Senate Counsel, Research
and Fiscal Analysis
G-17 State Capitol
75 Rev. Dr. Martin Luther King Jr. Blvd.
St. Paul, MN 55155-1606
(651) 296-4791
Fax: (651) 296-7747
Tom Bottern
Director
   Senate   
State of Minnesota
 
 
 
 
 
S.F. No. 760 - Omnibus Health and Human Services Finance Bill (The Conference Committee Report)
 
Author: Senator David W. Hann
 
Prepared By: Katie Cavanor, Senate Counsel (651/296-3801)
Joan White, Senate Counsel (651/296-3814)
David A. Lobejko, Senate Analyst (651/296-7178)
 
Date: May 20, 2011



 
ARTICLE 1
CHILDREN AND FAMILY SERVICES
 
Sections 1 to 9 modify the child care chapter of law. 
 
Section 1 (119B.011, subdivision 13) limits the time an adult family member who is not in an authorized activity may be temporarily absent from the home to 60 days.  This section is effective April 16, 2012.
 
Section 2 (119B.035, subdivision 4)  reduces the maximum rate of assistance that can be paid for the at-home infant child care program from 90 percent to 68 percent of the rate that is paid for licensed family child care assistance. This section is effective October 31, 2011.
 
Sections 3 and 4 (119B.09, subdivisions 9a and 10) limit child care assistance payments (CCAP) to child care centers that provide services and receive CCAP payments for children whose parent or a person who resides with the child is employed at the center.  Section 3 is effective January 1, 2013, and section 4 is effective March 5, 2012. 
 
Section 5 (119B.09, subdivision 13) prohibits CCAP payments for child care provided in the child’s home, unless certain conditions are met as specified in this section.  This section is effective March 5, 2012.
 
Section 6 (119B.125, subdivision 1b) requires legal nonlicensed child care providers to complete CPR training, effective November 1, 2011. 
 
Section 7 (119B.13, subdivision 1) reduces child care rates by five percent beginning October 31, 2011. Paragraph (d) eliminates increased payments for care provided during nonstandard hours, and Paragraph (e) eliminates payments for activity fees.  Paragraph (d) is effective April 16, 2012. Paragraph (e) is effective September 3, 2012.
 
Section 8 (119B.13, subdivision 1a) establishes maximum daily and weekly rates and reduces legal nonlicensed family child care provider rates from 80 percent to 68 percent of the rate paid for licensed family child care. This section is effective April 16, 2012, except the amendment changing 80 to 68 and 0.80 to 0.68 is effective October 31, 2011.
 
Section 9 (119B.13, subdivision 7) eliminates absent day payments for legal nonlicensed child care providers and limits absent day payments to ten days per calendar year for licensed providers.  This section is effective January 1, 2013.
 
Section 10 (256.987, subdivision 1) requires cash benefits for GA, MSA, and MFIP to be issued on a separate EBT card with the head of household's name printed on the card.  Requires the card to include a statement that it is unlawful to use the card to purchase tobacco or alcoholic beverages.
 
Subdivision 2 prohibits EBT debit cardholders from using the EBT debit card at vendors located outside of Minnesota.  Specifies that this subdivision does not apply to the food portion. 
 
Subdivision 3 prohibits EBT cardholders from using the card to purchase tobacco products or alcoholic beverages. Violation is a petty misdemeanor. A retailer must not be held liable for the crime of another under this section. 
           
           Subdivisions 1 and 2 are effective June 1, 2012.
 
Section 11 (256D.02, subdivision 12a) continues the 30-day residency requirement for general assistance medical care and strikes existing language in this subdivision related to general assistance.  This section is effective October 1, 2012.
 
Section 12 (256D.05, subdivision 1) modifies eligibility for the general assistance program by removing several categories of eligibility. This section is effective May 1, 2012.
 
Section 13 (256D.06, subdivision 2) modifies eligibility criteria for emergency assistance.  This section is effective November 1, 2011.
 
Sections 14 and 16 (256D.44, subdivision 5; and 256D.47) amend the Minnesota supplemental aid program by eliminating allowances for special needs and special diets.  Sections 14 and 16 are effective August 1, 2012.
 
Section 15 (256D.46, subdivision 1) modifies eligibility of SSI and MSA recipients for emergency assistance.  This section is effective November 1, 2011.
 
Sections 17 and 18 (256E.35, subdivision 5; and 256E.35, subdivision 6) strike references to funding for the family assets for independence program.  
 
Section 19 (256I.03, subdivision 8) defines "supplementary services" in the Group Residential Housing (GRH) chapter of law.
 
Section 20 (256I.04, subdivision 1) modifies eligibility for GRH, requiring 20 hours of work per month and incorporating additional eligibility criteria. This section is effective October 1, 2012.
 
Section 21 (256I.04, subdivision 2b) prohibits counties from entering into agreements with GRH providers that do not include a residency requirement of at least 20 hours per month of volunteer or paid work.  This section is effective May 1, 2012.
 
Section 22 (256I.05, subdivision 1a) prohibits counties from negotiating supplementary service rates with providers that do not encourage a policy of sobriety.  This section is effective May 1, 2012.
 
Sections 23 and 24 (256J.12, subdivision 1a; 256J.12, subdivision 2) impose a 60-day residency requirement on the Minnesota Family Investment program.   Current law imposes a 30-day residency requirement.  Current law is stricken that allows the residency requirement to be waived for unusual hardship, as defined in this section. 
 
Section 25 (256J.20, subdivision 3) reduces the MFIP vehicle asset limit from $15,000 to $10,000.  This section is effective October 1, 2011.
 
Section 26 (256J.37, subdivision 3c) modifies the MFIP program by reducing the MFIP grant by $50 per SSI adult recipient who resides in the household.  This section is effective May 1, 2012. 
 
Section 27 (256J.49, subdivision 13) specifies that “work activity” under the MFIP does not include activities done for political purposes. 
 
Section 28 (256J.53, subdivision 2) requires participants to be working in unsubsidized employment at least ten hours per week in order for postsecondary education or training to be an approved activity in an MFIP employment plan.  Specifies this requirement does not apply for intensive education or training programs lasting 12 weeks or less when full-time attendance is required.
 
Sections 29 to 34 (256N.10; 256N.20; 256N.22; 256N.25; 256N.30; and 256N.35) establish the adult assistance program by combining the general assistance, emergency general assistance, emergency supplemental aid, and Minnesota supplemental aid special needs and special diets, into one block grant to counties for low-income adults, with a 60-day residency requirement. The county is given flexibility to spend the funds on the target population.  The sections are effective October 1, 2012. 
 
Section 35 (260C.157, subdivision 3) adds that county juvenile treatment screening teams must conduct screenings within 15 days of a request for a screening.  Adds the child's parent, guardian, or permanent legal custodian as a member of the team.
 
Section 36 (260D.01) adds a cross-reference to Minnesota Statutes, section 260C.157 so that children in voluntary foster care for treatment can be screened by the juvenile treatment screening team.
 
Section 37 (393.07, subdivision 10a) modifies the time in which counties have to issue food support for applicants who meet the federal criteria for expedited issuance of food support. Current law requires the immediate issuance of food support. This section allows the county to provide food support within five days. Removes obsolete language.
 
Section 38 (Section 518A.51) specifies how the child support fee is distributed, as language containing this formula is repealed.
 
Section 39 (Requirement for liquor stores, tobacco stores, gambling establishments, and tattoo parlors) modifies distribution of nonfederal fees to counties. Requires  liquor stores, tobacco stores, gambling establishments, and tattoo parlors to negotiate with their third-party processors to block EBT cash transactions at their places of business and withdrawals of cash at ATMs located in their places of business. 
 
Section 40 (Minnesota EBT Business Task Force), Subdivision 1, establishes the membership of the Minnesota EBT Business Task Force.
 
           Subdivision 2 establishes the duties of the task force.
 
Subdivision 3 requires the task force to report to the legislative committees with jurisdiction over Health and Human Services policy and finance by April 1, 2012, with recommendations related to the duties in subdivision 2.
 
           Subdivision 4 makes the task force expire on June 30, 2012.
 
Section 41 (Streamlining Children and Community Services Act reporting requirements) requires the Commissioner of Human Services, in consultation with other interested parties, to develop a streamlined alternative to current reporting requirements under the CCSA service plan.  Requires the commissioner to submit recommendations and draft legislation to the Legislature by November 15, 2012.
 
Section 42 is a revisor’s instruction to make conforming amendments and correct statutory cross-references as necessitated by the creation of Minnesota Statutes, chapter 256N, and related repealers. 
 
Section 43 provides the repealers: Paragraph (a) Minnesota Statutes 2010, section 256.9862, subdivision 2, is repealed effective February 1, 2012.
 
Paragraph (b) Minnesota Statutes 2010, sections 256.979, subdivisions 5, 6, 7, and 10;  256.9791; 256D.01, subdivisions 1, 1a, 1b, 1e, and 2; 256D.03, subdivisions 1, 2, and 2a; 256D.05, subdivisions 1, 2, 4, 5, 6, 7, and 8; 256D.0513; 256D.06, subdivisions 1, 1b, 2, 5, 7, and 8; 256D.09, subdivisions 1, 2, 2a, 2b, 5, and 6; 256D.10; 256D.13; 256D.15; 256D.16; 256D.35, subdivision 8b; and 256D.46, are repealed effective October 1, 2012.
 
           Paragraph (c) Minnesota Rules, part 3400.0130, subpart 8, is repealed effective  September 3, 2012.
           
 Paragraph (d) Minnesota Rules, part 9500.1261, subparts 3, items D and E, 4, and 5, are repealed effective November 1, 2011.
 
ARTICLE 2
DEPARTMENT OF HEALTH
 
Section 1 (62D.08, subdivision 7) requires that the definition of “administrative expenses” must be consistent with the definition provided by the National Association of Insurance Commissioners (NAIC) for purposes of health maintenance organization’s (HMOs) reporting.
 
Section 2 (62J.04, subdivision 3) removes reference to section 62J.41, which is repealed in this article.
 
Section 3 (62J.17, subdivision 4a) removes certain annual reporting requirements related to major spending commitments for physician clinics.
 
Section 4 (62J.495 by adding subdivision 7) exempts certain small clinical practices from the current 2015 deadline for interoperable electronic health records. States that this exemption expires December 31, 2020.
 
Section 5 (62J.692) makes changes in the medical education and research cost fund (MERC).
 
Subdivision 3 eliminates language requiring a clinical medical education program that trains pediatricians to include curriculum training in case management for children suffering from mental illness to be eligible for MERC funds. Requires a clinical medical education program to provide their national provider identification number and the federal tax identification number of each training site used in the program for which funds are being sought.
 
Subdivision 4 modifies the existing MERC distribution formula. Makes training sites whose grant amount based on the formula is less than $1,000 ineligible for funds. Reduces existing direct payments to University of Minnesota Medical Center – Fairview, the School of Dentistry, and the Academic Health Center.
 
Subdivision 6 makes a conforming change.
 
Subdivision 7 makes a conforming change.
 
Subdivision 8 makes a conforming change.
 
Subdivision 11 proposes a new MERC distribution formula, subject to federal approval. If approval is received, this distribution formula supersedes the distribution formula in subdivision 4.
 
Section 6 (62U.15) requires the Commissioner of Health to establish and collect quality measures for Alzheimer’s disease.

Subdivision 1, paragraph (a) requires the commissioner, beginning July 1, 2012, to review quality measure and make recommendations for future measurements for improving assessment and care related to Alzheimer’s and other dementia diagnoses, including cognitive screening, diagnoses and treatment plans.

 Paragraph (b) permits the commissioner to contact with a private entity to collect the data under this section and permits the commissioner to use an existing contract to do so.

Subdivision 2 requires the commissioner to develop, by July 1, 2012, a health care home learning collaborative curriculum for identification and management of Alzheimer's disease and other dementia patients.

Subdivision 3 requires the Commissioners of Health and Human Services, the Minnesota Board of Aging, and other appropriate state offices to conduct a literature review in order to estimate current outcomes and costs compared with improved practices related to Alzheimer's disease and other dementias.

Subdivision 4 requires the commissioner to provide a progress report to the Legislature by January 15, 2013.

Section 7 (144.1501, subdivision 1) modifies the definition of “designated rural area” for purposes of the health professionals loan forgiveness program, to include small rural and isolated rural areas as described by the Rural Urban Commuting Area system.
 
Section 8 (144.396, subdivision 5) requires the commissioner to award statewide tobacco prevention grants within available appropriations.

Section 9 (144.396, subdivision 6) requires the commissioner to award local tobacco prevention grants within available appropriations.

Sections 10 to 13 create an accreditation exemption for certain environmental laboratories.
 
Section 10 (144.98, subdivision 2a) makes a conforming change related to environmental laboratory accreditation.
 
Section 11 (144.98, subdivision 7) makes a conforming change related to environmental laboratory accreditation.
 
Section 12 (144.98, subdivision 8) permits certain environmental laboratories to request an exemption from personnel requirements and specified quality control provisions, as of January 1, 2012. Permits the Commissioner of Health to grant exemptions provided the labatory complies with methodology and quality control requirements.
 
Section 13 (144.98, subdivision 9) requires laboratories requesting accreditations under the exemption in section 144.98, subdivision 8, to obtain acceptable proficiency test results and sets out requirements related to subsequent analysis of proficiency testing samples.
 
Section 14 (144A.102) requires the Commissioner of Health to work with certain long-term care providers to examine state and federal rules and regulations. Requires the commissioner to report to the Legislature by January 31, 2012, as to the implementation of this section.

Section 15 (144A.61, subdivision 9) requires the Commissioner of Health to accept electronic transmission of applications and supporting documents for the nursing assistant registry. 

Section 16 (144E.123) removes the penalty to licensees for failing to report prehospital care data to the Emergency Medical Services (EMS) Board. Requires the EMS regulatory board to convene a working group, by October 1, 2011, to redesign policies related to data collection from licensees. Requires the working group to report its findings to the board by July 1, 2012.
Provides an immediate effective date.
 
Sections 17 (145.4221) prohibits any person or entity, whether public or private, from performing or attempting to perform human cloning; participating in an attempt to perform human cloning; shipping, importing, or receiving for any purpose an embryo produced by human cloning or any product derived from such an embryo; or shipping or receiving, in whole or in part, any oocyte, embryo, fetus, or human somatic cell for the purpose of human cloning.  A knowing or reckless violation of the prohibition is punishable as a misdemeanor.  Defines "human cloning" and "somatic cell."  Provides that nothing in the law restricts areas of scientific research, including stem cell research, not specifically prohibited by the provision.  Includes a severability provision. 
 
Section 18 (145.925, subdivision 1) limits the family planning special project grants to available appropriations.
 
Section 19 (145.925, subdivision 2) prohibits the commissioner from making family planning grants to any eligible organization that performs abortions or provides referrals for abortion services. Prohibits the use of state funds under contract from a grantee to any eligible organization that performs abortions or provides referrals for abortion services.
 
Section 20 (145.9271) requires the White Earth Band of Ojibwe Indians, if it accepts state funds to establish and operate one or more health clinics in Minneapolis or greater Minnesota to serve members of the White Earth Tribe, or may use the funds to qualify as a federally qualified health center. Requires the tribe to submit to the commissioner a work plan and budget that describes its annual plan for the funds.
 
Section 21 (145.9272) requires the Commissioner of Health to distribute grants to community mental health centers operating on July 1, 2011, for providing services to low-income consumers and patients with mental illness. Provides a formula for determining the amount of the grant based on public program revenues.
 
Section 22 (145.928, subdivision 7) requires the commissioner to award health disparities grants to reduce immunization rates and infant mortality within the available appropriations.
 
Section 23 (145.928, subdivision 8) requires the commissioner to award health disparities grants within the available appropriations.
 
Section 24 (145.987) requires the commissioner to award development grants to expand community health centers by establishing new community health centers in small or isolated rural areas, as described by the Rural Urban Commuting Area system. Specifies uses for these community health center development grants. This section is effective upon federal approval of section 62J.692, subdivision 11.
 
Section 25 (145A.17, subdivision 3) requires local public health family home visiting programs to obtain permission from the family to share data with other family service providers in order to select a lead agency for the family and coordinate available resources. 
 
Section 26 (157.15, subdivision 21) creates a “limited food establishment” as a type of food and beverage establishment. Requires them to use equipment that is nontoxic and durable, and permits them to request a plumbing variance from the commissioner.
 
Section 27 (157.20, subdivision 5) permits a person to request a variance from all parts, Minnesota Rules, chapter 4626 (food code), with some specified exceptions. 
 
Section 28 (297F.10, subdivision 1) reduces the amount that is to be transferred from cigarette tax revenue to the MERC account, effective July 1, 2011, from $8,550,000 to $6,244,000.
 
Section 29 requires the Commissioners of Health and Human Services to evaluate and recommend options for reorganizing a variety of regulatory responsibilities. Requires that recommendations be submitted to the Legislature by February 15, 2012. 
 
Section 30 requires the Commissioner of Health to contract with an entity to study efficiency, cost, service quality and enrollee satisfaction data for for-profit health maintenance organizations (HMO) relative to the non-profit HMO’s. Requires a report on the findings by January 15, 2012.
 
Section 31 establishes a Minnesota Task Force of Prematurity to evaluate and make recommendations on methods to reduce prematurity and improve premature infant health care. Specifies membership of the task force and requires the Commissioner of Health to convene the first meeting by July 31, 2011. Requires a report on the current state of prematurity by November 30, 2011, and a final report by January 15, 2013. 
 
Section 32 requires the Commissioner of Health to work with stakeholders to review, implement, and make recommendations related to efficiency for nursing home licensure.
 
Section 33, paragraph (a), repeals sections 62J.17, subds. 1, 3, 5a, 6a, and 8 (provisions related to expenditure reporting); 62J.321, subdivision 5a (prescription drug price disclosure data); 62J.381 (prescription drug price disclosure); 62J.41, subds. 1 and 2 (cost containment reporting); 144.1464 (summer health care interns); 144.147 (rural hospital planning and transition grant program); and 144.1499 (promotion of health care and long-term care careers).
 
Paragraph (b) repeals certain provisions of Minnesota Rules, chapter 4651 related to health care provider reporting.
 
ARTICLE 3
MISCELLANEOUS
 
Section 1 (245A.14, subdivision 4) permits a family day care or group family day care provider to locate the program in a commercial space, rather than a residence, if the license holder is the primary provider of care and complies with specific requirements: local zoning regulations, specified fire code, and age and capacity limitations and square footage determinations as required by the fire code. Requires the license holder to display the license issued by the commissioner, which will contain the statement, “This special family child care provider is not licensed as a child care center.”
Section 2 (245C.03) add a subdivision requiring the commissioner to conduct background studies when initiated by a children’s therapeutic services and supports provider.
Section 3 (245C.10) requires the commissioner to recover the cost of background studies for the purposes of children’s therapeutic services and supports through a license holder fee of no more than $20.
Section 4 (256B.04, subdivision 14a) limits charges and payments for level of need determinations for medical nonemergency transportation, including special transportation, to $25.
Section 5 (256B.0625, subdivision 17) requires the most direct route for purposes of reimbursement to special transportation providers to be determined by commercially available mileage software.
Section 6 (256B.0943) adds a subdivision allowing that background study requirements may be met by a children’s therapeutic services and supports services agency through the NETStudy system.
Section 7 (256B.14) adds a subdivision on spousal contribution. Paragraph (a) provides definitions of commissioner, community spouse, cost of care, department, disabled child, income, and long-term care spouse.
Paragraph (b) requires the spouse of the long-term care spouse who receives MA for long-term care services or alternative care services to contribute to the cost of care unless the community spouse is caring for a minor or disabled child in the home.
Paragraphs (c) to (f) provide a formula for computing the contribution amount.
Paragraph (g) requires the county or tribal agency at the time of application for services to provide the spouse and community spouse a written explanation of the spousal contribution requirement, how to request a variance for undue hardship, review and determination of the contribution, and consequences for noncompliance.
Paragraph (h) provides that the contribution is to be assessed for each month the long-term care spouse has a community spouse and is eligible for MA or alternative care.
Paragraph (i) requires a review of the spousal contribution a minimum of once every 12 months or when there is a loss or gain of more than ten percent in income. 
Paragraph (j) provides that the contribution cannot exceed the amount of MA expended or the cost of alternative care services provided. Sets out the method of reimbursement if the community spouse has contributed an amount in excess of costs.
Paragraph (k) allows a community spouse who has personal medical needs to request a variance for undue hardship if the spouse needs to retain the contribution amount to pay for these medical needs.
Paragraph (l) sets out the appeal rights.
Paragraph (m) sets out the method to enforce payments.
Paragraph (n) provides that counties and tribes are entitled to one-half of the nonfederal share of collections for long-term care spouses on MA and one-quarter of the nonfederal share of collections for long-term care spouses on alternative care.
Makes this section effective July 1, 2012.
Section 8 (326B.175) modifies the requirement that elevators not meeting building code requirements be taken out of service until modifications to bring the device into compliance with code requirements are completed.
Section 9 (326B.188) provides an alternative compliance timeline for elevators that have a current law compliance deadline of January 29, 2012, or later.
Section 10 creates a working group to develop a proposal to create a single administrative structure for providing medical nonemergency transportation services to fee-for-service MA recipients. A report is due to the Legislature on January 15, 2012.
ARTICLE 4
HEALTH RELATED LICENSING
 
Section 1 (148.07 subdivision 1) makes technical change to require the Board of Chiropractic Examiners to set fees in statute rather than by rule.
Section 2 (148.108, subdivision 4) establishes animal chiropractic registration fees. 
 
Sections 3 to 7 (148.191, subdivision 2; 148.212, subdivision 1; 148.231; 148.232; 148.243) modify the Nursing Board. The sections strike obsolete language related to temporary permits for graduate nurses, allow the board to accept or expend grants or gifts and accept registration fees for the purposes of board activities, eliminate the late fee applied to registration renewal applications that are submitted within 30 days of the license’s registration expiration date, codify the fee structure, and establish a new fee for nurses from bordering states who are authorized to practice nursing without a Minnesota license. 
 
Sections 8 to 12 create the nurse licensure compact.
 
Section 8 (148.2855) establishes the nurse licensure compact, which includes ten articles specifying the enforcement of the compact. 
 
Section 9 (148.2856) states that nurses practicing in Minnesota under the nurse licensure shall have the same obligations, privileges, and rights as if the nurse was licensed in Minnesota, and shall be required to comply with and follow all laws and rules as nurses licensed in Minnesota. 
 
Section 10 (148.2857) allows the Governor to withdraw the state from the nurse licensure compact. 
 
Section 11 (148.2858) authorizes the Board of Nursing to recover costs of investigation and disposition of cases resulting from any adverse action taken against a nurse practicing under the compact.
 
Section 12 (148.2859) establishes the nurse licensure compact advisory committee. 
 
Section 13 (148B.17) makes technical changes and sets out the fee schedule in statute for the Board of Marriage and Family Therapy.
 
Section 14 (148B.33, subdivision 2) makes a conforming change.

Section 15 (148B.52) makes a technical change to require fees for Behavioral Health and Therapy to be established in statute.

Sections 16 to 21 make changes to the Board of Dentistry.

Section 16 (150A.091, subdivision 2) adds a fee for advanced dental therapist certification and for full faculty dentist.
 
Seciton 17 (150A.091, subdivision 3) makes a conforming change.
 
Section 18 (150A.91, subdivision 4) clarifies annual license fee.
 
Section 19 (150A.91, subdivision 5) makes a conforming change.
 
Section 20 (150A.091, subdivision 8) makes a conforming change.
 
Section 21 (150A.091, subdivision 16) provides a fee to be collected by the Board of Dentistry for a licensee who fails two consecutive professional development audits.
 
Sections 22 to 32 make changes to the Board of Pharmacy.
 
Section 22 (151.065) sets out a fee schedule in statute for the Board of Pharmacy.
 
Section 23 (151.07) makes a conforming change.
 
Section 24 (151.101) makes a conforming change and modifies a reference from licensure of interns to registration of interns.
 
Section 25 (151.102, subdivision 3) requires a fee for pharmacy technicians to be registered by the Board of Pharmacy.
 
Section 26 (151.12) makes a conforming change.
 
Section 27 (151.13, subdivision 1) makes conforming changes and modifies references to fee changes by cross-referencing Minnesota Statutes, section 151.065.
 
Section 28 (151.19) makes conforming changes and modifies references to fee changes by cross-referencing Minnesota Statutes, section 151.065.
 
Section 29 (151.25) makes a conforming change.
 
Section 30 (151.47, subdivision 1) makes a conforming change.
 
Section 31 (151.48) makes a conforming change.
 
Section 32 (152.12, subdivision 3) adds a cross-reference to fees set out in Minnesota Statutes, section 151.065.
 
Section 33 (214.107) establishes an administrative services unit for health-related licensing boards to perform administrative, financial, and management functions common to all the boards in a manner that streamlines services and reduces expenditures. The administrative services shall act as an agent of the boards. The funding for the administrative services unit shall be apportioned from each board. 
 
Section 34 makes sections 8 to 12 (related to the nurse licensure compact) effective July 1, 2012, or upon implementation of a coordinated licensure information system, whichever is later. 
 
ARTICLE 5
HEALTH CARE
 
Section 1 (1.06) establishes the Freedom of Choice in Health Care Act.
Subdivision 1 states that this section may be cited as the “Freedom of Choice in Health Care Act.”
 
Subdivision 2 defines the following terms:  "health care service," "mode of securing," and "penalty."
 
Subdivision 3, paragraph (a), states as public policy that the power to require or regulate a person’s choice of in the mode of securing health care services or to impose a penalty related to that choice is not found in the U.S. Constitution and that the state hereby exercises its sovereign power to declare the right of all persons residing in the state in choosing the mode of securing health care services.
 
Paragraph (b) declares that as a public policy of the state of Minnesota every resident is free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty.
  
Paragraph (c) states that this public policy is not to be applied to impair any right of contract related to the provision of health care services to any person or group.
 
Subdivision 4 states that no public official, employee, or agent of the state or any of its political subdivisions shall act to impose, collect, enforce, or effectuate any penalty that violates the public policy set forth in this section. This subdivision also requires the Attorney General to take any action as provided in this section or in Minnesota Statutes, ection 8.31, to defend or prosecute the rights protected under this section.
 
Section 2 (8.31, subdivision 1) requires the Attorney General to seek injunctive and any other appropriate relief to preserve the rights and property of the residents of the state and to defend the state’s officials, employees, and agents in the event that there is a law or regulation that violates the public policy as set forth in the Freedom of Choice in Health Care Act. This section also requires the Attorney General to seek injunctive and any other appropriate relief in the event that any law or regulation that violates the public policy of the Freedom of Choice in Health Care Act is enacted without adequate federal funding to the state to ensure affordable health care coverage is available to the residents of the state.
 
Section 3 (8.31, subdivision 3a) states that any person injured by a violation of the public policy in section 1.06 may bring a civil action and recover damages, cost and disbursements, and other equitable relief as determined by the court. This section also states that an action brought under this section for a violation of section 1.06 is in the public interest.
 
Section 4 (62E.08, subdivision 1) provides that the MCHA premium for the high-deductible, basic plan offered under section 62E.121 shall range from 101 to 125 percent of the weighted average of rates for comparable plans offered outside of MCHA.
 
Section 5 (62E.121) creates a high-deductible, basic plan in MCHA.
 
Subdivision 1 requires MCHA to offer a high-deductible, basic plan that meets the requirements in this section. Specifies that the plan is a one-person plan and that dependents must be covered separately.

Subdivision 2, paragraph (a) requires the plan to provide in-network annual deductible options of $3,000, $6,000, $9,000, and $12,000, with an in-network out-of-pocket maximum that is $1,000 greater than the amount of the annual deductible.

Paragraph (b) provides an annual increase in the deductible, based on the change in the CPI.

Subdivision 3 specifies different levels of copayments for the first three nonpreventive office visits, depending upon the deductible option chosen. Provides 80 percent coverage for subsequent visits, after the deductible is met.

Subdivision 4 provides 100 percent coverage for preventive care, with no cost-sharing.

Subdivision 5 requires a $10 copayment for preferred generic drugs, and requires enrollees to pay 100 percent of the plan’s rate for preferred brand name drugs.

Subdivision 6 requires a $20 copayment for the first three convenience center visits, with 80 percent coverage for subsequent visits after the deductible is met.

Subdivision 7 requires a $100 copayment for the first urgent care visit, and provides 80 percent coverage for subsequent visits after the deductible is met.

Subdivision 8 requires a $200 copayment for the first emergency room visit, and provides 80 percent coverage for subsequent visits after the deductible is met.

Subdivision 9 provides that these services are covered at 80 percent after the deductible is met.

    Subdivision 10 pays $50 per calendar year for eyewear.

Subdivision 11 specifies that maternity, labor and delivery, and postpartum care are not covered. Provides 100 percent coverage for prenatal care with no deductible.

Subdivision 12 provides 80 percent coverage for other eligible health care services after the deductible is met.

Subdivision 13 allows enrollees to remove mental health and substance abuse coverage and receive a reduced premium.

Subdivision 14 allows enrollees to upgrade prescription drug coverage in return for an increased premium.

Subdivision 15 provides that: the out-of-network deductible is twice the in-network annual deductible; there is no out-of-pocket maximum for out-of-network services; out-of-network benefits are covered at 60 percent after the deductible is met; and the lifetime maximum for out-of-network services is $1 million.

    Subdivision 16 lists services not covered by the plan.

Section 6 (62E.14, subdivision 4f) specifies that a person who is eligible for the Healthy Minnesota Contribution Program under Minnesota Statutes, section 256L.031, may enroll in MCHA with a waiver of the preexisting condition limitation if the person has been denied coverage in the individual market.

Section 7 (62J.04, subdivision 9) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.

Section 8 (62J.692, subdivision 7) makes a conforming change to the medical education and research (MERC) payments from the PMAP carve out.

Section 9 (62J.692, subdivision 9) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.

Section 10 (62J.824) prohibits a health care provider from billing and being reimbursed for any service provided to reverse, correct, or otherwise minimize the effects of an adverse health event for which the health care provider is responsible.

Section 11 (62Q.32) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.

Section 12 (62U.04, subdivision 3) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.

Section 13 (62U.04, subdivision 9) requires information on provider cost and quality to be used by government and the private sector as coverage is offered, sold, issued, or renewed, but not less than the current standard of within 12 months of when the information is published.

Section 14 (62U.06, subdivision 2) makes a conforming change related to the elimination of the Legislative Commission on Health Care Access.
 
Section 15 (256B.01, subdivision 2b) eliminates the pay-for-performance system providing performance payments to eligible medical groups and clinics that demonstrate optimum care for individuals with chronic disease enrolled in state health care programs.

Section 16 (256.01, subdivision 33) implements federal program integrity audits and authorizes the commissioner to retain the contingency state share of recoveries in order to implement a contract with a vendor for the audits.

Section 17 (256.969, subdivision 2b) delays rebasing of hospital rates under medical assistance (MA) for six months.

Section 18 (256B.04, subdivision 18) requires the commissioner to modify the Minnesota health care programs application form to ask applicants if they have ever served in the U.S. military.

Sections 19 and 20 (256B.056, subds. 3 and 4) make conforming changes to the elimination of MA coverage for adults without children.

Section 21 (256B.06, subdivision 4) eliminates state-funded medical assistance coverage for legal noncitizens, and limits coverage under the emergency medical assistance program by specifying that various services, including those related to chronic conditions, are not covered.
 
Section 22 (256B.0625, subdivision 3g) requires the commissioner to implement a program to reduce the number of elective inductions of labor prior to 39 weeks gestation. For births covered by MA or MinnesotaCare on or after January 1, 2012, prohibits payments for professional services associated with a delivery unless certain information is submitted to the commissioner. Exempts from this requirement deliveries performed at hospitals that have policies and processes in place to prohibit elective inductions prior to 39 weeks gestation, that have been approved by the commissioner. Allows the commissioner to not implement or discontinue the program, if the commissioner determines that at least 90 percent of MA and MinnesotaCare births occur at hospitals that have approved policies.
 
Sections 23 to 26 (256B.0625, subdivisions 8, 8a, 8b, and 8c) eliminate coverage for specialized maintenance therapy for adults.
 
Section 27 (256B.0625, subdivision 8e) increases from 12 to 24 the number of chiropractic visits allowed under MA before prior authorization is required.

Section 28 (256B.0625, subdivision 8f) provides MA coverage for acupuncture, only when provided by a licensed acupuncturist, or by a practitioner for whom acupuncture is within scope of practice and who has specific acupuncture training or credentialing.

Section 29 (256B.0625, subdivision 13e), paragraph (a) converts MA payment for drug ingredient costs from a formula based on average wholesale price (AWP) to one based on wholesale acquisition cost (WAC). Sets payments at WAC plus four percent for independently owned pharmacies located in a designated rural area within Minnesota, and at WAC plus two percent for all other pharmacies. Also strikes payment language related to antihemophilic factor drugs.
Paragraph (d) sets payment rates for drugs administered in an outpatient setting at the lower of the usual and customary cost or 106 percent of the average sales price. Payment under current law is at the lower of the usual and customary cost or the amount established by Medicare.
Paragraph (e) includes antihemophilic factor products in the list of specialty pharmacy products for which the commissioner may negotiate lower reimbursement rates and require enrollees to obtain from providers that have agreed to the lower rates.
Provides an effective date of July 1, 2011, or upon federal approval.

Section 30 (256B.0625, subdivision 13h) makes the following changes related to coverage of medication therapy management services:

·         allows persons taking three or more prescriptions with one or more chronic conditions to be eligible (current law requires four or more prescriptions with two or more chronic conditions);
·         allows coverage of persons with a drug therapy problem that is identified by a pharmacist and approved by the commissioner; and
·         allows provision of the service in home settings, without an order from the provider-directed care coordination team, and also expands the definition of home settings to include long-term care settings, group homes, and assisted living facilities.

Section 31 (256B.0625, subdivision 17) effective July 1, 2011, reduces nonemergency transportation rates, including special transportation, taxi, and other commercial carriers, by 4.5 percent. Requires managed care and county-based purchasing plan payments to be reduced beginning January 1, 2012, to reflect this reduction.

Section 32 (256B.0625, subdivision 17a) effective July 1, 2011, reduces ambulance service rates by 4.5 percent. Requires managed care and county-based purchasing plan payments to be reduced beginning January 1, 2012, to reflect this reduction.

Section 33 (256B.0625, subdivision 18) removes language providing that MA covers the “costs” of the most appropriate and cost-effective form of transportation.

Section 34 (256B.0625, subdivision 25b), paragraph (a) prohibits the commissioner from considering a request for authorization of a service when the recipient has third-party coverage, unless the provider has made a good faith effort to obtain payment or authorization from the third-party.
Paragraph (b) states that a provider is not required to bill Medicare before requesting authorization from the commissioner, if the provider has reason to believe the service is not eligible for Medicare payment.
Paragraph (c) provides that authorization is not required if a third-party has made payment equal to or greater than 60 percent of the maximum payment allowed under MA.

Section 35 (256B.0625, subdivision 31a) requires augmentative and alternative communication systems to be paid at the lower of: (1) the submitted charge; or (2) the manufacturer’s suggested retail price minus 20 percent for providers that are manufacturers, or the manufacturer’s invoice charge plus 20 percent for providers that are not manufacturers. (Under current law, payment is at the manufacturer’s suggested retail price.)

Section 36 (256B.0625, subdivision 55) allows a provider to seek payment from the recipient for services not eligible for payment under MA when the provider reviews and considers all available covered alternatives with the recipient, and obtains a signed acknowledgement from the recipient of the potential of the recipient’s liability.

Section 37 (256B.0625, subdivision 56), paragraph (a) provides MA coverage for in-reach community-based care coordination that is performed in a hospital emergency department as an eligible procedure under a state health care program or private insurance for a frequent user. Defines a frequent user. States that this service includes navigating services to address mental health, chemical health, social, economic, and housing needs, and any other activity targeted at reducing emergency room and other nonmedically necessary health care utilization.

Paragraph (b) requires reimbursement to be made in 15-minute increments under Medicaid social work reimbursement methodology. Requires in-reach care coordinators to hold a minimum of a bachelor’s degree in a specified field. Requires the commissioner to submit to the Centers for Medicare and Medicaid Services any waiver requests necessary to implement this subdivision.
Paragraph (c) defines “in-reach community-based care coordination” as the practice of a community-based worker meeting specified criteria working with an organization’s staff to transition an individual back into the individual’s living environment. Provides that this coordination includes working with an individual during discharge and for up to a defined amount of time in the individual’s living environment, reducing the individual’s need for readmittance.
 
Section 38 (256B.0625, subdivision 57) limits MA payment for Medicare crossover claims to the MA payment rate. This is effective for services provided on or after January 1, 2012. 
 
Section 39 (256B.0625, subdivision 58) limits MA payment amounts for EPSDT screening to the payment rate established in rule (75th percentile of charges) and in effect on October 1, 2010 (this has the effect of eliminating annual adjustments to the rate).
 
Section 40 (256B.0625, subdivision 59) provides MA coverage for services provided by advanced dental therapists and dental therapists, when provided within their scope of practice.

Section 41 (256B.0631, subdivision 1) makes the following changes related to MA cost-sharing:

·         reinstates certain co-payments (these had been reduced or eliminated by the Legislature);
·         requires a family deductible; and
·         establishes tiered co-payments for nonpreventive visits.

Section 42 (256B.0631, subdivision 2) makes a conforming change related to cost-sharing changes.

Section 43 (256B.0631, subdivision 3) makes a conforming change related to cost-sharing changes.

Section 44 (256B.0644) exempts Courage Center from Rule 101 if the patient population enrolled in state health care programs exceeds 30 percent of the center’s overall patient population.

Section 45 (256B.0751, subdivision 4) requires the Commissioner of Health to waive health care home certification requirements if the applicant demonstrates that compliance will create a major financial hardship or is not feasible, and establishes an alternative method of meeting the objectives of the certification requirement.

Section 46 (256B.0751, subdivision 8) requires health care homes and counties to coordinate care and services for health care home enrollees with complex medical or socio-economic needs or a disability, who need or are eligible for waivered services, mental health services, or other local services.

Section 47 (256B.69, subdivision 5a) includes, as part of the performance targets required to be met by managed care plans, a requirement that the plan reduces its hospitalization rate for subsequent hospitalizations within 30 days of the previous hospitalization by five percent from the previous calendar year’s rate. This target is to be increased each year by five percent until the plan’s subsequent hospitalization rate is reduced by 25 percent.

Section 48 (256B.69, subdivision 5c), beginning July 1, 2011, requires the commissioner to reduce the amount transferred from the PMAP payment carve out to the medical education research fund by $6,404,000.

 
Section 49 (256B.69 subdivision 28) requires persons with disabilities who are eligible for MA to enroll in the MA special needs basic health care plan. These individuals may opt out of this enrollment.
 
Section 50 (256B.69, subdivision 30) requires managed care and county-based purchasing plans to implement progressive payment withhold methodologies, based upon a provider’s risk adjusted total annual cost of care, relative to other providers of the same type. Requires each plan to establish a benchmark percentile for the return of the withhold that allows it to adjust provider payments to reflect the reduction in capitation rates. Requires the commissioner to reduce capitation rates by ten percent, for the contract year beginning January 1, 2012, and allows additional reductions in future years. Limits managed care plans and county-based purchasing plans from reducing payments (1) to providers whose risk-adjusted total annual cost of care is at or below the 70 percentile of providers of the same type or specialty, or (2) hospitals that specialize in children.
 
Section 51 (256B.69, subdivision 32) directs the commissioner to require managed care and county-based purchasing plans to provide health education, wellness training, and information about the availability and benefits of preventive services to all MA and MinnesotaCare enrollees, beginning January 1, 2012.
 
Section 52 (256B.76, subdivision 4) relates to critical access dental (CAD) providers to clarify that only clinics that are University of Minnesota or Minnesota State Colleges and Universities owned and operated may be designated as CAD providers. 
 
Section 53 (256B.771) requires the commissioner, in consultation with the Commissioner of Health, to contract with a Minnesota-based academic and research institution specializing in complementary and alternative medicine to implement a demonstration project to improve the care provided to MA enrollees with neck and back problems. The project must be conducted with FQHCs and FQHC look-alikes. Requires the project to be implemented beginning July 1, 2011, or upon federal approval, whichever is later.
 
Section 54 (256B.841) establishes the Minnesota Choice waiver application and process.
     
Subdivision 1 provides an intent statement.

Subdivision 2 requires the commissioner to apply for a waiver and any necessary state plan amendments that provides program flexibility and under which Minnesota will operate its MA program. Requires the commissioner to provide the relevant legislative committees with the waiver application and related materials. If the waiver application is approved, requires the commissioner to notify legislative chairs, allow review by legislative committees, and not implement the waiver until ten legislative days have passed following notification.

Subdivision 3 upon acceptance of the waiver, requires the commissioner to adopt rules and to propose any legislative changes needed to implement the waiver.

Subdivision 4 requires the Governor to establish a joint commission on waiver implementation. Specifies membership and duties.

Section 55 (256B.842) establishes the principles and goals of MA reform.

Subdivision 1 requires the commissioner to ensure that the reformed MA program is a person-centered, financially sustainable, and cost-effective program.

Subdivision 2 establishes criteria for the reformed program.

Subdivision 3 requires the commissioner to report annually to the Governor and the Legislature on the status of the administration and implementation of the waiver.

Section 56 (256B.843) establishes Choice waiver application requirements.

Subdivision 1 requires the commissioner to seek federal approval to enter into a five-year agreement with the federal government under section 1115a to waive specific provisions of Medicaid law, including but not limited to a statewide comparability of services, and freedom of choice of providers. Also requires the commissioner to seek a waiver of Medicaid law provisions, in order to expand cost-sharing, establish health savings or power accounts, provide enrollees with a choice of appropriate private sector coverage, consolidate waivered services, and implement other specified initiatives.

Subdivision 2 requires the commissioner to establish an intraagency assessment and coordination unit.

Section 57 (256D.03, subdivision 3) reestablishes the general assistance medical care (GAMC) program, beginning October 1, 2011.

Section 58 (256D.031, subdivision 1) changes the income eligibility limit for the GAMC program to 125 percent or less of federal poverty guidelines.
 
Section 59 (256D.031, subdivision 6) reinstates coordinated care delivery systems effective October 1, 2011, and permits a hospital, group of hospitals, or a county-based purchasing plan to contract with the commissioner to deliver services if the hospital, group of hospitals, or plan agrees to satisfy the requirements for coordinated care delivery systems.
 
Section 60 (256D.031, subdivision 7) establishes the payment rates for the coordinated care delivery systems. Payments shall be allocated among the hospitals and plans based upon the enrollment thresholds negotiated with the commissioner.
 
Section 61 (256D.031, subdivision 9) establishes the prescription drug pool effective October 1, 2011, for the GAMC program, and establishes a quarterly assessments on coordinated care delivery systems for prescription drugs beginning January 1, 2012.
 
Section 62 (256D.031, subdivision 10) makes a conforming change.
 
Section 63 (256L.01, subdivision 4a) makes conforming changes to the reduction in the MinnesotaCare eligibility period from 12 to six months.
 
Section 64 (256L.02, subdivision 3) makes a conforming change related to elimination of the Legislative Commission on Health Care Access.
 
Section 65 (256L.03, subdivision 5) requires MinnesotaCare enrollees to pay a family deductible. Effective January 1, 2012, establishes tiered copayments for nonpreventive visits.
 
Section 66 (256L.031) establishes the Healthy Minnesota Contribution Program.
 
Subdivision 1, paragraph (a), requires the commissioner, beginning January 1, 2012, to provide MinnesotaCare enrollees who are adults without children with gross family income greater than 125 percent of FPG with a monthly defined contribution in order to purchase health coverage through a health plan in the private individual market. 
 
Paragraph (b) requires the commissioner, beginning January 1, 2012, to provide MinnesotaCare adult enrollees eligible under section 256L.04, subdivision 1, with gross family income greater than 133 percent of FPG with a monthly defined contribution in order to purchase health coverage through a health plan in the private individual market.
 
Paragraph (c) exempts these MinnesotaCare enrollees from MinnesotaCare premiums and the required enrollment in a managed care plan or a county-based purchasing plan.
 
Paragraph (d) states that the MinnesotaCare provisions related to covered services (Minnesota Statutes, section 256L.03), cost sharing (section 256L.03, subdivision 5), the effective date of coverage (section 256L.05, subdivision 3), and provider payments (section 256L.11) do not apply to these enrollees.  This paragraph also states that the covered services, cost sharing, disenrollment for nonpayment of premiums, appeal rights and complaint procedures, and the effective date of coverage for enrollees are, instead, provided by the terms of the health plan purchased by the enrollee.
 
Paragraph (e) specifies that unless otherwise provided in this section, all MinnesotaCare requirements related to eligibility, income and asset methodology, income reporting, and program administration continue to apply.
 
Subdivision 2, paragraph (a) allows enrollees to use up to the monthly defined contribution as determined under subdivision 3 to pay premiums for coverage under a health plan.
 
Paragraph (b) requires an enrollee to select a health plan within three calendar months of approval of MinnesotaCare eligibility. If a health plan is not selected, the enrollee must reapply and meet al eligibility criteria.
 
Paragraph (c) requires the health plan that is purchased to cover mental health and chemical dependency treatment coverage and to meet the abortion coverage exclusion.
 
Subdivision 3, paragraph (a), requires the commissioner to determine the defined contribution amount using a sliding scale, under which the per person defined contribution is a function of age and income.  This paragraph specifies that the monthly per person base contribution ranges from $122.79 for persons under the age of 21 to $357.19 for persons age 60 and over.  The base contribution is multiplied by a percentage inversely related to income, ranging from 110 to 80 percent, to obtain the monthly per person defined contribution amount.
 
Paragraph (b) requires the defined contribution amount calculated under paragraph (a) to be increased by 20 percent for enrollees who are denied coverage in the private individual market and who purchase coverage through MCHA.
 
Subdivision 4, paragraph (a), requires the commissioner to administer the defined contributions by calculating and processing defined contributions for enrollees and paying the defined contribution to the health plan companies or MCHA, as applicable.
 
Paragraph (b) states that nonpayment of a premium results in disenrollment and prohibits the enrollee from reenrolling for four months.
 
Subdivision 5 requires the commissioner, in consultation with the Commissioner of Commerce, to develop an efficient and cost-effective method to refer eligible enrollees to professional insurance agent associations.
 
Subdivision 6 states that beginning January 1, 2012, MinnesotaCare enrollees who are eligible under this section, and who are denied coverage in the individual market are eligible for coverage through MCHA and may enroll in MCHA in accordance with chapter 62E.  This paragraph also states that any difference between the revenue and covered losses to MCHA related to the implementation of this section shall be paid to MCHA from the health care access fund.
 
Subdivision 7 requires the commissioner to seek all federal approvals and waivers necessary to implement coverage for enrollees eligible under subdivision 1 and to seek the continuation of federal participation for adult enrollees eligible under section 256L.04, subdivision 1.

Section 67 (256L.04, subdivision 1) eliminates an exemption from the program income limit for certain children who transition from MA to MinnesotaCare (other provisions related to this transition group are repealed in this article; federal approval for this transition has not yet been obtained). The elimination of the exemption from the income limit is effective retroactively to October 1, 2008. Also reinstates in law the $50,000 limit for parents under MinnesotaCare (the increase of $57,500 has not been approved by the federal government).

Section 68 (256L.04, subdivision 7) eliminates MinnesotaCare eligibility for single adults without children with income less than 125 percent of FPG, effective October 1, 2011.
 
Section 69 (256L.04, subdivision 10) eliminates MinnesotaCare eligibility for legal noncitizens who are not eligible for federal participation.
 
Section 70 (256L.05, subdivision 2) reinstates language repealed in a previous session that requires the commissioner to verify both earned and unearned income for MinnesotaCare enrollees, and verify eligibility for employer-subsidized insurance.
 
Section 71 (256L.05, subdivision 3a) requires MinnesotaCare eligibility to be renewed every six months. (Under current law, eligibility must be renewed every 12 months.)
 
Section 72 (256L.05, subdivision 6) requires the commissioner to ensure that all MinnesotaCare applicants who identify themselves as veterans, are referred to a county veterans service officer for assistance in applying to the U.S. Department of Veterans Affairs for any VA benefits for which they are eligible.
 
Section 73 (256L.07, subdivision 1) reinstates in law the $50,000 income limit for parents under MinnesotaCare (the increase to $57,500 has not yet been approved by the federal government). Also makes conforming changes related to the establishment of a six-month renewal period.

Section 74 (256L.11, subdivision 7) reduces the critical access dental (CAD) add-on payment for MinnesotaCare from 50 percent to 30 percent, which is in line with the CAD add-on payment for MA.

Section 75 (256L.12, subdivision 9) includes, as part of the performance targets required to be met by managed care plans, a requirement that the plan reduces its hospitalization rate for subsequent hospitalizations within 30 days of the previous hospitalization by five percent from the previous calendar year’s rate. This target is to be increased each year by five percent until the plan’s subsequent hospitalization rate is reduced by 25 percent.

Section 76 (256L.15, subdivision 1a) requires the commissioner to include information about MinnesotaCare premium payment options on each premium notice.

 Section 77 requires the Commissioner of Human Services to submit to the Legislature, by December 15, 2011, a plan to provide care coordination to MA and MinnesotaCare enrollees who are children with high-cost mental health conditions.
 
Section 78 requires the Commissioner of Human Services to convene a regulatory simplification and report reduction work group.
 
Section 79 requires the Commissioner of Human Services to evaluate whether providing MA coverage for specialized maintenance therapy will reduce rates of hospitalization for enrollees with serious and persistent mental illness. Requires a report to the Legislature by December 15, 2011.
 
Section 80 requires the Commissioner of Human Services to analyze and make recommendations for state plan amendments to provide different benefits for different demographic populations under MA as permitted under federal law.
 
Section 81 requires the Commissioner of Human Services to provide recommendations to reduce hospitalization rates for state health care program enrollees who are children with high-cost medical conditions.
 
Section 82 requires the Commissioner of Human Services to issue a request for proposals to prevent and detect Medicaid fraud.  The Commissioner shall select a vendor by September 1, 2011. 
 
Section 83 requires the Health Services Policy Committee to study the effectiveness of wound care treatment for MA and MinnesotaCare enrollees with diabetes, and submit recommendations to the Legislature by December 15, 2011.
 
Section 84 prohibits state funds to be expended in the planning or implementation of the Patient Protection and Affordable Care Act, and no provisions of the act may be implemented until the constitutionality of the act has been affirmed by the United States Supreme Court. This section is effective the day following final enactment.
 
Section 85 suspends the implementation of the MA early expansion that expanded MA eligibility to single adults without children, effective October 1, 2011.
 
Sections 86 revives language that established a modified GAMC program, based upon delivery of services through coordinated care delivery systems. This language was repealed upon the implementation of the early MA expansion for single adults without children.
 
Section 87, paragraph (a), repeals § 256.01, subdivision 2b (pay-for-performance system for medical groups and clinics), effective July 1, 2011.
Paragraph (b) repeals § 62J.07, subds. 1, 2, and 3 (Legislative Commission on Health Care Access).
Paragraph (c) repeals an exemption for low-income children from the MinnesotaCare employer-subsidized insurance barrier (see § 256L.07 subdivision 2; this provision has not yet been approved by the federal government).
Paragraph (d) repeals an exemption for low-income children from the Minnesota four-month uninsured requirement (see § 256L.07, subdivision 3; this provision has not yet been approved by the federal government).
Paragraph (e) repeals an exemption for low-income children from MinnesotaCare premiums (see § 256L.15, subdivision 2; this provision has not yet been approved by the federal government).
Paragraph (f) repeals § 256L.07, subdivision 7 (exemption of certain children transitioned from MA from MinnesotaCare insurance barriers) retroactively from October 1, 2008 (this provision has not yet been approved by the federal government).
Paragraph (g) repeals an exemption for certain children transitioned from MA from MinnesotaCare income limits (see § 256L.04, subdivision 1) retroactively from January 1, 2009 (this provision has not yet been approved by the federal government).
Paragraph (h) repeals a provision allowing children with incomes over 275 percent of FPG to remain on the program (see § 256L.04, subdivision 1b) retroactively from January 1, 2009 (this provision has not yet been approved by the federal government).
Paragraph (i) repeals a provision requiring a streamlined application and enrollment process for MA and MinnesotaCare enrollees (see § 256L.05, subdivision 1c) retroactively from July 1, 2009 (this provision has not yet been approved by the federal government).
Paragraph (j) repeals a provision providing automatic MinnesotaCare eligibility for certain children from foster care and juvenile correctional facilities (see § 256L.07, subdivision 8) retroactively from July 1, 2009 (this provision has not yet been approved by the federal government).
Paragraph (k) repeals a conforming change related to a provision allowing children with incomes over 275 percent of FPG to remain on MinnesotaCare, that is repealed elsewhere in this section (see § 256L.04, subdivision 7a).
Paragraph (l) repeals language establishing the effective date of coverage for children from foster care and juvenile correctional facilities (see § 256L.05, subdivision 3).
Paragraph (m) repeals a provision that provides continued eligibility under MinnesotaCare for children who fail to submit renewal information in a timely manner (see § 256L.05, subd 3a) retroactively from July 1, 2009 (this provision has not yet been approved by the federal government).
Paragraph (n) repeals language related to a provision allowing children with incomes over 275 percent of FPG to remain on MinnesotaCare, that is repealed elsewhere in this section (see § 256L.07, subdivision 1; this provision has not yet been approved by the federal government).
Paragraph (o) repeals an exemption for low-income children from the MinnesotaCare employer-subsidized insurance barrier (see § 256L.07, subdivision 2; this provision has not yet been approved by the federal government).
Paragraph (p) repeals an exemption for low-income children from the MinnesotaCare four-month uninsured requirement (see § 256L.07, subdivision 3; this provision has not yet been approved by the federal government).
Paragraph (q) repeals an exemption for low-income children from MinnesotaCare premiums (see § 256L.15, subdivision 2; this provision has not yet been approved by the federal government).
Paragraph (r) repeals a provision exempting low-income children from MinnesotaCare premiums (see § 256L.15; this provision has not yet been approved by the federal government).
Paragraph (s) repeals a provision requiring the Commissioner of Human Services to request approval from the federal government to eliminate the add-back of depreciation when determining income eligibility under MinnesotaCare for self-employed farmers (uncodified section; this request has not yet been approved by the federal government).
Paragraph (t) repeals § 256B.057, subdivision 2c (extended MA coverage for certain children; this provision has not yet been approved by the federal government).
Paragraph (u) repeals provisions providing MinnesotaCare enrollees with a renewal rolling month and a premium grace month (these provisions have not yet been approved by the federal government).
Section 88 repeals section 256B.055, subdivision 15 (MA eligibility for adults without children), and section 256B.0756 (Hennepin and Ramsey Counties pilot program).
ARTICLE 6
CONTINUING CARE
 
Section 1 (15.996) allows the Governor to designate programs in the Department of Human Services (DHS) and other programs serving people with disabilities as performance-based organizations. In exchange for greater operational flexibility, state programs (or nonstate entities under contract) are subject to more accountability. Performance-based organizations must enter into a performance-based agreement, which is limited to up to three years and renewable. The Legislature must approve a performance-based organization before it can enter into a performance-based agreement.
 
Section 2 (252.27. subdivision 2a) makes TEFRA parental fee temporary increases made in 2010 permanent.
 
Section 3 (256.01, subdivision 24) modifies the Disability Linkage Line by adding information dissemination responsibilities.
 
Section 4 (subdivision 256.01, subdivision 29) makes conforming language changes related to section 8.
 
Section 5 (subdivision 256B.04) adds a subdivision creating the Money Follows the Person Rebalancing demonstration project, transferring federal demonstration project grant funds from the medical assistance (MA)account in the general fund to the special revenue fund.
 
Section 6 (256B.05) adds a subdivision requiring county agencies to act on applications for MA within ten days.
 
Section 7 (256B.056, subdivision 3) removes obsolete language, corrects an internal reference, and makes this section effective January 1, 2014.
 
Section 8 (256B.057, subdivision 9) makes technical changes reorganizing the language in this subdivision and removes obsolete language. Excludes spousal assets for purposes of determining eligibility for medical assistance for employed persons with disabilities (MA-EPD). Increases the MA-EPD premium and increases the amount of unearned income that must be paid in addition to the premium. Requires the commissioner to reimburse enrollees with incomes below 200 percent of the federal poverty guidelines for Medicare Part B premiums. Makes this section effective January 1, 2014, for adults age 21 or older, and October 1, 2019, for children age 16 to before child’s 21st birthday.
 
Section 9 (256B.0659, subdivision 11) limits payments to personal care assistants (PCA) who are providing services to a relative. Defines “relative” for purposes of this section. Makes this section effective October 1, 2011.
 
Section 10 (256B.0659, subdivision 28) expands documentation requirements for PCA provider agencies and allows the commissioner to fine agencies that do not comply with documentation requirements.
 
Section 11 (256B.0911, subdivision 1a) modifies the definition of “long-term care consultation services.” Makes this section effective January 1, 2012.
 
Section 12 (256B.0911 subdivision 3a) modifies the timeline for the long-term care consultation team to visit a person requesting services. For persons determined eligible for specified services, requires the community support plan to include the estimated annual and monthly average authorized budget amount for those services. Specifies what information must be included in the community support plan. Allows updated assessments to be completed by a face-to-face visit, written communication, or telephone. Makes this section effective January 1, 2012.
 
Section 13 (256B.0913, subdivision 4) modifies eligibility criteria for alternative care to conform to federal maintenance of effort requirements. Makes eligibility changes for individuals assigned a case mix classification A and reduces monthly budget cap for these individuals.
 
Section 14 (256B.0915, subdivision 3a) removes an automatic annual adjustment to elderly waiver (EW) monthly case mix caps related to nursing facility payment rates. Makes eligibility changes for individuals assigned a case mix classification A and reduces the monthly budget cap for these individuals.
 
Section 15 (256B.0915, subdivision 3b) removes an automatic annual adjustment to EW monthly case mix caps related to nursing facility payment rates. Modifies the monthly conversion budget limit calculation.
 
Section 16 (256B.0915, subdivision 3e) sets the monthly payments for customized living services to 24 percent lower than the current case mix A rate for new or reassessed EW services recipients meeting specific criteria. Allows input from the customized living services provider in ensuring proper documented need. Effective July 1, 2011.
 
Section 17 (256B.0915, subdivision 3h) increases the criteria for 24-hour customized living. Prohibits providers from billing or otherwise charging an EW participant or their family for additional units of any allowable component service beyond those available under the service rate limits, nor for additional units of any allowable component services beyond those approved in the service plan by the lead agency.
 
Section 18 (256B.0915, subdivision 10) removes obsolete language.  Prohibits MA rates paid to customized living service providers by managed care organizations from exceeding the maximum component rates.
 
Section 19 (256B.0916, subdivision 6a) makes technical changes and specifies that paragraph (b) is in effect until a waiver amendment is effective. Makes this section effective July 1, 2011.
 
Section 20 (256B.092, subdivision 1b) requires each recipient of case management services and any legal representative to be provided a written copy of the coordinated services and support plan and specifies requirements of the plans. Makes this section effective January 1, 2013.
 
Section 21 (256B.092, subdivision 1e) requires the case management service provider to assure that individual provider plans are developed by the providers when a need for the plans is identified in the coordinated service and support plan. Specifies the requirements the provider plans must meet. Makes technical changes. Makes this section effective January 1, 2012.
Section 22 (256B.092, subdivision 1g) makes conforming changes related to the renaming of individual service plans to coordinated services and support plans. Makes this section effective January 1, 2012.
 
Section 23 (256B.092, subdivision 3) makes technical and conforming changes. Makes this section effective January 1, 2012.
 
Section 24 (256B.092, subdivision 8) makes technical and conforming changes related to changes in terminology. Requires the certified assessor to provide written notice of the annual and monthly amount authorized to be spent for services for the recipient. Makes this section effective January 1, 2012.
 
Section 25 (256B.0961) adds a new section creating the State Quality Assurance, Quality Improvement, and Licensing System. Subdivision 1 lists the scope of the system.
 
Subdivision 2 outlines the DHS Commissioner’s duties.
 
Subdivision 3 creates the State Quality Council, lists the members of the council, and outlines the duties and responsibilities of the council.
 
Subdivision 4 creates regional quality councils, lists the members of the councils, and outlines the duties and responsibilities of the council.
 
Subdivision 5 requires the commissioner, in consultation with the State Quality Council, to conduct an annual independent statewide survey of service recipients to determine the
effectiveness and quality of disability services.
 
Subdivision 6 makes members of the State Quality Council mandated reporters as defined under existing statute.
 
Section 26 (256B.431, subdivision 2r) limits payments for leave days in a nursing facility to 30 percent of that nursing facility’s total payment rate for the involved resident and allows this payment only when the occupancy of the nursing facility, inclusive of bed-hold days, is equal to or greater than 96 percent.
 
Section 27 (256B.431, subdivision 32) makes technical language changes.
 
Section 28 (256B.434, subdivision 4) suspends automatic property rate adjustments for the rate years beginning October 1, 2011, and October 1, 2012.
 
Section 29 (256B.437, subdivision 6) prohibits the commissioner from accepting applications for planned closure rate adjustments as of July 16, 2011.
 
Section 30 (256B.441, subdivision 50a) modifies certain nursing facility operating payment rates proximity adjustments.

Section 31 (256B.441, subdivision 61) increases the operating payment rates for certain low-rate nursing facilities.

Section 32 (256B.48, subdivision 1) modifies the nursing facility rate equalization provision to allow private pay rates to increase by two percent per year in perpetuity.
 
Section 33 (256B.49, subdivision 13) modifies how case management services are to be provided to recipients of the community alternative care, community alternatives for disabled individuals, and traumatic brain injury waivers. Aligns case management services for these recipients with case management services for recipients of the developmental disabilities (DD) waiver. Makes this section effective January 1, 2012.
 
Section 34 (256B.49, subdivision 14) adds a cross-reference to assessments under long-term care consultation services. Requires the commissioner to develop criteria to identify individuals whose level of functioning is reasonably expected to improve and reassess these individuals every six months. Requires individuals who meet the commissioner’s criteria to have a comprehensive transitional service plan developed. Make counties, case managers, and service providers responsible for conducting these reassessments and for completing them within existing funds. Makes this section effective January 1, 2012, except for paragraph (f), which is effective July 1, 2013.
 
Section 35 (256B.49, subdivision 15) aligns the coordinated service and support plan requirements for recipients of waivers under this section with the requirements for DD waiver recipients. Specifies timelines and requirements in developing and implementing comprehensive transitional service plans and maintenance service plans. Makes this section effective January 1, 2012, except for paragraphs (b), (c), and (d), which are effective July 1, 2013.
 
Section 36 (256B.5012) adds a subdivision requiring the commissioner to increase the daily rate to $138.23 at a specified intermediate care facilities for the mentally retarded (ICF/MR) facility in Clearwater County. Makes this section effective July 1, 2011.
 
Section 37 (256B.5012) adds a subdivision requiring the commissioner to decrease operating payment rates for all ICF/MR facilities, with one exception, equal to 0.095 percent of the operating payment rates in effect on June 30, 2011. Specifies how the rate reduction must be applied to each facility by the commissioner.
Section 38 (256G.02, subdivision 6) removes a reference to the PCA program from the definition of “excluded time” under the unitary residence and financial responsibility chapter. Makes this section effective July 1, 2011.
 
Section 39 (Laws 2009, ch. 79, art. 13, section 3, subdivision 8, as amended by Laws 2009, ch. 173, art. 2, section 1, subdivision 8, and Laws 2010, First Special Session, ch. 1, art. 15, section 5 and art. 25, section 16) removes a provision related to alternatives to PCA services.
 
Section 40 requires the commissioner to establish rates to begin paying for certain in-home services and personal supports under home and community-based waiver services programs by January 1, 2012.
 
Section 41 requires the commissioner to establish the rate to be paid for certain case management services by July 1, 2012.
 
Section 42 requires the commissioner to develop a legislative report by February 1, 2012, with recommendations and language for proposed legislation on case management redesign, including county responsibilities and functions.
 
Section 43 establishes the My Life, My Choices Task Force to create a system of supports and services for people living with disabilities.
 
Section 44 directs the Office of Ombudsman for Long-Term Care to develop a working group to address issues related to, among others, housing with services fees, staffing, and quality assurance.

Section 45 directs counties to inform individuals who have had a level of service reduction of their right to request an informal review conference with their case worker and any other relevant county staff.

Section 46 creates a nursing facility pilot project to develop a new approach to caring for certain individuals. A report is due to the Legislature on November 15, 2011.
 
ARTICLE 7
CHEMICAL AND MENTAL HEALTH
 
Section 1 (246B.10) increase the county share for person civilly committed to the Minnesota Sex Offender Program from ten percent to 25 percent.
This section is effective for all individuals who are civilly committed to the Minnesota Sex Offender Program on or after August 1, 2011.
Section 2 (252.025, subdivision 7) prohibits midcontract layoffs from occurring as a result of restructuring this program, but permits layoffs as a result of low census or closure of the facility due to decreased census.
Section 3 (253B.212) allows the White Earth Band to enter into agreements with the Indian Health Service for the care and treatment of tribal members committed for care and treatment due to mental illness, developmental disability, or chemical dependency. Adds that White Earth can also contract with the Commissioner of Human Services for treatment of tribal members who have been committed by the tribal court. Requires tribal court commitment procedures to comply with the provisions of Minnesota Statutes, section 253B.05 to 253B.10.
Section 4 (254B.03, subdivision 1) adds that the county requirement to provide chemical dependency treatment services is subject to the limitations imposed in section 254B.04, subdivision 1.
Section 5 (254B.03, subdivision 4) increases the county share under the consolidated chemical dependency treatment fund for chemical dependency treatment costs from 16.14 percent to 22.95 percent. This section is effective for claims processed beginning July 1, 2011.

Section 6 (254B.04, subdivision 1) limits access to residential chemical dependency treatment services to no more than three treatment episodes for the same person in a four year period, and no more than four episodes in a lifetime. Provides an exception that additional placements can be made when the person meets criteria established by the commissioner. This section is effective for all chemical dependency residential treatment beginning on or after July 1, 2011.

Section 7 (254B.04, subdivision 2a)  increases the assessment level score for an individual to be approved for residential chemical dependency treatment. 
Section 8 (254B.06, subdivision 2) makes conforming changes to the allocation of collections related to section 5, which increases the county share for chemical dependency services under the consolidated chemical dependency treatment fund. This section is effective for claims processed beginning July 1, 2011.
 
Section 9 (256B.0625, subdivision 41) adds “an American Indian tribe” to providers of residential services for children who have a severe emotional disturbance and require residential care that are covered by MA. This section is effective October 1, 2011. 

Section 10 (256B.0945, subdivision 4) adds paragraph (c), which states that payment for mental health rehabilitative services provided by tribal organizations must be made according to section 256B.0625, subdivision 34, (MA payments to Indian health services facilities) or other federally approved methodology. This section is effective October 1, 2011.

Section 11 (Community mental health services; use of behavioral health hospitals) instructs the commissioner to issue a report to the Legislature on how the community behavioral health hospitals will be utilized to meet the mental health needs of the regions in which they are located. Requires the report to address future use of the hospitals that are not certified as Medicaid eligible or have less than 65 percent licensed bed occupancy. Requires the commissioner to consult with the regional mental health authorities.

Section 12 (Integrated dual diagnosis treatment) requires the commissioner to require individuals who perform chemical dependency or mental health assessments to use screening tools approved by the commissioner in order to determine co-occurring disorders.  The screening must begin no later than December 31, 2011. The commissioner shall adopt rules as necessary and apply for necessary federal waivers.

Section 13 (Regional treatment centers; employees; report) requires the commissioner to issue a report that provides the number of employees in management positions at the Anoka RTC and the Minnesota Security Hospital, and the ratio of management to direct care staff for each facility.

Section 14 (Commissioner’s criteria for residential treatment)  instructs the commissioner to develop criteria to approve treatment for individuals who require residential chemical dependency treatment in excess of the number allowed in section 256B.04, subdivision 1. Requires criteria to be established by October 1, 2011.

 Section 15 repeals: Laws 2009, chapter 79, article 3, section 18, as amended by Laws 2010, First Special Session chapter 1, article 19, section 19.
 
ARTICLE 8
REDESIGNING SERVICE DELIVERY
 
Section 1 (section 256.01, subdivision 14) limits funding for child welfare pilot programs to available appropriations.
 
Section 2 (256.01, subdivision 14b) allows the commissioner to authorize a test project for the White Earth Band to provide child welfare services to tribal children who are residents of Hennepin County. Requires Hennepin County to transfer the proportion of property taxes collected and used to fund child welfare services for this population to the tribe when the tribe assumes responsibility for providing services.
 
Section 3 (256B.69, subdivision 30) permits prepaid health plans to provide medical assistance enrollees and potential enrollees with required materials in a medium other than paper.
 
Section 4 (256D.09, subdivision 6) exempts certain GA recipients from recovery of overpayments. Limits establishment of an overpayment to 12 months prior to the month of discovery due to agency error and six years prior to the month of discovery due to client error or an intentional program violation.
 
Sections 5, 6, and 7 (256D.49, subdivision 3; 256J.38, subdivision 1; 393.07, subdivision 10) make uniform the policy related overpayments of assistance across programs.  The new language provides that the establishment of an overpayment is limited to 12 months prior to the month of discovery due to agency error and six years prior to the month of discovery due to client error or a program violation. 
 
Section 8 (section 402A.10, subdivision 4) adds tribal services to the definition of “essential human services” or “essential services.”   
 
Section 9 (section 402A.10, subdivision 5) adds that the commissioner has the authority to assign a county to be a member of a service delivery authority. Adds that a tribe or group of tribes to the definition of “service delivery authority.”
 
Section 10 (section 402A.15, subdivision 1) removes the requirement for the steering committee to include recommendations on resources and funding needed to achieve performance measures. Eliminates certain considerations such as geography, populations served, and administrative demands when determining performance measures and goals. Requires the steering committee to incorporate federal performance measures when federal funding is contingent on meeting these performance measures.
 
 Subdivision 2 removes the requirement for two members of the steering committee to       also serve as representatives to the redesign council.
 
Section 11 (section 402A.18, subdivision 1) grants the commissioner authority to adjust state and federal funds for an underperforming county.
           
Subdivision 2 makes technical changes.

 Subdivision 2a requires an underperforming county to provide the nonfederal and nonstate funding needed to remedy performance deficiencies to the entity assuming administration of the essential service.

           Subdivision 3 makes a technical change.

Section 12 (section 402A.20, subdivision 1) clarifies that recommendations must be approved by a majority of the voting council members. There are nonvoting members of the council.
           
            Subdivision 2 clarifies the duties of the council.

 Subdivision 3 requires the council to request that the legislative auditor perform a reevaluation of human service administration that was initially reported in 2007.

Section 13 (402A.35, subdivision 1), paragraph (a) provides the requirements for establishing a service delivery authority.

Subdivision 2 lists the statutory mandates. Allows the service delivery authorities to request additional waivers from other statutory and rule mandates in order to allow greater flexibility and control.

          Subdivision 3 lists the duties of the service delivery authority.

          Subdivision 4 provides the process for establishing a service delivery authority.

Subdivision 5 gives the commissioner authority to grant waivers, but they must be pproved by the council.
 
Section 14 (402A.40) establishes the transition for new bargaining unit structure related to service delivery authorities and their employees.
 
Section 15 (County electronic verification procedures) the Commissioner of Human Services shall define which public assistance program requirements may be electronically verified for the purposes of determining eligibility, and shall also define procedures for electronic verification. The Commissioner of Human Services shall report back to the chairs and ranking minority members of the legislative committees with jurisdiction over these issues by January 15, 2012, with draft legislation to implement the procedures if legislation is necessary for purposes of implementation.
 
Section 16 (Alignment of program policy and procedures) requires the commissioner, in consultation with counties and other key stakeholders, to analyze and develop recommendations to align program policy and procedures across all public assistance programs to simplify and streamline program eligibility and access. The commissioner shall report back by January 15, 2013, with recommendations. 
 
Section 17 (Alternative strategies for certain redeterminations) requires the commissioner to develop and implement by January 15, 2012, a simplified process to redetermine eligibility for a specific population who are expected to experience minimal change in income or assets from month to month. 
 
Section 18 (Simplification of eligibility and enrollment process) the Commissioner of Human Services shall issue a request for information for an integrated service delivery system for health care programs, food support, cash assistance, and child care. The commissioner shall determine, in consultation with partners in paragraph (c), if the products meet departments' and counties' functions. The request for information may incorporate a performance-based vendor financing option in which the vendor shares the risk of the project's success. The health care system must be developed in phases with the capacity to integrate food support, cash assistance, and child care programs as funds are available. This section is effective the day following final enactment.
 
Section 19 (White Earth Band of Ojibwe Human Services Project)  the Commissioner of Human
Services, in consultation with the White Earth Band of Ojibwe, shall transfer legal responsibility to the tribe for providing human services to tribal members and their families who reside on or off the reservation in Mahnomen County. No later than January 15, 2012, the commissioner shall submit a written report detailing the transfer progress to the chairs and ranking minority members of the legislative committees with jurisdiction over Health and Human Services.
 
Section 20 repeals: Minnesota Statutes 2010, sections 402A.30 (Designation of Service Delivery Authority); and 402A.45 (Essential Services Outside Jurisdiction of Service Delivery Authority). Minnesota Rules, part 9500.1243, subpart 3, (Recoupment of overpayments).
 
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