, diagnosis, and treatment service" means a service provided to a recipient under age 21 to identify a potentially disabling condition and to provide diagnosis and treatment for a condition identified according to the requirements of the Code of Federal Regulations, title 42, section 441.55 and parts 9505.1693 to 9505.1748.
9505.0370 DEFINITIONS.
Subpart 1.
Scope.
For parts 9505.0370 to 9505.0372, the following terms have the meanings given them.
Subp. 2.
Adult day treatment.
"Adult day treatment" or "adult day treatment program" means a structured program of treatment and care.
Subp. 4.
Client.
"Client" means an eligible recipient who is determined to have or who is being assessed for a mental illness as specified in part 9505.0371.
Subp. 5.
Clinical summary.
"Clinical summary" means a written description of a clinician's formulation of the cause of the client's mental health symptoms, the client's prognosis, and the likely consequences of the symptoms; how the client meets the criteria for the diagnosis by describing the client's symptoms, the duration of symptoms, and functional impairment; an analysis of the client's other symptoms, strengths, relationships, life situations, cultural influences, and health concerns and their potential interaction with the diagnosis and formulation of the client's mental health condition; and alternative diagnoses that were considered and ruled out.
Subp. 6.
Clinical supervision.
"Clinical supervision" means the documented time a clinical supervisor and supervisee spend together to discuss the supervisee's work, to review individual client cases, and for the supervisee's professional development. It includes the documented oversight and supervision responsibility for planning, implementation, and evaluation of services for a client's mental health treatment.
Subp. 7.
Clinical supervisor.
"Clinical supervisor" means the mental health professional who is responsible for clinical supervision.
Subp. 8.
Cultural competence or culturally competent.
"Cultural competence" or "culturally competent" means the mental health provider's:
A.
awareness of the provider's own cultural background, and the related assumptions, values, biases, and preferences that influence assessment and intervention processes;
B.
ability and will to respond to the unique needs of an individual client that arise from the client's culture;
C.
ability to utilize the client's culture as a resource and as a means to optimize mental health care; and
D.
willingness to seek educational, consultative, and learning experiences to expand knowledge of and increase effectiveness with culturally diverse populations.
Subp. 9.
Cultural influences.
"Cultural influences" means historical, geographical, and familial factors that affect assessment and intervention processes. Cultural influences that are relevant to the client may include the client's:
Subp. 10.
Culture.
"Culture" means the distinct ways of living and understanding the world that are used by a group of people and are transmitted from one generation to another or adopted by an individual.
Subp. 11.
Diagnostic assessment.
"Diagnostic assessment" means a written assessment that documents a clinical and functional face-to-face evaluation of the client's mental health, including the nature, severity and impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies the client's strengths and resources.
Subp. 12.
Dialectical behavior therapy.
"Dialectical behavior therapy" means an evidence-based treatment approach provided in an intensive outpatient treatment program using a combination of individualized rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program is certified by the commissioner and involves the following service components: individual dialectical behavior therapy, group skills training, telephone coaching, and team consultation meetings.
Subp. 13.
Explanation of findings.
"Explanation of findings" means the explanation of a client's diagnostic assessment, psychological testing, treatment program, and consultation with culturally informed mental health consultants as required under parts 9520.0900 to 9520.0926, or other accumulated data and recommendations to the client, client's family, primary caregiver, or other responsible persons.
Subp. 14.
Family.
"Family" means a person who is identified by the client or the client's parent or guardian as being important to the client's mental health treatment. Family may include, but is not limited to, parents, children, spouse, committed partners, former spouses, persons related by blood or adoption, or persons who are presently residing together as a family unit.
Subp. 15.
Individual treatment plan.
"Individual treatment plan" means a written plan that outlines and defines the course of treatment. It delineates the goals, measurable objectives, target dates for achieving specific goals, main participants in treatment process, and recommended services that are based on the client's diagnostic assessment and other meaningful data that are needed to aid the client's recovery and enhance resiliency.
Subp. 16.
Medication management.
"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a person who is qualified according to part 9505.0371, subpart 5, items B and C, and provides mental health services to a client with a mental illness under the clinical supervision of a mental health professional.
Subp. 18.
Mental health professional.
"Mental health professional" means a person who is enrolled to provide medical assistance services and is qualified according to part 9505.0371, subpart 5, item A.
Subp. 19.
Mental health telemedicine.
"Mental health telemedicine" has the meaning given in Minnesota Statutes, section 256B.0625, subdivision 46.
Subp. 20.
Mental illness.
"Mental illness" has the meaning given in Minnesota Statutes, section 245.462, subdivision 20. "Mental illness" includes "emotional disturbance" as defined in Minnesota Statutes, section 245.4871, subdivision 15.
Subp. 21.
Multidisciplinary staff.
"Multidisciplinary staff" means a group of individuals from diverse disciplines who come together to provide services to clients under part 9505.0372, subparts 8, 9, and 10.
Subp. 22.
Neuropsychological assessment.
"Neuropsychological assessment" means a specialized clinical assessment of the client's underlying cognitive abilities related to thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist.
Subp. 23.
Neuropsychological testing.
"Neuropsychological testing" means administering standardized tests and measures designed to evaluate the client's ability to attend to, process, interpret, comprehend, communicate, learn and recall information; and use problem-solving and judgment.
Subp. 24.
Partial hospitalization program.
"Partial hospitalization program" means a provider's time-limited, structured program of psychotherapy and other therapeutic services, as defined in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x, (ff), that is provided in an outpatient hospital facility or community mental health center that meets Medicare requirements to provide partial hospitalization services.
Subp. 25.
Primary caregiver.
"Primary caregiver" means a person, other than the facility staff, who has primary legal responsibility for providing the client with food, clothing, shelter, direction, guidance, and nurturance.
Subp. 26.
Psychological testing.
"Psychological testing" means the use of tests or other psychometric instruments to determine the status of the recipient's mental, intellectual, and emotional functioning.
Subp. 27.
Psychotherapy.
"Psychotherapy" means treatment of a client with mental illness that applies the most appropriate psychological, psychiatric, psychosocial, or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the client.
9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.
Subpart 1.
Purpose.
This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.
Subp. 2.
Client eligibility for mental health services.
The following requirements apply to mental health services:
A.
The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:
(1)
prior to completion of a client's initial diagnostic assessment, a client is eligible for:
(c)
either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and
(2)
for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.
B.
A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:
(1)
may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:
(b)
an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and
(2)
may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and
(3)
must not be used for:
(a)
a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or
(b)
more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.
C.
For a child, a new standard or extended diagnostic assessment must be completed:
(3)
when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or
(4)
when the child's current mental health condition does not meet criteria of the child's current diagnosis.
D.
For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:
(1)
when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;
(2)
at least every three years following the initial diagnostic assessment for an adult who receives mental health services;
(3)
when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or
(4)
when the adult's current mental health condition does not meet criteria of the current diagnosis.
E.
An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.
Subp. 3.
Authorization for mental health services.
Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.
Subp. 4.
Clinical supervision.
A.
Clinical supervision must be based on each supervisee's written supervision plan and must:
(3)
promote cultural competency by:
(a)
developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;
(b)
addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;
(c)
developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and
(d)
emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;
(4)
recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and
(5)
monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.
B.
Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.
(2)
Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.
C.
The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:
(1)
the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;
(3)
the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;
(4)
the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;
D.
Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:
E.
Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.
Subp. 5.
Qualified providers.
Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.
A.
A mental health professional must be qualified in one of the following ways:
(1)
in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;
(2)
in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;
(3)
in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;
(4)
in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;
(5)
in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;
(6)
a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or
(7)
in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:
(b)
for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or
(c)
for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.
B.
A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be qualified in at least one of the following ways:
(1)
holds a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university; and
(a)
has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or
(b)
is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioner's clients belong, completes 40 hours of training in the delivery of services to clients with mental illness, and receives clinical supervision from a mental health professional at least once a week until the requirements of 2,000 hours of supervised experience are met;
(2)
has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;
(3)
is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;
(4)
holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or
(5)
is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.
C.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:
(1)
the mental health practitioner is:
(a)
complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or
(b)
a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional defined in item A; and
(2)
the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:
D.
A clinical supervisor must:
(2)
hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;
(3)
be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;
(4)
be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;
(5)
not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;
(6)
have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:
(d)
ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and
(7)
accept full professional liability for a supervisee's direction of a client's mental health services;
(8)
instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;
(9)
review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;
(10)
review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;
(14)
ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;
(15)
establish an evaluation process that identifies the performance and competence of each supervisee; and
(16)
document clinical supervision of each supervisee and securely maintain the documentation record.
Subp. 6.
Release of information.
Providers who receive a request for client information and providers who request client information must:
A.
comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and
B.
subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.
Subp. 7.
Individual treatment plan.
Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:
B.
developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and
C.
reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.
Subp. 8.
Documentation.
To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:
A.
in the client's mental health record:
(1)
each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and
(2)
all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;
B.
the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and
C.
dates that treatment begins and ends and reason for the discontinuation of the mental health service.
Subp. 9.
Service coordination.
The provider must coordinate client services as authorized by the client as follows:
A.
When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.
B.
The mental health provider must coordinate mental health care with the client's physical health provider.
Subp. 10.
Telemedicine services.
Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telemedicine.
9505.0372 COVERED SERVICES.
Subpart 1.
Diagnostic assessment.
Medical assistance covers four types of diagnostic assessments when they are provided in accordance with the requirements in this subpart.
A.
To be eligible for medical assistance payment, a diagnostic assessment must:
(1)
identify a mental health diagnosis and recommended mental health services, which are the factual basis to develop the recipient's mental health services and treatment plan; or
B.
A standard diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The standard diagnostic assessment must be done within the cultural context of the client and must include relevant information about:
(1)
the client's current life situation, including the client's:
(e)
significant personal relationships, including the client's evaluation of relationship quality;
(2)
the reason for the assessment, including the client's:
(g)
health history and family health history, including physical, chemical, and mental health history; and
(4)
the assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(5)
the screenings used to determine the client's substance use, abuse, or dependency and other standardized screening instruments determined by the commissioner;
(6)
assessment methods and use of standardized assessment tools by the provider as determined and periodically updated by the commissioner;
(7)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(8)
the client data that is adequate to support the findings on all axes of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and any differential diagnosis.
C.
An extended diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The face-to-face interview is conducted over three or more assessment appointments because the client's complex needs necessitate significant additional assessment time. Complex needs are those caused by acuity of psychotic disorder; cognitive or neurocognitive impairment; need to consider past diagnoses and determine their current applicability; co-occurring substance abuse use disorder; or disruptive or changing environments, communication barriers, or cultural considerations as documented in the assessment. For child clients, the appointments may be conducted outside the diagnostician's office for face-to-face consultation and information gathering with family members, doctors, caregivers, teachers, and other providers, with or without the child present, and may involve directly observing the child in various settings that the child frequents such as home, school, or care settings. To complete the diagnostic assessment with adult clients, the appointments may be conducted outside of the diagnostician's office for face-to-face assessment with the adult client. The appointment may involve directly observing the adult client in various settings that the adult frequents, such as home, school, job, service settings, or community settings. The appointments may include face-to-face meetings with the adult client and the client's family members, doctors, caregivers, teachers, social support network members, recovery support resource representatives, and other providers for consultation and information gathering for the diagnostic assessment. The components of an extended diagnostic assessment include the following relevant information:
(1)
for children under age 5:
(b)
an early childhood mental status exam that assesses the client's developmental, social, and emotional functioning and style both within the family and with the examiner and includes:
iii.
self-regulation, including sensory regulation, unusual behaviors, activity level, attention span, and frustration tolerance;
iv.
physical aspects, including motor function, muscle tone, coordination, tics, abnormal movements, and seizure activity;
vii.
affect and mood, including modes of expression, range, responsiveness, duration, and intensity;
(2)
for children ages 5 to 18, completion of other assessment standards for children as determined and periodically revised by the commissioner; and
(3)
for adults, completion of other assessment standards for adults as determined and periodically revised by the commissioner.
D.
A brief diagnostic assessment must include a face-to-face interview with the client and a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The professional or practitioner must gather initial background information using the components of a standard diagnostic assessment in item B, subitems (1), (2), unit (b), (3), and (5), and draw a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's immediate needs or presenting problem. Treatment sessions conducted under authorization of a brief assessment may be used to gather additional information necessary to complete a standard diagnostic assessment or an extended diagnostic assessment.
E.
Adult diagnostic assessment update includes a face-to-face interview with the client, and contains a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C, who reviews a standard or extended diagnostic assessment. The adult diagnostic assessment update must update the most recent assessment document in writing in the following areas:
(1)
review of the client's life situation, including an interview with the client about the client's current life situation, and a written update of those parts where significant new or changed information exists, and documentation where there has not been significant change;
(2)
review of the client's presenting problems, including an interview with the client about current presenting problems and a written update of those parts where there is significant new or changed information, and note parts where there has not been significant change;
(3)
screenings for substance use, abuse, or dependency and other screenings as determined by the commissioner;
(5)
assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(6)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary, or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(7)
the client's diagnosis on all axes of the current edition of the Diagnostic and Statistical Manual and any differential diagnosis.
Subp. 2.
Neuropsychological assessment.
A neuropsychological assessment must include a face-to-face interview with the client, the interpretation of the test results, and preparation and completion of a report. A client is eligible for a neuropsychological assessment if at least one of the following criteria is met:
A.
There is a known or strongly suspected brain disorder based on medical history or neurological evaluation such as a history of significant head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative disorders, significant exposure to neurotoxins, central nervous system infections, metabolic or toxic encephalopathy, fetal alcohol syndrome, or congenital malformations of the brain; or
B.
In the absence of a medically verified brain disorder based on medical history or neurological evaluation, there are cognitive or behavioral symptoms that suggest that the client has an organic condition that cannot be readily attributed to functional psychopathology, or suspected neuropsychological impairment in addition to functional psychopathology. Examples include:
(5)
in children or adolescents, significant delays in academic skill acquisition or poor attention relative to peers;
(6)
in children or adolescents, significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers; and
(7)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.
C.
If neither criterion in item A nor B is fulfilled, neuropsychological evaluation is not indicated.
D.
The neuropsychological assessment must be conducted by a neuropsychologist with competence in the area of neuropsychological assessment as stated to the Minnesota Board of Psychology who:
(1)
was awarded a diploma by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or the American Board of Pediatric Neuropsychology;
(2)
earned a doctoral degree in psychology from an accredited university training program:
(a)
completed an internship, or its equivalent, in a clinically relevant area of professional psychology;
(b)
completed the equivalent of two full-time years of experience and specialized training, at least one which is at the postdoctoral level, in the study and practices of clinical neuropsychology and related neurosciences supervised by a clinical neuropsychologist; and
(3)
is licensed or credentialed by another state's board of psychology examiners in the specialty of neuropsychology using requirements equivalent to requirements specified by one of the boards named in subitem (1); or
(4)
was approved by the commissioner as an eligible provider of neuropsychological assessment prior to December 31, 2010.
Subp. 3.
Neuropsychological testing.
A.
Medical assistance covers neuropsychological testing when the client has either:
(1)
a significant mental status change that is not a result of a metabolic disorder that has failed to respond to treatment;
(2)
in children or adolescents, a significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers;
(3)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities, as required to adapt to new or changing cognitive, social, physical, or emotional demands; or
(4)
a significant behavioral change, memory loss, or suspected neuropsychological impairment in addition to functional psychopathology, or other organic brain injury or one of the following:
(k)
exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction;
(l)
systemic medical conditions known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and related hematologic anomalies, and autoimmune disorders such as lupus, erythematosis, or celiac disease;
(m)
congenital genetic or metabolic disorders known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
(o)
a condition presenting in a manner making it difficult for a clinician to distinguish between:
ii.
a major depressive disorder when adequate treatment for major depressive disorder has not resulted in improvement in neurocognitive function, or another disorder such as autism, selective mutism, anxiety disorder, or reactive attachment disorder.
B.
Neuropsychological testing must be administered or clinically supervised by a neuropsychologist qualified as defined in subpart 2, item D.
Subp. 4.
Psychological testing.
Psychological testing must meet the following requirements:
A.
The psychological testing must:
(1)
be administered or clinically supervised by a licensed psychologist with competence in the area of psychological testing as stated to the Minnesota Board of Psychology; and
(2)
be validated in a face-to-face interview between the client and a licensed psychologist or a mental health practitioner working as a clinical psychology trainee as required by part 9505.0371, subpart 5, item C, under the clinical supervision of a licensed psychologist according to part 9505.0371, subpart 5, item A, subitem (2).
B.
The administration, scoring, and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.
Subp. 5.
Explanations of findings.
To be eligible for medical assistance payment, the mental health professional providing the explanation of findings must obtain the authorization of the client or the client's representative to release the information as required in part 9505.0371, subpart 6. Explanation of findings is provided to the client, client's family, and caregivers, or to other providers to help them understand the results of the testing or diagnostic assessment, better understand the client's illness, and provide professional insight needed to carry out a plan of treatment. An explanation of findings is not paid separately when the results of psychological testing or a diagnostic assessment are explained to the client or the client's representative as part of the psychological testing or a diagnostic assessment.
Subp. 6.
Psychotherapy.
Medical assistance covers psychotherapy as conducted by a mental health professional or a mental health practitioner as defined in part 9505.0371, subpart 5, item C, as provided in this subpart.
B.
Family psychotherapy is designed for the client and one or more family members or the client's primary caregiver whose participation is necessary to accomplish the client's treatment goals. Family members or primary caregivers participating in a therapy session do not need to be eligible for medical assistance. For purposes of this subpart, the phrase "whose participation is necessary to accomplish the client's treatment goals" does not include shift or facility staff members at the client's residence. Medical assistance payment for family psychotherapy is limited to face-to-face sessions at which the client is present throughout the family psychotherapy session unless the mental health professional believes the client's absence from the family psychotherapy session is necessary to carry out the client's individual treatment plan. If the client is excluded, the mental health professional must document the reason for and the length of time of the exclusion. The mental health professional must also document the reason or reasons why a member of the client's family is excluded.
C.
Group psychotherapy is appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive mutual benefit from treatment in a group setting. For a group of three to eight persons, one mental health professional or practitioner is required to conduct the group. For a group of nine to 12 persons, a team of at least two mental health professionals or two mental health practitioners or one mental health professional and one mental health practitioner is required to co-conduct the group. Medical assistance payment is limited to a group of no more than 12 persons.
D.
A multiple-family group psychotherapy session is eligible for medical assistance payment if the psychotherapy session is designed for at least two but not more than five families. Multiple-family group psychotherapy is clearly directed toward meeting the identified treatment needs of each client as indicated in client's treatment plan. If the client is excluded, the mental health professional or practitioner must document the reason for and the length of the time of the exclusion. The mental health professional or practitioner must document the reasons why a member of the client's family is excluded.
Subp. 7.
Medication management.
The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse, as defined in Minnesota Statutes, sections 148.171 to 148.285, who is qualified in psychiatric nursing.
Subp. 8.
Adult day treatment.
Adult day treatment payment limitations include the following conditions.
A.
Adult day treatment must consist of at least one hour of group psychotherapy, and must include group time focused on rehabilitative interventions, or other therapeutic services that are provided by a multidisciplinary staff. Adult day treatment is an intensive psychotherapeutic treatment. The services must stabilize the client's mental health status, and develop and improve the client's independent living and socialization skills. The goal of adult day treatment is to reduce or relieve the effects of mental illness so that an individual is able to benefit from a lower level of care and to enable the client to live and function more independently in the community. Day treatment services are not a part of inpatient or residential treatment services.
B.
To be eligible for medical assistance payment, a day treatment program must:
(2)
be provided to a group of clients by a multidisciplinary staff under the clinical supervision of a mental health professional;
(3)
be available to the client at least two days a week for at least three consecutive hours per day. The day treatment may be longer than three hours per day, but medical assistance must not reimburse a provider for more than 15 hours per week;
(4)
include group psychotherapy done by a mental health professional, or mental health practitioner qualified according to part 9505.0371, subpart 5, item C, and rehabilitative interventions done by a mental health professional or mental health practitioner daily;
(5)
be included in the client's individual treatment plan as necessary and appropriate. The individual treatment plan must include attainable, measurable goals as they relate to services and must be completed before the first day treatment session. The vendor must review the recipient's progress and update the treatment plan at least every 30 days until the client is discharged and include an available discharge plan for the client in the treatment plan; and
C.
To be eligible for adult day treatment, a recipient must:
(2)
not be residing in a nursing facility, hospital, institute of mental disease, or regional treatment center, unless the recipient has an active discharge plan that indicates a move to an independent living arrangement within 180 days;
(4)
have the capacity to engage in the rehabilitative nature, the structured setting, and the therapeutic parts of psychotherapy and skills activities of a day treatment program and demonstrate measurable improvements in the recipient's functioning related to the recipient's mental illness that would result from participating in the day treatment program;
(5)
have at least three areas of functional impairment as determined by a functional assessment with the domains prescribed by Minnesota Statutes, section 245.462, subdivision 11a;
(6)
have a level of care determination that supports the need for the level of intensity and duration of a day treatment program; and
(7)
be determined to need day treatment by a mental health professional who must deem the day treatment services medically necessary.
D.
The following services are not covered by medical assistance if they are provided by a day treatment program:
(1)
a service that is primarily recreation-oriented or that is provided in a setting that is not medically supervised. This includes: sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;
(2)
a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's mental illness;
(3)
consultation with other providers or service agency staff about the care or progress of a client;
(8)
participation in meal preparation and eating that is not part of a clinical treatment plan to address the client's eating disorder.
Subp. 9.
Partial hospitalization.
Partial hospitalization is a covered service when it is an appropriate alternative to inpatient hospitalization for a client who is experiencing an acute episode of mental illness that meets the criteria for an inpatient hospital admission as specified in part 9505.0520, subpart 1, and who has the family and community resources necessary and appropriate to support the client's residence in the community. Partial hospitalization consists of multiple intensive short-term therapeutic services provided by a multidisciplinary staff to treat the client's mental illness.
Subp. 10.
Dialectical behavior therapy (DBT).
Dialectical behavior therapy (DBT) treatment services must meet the following criteria:
A.
DBT must be provided according to this subpart and Minnesota Statutes, section 256B.0625, subdivision 5l.
B.
DBT is an outpatient service that is determined to be medically necessary by either: (1) a mental health professional qualified according to part 9505.0371, subpart 5, or (2) a mental health practitioner working as a clinical trainee according to part 9505.0371, subpart 5, item C, who is under the clinical supervision of a mental health professional according to part 9505.0371, subpart 5, item D, with specialized skill in dialectical behavior therapy. The treatment recommendation must be based upon a comprehensive evaluation that includes a diagnostic assessment and functional assessment of the client, and review of the client's prior treatment history. Treatment services must be provided pursuant to the client's individual treatment plan and provided to a client who satisfies the criteria in item C.
C.
To be eligible for DBT, a client must:
(2)
have mental health needs that cannot be met with other available community-based services or that must be provided concurrently with other community-based services;
(3)
meet one of the following criteria:
(b)
have multiple mental health diagnoses and exhibit behaviors characterized by impulsivity, intentional self-harm behavior, and be at significant risk of death, morbidity, disability, or severe dysfunction across multiple life areas;
(4)
understand and be cognitively capable of participating in DBT as an intensive therapy program and be able and willing to follow program policies and rules assuring safety of self and others; and
D.
The treatment components of DBT are individual therapy and group skills as follows:
(1)
Individual DBT combines individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and reinforce the use of adaptive skillful behaviors. The therapist must:
(c)
generalize DBT skills to the client's natural environment through telephone coaching outside of the treatment session;
(f)
help the client learn and apply effective behaviors when working with other treatment providers.
(2)
Individual DBT therapy is provided by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
(3)
Group DBT skills training combines individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce the client's suicidal and other dysfunctional coping behaviors and restore function by teaching the client adaptive skills in the following areas:
(4)
Group DBT skills training is provided by two mental health professionals, or by a mental health professional cofacilitating with a mental health practitioner.
(5)
The need for individual DBT skills training must be determined by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
E.
A program must be certified by the commissioner as a DBT provider. To qualify for certification, a provider must:
(1)
hold current accreditation as a DBT program from a nationally recognized certification body approved by the commissioner or submit to the commissioner's inspection and provide evidence that the DBT program's policies, procedures, and practices will continuously meet the requirements of this subpart;
(4)
have a manual that outlines the DBT program's policies, procedures, and practices which meet the requirements of this subpart.
F.
The DBT treatment team must consist of persons who are trained in DBT treatment. The DBT treatment team may include persons from more than one agency. Professional and clinical affiliations with the DBT team must be delineated:
(1)
A DBT team leader must:
(a)
be a mental health professional employed by, affiliated with, or contracted by a DBT program certified by the commissioner;
(c)
have knowledge of and ability to apply the principles and DBT practices that are consistent with evidence-based practices.
(2)
DBT team members who provide individual DBT or group skills training must:
(a)
be a mental health professional or be a mental health practitioner, who is employed by, affiliated with, or contracted with a DBT program certified by the commissioner;
(b)
have or obtain appropriate competencies and working knowledge of DBT principles and practices within the first six months of becoming a part of the DBT program;
(c)
have or obtain knowledge of and ability to apply the principles and practices of DBT consistently with evidence-based practices within the first six months of working at the DBT program;
(e)
require mental health practitioners to have ongoing clinical supervision by a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices.
Subp. 11.
Noncovered services.
The mental health services in items A to J are not eligible for medical assistance payment under this part:
B.
a neuropsychological assessment carried out by a person other than a neuropsychologist who is qualified according to part 9505.0372, subpart 2, item D;
C.
a service ordered by a court that is solely for legal purposes and not related to the recipient's diagnosis or treatment for mental illness;
D.
services dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health;
E.
a service that is only for a vocational purpose or an educational purpose that is not mental health related;
9505.1693 SCOPE AND PURPOSE.
Parts 9505.1693 to 9505.1748 govern the early and periodic screening, diagnosis, and treatment (EPSDT) program.
Parts 9505.1693 to 9505.1748 must be read in conjunction with section 1905(a)(4)(B) of the Social Security Act, as amended through December 31, 1981, and the Code of Federal Regulations, title 42, part 441, subpart B, as amended through October 1, 1987, and section 6403 of the Omnibus Budget Reconciliation Act of 1989. The purpose of the EPSDT program is to identify potentially disabling conditions in children eligible for medical assistance, to provide diagnosis and treatment for conditions identified, and to encourage parents and their children to use health care services when necessary.
9505.1696 DEFINITIONS.
Subpart 1.
Applicability.
As used in parts 9505.1693 to 9505.1748, the following terms have the meanings given them.
Subp. 2.
Child.
"Child" means a person who is eligible for early and periodic screening, diagnosis, and treatment under part 9505.1699.
Subp. 3.
Community health clinic.
"Community health clinic" means a clinic that provides services by or under the supervision of a physician and that:
B.
is exempt from federal income tax under Internal Revenue Code of 1986, section 501(c)(3), as amended through December 31, 1987;
D.
has written clinic policies describing the services provided by the clinic and concerning (1) the medical management of health problems, including problems that require referral to physicians, (2) emergency health services, and (3) the maintenance and review of health records by the physician.
Subp. 5.
Diagnosis.
"Diagnosis" means the identification and determination of the nature or cause of a disease or abnormality through the use of a health history; physical, developmental, and psychological examination; and laboratory tests.
Subp. 6.
Early and periodic screening clinic or EPS clinic.
"Early and periodic screening clinic" or "EPS clinic" means an individual or facility that is approved by the Minnesota Department of Health under parts 4615.0900 to 4615.2000.
Subp. 7.
Early and periodic screening, diagnosis, and treatment program or EPSDT program.
"Early and periodic screening, diagnosis, and treatment program" or "EPSDT program" means the program that provides screening, diagnosis, and treatment under parts 9505.1693 to 9505.1748; Code of Federal Regulations, title 42, section 441.55, as amended through October 1, 1986; and Minnesota Statutes, section 256B.02, subdivision 8, paragraph (12).
Subp. 8.
EPSDT clinic.
"EPSDT clinic" means a facility supervised by a physician that provides screening according to parts 9505.1693 to 9505.1748 or an EPS clinic.
Subp. 9.
EPSDT provider agreement.
"EPSDT provider agreement" means the agreement required by part 9505.1703, subpart 2.
Subp. 11.
Follow-up.
"Follow-up" means efforts by a local agency to ensure that a screening requested for a child is provided to that child and that diagnosis and treatment indicated as necessary by a screening are also provided to that child.
Subp. 12.
Head Start agency.
"Head Start agency" refers to the child development program administered by the United States Department of Health and Human Services, Office of Administration for Children, Youth and Families.
Subp. 13.
Local agency.
"Local agency" means the county welfare board, multicounty welfare board, or human service agency established in Minnesota Statutes, section 256B.02, subdivision 6, and Minnesota Statutes, chapter 393.
Subp. 14.
Medical assistance.
"Medical assistance" means the program authorized by title XIX of the Social Security Act and Minnesota Statutes, chapters 256 and 256B.
Subp. 15.
Outreach.
"Outreach" means efforts by the department or a local agency to inform eligible persons about early and periodic screening, diagnosis, and treatment or to encourage persons to use the EPSDT program.
Subp. 17.
Physician.
"Physician" means a person who is licensed to provide health services within the scope of the person's profession under Minnesota Statutes, chapter 147.
Subp. 18.
Prepaid health plan.
"Prepaid health plan" means a health insurer licensed and operating under Minnesota Statutes, chapters 60A, 62A, and 62C, and a health maintenance organization licensed and operating under Minnesota Statutes, chapter 62D to provide health services to recipients of medical assistance entitlements.
Subp. 19.
Public health nursing service.
"Public health nursing service" means the nursing program provided by a community health board under Minnesota Statutes, section 145A.04, subdivisions 1 and 1a.
Subp. 20.
Screening.
"Screening" means the use of quick, simple procedures to separate apparently well children from those who need further examination for possible physical, developmental, or psychological problems.
Subp. 21.
Skilled professional medical personnel and supporting staff.
"Skilled professional medical personnel" and "supporting staff" means persons as defined by Code of Federal Regulations, title 42, section 432.2, as amended through October 1, 1987.
Subp. 22.
Treatment.
"Treatment" means the prevention, correction, or amelioration of a disease or abnormality identified by screening or diagnosis.
9505.1699 ELIGIBILITY TO BE SCREENED.
A person under age 21 who is eligible for medical assistance is eligible for the EPSDT program.
9505.1701 CHOICE OF PROVIDER.
Subpart 1.
Choice of screening provider.
Except as provided by subpart 3, a child or parent of a child who requests screening may choose any screening provider who has signed an EPSDT provider agreement and a medical assistance provider agreement.
Subp. 2.
Choice of diagnosis and treatment provider.
Except as provided by subpart 3, a child or parent of a child may choose any diagnosis and treatment provider as provided by part 9505.0190.
Subp. 3.
Exception to subparts 1 and 2.
A child who is enrolled in a prepaid health plan must receive screening, diagnosis, and treatment from that plan.
9505.1703 ELIGIBILITY TO PROVIDE SCREENING.
Subpart 1.
Providers.
An EPSDT clinic or a community health clinic shall be approved for medical assistance reimbursement for EPSDT services if it complies with the requirements of parts 9505.1693 to 9505.1748. A Head Start agency shall be approved as provided by subpart 2.
Subp. 2.
EPSDT provider agreement.
To be eligible to provide screening and receive reimbursement under the EPSDT program, an individual or facility must sign an EPSDT provider agreement provided by the department and a medical assistance provider agreement under part 9505.0195 or be a prepaid health plan.
Subp. 3.
Terms of EPSDT provider agreement.
The EPSDT provider agreement required by subpart 2 must state that the provider must:
9505.1706 REIMBURSEMENT.
Subp. 2.
Eligibility for reimbursement; Head Start agency.
A Head Start agency may complete all the screening components under part 9505.1718, subparts 2 to 14 or those components that have not been completed by another provider within the six months before completion of the screening components by the Head Start agency. A Head Start agency that completes the previously incomplete screening components must document on the EPSDT screening form that the other screening components of part 9505.1718, subparts 2 to 14, have been completed by another provider.
The department shall reimburse a Head Start agency for those screening components of part 9505.1718, subparts 2 to 14, that the Head Start agency has provided. The amount of reimbursement must be the same as a Head Start agency's usual and customary cost for each screening component or the maximum fee determined under subpart 1, whichever is lower.
Subp. 3.
Prepaid health plan.
A prepaid health plan is not eligible for a separate payment for screening. The early and periodic screening, diagnosis, and treatment screening must be a service included within the prepaid capitation rate specified in its contract with the department.
9505.1712 TRAINING.
The department must train the staff of an EPSDT clinic that is supervised by a physician on how to comply with the procedures required by part 9505.1718 if the EPSDT clinic requests the training.
9505.1715 COMPLIANCE WITH SURVEILLANCE AND UTILIZATION REVIEW.
A screening provider must comply with the surveillance and utilization review requirements of parts 9505.2160 to 9505.2245.
9505.1718 SCREENING STANDARDS FOR AN EPSDT CLINIC.
Subpart 1.
Requirement.
An early and periodic screening, diagnosis, and treatment screening must meet the requirements of subparts 2 to 15 except as provided by part 9505.1706, subpart 2.
Subp. 2.
Health and developmental history.
A history of a child's health and development must be obtained from the child, parent of the child, or an adult who is familiar with the child's health history. The history must include information on sexual development, lead and tuberculosis exposure, nutrition intake, chemical abuse, and social, emotional, and mental health status.
Subp. 3.
Assessment of physical growth.
The child's height or length and the child's weight must be measured and the results plotted on a growth grid based on data from the National Center for Health Statistics (NCHS). The head circumference of a child up to 36 months of age or a child whose growth in head circumference appears to deviate from the expected circumference for that child must be measured and plotted on an NCHS-based growth grid.
Subp. 4.
Physical examination.
The following must be checked according to accepted medical procedures: pulse; respiration; blood pressure; head; eyes; ears; nose; mouth; pharynx; neck; chest; heart; lungs; abdomen; spine; genitals; extremities; joints; muscle tone; skin; and neurological condition.
Subp. 5.
Vision.
A child must be checked for a family history of maternal and neonatal infection and ocular abnormalities. A child must be observed for pupillary reflex; the presence of nystagmus; and muscle balance, which includes an examination for esotropia, exotropia, phorias, and extraocular movements. The external parts of a child's eyes must be examined including the lids, conjunctiva, cornea, iris, and pupils. A child or parent of the child must be asked whether he or she has concerns about the child's vision.
Subp. 6.
Vision of a child age three or older.
In addition to the requirements of subpart 5, the visual acuity of a child age three years or older must be checked by use of the Screening Test for Young Children and Retardates (STYCAR) or the Snellen Alphabet Chart.
Subp. 7.
Hearing.
A child must be checked for a family history of hearing disability or loss, delay of language acquisition or history of such delay, the ability to determine the direction of a sound, and a history of repeated otitis media during early life. A child or parent of the child must be asked whether he or she has any concerns regarding the child's hearing.
Subp. 8.
Hearing of a child age three or older.
In addition to the requirements of subpart 7, a child age three or older must receive a pure tone audiometric test or referral for the test if the examination under subpart 7 indicates the test is needed.
Subp. 9.
Development.
A child must be screened for the following according to the screening provider's standard procedures: fine and gross motor development, speech and language development, social development, cognitive development, and self-help skills. Standardized tests that are used in screening must be culturally sensitive and have norms for the age range tested, written procedures for administration and for scoring and interpretation that are statistically reliable and valid. The provider must use a combination of the child's health and developmental history and standardized test or clinical judgment to determine the child's developmental status or need for further assessment.
Subp. 10.
Sexual development.
A child must be evaluated to determine whether the child's sexual development is consistent with the child's chronological age. A female must receive a breast examination and pelvic examination when indicated. A male must receive a testicular examination when indicated. If it is in the best interest of a child, counseling on normal sexual development, information on birth control and sexually transmitted diseases, and prescriptions and tests must be offered to a child. If it is in the best interest of a child, a screening provider may refer the child to other resources for counseling or a pelvic examination.
Subp. 11.
Nutrition.
When the assessment of a child's physical growth performed according to subpart 3 indicates a nutritional risk condition, the child must be referred for further assessment, receive nutritional counseling, or be referred to a nutrition program such as the Special Supplemental Food Program for Women, Infants, and Children; food stamps or food support; Expanded Food and Nutrition Education Program; or Head Start.
Subp. 12.
Immunizations.
The immunization status of a child must be compared to the "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition. Immunizations that the comparison shows are needed must be offered to the child and given to the child if the child or parent of the child accepts the offer. The "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition, is developed and distributed by the Minnesota Department of Health, 717 Delaware Street Southeast, Minneapolis, Minnesota 55440. The "Recommended Schedule for Active Immunization of Normal Infants and Children," current edition, is incorporated by reference and is available at the State Law Library, Judicial Center, 25 Rev. Dr. Martin Luther King Jr. Blvd., Saint Paul, Minnesota 55155. It is subject to frequent change.
Subp. 13.
Laboratory tests.
Laboratory tests must be done according to items A to F.
A.
A Mantoux test must be administered yearly to a child whose health history indicates ongoing exposure to tuberculosis, unless the child has previously tested positive. A child who tests positive must be referred for diagnosis and treatment.
B.
A child aged one to five years must initially be screened for lead through the use of either an erythrocyte protoporphyrin (EP) test or a direct blood lead screening test until December 31, 1992. Beginning January 1, 1993, a child age one to five must initially be screened using a direct blood lead screening test. Either capillary or venous blood may be used as the specimen for the direct blood lead test. Blood tests must be performed at a minimum of once at 12 months of age and once at 24 months of age or whenever the history indicates that there are risk factors for lead poisoning. When the result of the EP or capillary blood test is greater than the maximum allowable level set by the Centers for Disease Control of the United States Public Health Service, the child must be referred for a venous blood lead test. A child with a venous blood lead level greater than the maximum allowable level set by the Centers for Disease Control must be referred for diagnosis and treatment.
C.
The urine of a child must be tested for the presence of glucose, ketones, protein, and other abnormalities. A female at or near the age of four and a female at or near the age of ten must be tested for bacteriuria.
D.
Either a microhematocrit determination or a hemoglobin concentration test for anemia must be done.
E.
A test for sickle cell or other hemoglobinopathy, or abnormal blood conditions must be offered to a child who is at risk of such abnormalities and who has not yet been tested. These tests must be provided if accepted or requested by the child or parent of the child. If the tests identify a hemoglobin abnormality or other abnormal blood condition, the child must be referred for genetic counseling.
F.
Other laboratory tests such as those for cervical cancer, sexually transmitted diseases, pregnancy, and parasites must be performed when indicated by a child's medical or family history.
Subp. 14.
Oral examination.
An oral examination of a child's mouth must be performed to detect deterioration of hard tissue, and inflammation or swelling of soft tissue. Counseling about the systemic use of fluoride must be given to a child when fluoride is not available through the community water supply or school programs.
Subp. 14a.
Health education and health counseling.
Health education and health counseling concerning the child's health must be offered to the child who is being screened and to the child's parent or representative. The health education and health counseling are for the purposes of assisting the child or the parent or representative of the child to understand the expected growth and development of the child and of informing the child or the parent or representative of the child about the benefits of healthy lifestyles and about practices to promote accident and disease prevention.
Subp. 15.
Schedule of age related screening standards.
An early and periodic screening, diagnosis, and treatment screening for a child at a specific age must include, at a minimum, the screening requirements of subparts 2 to 14 as provided by the following schedule:
Schedule of age related screening standards
A.
Infancy:
| Standards | Ages | |||||
| By 1 month | 2 months | 4 months | 6 months | 9 months | 12 months | |
| Health History | X | X | X | X | X | X |
| Assessment of Physical Growth: | ||||||
| Height | X | X | X | X | X | X |
| Weight | X | X | X | X | X | X |
| Head Circumference | X | X | X | X | X | X |
| Physical Examination | X | X | X | X | X | X |
| Vision | X | X | X | X | X | X |
| Hearing | X | X | X | X | X | X |
| Development | X | X | X | X | X | X |
| Health Education/Counseling | X | X | X | X | X | X |
| Sexual Development | X | X | X | X | X | X |
| Nutrition | X | X | X | X | X | X |
| Immunizations/Review | X | X | X | X | X | |
| Laboratory Tests: | ||||||
| Tuberculin | if history indicates | |||||
| Lead Absorption | if history indicates | X | ||||
| Urinalysis | ← | ← | ← | X | ← | ← |
| Hematocrit or Hemoglobin | ← | ← | ← | ← | X | X |
| Sickle Cell | at parent's or child's request | |||||
| Other Laboratory Tests | as indicated | |||||
| Oral Examination | X | X | X | X | X | X |
X = Procedure to be completed.
← = Procedure to be completed if not done at the previous visit, or on the first visit.
B.
Early Childhood:
| Standards | Ages | ||||
| 15 months | 18 months | 24 months | 3years | 4years | |
| Health History | X | X | X | X | X |
| Assessment of Physical Growth: | |||||
| Height | X | X | X | X | X |
| Weight | X | X | X | X | X |
| Head Circumference | X | X | X | X | X |
| Physical Examination | X | X | X | X | X |
| Vision | X | X | X | X | X |
| Hearing | X | X | X | X | X |
| Blood Pressure | X | X | |||
| Development | X | X | X | X | X |
| Health Education/Counseling | X | X | X | X | X |
| Sexual Development | X | X | X | X | X |
| Nutrition | X | X | X | X | X |
| Immunizations/Review | X | X | X | X | X |
| Laboratory Tests: | |||||
| Tuberculin | if history indicates | ||||
| Lead Absorption | if history indicates | X | if history indicates | ||
| Urinalysis | ← | ← | X | ← | ← |
| Bacteriuria (females) | X | ||||
| Hematocrit or Hemoglobin | ← | ← | ← | ← | ← |
| Sickle Cell | at parent's or child's request | ||||
| Other Laboratory Tests | as indicated | ||||
| Oral Examination | X | X | X | X | X |
X = Procedure to be completed.
← = Procedure to be completed if not done at the previous visit, or on the first visit.
C.
Late childhood:
| Standards | Ages | ||||
| 5 years | 6 years | 8 years | 10 years | 12 years | |
| Health History | X | X | X | X | X |
| Assessment of Physical Growth: | |||||
| Height | X | X | X | X | X |
| Weight | X | X | X | X | X |
| Physical Examination | X | X | X | X | X |
| Vision | X | X | X | X | X |
| Hearing | X | X | X | X | X |
| Blood Pressure | X | X | X | X | X |
| Development | X | X | X | X | X |
| Health Education/Counseling | X | X | X | X | X |
| Sexual Development | X | X | X | X | X |
| Nutrition | X | X | X | X | X |
| Immunizations/Review | X | X | X | X | X |
| Laboratory Tests: | |||||
| Tuberculin | if history indicates | ||||
| Lead Absorption | if history indicates | ||||
| Urinalysis | ← | ← | X | ← | ← |
| Bacteriuria (females) | ← | ← | X | ← | ← |
| Hemoglobin or Hematocrit | ← | ← | X | ← | |
| Sickle Cell | at parent's or child's request | ||||
| Other Laboratory Tests | as indicated | ||||
| Oral Examination | X | X | X | X | X |
X = Procedure to be completed.
← = Procedure to be completed if not done at the previous visit, or on the first visit.
D.
Adolescence:
| Standards | Ages | |||
| 14 years | 16 years | 18 years | 20 years | |
| Health History | X | X | X | X |
| Assessment of Physical Growth: | ||||
| Height | X | X | X | X |
| Weight | X | X | X | X |
| Physical Examination | X | X | X | X |
| Vision | X | X | X | X |
| Hearing | X | X | X | X |
| Blood Pressure | X | X | X | X |
| Development | X | X | X | X |
| Health Education/Counseling | X | X | X | X |
| Sexual Development | X | X | X | X |
| Nutrition | X | X | X | X |
| Immunizations/Review | X | X | X | X |
| Laboratory Tests: | ||||
| Tuberculin | if history indicates | |||
| Lead Absorption | if history indicates | |||
| Urinalysis | ← | X | ||
| Bacteriuria (females) | ← | ← | ||
| Hemoglobin or Hematocrit | ← | X | ||
| Sickle Cell | at parent's or child's request | |||
| Other Laboratory Tests | as indicated | |||
| Oral Examination | X | X | ||
X = Procedure to be completed.
← = Procedure to be completed if not done at the previous visit, or on the first visit.
Subp. 15a.
Additional screenings.
A child may have a partial or complete screening between the ages specified in the schedule under subpart 15 if the screening is medically necessary or a concern develops about the child's health or development.
9505.1724 PROVISION OF DIAGNOSIS AND TREATMENT.
Diagnosis and treatment identified as needed under part 9505.1718 shall be eligible for medical assistance payment subject to the provisions of parts 9505.0170 to 9505.0475.
9505.1727 INFORMING.
A local agency must inform each child or parent of a child about the EPSDT program no later than 60 days after the date the child is determined to be eligible for medical assistance. The information about the EPSDT program must be given orally and in writing, indicate the purpose and benefits of the EPSDT program, indicate that the EPSDT program is without cost to the child or parent of the child while the child is eligible for medical assistance, state the types of medical and dental services available under the EPSDT program, and state that the transportation and appointment scheduling assistance required under part 9505.1730 is available.
The department must send a written notice to a child or parent of a child who has been screened informing the child or parent that the child should be screened again. This notice must be sent at the following ages of the child: six months, nine months, one year, 18 months, two years, four years, and every three years after age four.
Each year, on the date the child was determined eligible for medical assistance entitlements, the department must send a written notice to a child or parent of a child who has never been screened informing the child or parent that the child is eligible to be screened.
9505.1730 ASSISTANCE WITH OBTAINING A SCREENING.
Within ten working days of receiving a request for screening from a child or parent of a child, a local agency must give or mail to the child or parent of the child:
9505.1733 ASSISTANCE WITH OBTAINING DIAGNOSIS AND TREATMENT.
An EPSDT clinic must notify a child or parent of a child who is referred for diagnosis and treatment that the local agency will provide names and addresses of diagnosis and treatment providers and will help with appointment scheduling and transportation to the diagnosis and treatment provider. The notice must be on a form provided by the department and must be given to the child or parent of the child on the day the child is screened.
If a child or parent of a child asks a local agency for assistance with obtaining diagnosis and treatment, the local agency must provide that assistance within ten working days of the date of the request.
9505.1736 SPECIAL NOTIFICATION REQUIREMENT.
A local agency must effectively inform an individual who is blind or deaf, or who cannot read or understand the English language, about the EPSDT program.
9505.1739 CHILDREN IN FOSTER CARE.
Subpart 1.
Dependent or neglected state wards.
The local agency must provide early and periodic screening, diagnosis, and treatment services for a child in foster care who is a dependent or neglected state ward under parts 9560.0410 to 9560.0470, and who is eligible for medical assistance unless the early and periodic screening, diagnosis, and treatment services are not in the best interest of the child.
Subp. 2.
Other children in foster care.
The local agency must discuss the EPSDT program with a parent of a child in foster care who is under the legal custody or protective supervision of the local agency or whose parent has entered into a voluntary placement agreement with the local agency. The local agency must help the parent decide whether to accept early and periodic screening, diagnosis, and treatment services for the child. If a parent cannot be consulted, the local agency must decide whether to accept early and periodic screening, diagnosis, and treatment services for the child and must document the reasons for the decision.
Subp. 3.
Assistance with appointment scheduling and transportation.
The local agency must help a child in foster care with appointment scheduling and transportation for screening, diagnosis, and treatment as provided by parts 9505.1730 to 9505.1733.
Subp. 4.
Notification.
The department must send a written notice to the local agency stating that a child in foster care who has been screened should be screened again. This notice must be sent at the following ages of the child: six months, nine months, one year, 18 months, two years, four years, and every three years thereafter.
Each year, by the anniversary of the date the child was determined eligible for medical assistance entitlements, the department must send a written notice to the local agency that a child in foster care who has never been screened is eligible to be screened.
If a written notice under this subpart pertains to a child who is a dependent or neglected state ward, the local agency must proceed according to subpart 1. The local agency must proceed according to subpart 2 if the written notice pertains to a child who is not a dependent or neglected state ward.
9505.1742 DOCUMENTATION.
The local agency must document compliance with parts 9505.1693 to 9505.1748 on forms provided by the department.
9505.1745 INTERAGENCY COORDINATION.
The local agency must coordinate the EPSDT program with other programs that provide health services to children as provided by Code of Federal Regulations, title 42, section 441.61(c), as amended through October 1, 1986. Examples of such agencies are a public health nursing service, a Head Start agency, and a school district.
9505.1748 CONTRACTS FOR ADMINISTRATIVE SERVICES.
Subpart 1.
Authority.
A local agency may contract with a county public health nursing service, a community health clinic, a Head Start agency, a community action agency, or a school district for early and periodic screening, diagnosis, and treatment administrative services. Early and periodic screening, diagnosis, and treatment administrative services include outreach; notification; appointment scheduling and transportation; follow-up; and documentation. For purposes of this subpart, "community action agency" means an entity defined in Minnesota Statutes, section 256E.31, subdivision 1, and "school district" means a school district as defined in Minnesota Statutes, section 120A.05, subdivisions 5, 10, and 14.
Subp. 2.
Federal financial participation.
The percent of federal financial participation for salaries, fringe benefits, and travel of skilled professional medical personnel and their supporting staff shall be paid as provided by Code of Federal Regulations, title 42, section 433.15(b)(5), as amended through October 1, 1986.
Subp. 3.
State reimbursement.
State reimbursement for contracts for EPSDT administrative services under this part shall be as provided by Minnesota Statutes, section 256B.19, subdivision 1, except for the provisions under subdivision 1 that pertain to a prepaid health plan.
Subp. 4.
Approval.
A contract for administrative services must be approved by the local agency and submitted to the department for approval by November 1 of the year before the beginning of the calendar year in which the contract will be effective. A contract must contain items A to L to be approved by the department for reimbursement:
D.
amount of the contract, budget breakdown, and a clause that stipulates that the department's procedures for certifying expenditures will be followed by the local agency;
F.
a clause that stipulates that the contract will be renegotiated if federal or state program regulations or federal financial reimbursement regulations change;
G.
a clause that stipulates that the contracting parties will provide program and fiscal records and maintain all nonpublic data required by the contract according to the Minnesota Government Data Practices Act and will cooperate with state and federal program reviews;
J.
signatures of the representatives of the contracting parties with the authority to obligate the parties by contract and dates of those signatures;
K.
a clause that stipulates that the services provided under contract must be performed by or under the supervision of skilled medical personnel; and
L.
a clause that stipulates that the contracting parties will comply with state and federal requirements for the receipt of medical assistance funds.
9520.0010 STATUTORY AUTHORITY AND PURPOSE.
Parts 9520.0010 to 9520.0230 provide methods and procedures relating to the establishment and operation of area-wide, comprehensive, community-based mental health, developmental disability, and chemical dependency programs under state grant-in-aid as provided under Minnesota Statutes, sections 245.61 to 245.69. Minnesota Statutes, sections 245.61 to 245.69 are entitled The Community Mental Health Services Act. For purposes of these parts, "community mental health services" includes services to persons who have mental or emotional disorders or other psychiatric disabilities, developmental disabilities, and chemical dependency, including drug abuse and alcoholism.
9520.0020 BOARD DUTIES.
The community mental health board has the responsibility for ensuring the planning, development, implementation, coordination, and evaluation of the community comprehensive mental health program for the mentally ill/behaviorally disabled, developmentally disabled, and chemically dependent populations in the geographic area it serves. It also has the responsibility for ensuring delivery of services designated by statute.
9520.0030 DEFINITIONS.
Parts 9520.0040 and 9520.0050 also set forth definitions of community mental health centers and community mental health clinics.
9520.0040 COMMUNITY MENTAL HEALTH CENTER.
A community mental health center means an agency which includes all of the following:
B.
Provides as a minimum the following services for individuals with mental or emotional disorders, developmental disabilities, alcoholism, drug abuse, and other psychiatric conditions. The extent of each service to be provided by the center shall be indicated in the program plan, which is to reflect the problems, needs, and resources of the community served:
(1)
collaborative and cooperative services with public health and other groups for programs of prevention of mental illness, developmental disability, alcoholism, drug abuse, and other psychiatric disorders;
(2)
informational and educational services to schools, courts, health and welfare agencies, both public and private;
(4)
consultative services to schools, courts, and health and welfare agencies, both public and private;
(6)
rehabilitative services, particularly for those who have received prior treatment in an inpatient facility.
C.
Provides or contracts for detoxification, evaluation, and referral for chemical dependency services (Minnesota Statutes, section 254A.08).
D.
Provides specific coordination for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. (Minnesota Statutes, sections 254A.07 and 245.61).
E.
Has a competent multidisciplinary mental health/developmental disability/chemical dependency professional team whose members meet the professional standards in their respective fields.
F.
The professional mental health team is qualified by specific mental health training and experience and shall include as a minimum the services of each of the following:
(2)
a doctoral clinical, counseling, or health care psychologist, who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
(3)
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
(4)
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health nursing with mental health major, maternal and child health with mental health major, etc.
G.
The multidisciplinary staff shall be sufficient in number to implement and operate the described program of the center. In addition to the above, this team should include other professionals, paraprofessionals, and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner. If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the center, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and show evidence of how the specialized functions of the required professionals are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0050 COMMUNITY MENTAL HEALTH CLINIC.
Subpart 1.
Definitions.
A community mental health clinic is an agency which devotes, as its major service, at least two-thirds of its resources for outpatient mental health diagnosis, treatment, and consultation by a multidisciplinary professional mental health team. The multidisciplinary professional mental health team is qualified by special mental health training and experience and shall include as a minimum the services of each of the following:
B.
a doctoral clinical, or counseling or health care psychologist who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
C.
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
D.
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health with a mental health major, maternal and child health with a mental health major.
Subp. 2.
Other members of multidisciplinary team.
The multidisciplinary team shall be sufficient in number to implement and operate the described program of the clinic. In addition to the above, this team should include other professionals, paraprofessionals and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner.
Subp. 3.
Efforts to acquire staff.
If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the clinic, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and evidence of how the specialized functions of the required professional positions are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0060 ANNUAL PLAN AND BUDGET.
On or before the date designated by the commissioner, each year the chair of the community mental health board or director of the community mental health program, provided for in Minnesota Statutes, section 245.62, shall submit an annual plan identifying program priorities in accordance with state grant-in-aid guidelines, and a budget on prescribed report forms for the next state fiscal year, together with the recommendations of the community mental health board, to the commissioner of human services for approval as provided under Minnesota Statutes, section 245.63.
9520.0070 FISCAL AFFILIATES.
Other providers of community mental health services may affiliate with the community mental health center and may be approved and eligible for state grant-in-aid funds. The state funding for other community mental health services shall be contingent upon appropriate inclusion in the center's community mental health plan for the continuum of community mental health services and conformity with the state's appropriate disability plan for mental health, developmental disability, or chemical dependency. Fiscal affiliates (funded contracting agencies) providing specialized services under contract must meet all rules and standards that apply to the services they are providing.
9520.0080 OTHER REQUIRED REPORTS.
The program director of the community mental health program shall provide the commissioner of human services with such reports of program activities as the commissioner may require.
9520.0090 FUNDING.
All state community mental health funding shall go directly to the community mental health board or to a human service board established pursuant to Laws of Minnesota 1975, chapter 402, which itself provides or contracts with another agency to provide the community mental health program. Such programs must meet the standards and rules for community mental health programs as enunciated in parts 9520.0010 to 9520.0230 in accordance with Laws of Minnesota 1975, chapter 402.
9520.0100 OPERATION OF OTHER PROGRAMS.
When the governing authority of the community mental health program operates other programs, services, or activities, only the community mental health center program shall be subject to these parts.
9520.0110 APPLICATIONS AND AGREEMENTS BY LOCAL COUNTIES.
New applications for state assistance or applications for renewal of support must be accompanied by an agreement executed by designated signatories on behalf of the participating counties that specifies the involved counties, the amount and source of local funds in each case, and the period of support. The local funds to be used to match state grant-in-aid must be assured in writing on Department of Human Services forms by the local funding authority(ies).
9520.0120 USE OF MATCHING FUNDS.
Funds utilized by the director as authorized by the community mental health board to match a state grant-in-aid must be available to that director for expenditures for the same general purpose as the state grant-in-aid funds.
9520.0130 QUARTERLY REPORTS.
The director of the community mental health program shall, within 20 days after the end of the quarter, submit quarterly prescribed reports to the commissioner of human services (controller's office), containing all receipts, expenditures, and cash balance, subject to an annual audit by the commissioner or his/her designee.
9520.0140 PAYMENTS.
Payments on approved grants will be made subsequent to the department's receipt of the program's quarterly reporting forms, unless the commissioner of human services has determined that funds allocated to a program are not needed for that program. Payments shall be in an amount of at least equal to the quarterly allocation minus any unexpended balance from the previous quarter providing this payment does not exceed the program grant award. In the event the program does not report within the prescribed time, the department will withhold the process of the program's payment until the next quarterly cycle.
9520.0150 FEES.
No fees shall be charged until the director with approval of the community mental health board has established fee schedules for the services rendered and they have been submitted to the commissioner of human services at least two months prior to the effective date thereof and have been approved by him/her. All fees shall conform to the approved schedules, which are accessible to the public.
9520.0160 SUPPLEMENTAL AWARDS.
The commissioner of human services may make supplemental awards to the community mental health boards.
9520.0170 WITHDRAWAL OF FUNDS.
The commissioner of human services may withdraw funds from any program that is not administered in accordance with its approved plan and budget. Written notice of such intended action will be provided to the director and community mental health board. Opportunity for hearing before the commissioner or his/her designee shall be provided.
9520.0180 BUDGET TRANSFERS.
Community mental health boards may make budget transfers within specified limits during any fiscal year without prior approval of the department. The specified limit which can be transferred in any fiscal year between program activity budgets shall be up to ten percent or up to $5,000 whichever is less. Transfers within an activity can be made into or out of line items with a specified limit of up to ten percent or up to $5,000 whichever is less. No line item can be increased or decreased by more than $5,000 or ten percent in a fiscal year without prior approval of the commissioner. Transfers above the specified limits can be made with prior approval from the commissioner. All transfers within and into program budget activities and/or line items must have prior approval by the community mental health board and this approval must be reflected in the minutes of its meeting, it must be reported to the commissioner with the reasons therefor, including a statement of how the transfer will affect program objectives.
9520.0190 BUDGET ADJUSTMENTS.
Budget adjustments made necessary by funding limitations shall be made by the commissioner and provided in writing to the director and board of the community mental health center.
9520.0200 CENTER DIRECTOR.
Every community mental health board receiving state funds for a community mental health program shall have a center director, who is the full-time qualified professional staff member who serves as the executive officer. To be considered qualified, the individual must have professional training to at least the level of graduate degree in his/her clinical and/or administrative discipline, which is relevant to MH-DD-CD and a minimum of two years experience in community mental health programs. The center director is responsible for the planning/design, development, coordination, and evaluation of a comprehensive, area-wide program and for the overall administration of services operated by the board.
The center director shall be appointed by the community mental health board and shall be approved by the commissioner of human services.
9520.0210 DEADLINE FOR APPROVAL OR DENIAL OF REQUEST FOR APPROVAL STATUS.
The commissioner shall approve or deny, in whole or in part, an application for state financial assistance within 90 days of receipt of the grant-in-aid application or by the beginning of the state fiscal year, whichever is the later.
9520.0230 ADVISORY COMMITTEE.
Subpart 1.
Purpose.
To assist the community mental health board in meeting its responsibilities as described in Minnesota Statutes, section 245.68 and to provide opportunity for broad community representation necessary for effective comprehensive mental health, developmental disability, and chemical dependency program planning, each community mental health board shall appoint a separate advisory committee in at least the three disability areas of mental health, developmental disability, and chemical dependency.
Subp. 2.
Membership.
The advisory committees shall consist of residents of the geographic area served who are interested and knowledgeable in the area governed by such committee.
Subp. 3.
Nominations for membership.
Nominations for appointments as members of the advisory committees are to be made to the community mental health board from agencies, organizations, groups, and individuals within the area served by the community mental health center. Appointments to the advisory committees are made by the community mental health board.
Subp. 4.
Board member on committee.
One community mental health board member shall serve on each advisory committee.
Subp. 5.
Nonprovider members.
Each advisory committee shall have at least one-half of its membership composed of individuals who are not providers of services to the three disability groups.
Subp. 6.
Representative membership.
Membership of each advisory committee shall generally reflect the population distribution of the service delivery area of the community mental health center.
Subp. 7.
Chairperson appointed.
The community mental health board shall appoint a chairperson for each advisory committee. The chairperson shall not be a community mental health board member nor a staff member. The power to appoint the chairperson may be delegated by the community mental health board to the individual advisory committee.
Subp. 8.
Committee responsibility to board.
Each advisory committee shall be directly responsible to the community mental health board. Direct communication shall be effected and maintained through contact between the chairperson of the particular advisory committee, or his/her designee, and the chairperson of the community mental health board, or his/her designee.
Subp. 9.
Staff.
Staff shall be assigned by the director to serve the staffing needs of each advisory committee.
Subp. 10.
Study groups and task forces.
Each advisory committee may appoint study groups and task forces upon consultation with the community mental health board. It is strongly recommended that specific attention be given to the aging and children and youth populations.
Subp. 12.
Annual report required.
Each advisory committee must make a formal written and oral report on its work to the community mental health board at least annually.
Subp. 13.
Minutes.
Each advisory committee shall submit copies of minutes of their meetings to the community mental health board and to the Department of Human Services (respective disability group program divisions).
Subp. 14.
Duties of advisory committee.
The advisory committees shall be charged by the community mental health board with assisting in the identification of the community's needs for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. The advisory committee also assists the community mental health board in determining priorities for the community programs. Based on the priorities, each advisory committee shall recommend to the community mental health board ways in which the limited available community resources (work force, facilities, and finances) can be put to maximum and optimal use.
Subp. 15.
Recommendations.
The advisory committee recommendations made to the community mental health board shall be included as a separate section in the grant-in-aid request submitted to the Department of Human Services by the community mental health board.
Subp. 16.
Assessment of programs.
The advisory committees shall assist the community mental health board in assessing the programs carried on by the community mental health board, and make recommendations regarding the reordering of priorities and modifying of programs where necessary.
9520.0750 PURPOSE.
Parts 9520.0750 to 9520.0870 establish standards for approval of mental health centers and mental health clinics for purposes of insurance and subscriber contract reimbursement under Minnesota Statutes, section 62A.152.
9520.0760 DEFINITIONS.
Subpart 1.
Scope.
As used in parts 9520.0760 to 9520.0870, the following terms have the meanings given them.
Subp. 2.
Application.
"Application" means the formal statement by a center to the commissioner, on the forms created for this purpose, requesting recognition as meeting the requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Approval.
"Approval" means the determination by the commissioner that the applicant center has met the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, and is therefore eligible to claim reimbursement for outpatient clinical services under the terms of Minnesota Statutes, section 62A.152. Approval of a center under these parts does not mean approval of a multidisciplinary staff person of such center to claim reimbursement from medical assistance or other third-party payors when practicing privately. Approval of a center under these parts does not mean approval of such center to claim reimbursement from medical assistance.
Subp. 4.
Case review.
"Case review" means a consultation process thoroughly examining a client's condition and treatment. It includes review of the client's reason for seeking treatment, diagnosis and assessment, and the individual treatment plan; review of the appropriateness, duration, and outcome of treatment provided; and treatment recommendations.
Subp. 5.
Center.
"Center" means a public or private health and human services facility which provides clinical services in the treatment of mental illness. It is an abbreviated term used in place of "mental health center" or "mental health clinic" throughout parts 9520.0750 to 9520.0870.
Subp. 6.
Client.
"Client" means a person accepted by the center to receive clinical services in the diagnosis and treatment of mental illness.
Subp. 7.
Clinical services.
"Clinical services" means services provided to a client to diagnose, describe, predict, and explain that client's status relative to a disabling condition or problem, and where necessary, to treat the client to reduce impairment due to that condition. Clinical services also include individual treatment planning, case review, record keeping required for treatment, peer review, and supervision.
Subp. 8.
Commissioner.
"Commissioner" means the commissioner of the Minnesota Department of Human Services or a designated representative.
Subp. 9.
Competent.
"Competent" means having sufficient knowledge of and proficiency in a specific mental illness assessment or treatment service, technique, method, or procedure, documented by experience, education, training, and certification, to be able to provide it to a client with little or no supervision.
Subp. 10.
Consultation.
"Consultation" means the process of deliberating or conferring between multidisciplinary staff regarding a client and the client's treatment.
Subp. 11.
Deferral.
"Deferral" means the determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 and is not approved, but is granted a period of time to comply with these standards and receive a second review without reapplication.
Subp. 13.
Disapproval or withdrawal of approval.
"Disapproval" or "withdrawal of approval" means a determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 14.
Discipline.
"Discipline" means a branch of professional knowledge or skill acquired through a specific course of study and training and usually documented by a specific educational degree or certification of proficiency. Examples of the mental health disciplines include but are not limited to psychiatry, psychology, clinical social work, and psychiatric nursing.
Subp. 15.
Documentation.
"Documentation" means the automatically or manually produced and maintained evidence that can be read by person or machine, and that will attest to the compliance with requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 16.
Individual treatment plan.
"Individual treatment plan" means a written plan of intervention and treatment developed on the basis of assessment results for a specific client, and updated as necessary. The plan specifies the goals and objectives in measurable terms, states the treatment strategy, and identifies responsibilities of multidisciplinary staff.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a staff person providing clinical services in the treatment of mental illness who is qualified in at least one of the following ways:
A.
by having a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and 2,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
B.
by having 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
C.
by being a graduate student in one of the behavioral sciences or related fields formally assigned to the center for clinical training by an accredited college or university; or
D.
by having a master's or other graduate degree in one of the behavioral sciences or related fields from an accredited college or university.
Documentation of compliance with part 9520.0800, subpart 4, item B is required for designation of work as supervised experience in the delivery of clinical services. Documentation of the accreditation of a college or university shall be a listing in Accredited Institutions of Postsecondary Education Programs, Candidates for the year the degree was issued. The master's degree in behavioral sciences or related fields shall include a minimum of 28 semester hours of graduate course credit in mental health theory and supervised clinical training, as documented by an official transcript.
Subp. 18.
Mental health professional.
"Mental health professional" has the meaning given in Minnesota Statutes, section 245.462, subdivision 18.
Subp. 19.
Mental illness.
"Mental illness" means a condition which results in an inability to interpret the environment realistically and in impaired functioning in primary aspects of daily living such as personal relations, living arrangements, work, and recreation, and which is listed in the clinical manual of the International Classification of Diseases (ICD-9-CM), Ninth Revision (1980), code range 290.0-302.99 or 306.0-316, or the corresponding code in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), Third Edition (1980), Axes I, II or III. These publications are available from the State Law Library.
Subp. 20.
Multidisciplinary staff.
"Multidisciplinary staff" means the mental health professionals and mental health practitioners employed by or under contract to the center to provide outpatient clinical services in the treatment of mental illness.
Subp. 21.
Serious violations of policies and procedures.
"Serious violations of policies and procedures" means a violation which threatens the health, safety, or rights of clients or center staff; the repeated nonadherence to center policies and procedures; and the nonadherence to center policies and procedures which result in noncompliance with Minnesota Statutes, section 245.69, subdivision 2 and parts 9520.0760 to 9520.0870.
Subp. 22.
Treatment strategy.
"Treatment strategy" means the particular form of service delivery or intervention which specifically addresses the client's characteristics and mental illness, and describes the process for achievement of individual treatment plan goals.
9520.0770 ORGANIZATIONAL STRUCTURE OF CENTER.
Subpart 1.
Basic unit.
The center or the facility of which it is a unit shall be legally constituted as a partnership, corporation, or government agency. The center shall be either the entire facility or a clearly identified unit within the facility which is administratively and clinically separate from the rest of the facility. All business shall be conducted in the name of the center or facility, except medical assistance billing by individually enrolled providers when the center is not enrolled.
Subp. 2.
Purpose, services.
The center shall document that the prevention, diagnosis, and treatment of mental illness are the main purposes of the center. If the center is a unit within a facility, the rest of the facility shall not provide clinical services in the outpatient treatment of mental illness. The facility may provide services other than clinical services in the treatment of mental illness, including medical services, chemical dependency services, social services, training, and education. The provision of these additional services is not reviewed in granting approval to the center under parts 9520.0760 to 9520.0870.
Subp. 3.
Governing body.
The center shall have a governing body. The governing body shall provide written documentation of its source of authority. The governing body shall be legally responsible for the implementation of the standards set forth in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 through the establishment of written policy and procedures.
Subp. 4.
Chart or statement of organization.
The center shall have an organizational chart or statement which specifies the relationships among the governing body, any administrative and support staff, mental health professional staff, and mental health practitioner staff; their respective areas of responsibility; the lines of authority involved; the formal liaison between administrative and clinical staff; and the relationship of the center to the rest of the facility and any additional services provided.
9520.0780 SECONDARY LOCATIONS.
Subpart 1.
Main and satellite offices.
The center shall notify the commissioner of all center locations. If there is more than one center location, the center shall designate one as the main office and all secondary locations as satellite offices. The main office as a unit and the center as a whole shall be in compliance with part 9520.0810. The main office shall function as the center records and documentation storage area and house most administrative functions for the center. Each satellite office shall:
E.
ensure that a mental health professional is at the satellite office and competent to supervise and intervene in the clinical services provided there, whenever the satellite office is open;
F.
ensure that its multidisciplinary staff have access to and interact with main center staff for consultation, supervision, and peer review; and
G.
ensure that clients have access to all clinical services provided in the treatment of mental illness and the multidisciplinary staff of the center.
Subp. 2.
Noncompliance.
If the commissioner determines that a secondary location is not in compliance with subpart 1, it is not a satellite office. Outpatient clinical services in the treatment of mental illness delivered by the center or facility of which it is a unit shall cease at that location, or the application shall be disapproved.
9520.0790 MINIMUM TREATMENT STANDARDS.
Subpart 1.
Multidisciplinary approach.
The center shall document that services are provided in a multidisciplinary manner. That documentation shall include evidence that staff interact in providing clinical services, that the services provided to a client involve all needed disciplines represented on the center staff, and that staff participate in case review and consultation procedures as described in subpart 6.
Subp. 2.
Intake and case assignment.
The center shall establish an intake or admission procedure which outlines the intake process, including the determination of the appropriateness of accepting a person as a client by reviewing the client's condition and need for treatment, the clinical services offered by the center, and other available resources. The center shall document that case assignment for assessment, diagnosis, and treatment is made to a multidisciplinary staff person who is competent in the service, in the recommended treatment strategy and in treating the individual client characteristics. Responsibility for each case shall remain with a mental health professional.
Subp. 3.
Assessment and diagnostic process.
The center shall establish an assessment and diagnostic process that determines the client's condition and need for clinical services. The assessment of each client shall include clinical consideration of the client's general physical, medical, developmental, family, social, psychiatric, and psychological history and current condition. The diagnostic statement shall include the diagnosis based on the codes in the International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and refer to the pertinent assessment data. The diagnosis shall be by or under the supervision of and signed by a psychiatrist or licensed psychologist. The diagnostic assessment, as defined by Minnesota Statutes, sections 245.462, subdivision 9, for adults, and 245.4871, subdivision 11, for children, must be provided by a licensed mental health professional in accordance with Minnesota Statutes, section 245.467, subdivision 2.
Subp. 4.
Treatment planning.
The individual treatment plan, based upon a diagnostic assessment of mental illness, shall be jointly developed by the client and the mental health professional. This planning procedure shall ensure that the client has been informed in the following areas: assessment of the client condition; treatment alternatives; possible outcomes and side effects of treatment; treatment recommendations; approximate length, cost, and hoped-for outcome of treatment; the client's rights and responsibilities in implementation of the individual treatment plan; staff rights and responsibilities in the treatment process; the Government Data Practices Act; and procedures for reporting grievances and alleged violation of client rights. If the client is considering chemotherapy, hospitalization, or other medical treatment, the appropriate medical staff person shall inform the client of the treatment alternatives, the effects of the medical procedures, and possible side effects. Clinical services shall be appropriate to the condition, age, sex, socioeconomic, and ethnic background of the client, and provided in the least restrictive manner. Clinical services shall be provided according to the individual treatment plan and existing professional codes of ethics.
Subp. 5.
Client record.
The center shall maintain a client record for each client. The record must document the assessment process, the development and updating of the treatment plan, the treatment provided and observed client behaviors and response to treatment, and serve as data for the review and evaluation of the treatment provided to a client. The record shall include:
G.
when necessary, the client's authorization to release private information, and client information obtained from outside sources;
H.
at the closing of the case, a statement of the reason for termination, current client condition, and the treatment outcome; and
Subp. 6.
Consultation; case review.
The center shall establish standards for case review and encourage the ongoing consultation among multidisciplinary staff. The multidisciplinary staff shall attend staff meetings at least twice monthly for a minimum of four hours per month, or a minimum of two hours per month if the multidisciplinary staff person provides clinical services in the treatment of mental illness less than 15 hours per week. The purpose of these meetings shall be case review and consultation. Written minutes of the meeting shall be maintained at the center for at least three years after the meeting.
Subp. 7.
Referrals.
If the necessary treatment or the treatment desired by the client is not available at the center, the center shall facilitate appropriate referrals. The multidisciplinary staff person shall discuss with the client the reason for the referral, potential treatment resources, and what the process will involve. The staff person shall assist in the process to ensure continuity of the planned treatment.
Subp. 8.
Emergency service.
The center shall ensure that clinical services to treat mental illness are available to clients on an emergency basis.
Subp. 9.
Access to hospital.
The center shall document that it has access to hospital admission for psychiatric inpatient care, and shall provide that access when needed by a client. This requirement for access does not require direct hospital admission privileges on the part of qualified multidisciplinary staff.
9520.0800 MINIMUM QUALITY ASSURANCE STANDARDS.
Subpart 1.
Policies and procedures.
The center shall develop written policies and procedures and shall document the implementation of these policies and procedures for each treatment standard and each quality assurance standard in subparts 2 to 7. The policies shall be approved by the governing body. The procedures shall indicate what actions or accomplishments are to be performed, who is responsible for each action, and any documentation or required forms. Multidisciplinary staff shall have access to a copy of the policies and procedures at all times.
Subp. 2.
Peer review.
The center shall have a multidisciplinary peer review system to assess the manner in which multidisciplinary staff provide clinical services in the treatment of mental illness. Peer review shall include the examination of clinical services to determine if the treatment provided was effective, necessary, and sufficient and of client records to determine if the recorded information is necessary and sufficient. The system shall ensure review of a randomly selected sample of five percent or six cases, whichever is less, of the annual caseload of each mental health professional by other mental health professional staff. Peer review findings shall be discussed with staff involved in the case and followed up by any necessary corrective action. Peer review records shall be maintained at the center.
Subp. 3.
Internal utilization review.
The center shall have a system of internal utilization review to examine the quality and efficiency of resource usage and clinical service delivery. The center shall develop and carry out a review procedure consistent with its size and organization which includes collection or review of information, analysis or interpretation of information, and application of findings to center operations. The review procedure shall minimally include, within any three year period of time, review of the appropriateness of intake, the provision of certain patterns of services, and the duration of treatment. Criteria may be established for treatment length and the provision of services for certain client conditions. Utilization review records shall be maintained, with an annual report to the governing body for applicability of findings to center operations.
Subp. 4.
Staff supervision.
Staff supervision:
A.
The center shall have a clinical evaluation and supervision procedure which identifies each multidisciplinary staff person's areas of competence and documents that each multidisciplinary staff person receives the guidance and support needed to provide clinical services for the treatment of mental illness in the areas they are permitted to practice.
B.
A mental health professional shall be responsible for the supervision of the mental health practitioner, including approval of the individual treatment plan and bimonthly case review of every client receiving clinical services from the practitioner. This supervision shall include a minimum of one hour of face-to-face, client-specific supervisory contact for each 40 hours of clinical services in the treatment of mental illness provided by the practitioner.
Subp. 5.
Continuing education.
The center shall require that each multidisciplinary staff person attend a minimum of 36 clock hours every two years of academic or practical course work and training. This education shall augment job-related knowledge, understanding, and skills to update or enhance staff competencies in the delivery of clinical services to treat mental illness. Continued licensure as a mental health professional may be substituted for the continuing education requirement of this subpart.
Subp. 6.
Violations of standards.
The center shall have procedures for the reporting and investigating of alleged unethical, illegal, or grossly negligent acts, and of the serious violation of written policies and procedures. The center shall document that the reported behaviors have been reviewed and that responsible disciplinary or corrective action has been taken if the behavior was substantiated. The procedures shall address both client and staff reporting of complaints or grievances regarding center procedures, staff, and services. Clients and staff shall be informed they may file the complaint with the department if it was not resolved to mutual satisfaction. The center shall have procedures for the reporting of suspected abuse or neglect of clients, in accordance with Minnesota Statutes, sections 611A.32, subdivision 5; 626.556; and 626.557.
Subp. 7.
Data classification.
Client information compiled by the center, including client records and minutes of case review and consultation meetings, shall be protected as private data under the Minnesota Government Data Practices Act.
9520.0810 MINIMUM STAFFING STANDARDS.
Subpart 1.
Required staff.
Required staff:
A.
The multidisciplinary staff of a center shall consist of at least four mental health professionals. At least two of the mental health professionals shall each be employed or under contract for a minimum of 35 hours a week by the center. Those two mental health professionals shall be of different disciplines.
C.
The mental health professional employed or under contract to the center to meet the requirement of item B shall be at the main office of the center and providing clinical services in the treatment of mental illness at least eight hours every two weeks.
Subp. 2.
Additional staff; staffing balance.
Additional mental health professional staff may be employed by or under contract to the center provided that no single mental health discipline or combination of allied fields shall comprise more than 60 percent of the full-time equivalent mental health professional staff. This provision does not apply to a center with fewer than six full-time equivalent mental health professional staff. Mental health practitioners may also be employed by or under contract to a center to provide clinical services for the treatment of mental illness in their documented area of competence. Mental health practitioners shall not comprise more than 25 percent of the full-time equivalent multidisciplinary staff. In determination of full-time equivalence, only time spent in clinical services for the treatment of mental illness shall be considered.
Subp. 3.
Multidisciplinary staff records.
The center shall maintain records sufficient to document that the center has determined and verified the clinical service qualifications of each multidisciplinary staff person, and sufficient to document each multidisciplinary staff person's terms of employment.
9520.0820 APPLICATION PROCEDURES.
Subpart 1.
Form.
A facility seeking approval as a center for insurance reimbursement of its outpatient clinical services in treatment of mental illness must make formal application to the commissioner for such approval. The application form for this purpose may be obtained from the Mental Illness Program Division of the department. The application form shall require only information which is required by statute or rule, and shall require the applicant center to explain and provide documentation of compliance with the minimum standards in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 2.
Fee.
Each application shall be accompanied by payment of the nonrefundable application fee. The fee shall be established and adjusted in accordance with Minnesota Statutes, section 16A.128 to cover the costs to the department in implementing Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Completed application.
The application is considered complete on the date the application fee and all information required in the application form are received by the department.
9520.0830 REVIEW OF APPLICANT CENTERS.
Subpart 1.
Site visit.
The formal review shall begin after the completed application has been received, and shall include an examination of the written application and a visit to the center. The applicant center shall be offered a choice of site visit dates, with at least one date falling within 60 days of the date on which the department receives the complete application. The site visit shall include interviews with multidisciplinary staff and examination of a random sample of client records, consultation minutes, quality assurance reports, and multidisciplinary staff records.
Subp. 2.
Documentation.
If implementation of a procedure is too recent to be reliably documented, a written statement of the planned implementation shall be accepted as documentation on the initial application. The evidence of licensure or accreditation through another regulating body shall be accepted as documentation of a specific procedure when the required minimum standard of that body is the same or higher than a specific provision of parts 9520.0760 to 9520.0870.
9520.0840 DECISION ON APPLICATION.
Subpart 1.
Written report.
Upon completion of the site visit, a report shall be written. The report shall include a statement of findings, a recommendation to approve, defer, or disapprove the application, and the reasons for the recommendation.
Subp. 2.
Written notice to center.
The applicant center shall be sent written notice of approval, deferral, or disapproval within 30 days of the completion of the site visit. If the decision is a deferral or a disapproval, the notice shall indicate the specific areas of noncompliance.
Subp. 3.
Noncompliance with statutes and rules.
An application shall be disapproved or deferred if it is the initial application of a center, when the applicant center is not in compliance with Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 4.
Deferral of application.
If an application is deferred, the length of deferral shall not exceed 180 days. If the areas of noncompliance stated in the deferral notice are not satisfactorily corrected by the end of the deferral period, the application shall be disapproved. The applicant center shall allow the commissioner to inspect the center at any time during the deferral period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center. At any time during the deferral period, the applicant center may submit documentation indicating correction of noncompliance. The application shall then be approved or disapproved. At any time during the deferral period, the applicant center may submit a written request to the commissioner to change the application status to disapproval. The request shall be complied with within 14 days of receiving this written request. The applicant center is not an approved center for purposes of Minnesota Statutes, section 62A.152 during a deferral period.
Subp. 5.
Effective date of decision.
The effective date of a decision is the date the commissioner signs a letter notifying the applicant center of that decision.
9520.0850 APPEALS.
If an application is disapproved or approval is withdrawn, a contested case hearing and judicial review as provided in Minnesota Statutes, sections 14.48 to 14.69, may be requested by the center within 30 days of the commissioner's decision.
9520.0860 POSTAPPROVAL REQUIREMENTS.
Subpart 1.
Duration of approval.
Initial approval of an application is valid for 12 months from the effective date, subsequent approvals for 24 months, except when approval is withdrawn according to the criteria in subpart 4.
Subp. 2.
Reapplication.
The center shall contact the department for reapplication forms, and submit the completed application at least 90 days prior to the expected expiration date. If an approved center has met the conditions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, including reapplication when required, its status as an approved center shall remain in effect pending department processing of the reapplication.
Subp. 3.
Restrictions.
The approval is issued only for the center named in the application and is not transferable or assignable to another center. The approval is issued only for the center location named in the application and is not transferable or assignable to another location. If the commissioner is notified in writing at least 30 days in advance of a change in center location and can determine that compliance with all provisions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 are maintained, the commissioner shall continue the approval of the center at the new location.
Subp. 4.
Noncompliance.
Changes in center organization, staffing, treatment, or quality assurance procedures that affect the ability of the center to comply with the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 shall be reported in writing by the center to the commissioner within 15 days of occurrence. Review of the change shall be conducted by the commissioner. A center with changes resulting in noncompliance in minimum standards shall receive written notice and may have up to 180 days to correct the areas of noncompliance before losing approval status. Interim procedures to resolve the noncompliance on a temporary basis shall be developed and submitted in writing to the commissioner for approval within 30 days of the commissioner's determination of the noncompliance. Nonreporting within 15 days of occurrence of a change that results in noncompliance, failure to develop an approved interim procedure within 30 days of the determination of the noncompliance, or nonresolution of the noncompliance within 180 days shall result in the immediate withdrawal of approval status.
Serious violation of policies or procedures, professional association or board sanctioning or loss of licensure for unethical practices, or the conviction of violating a state or federal statute shall be reported in writing by the center to the commissioner within ten days of the substantiation of such behavior. Review of this report and the action taken by the center shall be conducted by the commissioner. Approval shall be withdrawn immediately unless the commissioner determines that: the center acted with all proper haste and thoroughness in investigating the behavior, the center acted with all proper haste and thoroughness in taking appropriate disciplinary and corrective action, and that no member of the governing body was a party to the behavior. Failure to report such behavior within ten days of its substantiation shall result in immediate withdrawal of approval.
Subp. 5.
Compliance reports.
The center may be required to submit written information to the department during the approval period to document that the center has maintained compliance with the rule and center procedures. The center shall allow the commissioner to inspect the center at any time during the approval period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center.
9520.0870 VARIANCES.
Subpart 1.
When allowed.
The standards and procedures established by parts 9520.0760 to 9520.0860 may be varied by the commissioner. Standards and procedures established by statute shall not be varied.
Subp. 2.
Request procedure.
A request for a variance must be submitted in writing to the commissioner, accompanying or following the submission of a completed application for approval under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870. The request shall state:
B.
the specific reasons why the standard or procedure cannot be or should not be complied with; and
C.
the equivalent standard or procedure the center will establish to achieve the intent of the standard or procedure to be varied.
Subp. 3.
Decision procedure.
Upon receiving the variance request, the commissioner shall consult with a panel of experts in the mental health disciplines regarding the request. Criteria for granting a variance shall be the commissioner's determination that subpart 2, items A to C are met. Hardship shall not be a sufficient reason to grant a variance. No variance shall be granted that would threaten the health, safety, or rights of clients. Variances granted by the commissioner shall specify in writing the alternative standards or procedures to be implemented and any specific conditions or limitations imposed on the variance by the commissioner. Variances denied by the commissioner shall specify in writing the reason for the denial.
Subp. 4.
Notification.
The commissioner shall send the center a written notice granting or not granting the variance within 90 days of receiving the written variance request. This notice shall not be construed as approval or disapproval of the center under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
9530.6800 ASSESSMENT OF NEED FOR TREATMENT PROGRAMS.
Subpart 1.
Assessment of need required for licensure.
Before a license or a provisional license may be issued, the need for the chemical dependency treatment or rehabilitation program must be determined by the commissioner. Need for an additional or expanded chemical dependency treatment program must be determined, in part, based on the recommendation of the county board of commissioners of the county in which the program will be located and the documentation submitted by the applicant at the time of application.
If the county board fails to submit a statement to the commissioner within 60 days of the county board's receipt of the written request from an applicant, as required under part 9530.6810, the commissioner shall determine the need for the applicant's proposed chemical dependency treatment program based on the documentation submitted by the applicant at the time of application.
Subp. 2.
Documentation of need requirements.
An applicant for licensure under parts 9530.2500 to 9530.4000 and Minnesota Statutes, chapter 245G, must submit the documentation in items A and B to the commissioner with the application for licensure:
A.
The applicant must submit documentation that it has requested the county board of commissioners of the county in which the chemical dependency treatment program will be located to submit to the commissioner both a written statement that supports or does not support the need for the program and documentation of the rationale used by the county board to make its determination.
B.
The applicant must submit a plan for attracting an adequate number of clients to maintain its proposed program capacity, including:
(3)
documentation that the capacity or program designs of existing programs are not sufficient to meet the service needs of the chemically abusing or chemically dependent target population if that information is available to the applicant;
(4)
a list of referral sources, with an estimation as to the number of clients the referral source will refer to the applicant's program in the first year of operation; and
(5)
any other information available to the applicant that supports the need for new or expanded chemical dependency treatment capacity.
9530.6810 COUNTY BOARD RESPONSIBILITY TO REVIEW PROGRAM NEED.
When an applicant for licensure under parts 9530.2500 to 9530.4000 or Minnesota Statutes, chapter 245G, requests a written statement of support for a proposed chemical dependency treatment program from the county board of commissioners of the county in which the proposed program is to be located, the county board, or the county board's designated representative, shall submit a statement to the commissioner that either supports or does not support the need for the applicant's program. The county board's statement must be submitted in accordance with items A and B:
A.
the statement must be submitted within 60 days of the county board's receipt of a written request from the applicant for licensure; and