|S.F. No. 695 - Health and Human Services Appropriation (The Second Engrossment)|
|Author:||Senator Linda Berglin|
|Prepared by:||David Giel, Senate Research (296-7178)
Katie Cavanor, Senate Counsel (651/296-3801)
Joan White, Senate Counsel (651/296-3814)
|Date:||April 28, 2009|
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.
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 (144D.03, subdivision 3) prohibits a housing with services establishment from allowing a new resident to move in until the establishment has received certification from the Senior LinkAge line that a transition to housing with services consultation has been completed.
Section 9 (198.003, subdivision 7) requires the Commissioner of Veterans Affairs to apply to the federal government for Medicare certification of the veterans homes at Fergus Falls, Luverne, Silver Bay, and Minneapolis, and establishes application deadlines.
Section 10 (198.003, subdivision 8) requires the Commissioner of Veterans Affairs to maximize the use of Medicare Part D to pay pharmacy costs for eligible veterans residing at state veterans homes.
Section 11 (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.
Section 12 (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 13 (252.46, subdivision 1a) requires DHS to establish a statewide rate-setting methodology for all day training and habilitation services.
Section 14 (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.
Section 15 (256.476, subdivision 5) updates terminology regarding consumer support grants to reflect a temporary change in the MA federal share.
Section 16 (256.476, subdivision 11) updates terminology regarding consumer support grants to reflect a temporary change in the MA federal share.
Section 17 (256.9657, subdivision 1) increases the annual nursing home bed surcharge by $350, to an annual total of $3,165. It allows nursing homes that do not participate in medical assistance to enroll in the program and establishes a new formula to establish initial rates for homes that do enroll.
Section 18 (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. This section also modifies data required to be reported by housing with services establishments and their arranged home care providers.
Sections 19 to 32 modify the Personal Care Assistant (PCA) program.
Section 19 (256B.0625, subdivision 6a) defines MA home health services to be those specified in law rather than in rule.
Section 20 (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 21 (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 22 (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 23 (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 24 (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 is unchanged.
Subdivision 14 adds a new requirement that home care providers that do not accept Medicare payments must refer dually eligible recipients to Medicare-certified providers when Medicare is determined to be the appropriate payer.
Subdivision 15 is new language requiring 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 25 (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 26 (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 27 (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 28 (256B.0655, subdivision 1b) modifies home care assessment language by deleting language stating that a face-to-face assessment for PCA services is conducted on those recipients who have never had a county public health nurse assessment.
Section 29 (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.
Section 30 (256B.0657, subdivision 8) provides a formula to establish a budget for the PCA self-directed supports option.
Section 31 (256B.0657, subdivision 32) establishes caps on enrollment in the self-directed supports option and requires DHS to evaluate the option before it becomes available statewide.
Section 32 (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 DHS 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 requires the responsible party to live with the service recipient. 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.
Subdivision 10 establishes the duties of 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. 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.
Subdivision 14 requires all PCAs to be supervised by a qualified professional. 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, 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.
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.
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 live-in responsible party requirements and to ensure that PCA services are not being performed by the housing provider. DHS and the counties must provide this assistance until July 1, 2010.
Subdivision 30 requires all recipients affected by the changes in MA home care services to be given 30 days notice before the change becomes effective.
Sections 33 to 45 modify long-term care consultation services.
Section 33 (256B.0911, subdivision 1) modifies the purpose and goal statement of long-term care consultation services.
Section 34 (256B.0911, subdivision 1a) modifies definitions. This section is effective January 1, 2011.
Section 35 (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 36 (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 37 (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 38 (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. It modifies the assessment process.
Section 39 (256B.0911, subdivision 3b) expands the duties of the long-term consultation team regarding the provision of transition assistance to persons residing in a nursing facility, hospital, regional treatment center, or intermediate care facility.
Section 40 (256B.0911, subdivision 3c) strengthens the existing transitional long-term care consultation function for prospective residents of housing with services establishments. The establishment must inform prospective residents of the requirement to contact the Senior LinkAge line for long-term care options counseling and transitional consultation. After consultation, the Senior LinkAge line must provide a certificate to the prospective resident and send a copy to the establishment.
Section 41 (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 Minnesota Statutes, 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 42 (256B.0911, subdivision 5) requires DHS to streamline the processes required to provide long-term care consultation services. This section is effective January 1, 2011.
Section 43 (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 44 (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 45 (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 46 (256B.0915, subdivision 3a) establishes monthly service cost limits for Elderly Waiver clients with low dependencies in activities of daily living.
Section 47 (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 48 (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 49 (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 50 (256B.0915, subdivision 10) requires MA managed care rates to be adjusted effective October 1, 2009, to reflect the new maximum rate limits for all customized living services.
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 on the community alternative care, community alternatives for disabled individuals, developmental disabilities, and traumatic brain injury waivers. Service criteria are outlined.
Section 54 (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.
Section 55 (256B.37, subdivision 1) adds DHS subrogation rights for the costs of AC services to existing subrogation rights for MA service costs. This section is effective January 1, 2011.
Section 56 (256B.37, subdivision 5) states that private accident and health coverage is primary and must be exhausted before the AC program pays for services. This section is effective January 1, 2011.
Section 57 (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, 2013.
Section 58 (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 59 (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 60 (256B.441, subdivision 51a) authorizes DHS to negotiate rate adjustments for nursing facilities that provide specialized care and receive rate adjustments under subdivision 61 later in this bill. The general fund cost of these adjustments is limited to $150,000 per year.
Section 61 (256B.441, subdivision 53) increases the nursing facility payment rate for external fixed costs in order to offset the increase in the nursing home surcharge. The increase is effective June 1, 2009.
Section 62 (256B.441, subdivision 59) establishes a single-room rate of 111.5 percent of the established rate if a resident needs a single room due to medical necessity.
Section 63 (256B.441, subdivision 60) eliminates nursing facility rebasing and provides that nursing facility rates must be determined under section 256B.434 (alternative payment demonstration project), effective October 1, 2009.
Section 64 (256B.441, subdivision 61) provides a nursing facility rate reduction for facilities that have high operating payment rates within their geographic peer group and facility type. A formula is provided for determining the rate reductions. Notwithstanding the state equal rates law, facilities that receive a rate reduction under this subdivision are allowed to continue charging private pay residents the current rate until the MA rate is increased to a level in excess of the current rate.
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 1, 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.5012, subdivision 8) reduces operating payment rates by three percent for intermediate care facilities for persons with developmental disabilities, effective July 1, 2009.
Section 71 (256B.69, subdivision 5a) authorizes 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 72 (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.
Section 73 (626.5572, subdivision 13) amends the law governing reporting maltreatment of vulnerable adults to make counties responsible for investigating allegations of maltreatment by personal care assistance provider organizations.
Section 74 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 75 reduces grants, allocations, reimbursement rates, or rate limits, as applicable, by three percent, effective July 1, 2009, for a variety of community-based service providers.
Section 76 requires DHS to provide data to the pertinent committees by January 15, 2010, on the training developed and delivered for PCA program participants, audit and financial integrity measures and results, information developed for consumes and responsible parties, and quality assurance measures and results.
Section 77 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 78 requires DHS to give 30-days notice to persons affected by amendments in this article to listed sections.
Section 79 is a Revisor's instruction.
Section 80 repeals the following sections:
Section 256B.19, subdivision 1d (portion of nonfederal share to be paid by certain counties);
Section 256B.431, subdivision 23 (county nursing home payment adjustments);
Section 256B.0951 (quality assurance commission);
Section 256B.0655, various subdivisions (personal care assistant services); and
Section 256B.071 (Medicare maximization program).
MFIP/CHILD CARE/ADULT SUPPORTS/FRAUD PREVENTION
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 (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 4 (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 5 (256I.03, subdivision 7) reduces the group residential housing (GRH) personal needs allowance by $20.
Section 6 (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 7 and 10 (256J.42, subdivision 1a; 256J.425, subdivision 3a) suspends the MFIP 60-month time limit on assistance from July 1, 2009, to June 30, 2011.
Sections 8 and 9 (256J.425, subdivision 2; 256J.425, subdivision 3) modifies 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 7.
Section 11 (256J.425, subdivision 4) modifies the MFIP employed participants section of law, to expand the definition of employment to include unpaid work, if it is combined with job search, for up to 12 months in duration.
Section 12 (256J.46, subdivision 1) amends the provision relating to MFIP participants who are not complying with program requirements, to require the county agency or employment services provider to assess the participant and determine if the participant may be eligible for family stabilization services (FSS) after the seventh occurrence of noncompliance, but prior to closing the MFIP case.
Section 13 (256J.49, subdivision 1) corrects a cross-reference.
Section 14 (256J.521, subdivision 2) strikes language that is no longer necessary due to the implementation of Family Stabilization Services (FSS).
Section 15 (256J.53, subdivision 1) allows an associate or baccalaureate program to be considered an approved MFIP work activity, and strikes language restricting the postsecondary education to 24 months.
Section 16 (256J.545) strikes obsolete language related to the family violence waiver.
Section 17 (256J.561, subdivision 2) clarifies MFIP participation requirements.
Sections 18, 21, 26, and 27 (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.
Section 19 (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 20 (256J.575, subdivision 3) 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 eligibilty criteria.
Section 22 (256J.575, subdivision 6) makes a technical clarification to FSS.
Section 23 (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 24 (256J.621) reduces the work participation cash benefits from $75 to $50 per month.
Section 25 (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 28 (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 29 repeals the provision that allows a $12 group residential housing community living adjustment.
SERVICES FOR PERSONS WITH DISABILITIES
Section 1 (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 2 (245A.11, subdivision 7a) details the conditions that must be met for purposes of using technology for overnight supervision in adult foster care homes.
Sections 3 to 11 (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 7 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 12 (256B.5011, subdivision 2) deletes the requirement that DHS contracts with intermediate care facilities for persons with developmental disabilities must include a quality improvement plan.
Section 13 requires DHS to complete development of a common service menu for waivered service programs.
Section 14 require the commissioner to consult with ICF/MR providers and advocates to monitor progress made in response to the commissioner's December 15, 2008, report to the Legislature.
STATE-OPERATED SERVICES/MINNESOTA SEX OFFENDER PROGRAM
Article 4 modifies provisions related to state-operated services.
Sections 1, 2, and 3 (246.50, subdivision 5; 246.50, subdivision 10; 246.50, subdivision 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) requires counties to contribute to the cost of care for individuals receiving services at the Minnesota extended treatment options program (METO) according to the following schedule: Ten percent of the cost of care for the first 90 days, 20 percent for days 91 to 270, and 50 percent for days over 271. This section is effective January 1, 2010.
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, subdivision 1a; 246B.01, subdivision 1b; 246B.01, subdivision 2a; 246B.01, subdivision 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.
DEPARTMENT OF HEALTH
Section 1 (62Q.19, subdivision 1) requires the Commissioner of Health to designate licensed birthing centers as essential community providers.
Section 2 (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 3 and 4 (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.
Section 5 (144.122) increases fees for hospitals.
Section 6 (144.1222) increases fees for public pools and spas.
Section 7 (144.1501, subdivision 2) modifies the health professional education loan forgiveness program by including nurses agreeing to practice in a hospital pediatric psychiatric unit.
Section 8 (144.226) makes the $4 surcharge on vital records permanent.
Section 9 (144.566) establishes a licensing system for birthing centers.
Subdivision 1 defines the following terms: "birthing centers," "low-risk pregnancy," and "licensed traditional midwife."
Subdivision 2 requires any birthing center operating in the state to be licensed by the Commissioner of Health. The license is effective for a one-year period, and may not be transferred or assigned to any other person.
Subdivision 3 requires an application and the applicable fee to be submitted to the commissioner with the name of the applicant; the location of the birthing center; the name of the person in charge of the center; documentation that the required standards have been met; and any other information the commissioner deems necessary.
Subdivision 4 authorizes the commissioner to refuse to grant or renew or to suspend or revoke a license.
Subdivision 5, paragraph (a), requires a birthing center to meet the following requirements:
(1) clearly identify a governing body or person who is legally responsible for setting policies and procedures and ensuring that they are implanted;
(2) care must be provided by a physician, advanced practice registered nurse or a certified midwife during labor, birth, and puerperium;
(3) an obstetrician and pediatrician must be on call and available to provide medical guidance at all times;
(4) procedures must be in place to transfer a patient within 30 minutes from the time of diagnosis of an emergency to an acute care hospital capable of providing obstetrical and neonatal services;
(5) must be equipped to initiate emergency procedures in life-threatening events to the mother and baby; and
(6) must maintain a quality assurance program.
Paragraph (b) requires the birthing center to have procedures in place that specify the criteria by which risk status will be established and applied to each woman at admission and during labor. The center must fully inform each woman before admission on the risks and benefits of the services available at the center and each woman must sign an informed consent indicating that they have received this information.
Subdivision 6 states that a birthing center may not perform the following services:
(1) surgical procedures other than those normally accomplished during an uncomplicated birth;
(2) abortions; and
(3) general or conduction anesthesia.
Subdivision 7 establishes an annual license fee.
Subdivision 8 requires the commissioner to annually inspect each licensed birthing center.
Subdivision 9 authorizes the commissioner to adopt rules.
Sections 10 and 11 (144.72) change permits to licenses for youth camps.
Sections 12 to 15 (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 16 (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 17 (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 18 (144.9508, subdivision 2) requires the commissioner to adopt rules that are consistent with the federal Toxic Substances Control Act.
Section 19 (144.9508, subdivision 3) requires the commissioner to adopt rules to license lead sampling technicians.
Section 20 (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.
Sections 21 to 25 (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 26 to 35 (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 36 (144.99, subdivision 1) adds the provisions of the environmental laboratory certification program to the Health Enforcement Consolidation Act.
Section 37 (148.6445, subdivision 2a) establishes a fee for a duplicate license for an occupational therapist.
Section 38 (153A.17) increases the fee for hearing aid dispensers and establishes a temporary surcharge of $550.
Section 39 (157.15, subdivision 20) adds "youth camp" within the food, beverage, and lodging establishments regulation. This adds a licensing fee to youth camps.
Section 40 (157.16) increases food, beverage, and lodging establishment fees.
Section 41 (157.22) exempts concession stands operated in conjunction with school sponsored events on school property from the 21-day restriction.
Section 42 (327.14) adds a definition for "special event recreational camping area" to the manufactured home parks and camping areas chapter.
Sections 43 to 46 (327.15; 327.16; and 327.20) make a number of modifications to the fee structure for manufactured home parks and recreational camping areas. These sections also create operating standards for special event recreational camping areas.
Section 47 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 48 repeals Minnesota Statues, 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.
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 (256B.0625, subdivision 47) delays the implementation of treatment foster care for two years, until July 1, 2011.
Section 2 (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 3 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.
Section 1 (148.108) establishes fees in statute for chiropractors and increases the fees.
Sections 2 to 9 (148D.180 and 148E.180) reduce fees for social workers.
Section 10 (152.126, subdivision 1) includes schedule IV controlled substances in the controlled substances prescription electronic reporting system.
Section 11 (152.126, subdivision 2) provides more flexibility to the vendor that the Board of Pharmacy may contract with for the controlled substances prescription electronic reporting system.
Sections 12 to 14 (156.011; 156.012; and 156.015) establish fees in statute for veterinarians and increase the fees.
Section 15 repeals veterinarian fees that are in rule and section 148D.180, subdivision 8 (temporary fee reduction).
BODY ART TECHNICIANS AND ESTABLISHMENTS
Article 9 establishes a regulatory system for technicians who perform body art procedures and for body art establishments.
Section 1 (146B.01) defines the following terms: "aftercare," "antiseptic," "apprentice," "body art," "body art establishment," "body piercing," "commissioner," "contaminated waste," "department," "disinfection," "equipment," "establishment plan," "guest artist," "hand sink," "hot water," "jewelry," "liquid chemical germicide," "operator," "procedure area," "procedure surface," "sanitization," "safe level," "sharps," "sharps containers," "single use," "standard precautions or universal precautions," "sterilization," "tattooing," "technician," and "temporary body art establishment."
Section 2 (146B.02) establishes the licensure procedures for body art establishments.
Subdivision 1 states that beginning January 1, 2010, no person may maintain, own, or operate a body art establishment in the state without an establishment license issued by the Commissioner of Health under this chapter.
Subdivision 2 states that each application for an establishment license must be submitted on a form provided by the commissioner and accompanied with the applicable fee. Lists the information that must be included in the application. Upon approval of the application, the commissioner shall issue an establishment license, and the license shall be valid for a period of three years from the date of issuance and may be renewed upon approval by the commissioner.
Subdivision 3 requires the commissioner to inspect the body art establishment and review any records necessary to ensure that the standards required under this chapter are met before issuing a license. The commissioner is required to inspect an establishment at least once during the construction, if new construction, or during any remodeling. The commissioner is authorized to enter the premise to make the inspection.
Subdivision 4 prohibits the performance of any body art procedure at any location other than a licensed body art establishment except as otherwise permitted.
Subdivision 5 requires the license to be issued to a specific person and location and states that it is not transferable. It also requires the license to be prominently displayed onsite.
Subdivision 6 authorizes an owner or operator of a temporary body establishment to submit an application for a temporary events permit to the commissioner at least 14 days before the start of the event. The permit must be prominently displayed at the location. If the permit is approved, it is only valid for the specified dates and hours listed on the application and no permit can last longer than a 21-day period.
Subdivision 7 lists the information that must be kept on file for two years on the premise of the establishment, and must be made available for inspection upon the request of the commissioner.
Subdivision 8 exempts a body art establishment from state licensure if the establishment is located within a local jurisdiction that has enacted an ordinance that establishes a license for the establishment if the ordinance meets or exceeds the provisions of this chapter.
Section 3 (146B.03) establishes licensure procedures for body art technicians.
Subdivision 1 states that beginning January 1, 2010, no individual may perform body art procedures without a valid technician license issued by the Commissioner of Health under this chapter.
Subdivision 2 prohibits an individual from using certain titles or other letters in connection with the individual's name in a way that represents that the individual is engaged in the practice of tattooing or body piercing unless the individual is licensed to perform body art procedures under this chapter.
Subdivision 3 lists a number of health care professionals who may perform body art procedures within the scope of their practice without a technician license. A registered apprentice or guest artist is authorized to perform body art procedures without a technician's license.
Subdivision 4 states that an application and the applicable fees must be submitted to the commissioner on a form provided by the commissioner. The requirements that must be met for licensure are: (1) proof that the applicant is over 18; (2) proof of completing 200 hours of supervised training as an apprentice; and (3) proof of satisfactorily completing an approved course on bloodborne pathogens, the prevention of disease transmission, infection control, and aseptic technique. Until January 1, 2011, the supervised training requirement shall be waived if the applicant submits evidence to the commissioner that the applicant has, at a minimum, 200 hours of performing body art procedures within the last five years.
Subdivision 5 requires the commissioner to notify the applicant in writing on the action taken on the application. If the application is denied, the applicant has 20 days to file a request for a hearing on the determination. After the hearing, the commissioner must notify the applicant in writing of the decision.
Subdivision 6 requires the commissioner to issue a technician's license to any individual who holds a current license, certification, or registration from a municipality located within the state or from another jurisdiction if the commissioner determines that the standards in the other jurisdiction meets or exceeds the requirements of this chapter and a letter is received from that jurisdiction stating that the applicant is in good standing.
Subdivision 7 states that a technician's license is valid for one year and may be renewed upon payment of a renewal fee.
Subdivision 8 states that the license is not transferable to another individual and must be onsite and available to the public upon request.
Section 4 (146B.04) establishes the apprenticeship and guest artist registration.
Subdivision 1 states that before an individual may begin an apprenticeship or work as a guest artist, a licensed technician must register the apprentice or guest artist with the commissioner. The registration form must include the name of the apprentice or guest artist; the name of the licensed technician supervising the apprenticeship or sponsoring the guest artist; proof of completing the required courses on bloodborne pathogens, disease transmission, infection control, and aseptic technique; and the starting and anticipated completion dates of the apprenticeship or the dates the guest artist will be working.
Subdivision 2 requires an apprentice to complete a minimum of 200 hours of training under the direct supervision of a licensed technician.
Subdivision 3 prohibits a guest artist from conducting body art procedures for more than 30 days per calendar year per licensed establishment. If the guest artist exceeds this limit, the artist must apply for a technician's license.
Section 5 (146B.05) establishes grounds for closing an establishment.
Subdivision 1 states that the commissioner may order an owner or operator of a licensed establishment to discontinue all operations if certain conditions exist. These conditions are listed.
Subdivision 2 requires the establishment to submit to the commissioner proof that the problem or condition causing the closure has been corrected or removed, prior to reopening. An establishment may not reopen without written approval by the commissioner.
Section 6 (146B.06) establishes health and safety standards.
Subdivision 1 requires the establishment to meet the health and safety standards listed in this subdivision before a licensed technician may conduct body art procedures at the establishment.
Subdivision 2 exempts establishments that are operating as a body art establishment on August 1, 2009, for any standard that would require remodeling to comply.
Subdivision 3 requires that the equipment, instruments, and supplies must comply with the health and safety standards listed in this subdivision before a licensed technician may conduct body art procedures.
Subdivision 4 requires the body art procedures to comply with the health and safety standards that are listed in this subdivision.
Subdivision 5 requires the technician to comply with the health and safety standards listed in this subdivision.
Subdivision 6 establishes standards for handling infectious and contaminated waste.
Section 7 (146B.07) establishes professional standards for technicians.
Subdivision 1, paragraph (a), requires a technician to require proof of age before performing a body art procedure.
Paragraph (b) prohibits a technician from tattooing or piercing any individual under the age of 18, without notarized parental consent or the presence of the individual's parent or legal guardian. Nipple or genital piercing or tattooing is prohibited on any individual under the age of 18, regardless of parental consent.
Paragraph (c) requires the technician to provide the client with a release form before performing any body art procedure.
Paragraph (d) prohibits a technician from performing any body art procedure on any individual who appears to be under the influence of alcohol, controlled substances, or hazardous substances.
Paragraph (e) prohibits a technician from performing any body art procedure while under the influence of alcohol, controlled substance, or hazardous substances.
Paragraph (f) prohibits a technician from administering anesthetics or other medication.
Subdivision 2 requires a technician to obtain from the client a signed and dated informed consent form before performing a body art procedure.
Subdivision 3 requires the body art establishment operator to maintain proper records of each procedure. These records must be kept for two years, and must be available for inspection by the commissioner upon request.
Subdivision 4 requires a technician to provide each client with verbal and written instructions for the care of the tattooed or pierced site upon the completion of the procedure. The instructions must advise the client to consult with a health care professional at the first sign of infection.
Subdivision 5 requires an operator and technician to comply with all applicable state and municipal public health requirements.
Subdivision 6 requires the operator of an establishment to immediately notify the commissioner or local public health authority of any reports they receive of a potential bloodborne pathogen transmission.
Section 8 (146B.08) establishes the investigation process and grounds for disciplinary action.
Subdivision 1 authorizes the commissioner to initiate an investigation upon receiving a signed complaint or other signed written communication that alleges or implies that an individual or establishment has violated this chapter.
Subdivision 2 states that a licensee has the opportunity for a contested case hearing under Minnesota Statutes, chapter 14.
Subdivision 3 states the grounds for disciplinary action.
Subdivision 4 states the possible actions that may be taken by the commissioner if the commissioner finds grounds for such action.
Subdivision 5 states that upon suspension or revocation of licensure, an establishment or technician shall cease to perform body art procedures, use the protected titles, and represent to the public that the technician or establishment is licensed by the commissioner.
Subdivision 6 permits a technician who has had licensure suspended to petition the commissioner for reinstatement following the period of suspension.
Section 9 (146B.09) states that nothing in this chapter preempts or supersedes any municipal ordinances relating to land use, building and construction requirements, nuisance control, or licensing of commercial enterprises in general.
Section 10 (146B.10) establishes fees.
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 (125A.744, subdivision 3) eliminates the $350,000 cap on the share of federal medical assistance reimbursement provided to school districts for individual education plan health-related costs that the commissioner can retain to cover administrative costs. A five percent cap remains in place.
Section 6 (256.01, subdivision 2b) eliminates the patient incentive program for MA, GAMC, and the MinnesotaCare.
Section 7 (256.01, subdivision 18a) requires the commissioner 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 8 (256.01, subdivision 18b) mandates that DHS comply with federal requirements in the American Recovery and Reinvestment Act regarding American Indians.
Section 9 (256.01, subdivision 29) modifies the state medical review team (SMRT) process.
Paragraph (a) requires DHS to ensure timely processing of persons with disabilities who apply for MA and who request a determination of disability from SMRT. DHS must review medical evidence submitted by counties with a SMRT referral and seek additional information, where necessary, from providers, applicants, or enrollees to support the application.
Paragraph (b) provides that, prior to a denial or withdrawal of a disability determination request due to insufficient evidence, DHS must ensure that the missing evidence is necessary and appropriate to a determination and assist applicants and enrollees to obtain the evidence.
Paragraph (c) requires an annual report on SMRT activities.
Section 10 (256.964) establishes dental care pilot projects.
Subdivision 1 requires the commissioner to authorize a pilot project 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.
Subdivision 2 requires the commissioner to establish a pilot project to improve access to on-site dental services for residents of nursing facilities. This project must demonstrate methods of reducing total costs by providing more cost-effective delivery of dental services.
Subdivision 3 requires the commissioner to establish a pilot project under which dental providers are paid a care coordination fee to coordinate dental care for patients with existing dental disease.
Section 11 (256.9652) requires the commissioner to implement a demonstration project that incorporates e-prescribing applications with a clinical information database. The commissioner is required to ensure that providers who are currently using e-prescribing have available through their e-prescribing software specific patient medication history; the preferred drug list; prescription details; and drug interaction alerts.
Section 12 (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 72.5 percent of full value.
Section 13 (256.969, subdivision 3a) reduces inpatient hospital rates by one percent.
Section 14 (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 15 (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 section 256B.199, paragraph (d).
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.055, subdivision 7) modifies language governing MA eligibility for aged, blind, and disabled persons to clarify that persons determined not to be aged or blind and who have not been determined disabled by the Social Security Administration must be referred to SMRT for a disability determination.
Section 18 (256B.056, subdivision 3) 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 19 (256B.056, subdivision 3b) establishes that a pooled trust is considered an available asset unless the trust provides that upon the earlier of the death of the beneficiary or termination of the trust, DHS is reimbursed for MA benefits paid on behalf of the beneficiary, up to the amount remaining in the trust minus reasonable administrative fees.
Section 20 (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 21 (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 22 (256B.057, subdivision 9) modifies language governing MA eligibility for employed persons with disabilities to clarify that persons determined not to be aged or blind and who have not been determined disabled by the Social Security Administration must be referred to SMRT for a disability determination.
Section 23 (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 24 (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 25 (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 26 (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 27 and 28 (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 29 (256B.0625, subdivision 3), paragraph (b), limits reimbursement for anesthesiology services provided to physicians to when the physician directly performs the services.
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, 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 30 (256B.065, subdivision 9a) limits MA coverage for dental services to children.
Section 31 (256B.0625, subdivision 9b) limits MA coverage for dental services to adults.
Section 32 (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.
Section 33 (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 34 (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 35 (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 36 (256B.0625, subdivision 13i) requires the commissioner to establish a collaborative psychiatric consultation service that would be available to primary care practitioners and would include child and adolescent psychiatrists and adult psychiatrists. The section also requires prior authorization and a collaborative psychiatric consultation from a commissioner approved provider for ADHD, ADD, and psychotropic medication prescribed to children under specified circumstances.
Section 37 (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;
Section 38 (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 39 (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 40 (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 41 (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 42 (256B.0751, subdivision 7) requires enrollees who have complex or chronic conditions to select a primary care clinic with clinicians who have been certified as health care homes if there are two or more primary care clinics that have been certified as a health care home available to the enrollee.
Section 43 (256B.0756) requires the commissioner to implement a demonstration project for MA and GAMC enrollees who have or are at risk of developing diabetes. The project shall be designed as a podiatry-directed wound care program that focuses on the prevention and care of diabetic-related wounds to reduce wound treatment costs and prevent amputations.
Section 44 (256B.08, subdivision 4) requires the commissioner to accept data from the Social Security Administration as an application for medical assistance in accordance with federal law.
Section 45 (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 46 (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 47 (256B.15, subdivision 1h) deletes the definition of estate that is replaced in the prior section.
Section 48 (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 49 (256B.15, subdivision 2b) establishes certain property ownership rights solely for the purpose of MA recovery actions. It provides that:
The agency responsible for the claim may, at its discretion, release specific real and personal property from the provisions of this section.
Section 50 (256B.15, subdivision 9) allows DHS to intervene as a party in any MA recovery proceeding.
Section 51 (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 52 (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 53 (256B.69, subdivision 5a) requires the commissioner to include in the performance targets that managed care plans and county-based purchasing plans are required to meet in order for the five percent capitation rate withhold to be returned, a reduction in the plan's emergency room utilization rate for the state health care program enrollees by a measurable rate of five percent from the utilization rate from the previous calendar year. The withhold shall continue until the plan's utilization rate is reduced by 25 percent of the plan's utilization rate for calendar year 2008.
Sections 54 (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 55 (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 56 (256B.69, subdivision 6) carves out the provision of dental services from the PMAP contracts. States that dental services are to be provided on a fee-for-service basis.
Section 57 (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 58 (256B.69, subdivision 29) states that as a condition of participating in PMAP a managed care plan or county-based purchasing plan must either contract with or establish a birthing center.
Section 59 (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.
Section 60 (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.
Section 61 (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.
Section 62 (256B.767) requires active participation in a patient-centered decision-making process before authorization is approved or payment reimbursement is provided for a number of specific surgical procedures. Requires that the list of procedures be published in the State Register by October 1, 2009, and reviewed by the commissioner at least every two years. Prior to any changes to the list the commissioner must hold a public forum and receive public comment. Requires a health care provider to certify that the patient has participated in a patient-centered decision-making process before receiving authorization or reimbursement for any of the procedures on the list. Defines "patient-centered decision-making process."
Section 63 (256D.03, subdivision 4) applies to GAMC the three percent reduction to payments for basic care services.
Section 64 (256L.03, subdivision 1) makes a conforming change to the change in dental services coverage.
Section 65 (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.
Section 66 (256L.04, subdivision 1b) states that children with family income greater than 275 percent of federal poverty guidelines (FPG) are eligible for MinnesotaCare.
Section 67 (256L.04, subdivision 7a) makes a conforming change.
Section 68 (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.
Section 69 (256L.05, subdivision 3) states that the effective date of coverage for children eligible under Minnesota Statutes, 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.
Section 70 (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.
Section 71 (256L.05, subdivision 6) permits a child whose family gross income is less than 90 percent of the income standard and who meets all other eligibility requirements at the time of application to be determined eligible beginning the month of application, or according to Minnesota Statutes, section 256L.05, subdivision 3, if 90 percent of the child's family income is greater than 200 percent of the federal poverty guidelines. The child shall be required to provide all required verifications within 60 days' notice of eligibility determination.
Section 72 (256L.07, subdivision 1) permits children in families with income greater than 275 percent of FPG to remain on MinnesotaCare.
Section 73 (256L.07, subdivision 2) exempts children with family income equal to or less than 200 percent from the ESI barrier.
Section 74 (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.
Section 75 (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 76 (256L.11, subdivision 1) applies to MinnesotaCare the three percent reduction to payments for basic care services.
Section 77 (256L.12, subdivision 7) specifies that dental services covered under MinnesotaCare shall be provided on a fee-for-service basis.
Section 78 (256L.12, subdivision 9) requires the commissioner to include in the performance targets that managed care plans and county-based purchasing plans are required to meet in order for the five percent capitation rate withhold to be returned, a reduction in the plan's emergency room utilization rate for the state health care program enrollees by a measurable rate of five percent from the utilization rate from the previous calendar year. The withhold shall continue until the plan's utilization rate is reduced by 25 percent of the plan's utilization rate for calendar year 2008.
Sections 79 and 80 (256L.15) exempt children with family income equal to or below 200 percent of FPG from premiums.
Section 81 (256L.17, subdivision 5) exempts children from the asset limits (children already exempt).
Section 82 (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 83 (519.05) clarifies that joint and several spousal liability for medical debt includes liability for state claims.
Section 84 clarifies that the appropriation to the University if Minnesota from the health care access fund shall be transferred each year for MERC.
Section 85 makes technical change to an effective date from last year.
Section 86 requires the commissioner of Human Services, in consultation with the Commissioner of Health, to determine the amount of excess surplus each health maintenance organization (HMO) and county-based purchasing plan had as of December 31, 2008. For those HMOs and county-based purchasing plans that are determined to have had an excess of surplus, the commissioner is required to reduce the capitation rate paid for administrative costs by an amount equal to 26 percent of the excess for payments made between January 1, 2012, and June 30, 2013.
Section 87 establishes the autism spectrum disorder task force until June 30, 2011.
Section 88, paragraph (a), requires the Commissioner of Human Services to seek federal approval for section 256B.0751, subdivision 7 (health care home selection).
Paragraph (b) 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 89 repeals sections 62Q.80, subdivision 1a (awarding grants for community-based health care coverage program); 256.966, subdivision 7 (renewal notice requirements for DHS and HPCs); 256B.037 (prospective payment of dental services); 256B.69, subdivision 6c (dental services demonstration project); and 256L.17, subdivision 6 (asset test for children).
Article 11 modifies fiscal year 2009 appropriations to the Department of Human Services to reflect forecast adjustments.
HEALTH AND HUMAN SERVICES APPROPRIATIONS
Article 12 appropriates money to the Department of Human Services, the Minnesota Department of Health, a variety of health-related regulatory boards, the Department of Veterans Affairs, the Emergency Medical Services Regulatory Board, 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.
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