Sections 1, 6 to 17 (245A.10; 245A.16; 245C.04; 245C.05; 245C.08; 245C.10; 245C.17; 245C.20; 245C.21; 245C.23) modify the Department of Human Services background study statutes to transfer the responsibility to conduct background studies for adult foster care from the county to the Department of Human Services. Section 12 requires the commissioner to recover the cost of the background studies through a fee of no more than $20 per study charged to the license holder.

Section 2 (245A.10, subdivision 3) requires a waivered services program for persons with developmental disabilities to be licensed only in counties where the program will serve more than three persons. A provider licensed in a county may serve three or fewer persons in up to ten additional counties without applying for a license in that county. Some restrictions apply.

Section 3 (245A.11, subdivision 2a) clarifies that the commissioner shall issue adult foster care licenses with a maximum licensed capacity of four beds; however, if the Legislature adopts a rate reduction that impacts providers of adult foster care services, the commissioner may issue an adult foster care license with a licensed capacity of five adults, under certain circumstances.

Sections 4 and 5 (245A.11, subdivisions 7a and 8b) detail the conditions that must be met for purposes of using technology for overnight supervision in adult foster care homes. Section 5 address privacy issues related to the new technology.

Section 18 (256B.092, subdivision 5b) provides that if the Legislature adopts a rate reduction that impacts payments to providers of adult foster care services, the commissioner may issue a license that permits a capacity of five adults, if certain requirements are met. Prior to the admission of the fifth person, the county must negotiate a revised per diem rate that reflects the legislated rate reduction and results in an overall average per diem reduction for all recipients in the home. The revised rate 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 resulting from the rate cut.

Section 19 (256B.49, subdivision 17) modifies the home and community based waiver statute to reflect the same requirement in section 2 for the county to negotiate a revised per diem rate.

Section 20 requires the commissioner to request all federal approvals and waiver amendments to the home and community based waiver to allow properly licensed adult foster care homes to provide residential services for up to five individuals.

Section 21, paragraph (a), repeals obsolete subdivisions related to the adult foster care background study changes in the article, and paragraph (b) repeals an obsolete subdivision that is partially replaced by the new subdivision in section 2. Paragraph (c) repeals an obsolete rule.

Summary of the relevant sections contained in chapter 173, article 1:

Sections 3 to 10 modify DHS licensing provisions. These modifications consist of technical corrections and clarifications.

Section 1 (119B.09, subdivision 7) limits retroactive eligibility for MFIP and transition year child care to six months from the date of application for child care assistance. This section is effective October 1, 2009.

Section 2 (119B.13, subdivision 6) limits retroactive payments of child care provided with no services authorization for six months for CCAP. This section is effective October 1, 2009.

Section 3 (119B.21, subdivision 5) requires child care services grants to be increasingly awarded for activities that improve provider quality beginning July 1, 2009.

Section 4 (119B.21, subdivision 10) requires family child care technical assistance grants to be increasingly awarded for activities that improve provider quality beginning July 1, 2009.

Section 5 (119B.231, subdivision 2) allows additional providers to participate in the school readiness service agreement (SRSA) program if sufficient funds are available. This section gives priority for funds to providers who had agreements prior to June 30, 2009, and modifies the list of requirements providers must meet in order to be eligible to participate. This section also modifies the list of factors the commissioner must evaluate when determining whether or not to enter into an agreement with a provider.

Section 6 (119B.231, subdivision 3) requires families choosing a provider with an SRSA to maintain eligibility for child care assistance and be in an authorized activity.

Section 7 (119B.231, subdivision 4) requires providers who enter into an SRSA to comply with all SRSA requirements and requires providers who have been previously selected for an SRSA to begin the process of obtaining a rating using the Parent Aware quality rating system according to the timelines established by the commissioner. This section specifies provider and commissioner duties if a provider does not obtain a rating of at least three stars and requires providers who are selected for a new SRSA on or after July 1, 2009, to have at least a three star rating under the Parent Aware quality rating system at the time their agreement is signed.

Sections 8 and 17 (145A.17, subdivision 4a; 256J.49, subdivision 4) modify the home visitor statute and MFIP statute, respectively, to allow home visitors to be MFIP employment and training service providers for ill and incapacitated MFIP participants and MFIP minor caregivers.

Section 9 (256.045, subdivision 3) allows state agency hearings for any person with an outstanding debt resulting from receipt of public assistance, medical care, or food stands who is contesting a setoff claim by the Department of Human Services.

Section 10 (256.983, subdivision 1) modifies fraud prevention investigations by giving the commissioner the final authority in decisions regarding the creation or realignment of individual county or regional expansion of operations.

Section 11 (256I.03, subdivision 7) reduces the group residential housing (GRH) personal needs allowance by $20. This section is effective April 1, 2010.

Section 12 (256I.05, subdivision 7c) allows the expansion of the GRH food stamp demonstration project until October 1, 2009.

Section 13 (256J.24, subdivision 5) increases the MFIP transitional standard in order to acknowledge the increase in food assistance by the federal government. This section is effective retroactive to April 1, 2009, which is the date the federal changes become effective.

Sections 14 and 15 (256J.425, subdivision 2; 256J.425, subdivision 3) modify two MFIP categories of individuals; ill or incapacitated and hard-to-employ, by changing the phrase "a condition that prevents the person from obtaining or retaining employment" to "a condition that severely limits the person's ability to obtain or maintain suitable employment." The new phrase is defined in section 15.

Section 16 (256J.49, subdivision 1) corrects a cross-reference.

Section 18 (256J.521, subdivision 2) strikes language that is no longer necessary due to the implementation of Family Stabilization Services (FSS).

Section 19 (256J.545) strikes obsolete language related to the family violence waiver.

Section 20 (256J.561, subdivision 2) clarifies MFIP participation requirements.

Sections 21, 24, 29, and 30 (256J.561, subdivision 3; 256J.575, subdivision 4; 256J.95, subdivision 3; 256J.95, subdivision 11) except caregivers with a child under 12 months of age, instead of 12 weeks of age, from employment requirements. These sections are effective March 1, 2010.

Section 22 (256J.57, subdivision 1) expands the list of good cause exceptions for failure to comply with MFIP requirements, to include situations where the documentation needed to determine if a participant is eligible for family stabilization services is not available, but there is information that the participant may qualify and the participant is cooperating with the county to obtain the necessary documentation.

Section 23 (256J.575, subdivision 3) strikes a reference to DWP, adds the "60 or older" category to family stabilization services (FSS), and requires the county agency or employment services provider to assist the participant in obtaining documentation to determine eligibility for FSS if the county or provider has information that the participant may meet the eligibility criteria.

Section 25 (256J.575, subdivision 6) makes a technical clarification to FSS.

Section 26 (256J.575, subdivision 7) amends FSS sanction policy, by requiring the county agency or employment services provider to follow the sanction requirements under this section at the time the county or provider has information that the MFIP recipient may meet the FSS eligibility criteria. Provides clarifying language related to a current assessment, and the right to bring an advocate to the face to face meeting before a sanction is imposed.

Section 27 (256J.621) reduces the work participation cash benefits from $75 to $50 per month.

Section 28 (256J.626, subdivision 7) modifies the statute related to performance base funds by adding a definition for "Caseload Reduction Credit (CRC)" and "TANF participation rate target" and incorporates the new terms into this section of law.

Section 31 (256J.95, subdivision 12) modifies which participants are considered to be unlikely to benefit from DWP and converted to MFIP. This section also requires that participants who meet the requirements of Family Stabilization Services be considered to be unlikely to benefit from DWP, provided the necessary documentation is available to support that determination. This section is effective March 1, 2010.

Section 32 (256J.95, subdivision 13) eliminates the requirement that the DWP written referral include the date, time, and location of the scheduled employment services interview.

Section 33 (259.67, subdivision 3b) makes children who attain the age of 16 prior to the finalization of their adoption eligible for extension of the adoption assistance agreement to the date the child attains age 21 if the child meets certain requirements. This section is effective October 1, 2010.

Section 34 (270A.09, subdivision 1b) requires appeals hearings to be conducted in the same manner as other appeals within DHS for any debtor contesting a setoff claim by DHS or a county agency when claims relate to a debt resulting from receipt of certain program assistance.

Section 35 (American Indian Child welfare projects) allows the tribes to carryforward unspent funds to the next biennium.

Section 36 repeals the provision that allows a $12 group residential housing community living adjustment. (Laws 2009, chapter 173, article 1, section 40, makes this section is effective April 1, 2010.)

Sections 1, 2, and 3 (246.50, subdivisions 5, 10, and 11) define the terms "cost of care," "state operated community based program," and "health plan company," respectively.

Section 4 (246.51, subdivision 1a) requires the commissioner to determine the available health plan coverage from a health plan company for services provided to clients admitted to a state operated community based program. If health plan coverage is not available, the commissioner shall determine what part of the uncovered cost of care the client is able to pay. If the client is unable to pay, the commissioner shall determine the client's relatives' ability to pay.

Section 5 (246.51, subdivision 1b) requires the commissioner to determine what part of the cost of care a client served in regional treatment centers or nursing homes operated by state operated services is able to pay.

Section 6 (246.511) provides that the client's relatives must not be ordered to pay more than their ability to pay for services provided in a community based setting, and not more than 20 percent of the cost of care for services provided in a regional treatment center. Current law caps the amount at ten percent. The commissioner may accept voluntary payments in excess of 20 percent.

Section 7 (246.52) strikes "monthly," requiring relatives who have been determined able to pay, to pay to the state of Minnesota, instead of pay "monthly" to the state.

Section 8 (246.54, subdivision 2) is technical; strikes a reference to MSOP in the SOS chapter.

Sections 9 to 16 modify provisions in the Minnesota sex offender program (MSOP) chapter of law. Due to the separation of state-operated services and the MSOP within the Department of Human Services, the related statutes need to appear in both chapters of law. The MSOP sections in this article are simply being lifted from the SOS chapter and incorporated into the MSOP chapter of law, with technical modifications to tailor the provisions to the MSOP.

Sections 9, 10, 11, and 12 (246B.01, subdivisions 1a, 1b, 2a, 2b) define the terms "client," "client's county," "cost of care," and "local social services agency," respectively.

Section 13 (246B.07) requires the commissioner to determine what amount of the cost of care a client in the Minnesota sex offender program is able to pay.

Section 14 (246B.08) requires the commissioner to issue an order to the client or guardian of the estate requiring the client or guardian to pay the state the amounts determined for the cost of care.

Section 15 (246B.09) relates to a claim against the estate of a deceased MSOP client.

Subdivision 1 requires the commissioner to file a claim against the estate of a deceased client or former client, and proceeds collected must be divided between the state and county in proportion to the cost of care each has borne.

Subdivision 2 requires the estate claim be considered an expense of the last illness for purposes of the classification of claims under the uniform probate code.

Subdivision 3 provides that any statute of limitations that limits the commissioner in recovering the cost of care must not apply to any claim against the estate made under this section to recover the cost of care.

Section 16 (246B.10) requires the client's county to pay to the state a portion of the cost of care provided in the MSOP. If payments received exceed 90 percent of the cost of care, the county is responsible for paying the state the remainder.

Section 17 (252.025, subdivision 7) provides that the METO program is statewide and must provided an array of community based services with sufficient levels of care and a sufficient number of specialists to ensure the individuals referred to the program receive appropriate care.

Section 18 requires the development of community based mental health services for patients committed to the Anoka Metro RTC. The commissioner is required to develop, in consultation with community partners, an array of community based services to transform the current services provided to patients at the Anoka Metro RTC. The community-based services may be provided in facilities with 16 or fewer beds and must provide the appropriate level of care for patients being admitted to the facilities. The transition planning must be done by October 1, 2009, with a report to the Legislature by November 30, 2009, and semiannual progress reports until the transition is completed. The individuals working in the community based services facilities are state employees.

Section 19 repeals unnecessary SOS provisions.

Summary of relevant section contained in chapter 173, article 1:

Section 11 (246.60, subdivision 3) clarifies that the Minnesota Sex Offender Program is excluded from the definition of "state facility" in the state-operated services chapter of law.

Section 1 (62J.495) modifies the health information technology and infrastructure.

Subdivision 1 changes the name of the Health Information Technology Advisory Committee to the e-Health Advisory Committee. Requires the uniform standards be updated on an ongoing basis and an annual report to the Legislature.

Subdivision 1a defines key terms used in this section.

Subdivision 2 includes the name change for the advisory committee. Modifies the matters that the advisory committee must address.

Subdivision 3 requires the electronic health record to be a "qualified electronic health record." Makes changes to conform to federal law.

Subdivision 4 requires that the state update its implementation plan to be consistent with the updated federal HIT strategic plan. Requires the commissioner to coordinate among state, regional, and national efforts to support the effective use of health information technology (HIT). Requires the commissioner to monitor national activity in this area and coordinate state responses and input on related policy. Requires the Departments of Health and Human Services to apply for federal funding to the extent eligible. Requires a report to the Legislature as to any recommended policy changes the state should consider.

Subdivision 5 authorizes the commissioner to collect certain data from providers, group purchasers, and others to assess the adoption, effective use, and interoperability of e-health records for a variety of listed purposes. Prohibits the commissioner from collecting or publishing analyses that identify or could potentially identify individual patient data.

Section 2 (62J.496) modifies the existing electronic health record system revolving account and loan program to align with the requirements for the federal loan program. Modifies the definition of "eligible borrower" to expand the types of health care providers who are eligible for these loans.

Section 3 (62J.497, subdivision 1) adds a definition of "backward compatible" and modifies the definitions of "e-prescribing" and "NCPDP SCRIPT Standard."

Section 4 (62J.497, subdivision 2) modifies the requirements for e-prescribing.

Section 5 (62J.497, subdivision 4), paragraph (a), requires the Commissioner of Health, in consultation with the Minnesota Administrative Uniformity Committee, to develop by six weeks after enactment of this subdivision, a uniform prior authorization and formulary exception form that allows health care providers to request exceptions from group purchaser drug formularies, including Medicare Part D plans, using a uniform form. Upon development of the form, requires health care providers to submit requests for formulary exceptions using the uniform form, and requires group purchasers to accept this form from health care providers.

Paragraph (b), effective January 1, 2011, requires the form to be accessible by health care providers, and accepted and processed by group purchasers, electronically through the Internet.

Section 6 (62J.497, subdivision 5), paragraph (a), requires the Commissioner of Health, with others, to identify a way to standardize drug prior authorization requests.

Paragraph (b) requires that by January 1, 2011, drug prior authorization requests must be accessible, submitted, accepted, and processed electronically through secure electronic transmissions.

(This section was amended by chapter 173; see article 1, section 1.)

Section 7 (62Q.676) requires pharmacy benefit managers that provide prescription drug services to make medication therapy management services available to certain enrollees with chronic medical conditions. Provides a definition of "medication therapy management."

Section 8 (144.122) increases certain fees for hospitals and outpatient surgical centers.

Section 9 (144.226) makes the $4 surcharge on vital records permanent.

Section 10 (148.6445, subdivision 2a) establishes a fee for a duplicate license for an occupational therapist.

Summary of the relevant sections contained in chapter 173, article 1:

Section 1 (62J.497, subdivision 5) modifies the language in paragraph (b) by removing the requirement that drug prior authorization requests must be processed electronically by January 1, 2011.

Sections 1 to 3 (60A.092; 62D.03; 62D.05) authorize health maintenance organizations to provide reinsurance or insolvency insurance coverage to health insurers or nonprofit health service plan corporations.

Section 4 (62J.692, subdivision 7) specifies the distribution of MERC funds transferred from the prepaid capitation rates and establishes the amounts to be distributed at the federal limits imposed on the medical education carve outs.

Section 5 (256.01, subdivision 2b) eliminates the patient incentive program for MA, GAMC, and the MinnesotaCare.

Section 6 (256.01, subdivision 18a) requires the commissioner, effective October 1, 2009, to comply with federal requirements in implementing the Public Assistance Reporting Information System (PARIS) to determine eligibility for a number of public programs and requires the commissioner to determine eligibility using matches, including matches with programs operated by other states.

Section 7 (256.01, subdivision 18b) mandates that DHS comply with federal requirements in the American Recovery and Reinvestment Act regarding American Indians. (This section was amended by chapter 173; see article 1, section 12.)

Section 8 (256.962, subdivision 2) adds, as an outreach activity eligible for an outreach grant, targeting geographic areas with high rates of (1) eligible but unenrolled children; or (2) racial and ethnic minorities and health disparity population.

Section 9 (256.962, subdivision 6) requires charter schools, as well as school districts, to provide information to each student on the availability of health care coverage through Minnesota health care programs, including ow to obtain an application. Strikes and reinstates language related to provision of information on how to obtain an application for Minnesota health care programs, requires this information to be provided to all students, and eliminates the requirement that application assistance be provided to children eligible for free and reduced price lunches. Limits the provision of Web information to school districts and charter schools with a Web site.

Section 10 (256.964) requires the commissioner to authorize pilot projects to reduce the total cost of dental care by reducing hospital emergency room costs for preventable or nonemergency dental services. This project requires a community dental clinic or dental provider in collaboration with a hospital emergency room to provide urgent dental care as an alternative to the hospital emergency room for nonemergency dental care by diverting a patient presenting at an emergency room for nonemergency dental care to the dental community clinic or to an appropriate dental provider.

Section 11 (256.969, subdivision 2b) delays MA hospital rebasing for an additional three months, through March of 2011, then phases rebasing in for one year at 39.2 percent of full value. (This section was amended by chapter 173, article 1, section 13, to rebase rates at 74.25 percent of full value between January 1, 2011, and March 31, 2011.)

Section 12 (256.969, subdivision 3a) reduces inpatient hospital rates by one percent.

Section 13 (256.969, subdivision 3b) establishes state policy not to reimburse hospitals for costs related to hospital-acquired conditions.

Paragraph (a) prohibits the Department of Human Services (DHS) from making MA payments to a hospital for the cost of care that results from a condition listed in paragraph (c), if the condition was hospital acquired.

Paragraph (b) defines a condition to be hospital acquired if it is not identified by the hospital as present on admission. It also defines MA, for purposes of this section, to include General Assistance Medical Care and MinnesotaCare.

Paragraph (c) lists the conditions governed by the nonpayment policy.

Paragraph (d) applies the nonpayment language to any additional payments that result from a hospital acquired condition listed in paragraph (c), including additional treatment or procedures, readmission to the facility after discharge, increased length of stay, change to a higher diagnostic category, or transfer to another hospital. In the event of a transfer to another hospital, the hospital where the condition was acquired is responsible for any costs incurred at the hospital to which the patient is transferred.

Paragraph (e) prohibits a hospital from billing a service recipient for any payment disallowed under this subdivision.

Section 14 (256.969, subdivision 28) provides a temporary rate increase for hospitals with an MA utilization rate equal to or greater than 25 percent. The state share of this MA payment is the amount available under Minnesota Statutes, section 256B.199, paragraph (d).

Section 15 (256.969, subdivision 29) requires the commissioner to reimburse hospitals for the increase in the fee for early hearing detection and intervention program that are paid by the hospitals for public health care program patients. (This section was amended by chapter 173; see article 1, section 15.)

Section 16 (256B.032), paragraph (a), requires the commissioner by January 1, 2011, to establish performance thresholds for providers included in the provider peer grouping system developed by the Commissioner of Health under section 62U.04.

Paragraph (b) states that effective January 1, 2012, any provider with a combined cost and quality score below the threshold shall be prohibited from enrolling as a vendor of medical care in the state health care programs. Permits a disenrolled provider to reenroll effective January 1 of any subsequent year if the provider's most recent combined cost and quality score exceeds the threshold.

Paragraph (c) authorizes the commissioner to create an exception if the commissioner determines that a contract with the provider is necessary to ensure access to health care services.

Paragraph (d) requires the commissioner to report to the Legislature on the impact of this section by January 15, 2013.

Section 17 (256B.056, subdivision 3c) states that a bank account that contains personal income or assets or is used to pay personal expenses is not considered an exempt capital or operating asset of a trade or business for purposes of determining MA eligibility. This section also requires that assets be disclosed to the local agency at the time of application and eligibility redetermination and must be verified upon request of the local agency. This section is effective January 1, 2011.

Section 18 (256B.056, subdivision 3d) eliminates the ability of applicants to reduce assets in the three months before the month of application by designating burial funds. This section also states that excess assets may only be reduced beginning the month of application by paying bills for health services incurred during the time period in rule for local agencies to act on MA applications (45 days for the persons who are not blind or disabled, 60 days for persons who are blind or disabled). Applicants who have excess income as well as excess assets must first spend excess assets to pay health service bills and may meet income spenddown on remaining bills.

Section 19 (256B.057, subdivision 11) extends medical assistance coverage to participants who have been screened by the demonstration project and who needs treatment for colorectal cancer. Coverage is limited to services provided during the period that the individual receives treatment for colorectal cancer. This section expires December 31, 2010.

Section 20 (256B.0575) modifies the income deductions that may be retained by an institutionalized MA recipient or transferred to another person rather than applied to the cost of care.

Subdivision 1 deletes an existing description of reasonable expenses for medical or remedial care that may be deducted from income and inserts a cross-reference to subdivision 2, which is a new description of those expenses.

Subdivision 2 defines reasonable expenses for medical or remedial care.

Section 21 (256B.0595, subdivision 1) extends the reach of the law prohibiting certain transfers for less than fair market value by institutionalized persons and their spouses so that it applies to transfers into certain pooled trusts.

Section 22 (256B.0595, subdivision 2) amends the statute governing the period of ineligibility for long-term care services for a person who makes a transfer for less than fair market value. The period of ineligibility may be eliminated if all of the transferred assets, or their cash equivalent, are returned within 12 months after the period of ineligibility begins.

Sections 23 and 24 (256B.06) make modifications to conform to available federal financial participation under CHIP-RA for qualified noncitizen children and pregnant women who have lived in the United States for less than five years through the period of pregnancy and 60 days postpartum.

Section 25 (256B.0625, subdivision 3), paragraph (b), limits reimbursement for anesthesiology services that are provided under the medical direction of physicians to the rate paid to certified registered nurse anesthetist under medical direction. (This section was amended by chapter 173, article 1, section 41, by adding:

Paragraphs (c) to (f) prohibiting MA, GAMC, or MinnesotaCare payments for physician services related to (1) care related to certain treatments reportable as adverse health events (surgery performed on a wrong body part, surgery on the wrong patient, performance of the wrong surgical procedure, death during or immediately after surgery of a normal, healthy patient, and care ordered or provided by someone impersonating a licensed health care professional); and (2) care for which hospital reimbursement is prohibited under section 256.969, subdivision 3b, paragraph (c) (hospital-acquired conditions), or that is reportable as an adverse health event, if the physician services are billed by a physician who delivered care that contributed to or caused the adverse health care event or hospital-acquired condition resulting in nonpayment. A physician may not bill a recipient for any payment disallowed under this subdivision.)

Section 26 (256B.0625, subdivision 3c), paragraph (b), requires the commissioner to establish a dental subcommittee, to operate under the Health Services Policy Committee. Specifies membership. Requires the subcommittee to advise the commissioner regarding: (1) criteria for the critical access dental provider program; (2) any changes to the critical access dental program necessary to comply with expenditure limits; (3) dental coverage policy; (4) dental delivery models; and (5) dental services to be added or eliminated from section 256B.0625, subdivision 9, paragraph (b).

Paragraph (c) requires the committee to study approaches to making provider reimbursement under the MA, MinnesotaCare, and GAMC programs contingent on patient participation in a patient-centered decision-making process, and to evaluate the impact of these approaches on quality, patient satisfaction, and costs. Requires a report to the commissioner and the legislative committees with jurisdiction over health care by January 15, 2010.

Paragraph (d) requires the committee to monitor and track physician practice patterns under state health care programs, and requires the commissioner to notify physicians with higher than average utilization or costs.

Paragraph (e) requires the committee to review cesarean section rates for the fee-for-service medical assistance population, and allows the committee to develop best practices policies related to the minimization of cesarean sections, including but not limited to standards and guidelines for providers and facilities.

Section 27 (256B.0625, subdivision 9), modifies the MA of dental services as follows:

Paragraph (a) eliminates coverage for fixed bridges.

Paragraph (b) specifies dental coverage for nonpregnant adults. Limits coverage to:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, once per year;

(3) limited exams;

(4) bitewing x-rays, once per year;

(5) periapical x-rays;

(6) panoramic x-rays, once every five years and only if certain conditions are met. Allows panoramic x-rays to be provided once every two years to certain patients who cannot cooperate for intraoral film;

(7) prophylaxis, once per year;

(8) application of fluoride varnish, once per year;

(9) posterior fillings 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; and

(15) full mouth debridement, once every five years.

Paragraph (c) provides that MA also 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.

Paragraph (d) states that MA covers dental services for children that are medically necessary, and that the following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants once every five years per permanent molar; and

(3) application of fluoride varnish is limited to once every six months.

Provides an effective date of January 1, 2010.

Section 28 (256B.0625, subdivision 11) limits reimbursement for anesthesiology services provided by a certified registered nurse anesthetist who is not directed by a physician to the reimbursement paid to physicians who perform the services.

Section 29 (256B.0625, subdivision 13) provides medical assistance coverage for prescription drugs prescribed by a physician assistant contract with a community health board for purposes of communicable disease control.

Section 30 (256B.0625, subdivision 13e) reduces the MA pharmacy reimbursement rate for prescription drugs from average wholesale price minus 14 percent to minus 15 percent.

Section 31 (256B.0625, subdivision 13h) requires the commissioner to establish a pilot project for an intensive medication program for patients identified by the commissioner with multiple chronic conditions and a high number of medications who are at high risk of preventable hospitalizations, emergency room use, medication complications, and suboptimal treatment outcomes due to medication related problems.

Section 32 (256B.0625, subdivision 17) clarifies language regarding medical transportation services. It also provides a rate increase for special transportation in geographic areas classified as rural or super rural under the rural urban commuting area (RUCA) geographical classification system. The rate increases are as follows:

for a trip in an area defined to be super rural, the base rate is increased by 11.3 percent;

• for a rural or super rural trip equal to 17 miles or less, the mileage rate is 125 percent of the current rate; and



• for a rural or super rural trip between 18 and 50 miles, the mileage rate is 112.5 percent of the current rate.

Section 33 (256B.0625, subdivision 17a) requires providers of ambulance services to bill MA according to Medicare criteria (which require the provider to assign a "condition code" to the patient). Nonemergency ambulance services must not be reimbursed at the emergency rate.

Section 34 (256B.0625, subdivision 18b) prohibits DHS from using a broker for any purpose related to the provision of transportation services in the 11-county metropolitan area using a common carrier or private automobile.

Section 35 (256B.0625, subdivision 25a) requires prior authorization or decision support for the following diagnostic imaging services: CT, MRI, MRA, PET, cardiac imaging, and ultrasound diagnostic imaging. Permits the commissioner to contract with a private entity to provide prior authorization.

Section 36 (256B.0625, subdivision 26) modifies the reimbursement process for school districts that bill DHS for MA covered special education services. DHS must reimburse claims based on an interim rate and settle up at a final rate once established by DHS. A rate appeal process is established.

Section 37 (256B.08, subdivision 4) requires the commissioner, effective January 1, 2010, to accept data from the Social Security Administration as an application for medical assistance in accordance with federal law.

Section 38 (256B.15, subdivision 1) modifies language regarding claims against estates to recover MA payments by stating that, beginning January 1, 2010, MA does not include Medicare cost-sharing benefits under United States Code, title 42, section 1396p.

Section 39 (256B.15, subdivision 1a) modifies language regarding estates subject to MA claims by establishing a new definition of what is included in the estate of an MA recipient. The definition is expanded, with respect to cases where the MA recipient's death preceded the death of the other spouse, to include in the estate of the MA recipient all of the legal title and interests the MA recipient had in jointly owned or marital property, as defined later in this bill, at the time of the MA spouse's death, as well as the proceeds of those interests that passed to any other person through survivorship, a joint tenancy, a life estate, or other arrangement. "Other arrangement" includes any other means by which title to jointly owned or marital property passed from the predeceased MA recipient to another person, including transfers between spouses, whether permitted, prohibited, or penalized for MA purposes.

Section 40 (256B.15, subdivision 1h) deletes the definition of estate that is replaced in the prior section.

Section 41 (256B.15, subdivision 2) makes an MA claim against the estate of a surviving spouse who did not receive MA, for MA rendered to a predeceased spouse, payable from the full value of the predeceased spouse's assets and interests that are part of the nonrecipient surviving spouse's estate. The claim is limited to the value of assets that were marital property or jointly owned property at any time during the marriage. Claims against marital property are limited to claims against recipients who die on or after July 1, 2009.

Section 42 (256B.15, subdivision 2b) establishes certain property ownership rights solely for the purpose of MA recovery actions. It provides that:

• a predeceased recipient spouse has a legal title to the whole of property that was jointly owned or marital property during the marriage, regardless of the form or ownership or title;



• title and interest in the property does not end when the recipient dies;



• upon the death of the recipient, title and interest in the recipient's property vests with the surviving spouse by operation of law and continues after the death of the surviving spouse to permit MA recovery; and



• neither spouse shall encumber, disclaim, transfer, or otherwise divest themselves of these property interests before or upon death.

The agency responsible for the claim may, at its discretion, release specific real and personal property from the provisions of this section.

Section 43 (256B.15, subdivision 9) allows DHS to intervene as a party in any MA recovery proceeding.

Section 44 (256B.196) establishes a number of additional MA payments to Hennepin County Medical Center (HCMC) and Regions Hospital, with the state share coming from intergovernmental transfers (IGTs) to the state from Hennepin County and Ramsey County.

Subdivision 1 makes this section contingent on federal approval and on current payment of the new IGTs.

Subdivision 2 establishes additional payments for outpatient services, affiliated physicians, and the prepaid health plans at the two medical facilities. It establishes a process for determining the required IGT and requires the additional payments to be made upon receipt of the IGTs.

Subdivision 3 requires the two counties to make the IGTs determined under this section. It also requires the IGTs from each county to be used to match federal payments to each county's respective medical facility.

Subdivision 4 authorizes adjustments to the IGTs and the payments under certain circumstances.

Subdivision 5 makes the IGTs from October 1, 2008, to December 31, 2010, voluntary, with "voluntary" defined to mean the counties must agree in writing to the IGTs prior to any payments being issued.

Section 45 (256B.199) requires DHS to apply for additional disproportionate share hospital payments available under the American Recovery and Reinvestment Act. These payments shall become the state share of the temporary payments under section 256.969, subdivision 28.

Section 46 (256B.69, subdivision 5a) requires the commissioner to withhold 3.5 percent of managed care plan payments and county-based purchasing plan payments for PMAP paid on or after January 1, 2010, through December 31, 2010; four percent of payments paid on or after January 1, 2011, through December 31, 2011; 4.5 percent paid on or after January 1, 2013, through December 31, 2013; and for payments paid on or after January 1, 2014, three percent.

Sections 47 (256B.69, subdivision 5c) limits the transfers from the capitation rates for MERC to the total amount transferred for fiscal year 2009. Provides that any excess must first reduce the amounts transferred from general capitation rates, and then proportionally reduce the capitation rates to different geographic groups of counties. This section also requires the commissioner to transfer $21,714,000 each fiscal year to the MERC fund and transfer the balance to the MERC fund no earlier than July 1 of the following fiscal year.

Section 48 (256B.69, subdivision 5f) states that beginning July 1, 2009, the capitation rates are increased each year by the lesser of $21,714,000 or an amount equal to the difference between the estimated value of the county group reductions and the limit set for transfers.

Section 49 (256B.69, subdivision 23) requires DHS, in determining Minnesota disability health options (MnDHO) payment rates and risk adjustment methods, to consider methods used to determine county allocations for home and community-based program participants. If rate reductions are necessary to comply with this provision, the reductions are limited to ten percent in any calendar year.

Section 50 (256B.756) establishes the facility payment rates for cesarean section deliveries without complications, vaginal deliveries with complications, and vaginal deliveries without complications. This section also establishes the payment rate for professional services related to labor, delivery, antepartum, and postpartum care when provided for a cesarean section delivery without complications or a vaginal delivery with complications. These rates are effective for services provided on or after July 1, 2009, and are required to be reflected in managed care plan payments for services provided on or after October 1, 2009. (This section was amended by chapter 173; see article 1, sections 14 and 31.)

Section 51 (256B.76, subdivision 1) reduces the payment rates for physician and professional services by five percent. Office and outpatient services, preventive medicine services, and family planning services are exempt from this rate reduction when billed by primary care specialties (general practice, internal medicine, pediatrics, geriatrics, and family practice) or by an advanced practice registered nurse or physician assistant practicing in pediatrics, geriatrics, or family practice. These rates are effective July 1, 2009, and are required to be reflected in managed care payments for services provided on or after October 1, 2009. (This section was amended by chapter 173; see article 1, section 32.)

Section 52 (256B.766) reduces payment rates for basic care services by three percent but exempts physician and professional services, inpatient hospital services, family planning services, mental health services, dental services prescription drugs, and medical transportation. These rates are in effect for services provided on or after July 1, 2009, and are to be reflected in the managed care payments for services provided on or after October 1, 2009. (This section was amended by chapter 173; see article 1, section 42.)

Section 53 (256D.03, subdivision 4) applies to GAMC the three percent reduction to payments for basic care services.

Section 54 (256L.03, subdivision 3b) includes the following chiropractic services to MinnesotaCare coverage: exams, manual manipulation of the spine, and x-rays. (This section was amended by chapter 173; see article 1, section 35.)

Section 55 (256L.04, subdivision 1) exempts children who were residing in a foster home or juvenile residential correctional facility from the MinnesotaCare eligibility requirements that apply to families with children. (This section was amended by chapter 173; see article 1, section 36.)

Section 56 (256L.04, subdivision 1b) states that children with family income greater than 275 percent of federal poverty guidelines (FPG) are eligible for MinnesotaCare, effective July 1, 2009, or upon federal approval, whichever is later.

Section 57 (256L.04, subdivision 7a) makes a conforming change.

Section 58 (256L.04, subdivision 10a) states that sponsor income does not apply to pregnant women and children who are qualified noncitizens for purposes of MinnesotaCare eligibility, effective July 1, 2010, or upon federal approval, whichever is later.

Section 59 (256L.05, subdivision 1) requires application assistance to be made available to applicants applying online, requires the commissioner and local agencies to assist enrollees in choosing a managed care organization, and makes related changes.

Section 60 (256L.05, subdivision 1c) requires the commissioner and local agencies to develop a streamlined and efficient application and enrollment process for MA and MinnesotaCare enrollees that meets the criteria specified in the subdivision. The subdivision also requires the Commissioners of Human Services and Education to provide recommendations to the Legislature by January 15, 2010, on the creation of an open enrollment process tied to the public education system. Also requires the submittal on that date of an implementation plan for the open enrollment period and online application process. Requires the open enrollment process to be implemented with the 2010-2011 school year. Provides an effective date of July 1, 2010, or upon federal approval. (This section was amended by chapter 173; see article 1, section 37.)

Section 61 (256L.05, subdivision 3) states that the effective date of coverage for children eligible under section 256L.07, subdivision 8, shall be the first day of the month following the date of termination from foster care or a juvenile residential correctional facility, effective July 1, 2009, or upon federal approval, whichever is later.

Section 62 (256L.05, subdivision 3a) states that children in families with income equal to or below 275 percent of FPG who fail to submit renewal forms and related documentation necessary for verification of continued eligibility in a timely manner shall remain eligible for MinnesotaCare. If the commissioner determines through other means that there has been a change of income that affects premiums, the commissioner shall notify the family of the new premium payment. If the new premium payment is not received, the children will be disenrolled effective the first day of the calendar month following the calendar month for which the premium is due. This section is effective July 1, 2009, or upon federal approval, whichever is later.

Section 63 (256L.07, subdivision 1) permits children in families with income greater than 275 percent of FPG to remain on MinnesotaCare, effective July 1, 2009, or upon federal approval.

Section 64 (256L.07, subdivision 2) exempts children with family income equal to or less than 200 percent from the ESI barrier, effective July 1, 2009, or upon federal approval.

Section 65 (256L.07, subdivision 3) exempts children with family income equal to or less than 200 percent of FPG for the four- month no other health coverage barrier, effective July 1, 2009, or upon federal approval.

Section 66 (256L.07, subdivision 8) states that any child who was residing in foster care or a juvenile residential correctional facility on their 18th birthday is automatically deemed eligible for MinnesotaCare upon termination or release and is exempt from the ESI and four- month barriers and from premiums.

Section 67 (256L.11, subdivision 1) applies to MinnesotaCare the three percent reduction to payments for basic care services. (This section was amended by chapter 173; see article 1, section 38.)

Sections 68 and 69 (256L.15) exempt children with family income equal to or below 200 percent of FPG from premiums, effective July 1, 2009, or upon federal approval.

Section 70 (256L.17, subdivision 3) makes a clarifying change related to the form used to determine compliance with the MinnesotaCare asset requirement.

Section 71 (256L.17, subdivision 5) exempts children from the asset limits (technical change, since children are currently exempt).

Section 72 (501B.89, subdivision 4) establishes filing requirements for supplemental needs trusts.

Paragraph (a) requires the trustee of a supplemental needs trust to submit to DHS, at the time of the beneficiary's request for MA, a copy of the trust instrument and an inventory of its assets.

Paragraph (b) requires the trustee to report at least annually on the value of trust assets, additions and subtractions from the trust, and changes to the trust instrument during the accounting period.

Paragraph (c) defines accounting period.

Section 73 (519.05) clarifies that joint and several spousal liability for medical debt includes liability for state claims.

Section 74 clarifies that the appropriation to the University if Minnesota from the health care access fund shall be transferred each year for MERC.

Section 75 requires the Commissioner of Human Services to establish a demonstration project to provide additional MA coverage for 200 American Indian children who have health disparities due to the cumulative health impact of toxic environmental exposures.

Section 76 requires the Commissioner of Human Services to develop a methodology to allow for the release of summary data on claims and utilization for MA, GAMC, and MinnesotaCare enrollees at no charge to research institutions to conduct analyses of health care outcomes and treatment effectiveness.

Section 77 requires the Commissioner of Human Services, in cooperation with representatives of county agencies, to develop a plan that would require county agencies to administer MinnesotaCare. Requires the plan, to the extent feasible, to incorporate procedures and requirements that are identical to or consistent with these that apply to county administration of MA. Requires the commissioner to present recommendations to the legislative committees with jurisdiction over health care by January 15, 2010. Also requires the commissioner to report in detail to the chairs of the legislative committees with jurisdiction over health care finance, before entering into any contracts involving counties for streamlined electronic enrollment and eligibility determinations for state health care programs, if the contracts require payment from the general fund or health care access fund.

Section 78, subdivision 1, establishes a state premium subsidy equal to 35 percent of the premiums that an individual is required to pay for the continuation of health care coverage under COBRA if the individual and the individual's qualified beneficiaries are:

(1) eligible for COBRA continuation premium subsidy under ARRA;

(2) elect COBRA coverage; and

(3) are eligible for MA, GAMC, or MinnesotaCare except for the four-month barrier requirement.

Subdivision 2 requires the Commissioner of Human Services to pay 35 percent of the COBRA premiums that the individual must pay to the entity the individual is required to pay for the COBRA premiums.

Subdivision 3 requires the employers or plan administrators to include information to qualified individuals of the availability of the state subsidy.

Subdivision 4 states that any individual who receives a state subsidy under this section is exempt from the four-month requirement for MinnesotaCare eligibility when the individual no longer receives COBRA continuation coverage.

Subdivision 5 states that this section expires December 31, 2010.

Section 79 requires the commissioner to resubmit for federal approval the elimination of depreciation in determining income for self-employed farmers that was passed in 2007.

Section 80 repeals sections 256.962, subdivision 7 (renewal notice requirements for DHS and HPCs); and 256L.17, subdivision 6 (asset test for children).

Summary of relevant sections contained in chapter 173, article 1:

Section 12 (256.01, subdivision 18b) modifies the effective date of this section to July 1, 2009.

Section 13 (256.969, subdivision 2b) modifies rebasement value to 74.25 percent of the full value of the rebasing percentage change from January 1, 2011, to March 31, 2011.

Section 14 (256.969, subdivision 28) establishes payment rates for cesarean section deliveries without complications; vaginal deliveries with complications; and vaginal deliveries without complications, at no greater than $35.28. States that payments to managed care plans and county-based purchasing plans are to be reduced on or after October 1, 2009, to reflect these adjustments. States that prior authorization is not required before reimbursement is paid for a cesarean section delivery.

Section 15 (256.969, subdivision 29) makes minor modifications to the payment rate adjustment to hospitals for the early hearing detection and intervention program fee increase. Specifies that the payment rate increase is in place until the increase fully recognized in the base year cost.

Section 17 (256B.056, subdivision 3b) amends MA eligibility language regarding treatment of trusts by defining the circumstances under which a pooled trust is or is not considered an available asset. This section is effective for pooled trusts created on or after January 1, 2011.

Section 31 (256B.756) establishes a payment rate for professional services related to labor, delivery, antepartum, and postpartum care when provided for any of the diagnostic categories identified in section 256.969, subdivision 28. The calculated single rate must not reflect a shift of greater than five percent in the current proportion of all births delivered vaginally and by cesarean section.

Section 32 (256B.76, subdivision 1) makes clarifying changes to the reduction in payment rates for physician and professional services.

Section 35 (256L.03, subdivision 3b) clarifies that this section is effective January 1, 2010, or upon federal approval, whichever is later.

Section 36 (256L.04, subdivision 1) clarifies that paragraph (f) of this subdivision is effective July 1, 2009, or upon federal approval, whichever is later.

Section 37 (256L.05, subdivision 1c) clarifies that this subdivision is effective July 1, 2009, or upon federal approval, whichever is later.

Section 38 (256L.11, subdivision 1) adds a paragraph (c) that clarifies that the reduction in the payment rates for physician and professional services shall be reduced for MinnesotaCare as described in section 256B.76, subdivision 1, paragraph (c).

Section 41 (256B.0625, subdivision 3), paragraphs (c) to (f), prohibit MA, GAMC, or MinnesotaCare payments for physician services related to:

(1) care related to certain treatments reportable as adverse health events (surgery performed on a wrong body part; surgery on the wrong patient; performance of the wrong surgical procedure; death during or immediately after surgery of a normal, health patient; and care ordered or provided by someone impersonating a licensed health care professional); and

(2) care for which hospital reimbursement is prohibited under section 256.969, subdivision 3b, paragraph (c) (hospital-acquired conditions), or that is reportable as an adverse health event, if the physician services are billed by a physician who delivered care that contributed or caused the adverse health care event or hospital-acquired condition resulting in nonpayment. A physician may not bill a recipient for any payment disallowed under this subdivision.

Section 42 (256B.766) clarifies that the reduction in the payments for basic care services does not apply to federally qualified health centers, rural health centers, Indian health services, and Medicare cost sharing.

Article 6 was proposed by the Revisor of Statutes and corrects cross references related to the modifications of the personal care assistance services program in article 1.

Section 1 (245.462, subdivision 18) adds licensed professional clinical counselor to the definition of mental health professional for purposes of the Adult Mental Health Act.

Section 2 (245.470, subdivision 1) adds licensed professional clinical counselors as mental health professionals who can provide outpatient adult mental health services.

Section 3 (245.4871, subdivision 27) adds licensed professional clinical counselor to the definition of mental health professional for purposes of the Children's Mental Health Act.

Section 4 (245.488, subdivision 1) adds licensed professional clinical counselors as mental health professionals who can provide outpatient children's mental health services.

Sections 5 and 6 modify the definitions section of the treatment for alcohol and drug abuse chapter of law.

Section 5 (254A.02, subdivision 8a) defines the term "placing authority."

Section 6 (254A.16, subdivision 6) requires measurement of compliance with the Minnesota Rules governing chemical dependency care of public assistance recipients.

Section 7 (254B.03, subdivision 1) removes responsibility from the counties for negotiating provider rates for chemical dependency treatment services, and places this responsibility solely with the commissioner, effective July 1, 2011.

Section 8 (254B.03, subdivision 3) provides that counties do not have to pay the state for the county share of services when payment is made according to section 254B.09, subdivision 8, payments to improve services to American Indians.

Section 9 (254B.03, subdivision 9) authorizes the commissioner under paragraph (a), effective July 1, 2011, to enter into agreements with vendors that meet specified standards and to set rates for services.

Paragraph (b) requires the commissioner to consider the acuity and complexity of the problems presented by the client when the commissioner sets rates.

Paragraph (c) provides that rates set for a specific entity to provide chemical dependency treatment pursuant to the American Indian Health Improvement Act supersede rates set under this section.

Section 10 (254B.05, subdivision 1) removes the requirement that a chemical dependency vendor have certification by the county or tribal governing body of rules prohibiting residents from bringing chemicals into the facility or using chemicals within the facility. This section is effective July 1, 2011.

Section 11 (254B.09, subdivision 2) removes the responsibility from tribes for selecting vendors and negotiating rates for chemical dependency treatment. This section is effective July 1, 2011.

Section 12 (254B.11) is repealed in chapter 173, article 1, section 49.

Section 13 (254B.12) requires the commissioner to consult with stakeholders and present a report to the 2011 Legislature proposing a new rate methodology for the consolidated chemical dependency treatment fund. This methodology must replace county-negotiated rates with providers.

Section 14 (256B.0622, subdivision 2) adds licensed professional clinical counselors as mental health professionals who can provide intensive inpatient and outpatient rehabilitative mental health services.

Section 15 (256B.0623, subdivision 5) adds licensed professional clinical counselors as mental health professionals who can provide adult rehabilitative mental health services.

Section 16 (256B.0624, subdivision 5) adds licensed professional clinical counselors as mental health professionals who can provide adult mental health crisis intervention services.

Section 17 (256B.0624, subdivision 8) adds licensed professional clinical counselors as mental health professionals who can provide adult mental health crisis stabilization services.

Section 18 (256B.0625, subdivision 42) adds licensed professional clinical counselor to the definition of mental health professional for purposes of medical assistance.

Section 19 (256B.0943, subdivision 1) adds licensed professional clinical counselor to the definition of mental health professional for purposes of providing children's therapeutic services and supports.

Section 20 (256B.0625, subdivision 47) delays the implementation of treatment foster care for two years, until July 1, 2011.

Section 21 (256B.0943, subdivision 12) excludes from medical assistance reimbursement for children's therapeutic services and supports treatment by multiple providers within the same agency at the same clock time.

Section 22 (256B.0944, subdivision 4a) allows the commissioner to approve a crisis response provider that is unable to provide mobile crisis intervention services 24 hours a day, seven days a week.

Section 23 (256B.0947, subdivision 1) provides an effective date of November 1, 2010, subject to federal approval, for medical assistance coverage of medically necessary, intensive nonresidential rehabilitative mental health services.

Section 24 (256J.08, subdivision 73a) adds licensed professional clinical counselor to the definition of qualified professional for purposes of providing mental health services under the MFIP chapter.

Section 25 establishes the autism spectrum disorder task force until June 30, 2011.

Section 26 establishes a state-county chemical health care home pilot project to redesign the current chemical health service delivery system in a way that promotes greater accountability, productivity, and results in the delivery of state chemical dependency services. A workgroup must be convened by July 15, 2009, with a report back to the legislature by January 15, 2010, with draft proposals for pilot projects. The department shall evaluate the pilot projects by June 30, 2011. This section expires June 30, 2012.

Sections 1 to 5 modify the nursing facility resident reimbursement classification law, effective January 1, 2011.

Section 1 (144.0724, subdivision 2) adds definitions of "activities of daily living" and "nursing facility level of care determination" to the definitions subdivision.

Section 2 (144.0724, subdivision 4) adds two assessments to the existing list of assessments used to determine nursing facility level of care. The additions are preadmission screening and a face-to-face long-term care consultation.

Section 3 (144.0724, subdivision 8) modifies the law governing a request for reconsideration of a resident classification. It states that if a request for reconsideration involves one of the two assessments added in section 2, the resident remains eligible for nursing facility level of care while the request is pending.

Section 4 (144.0724, subdivision 11) establishes eligibility criteria that a person must satisfy in order to qualify for Medical Assistance (MA) payment of long-term care services. The assessment used to establish MA eligibility for payment of these services must occur no more than 90 days before the effective date of MA eligibility for long-term care services, and no MA payments may be made for long-term care before the date of the determination of nursing facility level of care. The assessment used to establish MA payment for Elderly Waiver (EW) services, waiver services for persons with disabilities, and Alternative Care (AC) services must occur no more than 60 days before the effective date of MA eligibility for payment of long-term care services. (Chapter 173, article 1, section 2, corrects a cross-reference in this section.)

Section 5 (144.0724, subdivision 12) authorizes appeals of level of care determinations under existing appeal procedures.

Section 6 (144A.073, subdivision 12) extends by an additional 18 months the project approval for nursing home moratorium exception projects approved through the Minnesota Department of Health administrative process between July 1, 2007, and June 30, 2009.

Section 7 (144A.44, subdivision 2) defines "home care services" to include personal care assistant services for purposes of the home care bill of rights.

Section 8 (245A.03, subdivision 7) establishes a moratorium on the licensure of additional adult and child foster care homes, generally referred to as corporate foster care, where the foster care home is not the primary residence of the license holder. Exceptions are listed. The Department of Human Services (DHS) is directed to study the effects of the moratorium and report to the Legislature in 2011. This section is effective the day following final enactment. (Chapter 173, article 1, section 43, makes this section effective July 1, 2009.)

Section 9 (245A.11, subdivision 8) requires DHS to establish provider standards for residential support services that integrate services standards and the residential setting under one community residential setting license. An implementation plan must be proposed to the 2011 Legislature. Adult and child foster care providers that offer residential support services, as defined later in this bill (section 256B.092, subdivision 11, paragraph (b)) must obtain a community residential setting license.

Section 10 (252.46, subdivision 1a) requires DHS to establish a statewide rate-setting methodology for all day training and habilitation services.

Section 11 (252.50, subdivision 1) states that while clients who work within state-operated, community-based treatment and habilitation programs for persons with developmental disabilities are not state employees, DHS may consider them to be employees for federal tax purposes.

Section 12 (256.01, subdivision 29) adds to the duties of DHS with respect to the state medical review team (SMRT) in order to ensure the timely processing of determinations of disability. It also requires an annual report on SMRT activities.

Section 13 (256.0281) authorizes DHS, the Minnesota Department of Health (MDH), and the Office of the Ombudsman for Mental Health and Developmental Disabilities to establish interagency agreements governing the electronic exchange of data on providers and individuals that is collected, maintained, or used by each agency for listed purposes involving enrollment, quality management, provider eligibility, and quality assurance. Agreement requirements are listed. (Chapter 173, article 1, section 44, corrects a cross-reference.)

Section 14 (256.476, subdivision 5) updates terminology regarding consumer support grants to reflect a temporary change in the MA federal share.

Section 15 (256.476, subdivision 11) updates terminology regarding consumer support grants to reflect a temporary change in the MA federal share.

Section 16 (256.975, subdivision 7) requires the Minnesota Board on Aging statewide information and assistance service to provide long-term care options counseling and describes counselor duties. Current law only requires the service to assist persons in accessing the information. Counseling must be provided to nursing home residents deemed appropriate for discharge. (Chapter 173, article 1, section 16, corrects a cross-reference in this section.)

Section 17 (256B.055, subdivision 7) requires an MA applicant under the aged, blind, or disabled category who is not aged or blind, does not qualify under any other MA eligibility category, and has not been determined to be disabled by the Social Security Administration, to be referred to SMRT for a determination of disability.

Section 18 (256B.0625, subdivision 6a) defines MA home health services to be those specified in law as well as in rule.

Section 19 (256B.0625, subdivision 7) modifies a cross-reference and provides an exception to the ban on reimbursement for private duty nursing services if the nurse is the family foster care provider of a recipient under age 18.

Section 20 (256B.0625, subdivision 19a) establishes new eligibility requirements for PCA services. A recipient must be determined to be dependent in one activity of daily living (ADL) or in a Level I behavior. Beginning July 1, 2011, a recipient must be dependent in two ADLs. It deletes language allowing certain relatives to provide PCA services if they are granted a waiver.

Section 21 (256B.0625, subdivision 19c) deletes the requirement that PCA services be approved by a physician in a statement of need. It also expands the definition of "qualified professional" to include a qualified developmental disabilities specialist.

Section 22 (256B.0641, subdivision 3) adds nursing facilities in receivership to the list of facilities governed by the policy that new owners are not responsible for medical assistance overpayments to former owners.

Section 23 (256B.0651) modifies home care services.

Subdivision 1 modifies definitions.

Subdivision 2 amends the list of covered services, which includes PCA services.

Subdivision 3 rewrites the list of noncovered home care services.

Subdivision 4 modifies exceptions to the general rule that home care services must be authorized before the services begin.

Subdivision 5 governing retroactive authorization is deleted.

Subdivision 6 modifies requirements for prior authorization, now simply called "authorization." It places specific limits on home care service hours for ventilator- dependent persons.

Subdivision 7 modifies authorization time limits. It deletes exceptions to the requirement that authorizations be effective for no more than 12 months.

Subdivision 8 modifies language regarding requests for temporary home care services by strictly limiting DHS authorizations for temporary services to 45 days.

Subdivision 9 places additional restrictions on PCA services provided in a foster care setting.

Subdivision 10, which places limitations on MA home care payments, is deleted.

Subdivision 11 updates language governing limits on home care services that do not require authorization.

Subdivision 12 corrects a cross-reference.

Subdivision 13 corrects a cross-reference.

Subdivision 14 adds a new requirement that home care providers that do not accept Medicare payments must refer dually eligible MA recipients to Medicare-certified providers when Medicare is determined to be the appropriate payer.

Subdivision 15 requires DHS to maintain a home care quality assurance process, including provider standards and training, consumer surveys, and random reviews of documentation.

Subdivision 16 gives DHS the authority to require PCA service providers to document that they meet provider standards, quality of care standards, and billing practice standards.

Section 24 (256B.0652) makes minor modifications in language governing authorization and review of home care services. It also requires the service authorization function to include a link on the DHS Web site to MinnesotaHelp.info for a list of enrolled home care agencies and pertinent information on them. The Web site must also include data on home care services including information from both fee-for-service and managed care plans on recipients as available.

Section 25 (256B.0653) modifies home health agency covered services.

Subdivision 1 replaces a definition of "skilled nurse visits" with a description of the home health agency services this section governs.

Subdivision 2 deletes language regarding home care visits provided through telehomecare and inserts a list of definitions.

Subdivision 3 deletes language regarding therapies provided through home health agencies and inserts language governing home health aide visits.

Subdivision 4 establishes requirements for skilled nurse visits.

Subdivision 5 establishes requirements for therapy services provided through home care.

Subdivision 6 lists noncovered home health agency services.

Section 26 (256B.0654) modifies private duty nursing (PDN) requirements.

Subdivision 1 modifies and expands a list of definitions.

Subdivision 2 makes minor modifications to language governing authorization for PDN services.

Subdivision 2a establishes parameters for use of PDN services.

Subdivision 2b describes noncovered PDN services.

Subdivision 3 modifies language governing the shared PDN option.

Subdivision 4 modifies language governing provision of PDN services by a parent, spouse, or legal guardian.

Section 27 (256B.0655, subdivision 1b) modifies home care assessment language to require that an in-person assessment must occur at least annually or when a significant change in condition or need occurs.

Section 28 (256B.0655, subdivision 4) modifies authorization requirements for PCA services and qualified professional services. This section describes the methodology to be used to determine a home care rating, which is the basis for authorizing PCA services. This section states that each home care rating has a base level of hours assigned to it based on the median paid units per day for each home care rating from fiscal year 2007 data. An additional 30 minutes of PCA time is added for (1) each critical activity of daily living dependency, (2) each complex health-related function; and (3) each behavior issue. A limit of 96 15-minute units of qualified professional supervision may be authorized for each recipient. Existing language for calculating assigned hours is deleted. (Chapter 173, article 1, section 22, makes a minor terminology correction in this section.)

Section 29 (256B.0657, subdivision 8) provides a formula to establish a budget for the PCA self-directed supports option.

Section 30 (256B.0657, subdivision 12) establishes caps on enrollment in the self-directed supports option and requires DHS to evaluate the option before it becomes available statewide.

Section 31 (256B.0659) establishes a new regulatory framework for the PCA program. It is a combination of new language, revisions of existing language, and unchanged language moved to this new location.

Subdivision 1 defines terms.

Subdivision 2 restates with changes existing language governing covered PCA services. These services are available to persons who need assistance with activities of daily living, health-related functions, observation and redirection of behaviors, and instrumental activities of daily living. The parameters of this assistance are outlined.

Subdivision 3 restates existing limits on provision of PCA services by a spouse, parent of a minor child, or responsible party, and adds new prohibitions on payment for PCA services in foster care and in lieu of other staffing in certain residential care settings. It also prohibits PCA services solely as a child care or babysitting service. This section also establishes other limits on PCA services in residential settings and expands the list of services not reimbursable as MA PCA services.

Subdivision 4 regulates assessments for PCA eligibility. A person must be assessed as dependent in an activity of daily living based on the person's need, on a daily basis, for cueing and constant supervision to complete a task or hands-on assistance to complete a task. Criteria are established for determining that a person has complex health-related functions or a need for assistance due to behaviors.

Subdivision 5 expands the description of the process required as part of the assessment to refer recipients to other payment sources, services, and community supports as appropriate. When the recipient qualifies for assistance due to mental illness or behaviors, a referral for a mental health diagnostic and functional assessment is mandatory. This section also restates current assessment rates and the penalty for late assessments.

Subdivision 6 restates the requirement that a service plan be completed and describes plan parameters.

Subdivision 7 clarifies requirements for the PCA care plan, including where the plan must be kept, what it must include, and when it must be completed.

Subdivision 8 states that the PCA program requires communication with the recipient's physician about the need for services. It directs the commissioner to work with the state medical director to develop communication options. It does not require a physician statement of need for PCA services.

Subdivision 9 states that the responsible party must be capable of providing the support necessary to assist the recipient to live in the community. This subdivision also establishes limits on who may act as the responsible party. It clarifies when a responsible party is required. It authorizes the appointment of two persons as the responsible party under certain circumstances. When a responsible part is required, the persons must be identified at the time of assessment and listed on the service agreement and care plan. (Chapter 173, article 1, section 23, deletes a delayed effective date from this subdivision.)

Subdivision 10 establishes the duties of the responsible party. (Chapter 173, article 1, section 24, deletes a requirement that the delegated responsible party of a minor or incapacitated person must reside with the recipient while serving as the responsible party.)

Subdivision 11 establishes new qualifications and requirements for personal care assistants and restates existing requirements. This subdivision also establishes a monthly cap of 310 hours that a PCA may be paid to work.

Subdivision 12 establishes new documentation requirements for PCA services. Services must be documented daily on a prescribed time sheet form. Monthly forms must be retained by the provider agency in the recipient's health record. This subdivision prescribes specific data elements to be documented.

Subdivision 13 establishes new qualifications and requirements for qualified professionals and restates existing qualifications. (Chapter 173, article 1, section 25, makes certain training requirements effective January 1, 2010.)

Subdivision 14 requires all PCAs to be supervised by a qualified professional, effective January 1, 2010. This subdivision also establishes new duties for qualified professionals and restates existing duties. Services that are not reimbursable as qualified professional services are listed.

Subdivision 15 restates and modifies existing language regarding the flexible use option, under which the hours of service provided may vary over time to effectively meet the client's needs. A new restriction is added so that the recipient may not use more than 75 percent of hours authorized for a 12-month period within a six-month period.

Subdivision 16 restates and modifies existing language regarding shared services, under which a PCA may provide services to two or three recipients at the same time in the same setting.

Subdivision 17 restates shared service rates.

Subdivision 18 restates and modifies language governing the personal care assistance choice option, called the fiscal intermediary option in current law, under which the recipient is responsible for hiring, training, scheduling, and firing PCAs and must use a provider agency to serve as a fiscal intermediary for assistance to pay and account for covered services.

Subdivision 19 restates and modifies language establishing the duties of the recipient or responsible party under the choice option. It also establishes the qualifications and duties of the personal care assistance choice provider agency.

Subdivision 20 restates and modifies language governing administration of the choice option.

Subdivision 21 substantially rewrites enrollment requirements for personal care assistance provider agencies, including documentation requirements. Included in the new requirements is a mandate that specified provider agency personnel, including owners, qualified professionals, and all other managing employees, must complete mandatory training as determined by DHS prior to enrollment as a provider agency. Existing agencies have 18 months to satisfy this requirement. This subdivision also requires provider agencies to allocate 72.5 percent of revenue for PCA wages and benefits. (Chapter 173, article 1, section 26, makes a language correction in this subdivision.)

Subdivision 22 establishes a new requirement that provider agencies annually resubmit the documentation specified in subdivision 21. If no documentation is submitted, the provider agency MA enrollment number must be terminated or suspended.

Subdivision 23 establishes new enrollment requirements for terminated agencies. The requirements apply to all named individuals on the current enrollment disclosure form and known or discovered affiliates of the provider agency. Terminated agencies may not enroll for two years following termination. Agencies that reenroll after two years must be placed on probation for one year, and probationary requirements are established.

Subdivision 24 restates and expands the duties of a provider agency. An added duty is the required provision of a copy of the home care bill or rights to each recipient at the start of service. This subdivision restates the language requiring 72.5 percent of agency revenue to be allocated to PCA wages and benefits.

Subdivision 25 restates and expands background study requirements for provider agencies. An organization is barred from MA enrollment if it has not complied with background study requirements.

Subdivision 26 establishes new duties of provider agencies to establish and implement policies and procedures to prevent, control, and investigate the spread of communicable diseases.

Subdivision 27 enhances ventilator training requirements for PCAs who work with ventilator-dependent recipients.

Subdivision 28 expands documentation requirements of provider agencies. Required documentation must be maintained in the provider agency file or the recipient's place of residence.

Subdivision 29 requires DHS, counties, and personal care assistance providers to cooperate to provide transitional assistance to recipients and families to help them comply with the new requirements and to ensure that PCA services are not being performed by the housing provider. (Chapter 173, article 1, section 27, makes this assistance applicable only to requirements that may require a change in living arrangement by August 10, 2010. It also deletes the requirement to ensure that PCA services are not provided by the housing provider.)

Subdivision 30 requires DHS to provide by October 31, 2009, certain information to clients likely to be effected by PCA changes and requires all recipients affected by the changes in MA home care services to be given 30 days notice before the change becomes effective.

Sections 32 to 43 modify long-term care consultation services.

Section 32 (256B.0911, subdivision 1) modifies the purpose and goal statement of long-term care consultation services.

Section 33 (256B.0911, subdivision 1a) modifies definitions. This section is effective January 1, 2011. (Chapter 173, article 1, section 28, corrects terminology in this section.)

Section 34 (256B.0911, subdivision 2b) requires counties, effective January 1, 2011, to use assessors in long-term care consultation services who have completed the training and certification process outlined in the next section and who meet the minimum criteria specified in this section.

Section 35 (256B.0911, subdivision 2c) requires DHS to develop curriculum and an assessor certification process by January 1, 2010. All county long-term care consultation services staff must be certified by December 30, 2010. Recertification is required every three years.

Section 36 (256B.0911, subdivision 3) requires DHS to encourage counties to establish joint local long-term care consultation teams to ensure that consultations comply with the timelines and parameters of the service.

Section 37 (256B.0911, subdivision 3a) expands long-term care consultation services to include applicants for personal care assistant services, private duty nursing services, and home health agency services, effective January 1, 2011. It modifies the assessment process.

Section 38 (256B.0911, subdivision 3b) expands the types of transition assistance that must be provided to persons residing in a nursing facility, hospital, regional treatment center, or intermediate care facility.

Section 39 (256B.0911, subdivision 3c) requires the Senior LinkAge line and long-term care consultation team to give highest priority to referrals at risk of nursing home placement.

Section 40 (256B.0911, subdivision 4a) provides that the determination of the need for nursing facility level of care must be made according to criteria established in section 144.0724, subdivision 11 (nursing facility level of care) and 256B.092 (services for persons with developmental disabilities) using forms developed by DHS. This section is effective January 1, 2011.

Section 41 (256B.0911, subdivision 5) requires DHS to streamline the processes required to provide long-term care consultation services.

Section 42 (256B.0911, subdivision 6) requires DHS to develop an alternative payment methodology for long-term care consultation services that includes funding under this subdivision and under the PCA program and under programs for persons with developmental disabilities. In developing the new methodology DHS must consider maximization of federal funding.

Section 43 (256B.0911, subdivision 7) specifies that MA nursing facility reimbursement is not available for a person who does not meet the level of care criteria in section 144.0724, subdivision 11 (earlier in this bill). This section is effective January 1, 2011.

Section 44 (256B.0913, subdivision 4) limits Alternative Care (AC) program eligibility to persons determined to require, if AC services are not provided, the level of care provided in a nursing facility according to section 144.0724, subdivision 11, effective January 1, 2011. It also limits AC costs to $600 per month for person with low or no dependencies in activities of daily living.

Section 45 (256B.0915, subdivision 3a) establishes monthly service cost limits for Elderly Waiver clients with low dependencies in activities of daily living.

Section 46 (256B.0915, subdivision 3e) modifies rate setting for customized living services (assisted living) under the Elderly Waiver (EW) program. Rates are no longer negotiated by counties. They are to be developed by counties and tribes based on the amount of component services to be provided, using component rates established by DHS. Payments are limited to 50 percent of, rather than the nonfederal share of, the nursing home rate used to set the customized living rate cap.

Section 47 (256B.0915, subdivision 3h) modifies service rate limits for 24-hour customized living services. It caps 24-hour service rates at the 95th percentile of 24-hour rates in effect on March 31, 2009, for each case mix resident class. Maximums must be updated annually based on legislative changes in service rates. DHS is authorized to establish an alternative payment system by applying a single hourly rate for direct services provided in certain housing with services establishments.

Section 48 (256B.0915, subdivision 5) clarifies that an EW client must be determined to require nursing facility level of care at initial and subsequent assessments in order to receive EW services. This section also specifies that only face-to-face long-term care consultation service assessments that result in a nursing facility level of care determination are acceptable for EW eligibility purposes. This section is effective January 1, 2011.

Section 49 (256B.0915, subdivision 10) requires MA managed care rates for EW services to be adjusted effective October 1, 2009, to reflect the new maximum rate limits for all customized living services.

Section 50 (256B.0916, subdivision 2) modifies the distribution of waiver service funds to counties by deleting existing distribution criteria and requiring instead that funds be allocated according to statewide priorities established in section 256B.092, subdivision 12 (later in this article).

Section 51 (256B.0917, subdivision 14) authorizes essential community supports grants of up to $400 per month for persons who are age 65 or older, not eligible for MA, would otherwise be financially eligible for the AC program, and have been assessed as not needing nursing facility living of care but do need at least one service from a list of community-based services in order to remain in the community. Grant parameters are established. This section is effective January 1, 2011.

Section 52 (256B.092, subdivision 8a) modifies the list of approved reasons for a county of service to refuse concur with the county of financial responsibility regarding the service plan for a person with developmental disabilities.

Section 53 (256B.092, subdivision 11) establishes, effective upon federal approval, a new service called residential support that is available through the community alternative care, community alternatives for disabled individuals, developmental disabilities, and traumatic brain injury waivers. Service criteria are outlined.

Section 54 (256B.092, subdivision 12) requires DHS to establish statewide priorities for persons on the developmental disabilities waiting list. Statewide priorities are outlined. An evaluation of statewide priorities is required.

Section 55 (256B.0948) requires a five percent reduction in rates paid by waiver service programs for adult foster care and supportive living services that are above 95 percent of the statewide rate for the service, provided that rates may not be reduced to below the 95^th percentile.

Section 56 (256B.37, subdivision 1) adds DHS subrogation rights for the costs of AC services to existing subrogation rights for MA service costs.

Section 57 (256B.37, subdivision 5) states that private accident and health coverage is primary and must be exhausted before the AC program pays for services.

Section 58 (256B.434, subdivision 4) suspends the automatic nursing facility rate adjustment on nonproperty-related costs for an additional three years, through the rate year beginning October 1, 2012.

Section 59 (256B.434, subdivision 21) establishes a formula to determine, for nursing facilities that convert from public to private ownership after September 30, 2006, the portion of post-PERA pension costs to be added to the historic operating rate.

Section 60 (256B.437, subdivision 6) requires DHS to calculate planned closure rate adjustments for planned nursing facility closures occurring after June 30, 2009, according to paragraph (a) of this subdivision, which limits the adjustments to $2,080 per closed bed.

Section 61 (256B.441, subdivision 55) suspends the phase-in schedule for rebasing nursing facility operating payment rates for four years, until October 1, 2013. During this period, the rebased portion of the rate will remain at 14 percent, and 86 percent of the rate will be based on the prior rate setting system. Beginning October 1, 2013, 65 percent of the rate will be rebased, as required by that date under current law. (Chapter 173, article 1, section 29, rephrases some of the language in this section.)

Section 62 (256B.441, subdivision 58) prohibits rebasing of nursing facility property payment rates and the removal of planned closure rate adjustments and single-bed room incentives from external fixed costs until 82 percent of the operating payment rate is rebased.

Section 63 (256B.441, subdivision 59) establishes a single-room rate of 111.5 percent of the established rate.

Section 64 (256B.49, subdivision 11a) requires DHS to establish statewide priorities for persons on waiting lists for the community alternative care, community alternatives for disabled individuals, and traumatic brain injury waivers. Statewide priorities are outlined. An evaluation of statewide priorities is required. (Chapter 173, article 1, section 30, modifies the headnote for subdivision 11a.)

Section 65 (256B.49, subdivision 12) adds a cross-reference related to the new nursing facility level of care criteria. This section is effective January 1, 2011.

Section 66 (256B.49, subdivision 13) adds a reference to the new nursing facility level of care criteria. This section is effective January 1, 2011.

Section 67 (256B.49, subdivision 14) inserts language clarifying that a client must be determined to require a hospital or nursing facility level of care to qualify for waiver services for persons with disabilities. It also states that only a face-to-face assessment conducted under certain provisions of section 256B.0911 is acceptable for this determination process. This section is effective January 1, 2011.

Section 68 (256B.49, subdivision 22) states that for the purposes of residential support services under these waiver programs, the provisions of section 256B.092, subdivision 11 (earlier in this bill) are controlling.

Section 69 (256B.4912) establishes procedures for ensuring that providers of waiver services to seniors and persons with disabilities meet provider qualifications. It requires direct care staff of waiver services providers to meet background studies requirements by July of 2010. It also requires DHS to establish rate-setting methodologies that meet federal standards for waiver service programs for persons with disabilities.

Section 70 (256B.5011, subdivision 2) deletes the requirement that each intermediate care facility for persons with developmental disabilities must have a quality improvement plan.

Section 71 (256B.5012, subdivision 8) reduces operating payment rates by 2.58 percent for intermediate care facilities for persons with developmental disabilities, effective July 1, 2009.

Section 72 (256B.69, subdivision 5a) mandates DHS, effective January 1, 2010, to require managed care plans to use the fee-for-service MA assessment and authorization processes, forms, standards, and policies for all PCA services under section 256B.0659.

Section 73 (256D.44, subdivision 5) allows waiver service recipients to relocate to services without 24-hour supervision and receive the equivalent of their group residential housing (GRH) allocation in Minnesota Supplemental Assistance (MSA) shelter needy funding under certain circumstances. The recipient may choose housing that is owned, operated, or controlled by the recipient's service provider. DHS must assess housing alternatives and whether a public equity housing fund could be established that would allow the state to recover its investment of GRH and MSA shelter needy funds from provider-owned housing when sold so that the funds could be used for future public needs under chapter 256D. (Chapter 173, article 1, section 45, replaces all of the new language in this section with language allowing certain shelter needy persons to choose housing that may or may not be owned, operated, or controlled by the recipient's service provider under certain conditions. This language expires June 30, 2011.)

Section 74 (626.556, subdivision 3c) amends the law governing reporting maltreatment of minors to make counties responsible for investigating allegations of maltreatment by unlicensed personal care assistance provider organizations. This section also makes the Minnesota Department of Health responsible for investigating child maltreatment allegations against licensed home care providers.

(Chapter 173, article 1, section 39, requires counties to forward to DHS copies of county findings related to personal care assistance provider organizations.)

Section 75 (626.5572, subdivision 13) amends the law governing reporting maltreatment of vulnerable adults to make counties responsible for investigating allegations of maltreatment of vulnerable adults by personal care assistance provider organizations.

Section 76 requires DHS to develop alternative services to PCA services for persons with mental health and other behavioral challenges who can benefit from other more appropriate services. DHS must report to the Legislature by January 15, 2011, with plans to implement the alternatives by July 1, 2011.

Section 77 requires DHS to give 30-days notice to persons affected by amendments in this article to listed sections. This section expires July 1, 2011.

Section 78 relieves a variety of community-based providers and intermediate care facilities for persons with developmental disabilities from the employee-compensation requirements included in rate increase legislation approved in 2007 and 2008. This section does not apply to employees covered by a collective bargaining agreement.

Section 79 reduces grants, allocations, reimbursement rates, or rate limits, as applicable, by 2.58 percent, effective July 1, 2009, for a variety of community-based service providers.

Section 80 requires DHS to consult with existing stakeholder groups on implementation of changes in the personal care assistance program and on various issues surrounding implementation. It also requires DHS to report data on training developed and delivered to program participants, audit and financial integrity measures and results, and other issues.

Section 81 requires DHS, in consultation with stakeholders, to develop a single set of standards governing services for persons with disabilities receiving waiver services to replace all or portions of existing laws and rules governing data practices, facility and provider licensure, and other issues. Requirements for the standards are outlined. DHS must report results by January 15, 2012.

Section 82 requires DHS to confer with interested parties to develop and update a common service menu for waiver programs.

Section 83 requires DHS to consult with stakeholders to monitor progress made in response to the agency's December 15, 2008, report to the Legislature regarding intermediate care facilities for persons with developmental disabilities.

Section 84 requires DHS, in consultation with various state agencies and stakeholders, to explore ways to maximize the availability and affordability of housing choices for persons with disabilities or who need care assistance due to other health challenges. DHS must report findings by December 15, 2010.

Section 85 is a Revisor's instruction.

Section 86 repeals the following sections:

Section 256B.0655, various subdivisions (personal care assistant services);

Section 256B.071 (Medicare maximization program);

Section 256B.19, subdivision 1d (portion of nonfederal share to be paid by certain counties); and

Section 256B.431, subdivision 23 (county nursing home payment adjustments).

Section 1 (402A.01) states that the section in this article may be cited as the "State-County Results, Accountability, and Services Delivery Reform Act."

Section 2 (402A.10) defines terms.

Section 3 (402A.15) establishes the Steering Committee on Performance and Outcome Reforms.

Section 4 (402A.18) establishes the commissioner's power to remedy failure to meet performance outcomes.

Section 5 (402A.20) establishes the council membership and council duties.

Section 6 (402A.30) provides the process to establish a service delivery authority and specifies the service delivery authorities' duties.

Section 7 (402A.45) allows a county that is in a service delivery authority to enter into cooperative arrangements with other authorities or counties to provide essential services that are not within the jurisdiction and duties of the service delivery authority.

Section 8 (402A.50) allows the council to seek and receive funds to provide expert technical assistance to the council.

Section 9 appropriates $350,000 for purposes of this article.

Section 1 (103I.208, subdivision 2) creates a permit fee for a monitoring well owned by a federal agency, state agency, or local unit of government that is unsealed under a maintenance permit.

Sections 2 and 3 (144.121) increase the fees for a facility with ionizing radiation producing equipment and establishes a fee for a facility with radiation therapy and accelerator equipment and a facility with an industrial accelerator. These sections exempt electron microscopy equipment from the registration fee requirements.

Section 4 (144.1222) increases fees for public pools and spas.

Section 5 (144.125, subdivision 1) increases the fee for the early hearing detection and intervention program from $101 to $106 effective July 1, 2010.

Sections 6 and 7 (144.72) change permits to licenses for youth camps, and moves the licensure of youth camps to chapter 157 (food, beverage, and lodging establishments).

Sections 8 to 11 (144.9501) make changes to the definitions for the Lead Poisoning Prevention Act by adding a definition of "disclosure pamphlet" and "renovation," and modify the definitions for "lead sampling technician" and "regulated lead work."

Section 12 (144.9505, subdivision 1g) specifies that a person who employs individuals to perform regulated lead work outside the person's property must obtain certification as a lead firm.

Section 13 (144.9505, subdivision 4) exempts renovation work from the notification requirement to the commissioner and local board of health that work is starting at a regulated lead worksite.

Section 14 (144.9508, subdivision 2) requires the commissioner to adopt rules that are consistent with the federal Toxic Substances Control Act.

Section 15 (144.9508, subdivision 3) requires the commissioner to adopt rules to license lead sampling technicians.

Section 16 (144.9508, subdivision 4) requires the commissioner to adopt rules establishing criteria for the content and presentation of training courses for lead renovation and lead sampling technicians.

Section 17 (144.9512, subdivision 2) removes the named grantee for swab team services. Modifies the services that grantees provide under this program. Requires that projects that provide certain matching funds receive priority for grant funding under this program.

Section 18 (144.966, subdivision 3a) requires the commissioner to contract with a nonprofit for services for families with children who are deaf or have hearing loss. Specifies certain family support services and information that must be provided. Requires the commissioner to give preference to a nonprofit that can provide services statewide.

Sections 19 to 23 (144.97) make changes to the definitions section of the environmental laboratory certification section by modifying the definition of "accreditation," "commercial laboratory," and "laboratory," and adding a new definition for "field of testing" and "test category."

Sections 24 to 33 (144.98) require the commissioner to accredit environmental laboratories according to national standards; establish an accreditation process; modify and establish fees for accreditation; require the commissioner to accredit laboratories that test samples under the clean water program, the safe drinking water program, the resource conservation and recovery program, the underground storage tank program, and the clean air program; and to maintain and publish a list of analytes available for accreditation.

Section 34 (144.99, subdivision 1) adds the provisions of the environmental laboratory certification program to the Health Enforcement Consolidation Act.

Section 35 (153A.17) increases the fees for hearing aid dispensers and establishes a temporary surcharge of $100 beginning July 1, 2009, until June 30, 2016.

Section 36 (157.15, subdivision 20) adds "youth camp" within the food, beverage, and lodging establishments regulations. This adds a licensing fee to youth camps.

Section 37 (157.16) increases food, beverage, and lodging establishment fees and establishes a fee for youth camps.

Section 38 (157.22) exempts concession stands operated in conjunction with school sponsored events on school property from the 21-day restriction.

Section 39 (327.14) adds a definition for "special event recreational camping area" to the manufactured home parks and camping areas chapter.

Sections 40 to 43 (327.15; 327.16; and 327.20) make a number of modifications to the fee structure for manufactured home parks and recreational camping areas. Creates a new fee structure for recreational camping areas that is based on the number of sites. These sections also create operating standards for special event recreational camping areas.

Section 44 establishes the Minnesota colorectal cancer screening prevention demonstration project.

Subdivision 1 requires the Commissioner of Health to award grants to Hennepin County Medical Center and MeritCare Bemidji for a colorectal screening demonstration project to provide screening to the uninsured and underinsured. States that the demonstration project expires December 31, 2010.

Subdivision 2 requires an applicant to: (1) be at least 50 years of age or at high risk for colon cancer; (2) be uninsured, or if insured, have coverage that does not cover the full cost of colorectal cancer screenings; (3) be ineligible for medical assistance, general assistance medical care, and MinnesotaCare programs; and (4) have a gross family income at or below 250 percent of FPG.

Subdivision 3 requires the services provided under the demonstration project to include: (1) colorectal cancer screening; (2) follow-up services for abnormal tests; and (3) diagnostic services to determine the extent of treatment.

Subdivision 4 requires the Commissioner of Health, in consultation with the University of Minnesota School of Public Health, to evaluate the demonstration project and make recommendations to the Legislature by January 1, 2011, for increasing the number of individuals in Minnesota who receive colon cancer screening.

Section 45 requires the Commissioner of Health to study and report to the Legislature by January 15, 2011, on the exposure pathways for per fluorochemicals focusing on food sources that might be affected by contact with contaminated water or air. The commissioner must also convene and consult with a citizen advisory group.

Section 46 requires the Commissioner of Health to provide a grant to Hennepin County Medical Center (HCMC) for a one-year pilot project through which HCMC will collect occupational and residential history data from newly diagnosed cancer patients. Lists the purposes of this pilot project, and requires HCMC to report to the Legislature by October 1, 2010. (This section was amended by chapter 173; see article 1, section 47.)

Section 47 requires the commissioner of health, in its collaborations with ClearWay, to prioritize smoking cessation activities in certain communities.

Section 48, paragraph (a), requires the Department of Public Safety to work with the Minnesota Ambulance Association (MAA) to create a medical response unit reimbursement pilot program.

Paragraph (b) specifies that the Department of Public Safety, in consultation with the MAA, Minnesota Fire Chief's Association, Emergency Services Regulatory Board, and the Minnesota Council of Health plans, must:

• identify no more than five medical response units to participate in the program;



• outline criteria for reimbursement;



• determine reimbursement amounts for each unit; and



• collect data for a final report.

Paragraph (c) provides certain criteria for the medical response unit reimbursement pilot program, including, but not limited to, the following:

• the program expires December 31, 2011, or when the appropriation is expended;



• the Department of Public Safety must report to the legislature by March 1, 2011, as to the effectiveness and value of the program;



• individual entities licensed to provide ambulance services are not eligible for participation in the program;



• if a participating medical response unit withdraws from the program, the Department of Public Safety may select another similarly operating unit to complete the program; and



• the Department of Public Safety and the other organizations involved have no ongoing responsibility to reimburse medical response units beyond this pilot program.

Section 49 requires the Commissioner of Health to review proposed regulatory legislation for body art technicians and body art establishments and develop recommendations on the proper level of regulation needed to protect public health. The recommendations must be submitted to the Legislature by January 15, 2010.

Section 50 states that costs incurred by the Department of Health for conducting investigations of uncertified hearing aid dispensers shall be apportioned between all licensed or credentialed professions that dispense hearing aids effective July 1, 2011.

Section 51 repeals sections 103I.112 (exemption for state and local governments for wells and borings); 144.9501, subdivision 17b (lead interim control worker); 327.14, subdivisions 5 and 6 (primary license and annual license for hotels, motels, resorts, and manufactured homes); and a rule regarding duplicate certificates for certified food managers.

Summary of the relevant sections contained in chapter 173, article 1:

Section 47 deletes the language stating that the funding for the grants for the pilot project for cancer surveillance shall come from MDH's current resources for the Chronic Disease and Environmental Epidemiology section.

Section 48 requires the Commissioner of Health to determine whether the levels of exposure to pentachlorophenol (PCP) in Minneapolis neighborhoods where certain treated utility poles are installed exceed human health risk limits or contaminant levels for residents or others who handle the poles.

Sections 1 to 8 (148D.180 and 148E.180) reduce fees for social workers.

Sections 9 to 11 (152.126) modify the controlled substances prescription electronic reporting system by including schedule IV controlled substances in the controlled substances prescription electronic reporting system; providing more flexibility to the vendor that the Board of Pharmacy may contract with for the controlled substances prescription electronic reporting system; and clarifying that data submitted to the board is private data but may be used by the vendor under contact with the board for the operation of the system and carry out the vendor's other duties.

Section 12 repeals section 148D.180, subdivision 8 (temporary fee reduction).

Article 11 modifies fiscal year 2009 appropriations to the Department of Human Services to reflect forecast adjustments.

Article 12 appropriates money to the Department of Human Services, the Minnesota Department of Health, a variety of health-related regulatory boards, the Emergency Medical Services Board, the Department of Veterans Affairs, the Department of Public Safety, the Council on Disability, the Ombudsman for Mental Health and Developmental Disabilities, and the Ombudsman for Families. It includes a number of budget-related riders. (Chapter 173, article 2, corrections appropriations and language in this article. It also repeals the direct appropriations to the Departments of Veterans Affairs and Public Safety. Instead, these appropriations are to the Emergency Medical Services Board for transfer to the two departments.)

DG/KC/JW/rer:rdr:ph

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