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Alexis C. Stangl
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State of Minnesota
 
 
 
 
 
H.F. No. 1233 - Health and Human Services (Laws 2013, Chapter 108)
 
Author: Senator Tony Lourey
 
Prepared By: Joan White, Senate Counsel (651/296-3814)
 
Date: June 5, 2013



 

ARTICLE 1: AFFORDABLE CARE ACT IMPLEMENTATION

Section 1 (16A.724, subd. 3) requires the federal funding received by Minnesota for the implementation and administration of MinnesotaCare as a basic health program as authorized in the Affordable Care Act to be deposited in the health care access fund.

Section 2 (254B.04, subd. 1) makes a conforming change due to a repealed section.

Section 3 (256.01, subd. 35) requires the commissioner to seek federal approval to operate a health coverage program for Minnesotans with income up to 275% of FPG and seek to secure all federal funding available from at least the following services; premium tax credits and cost-sharing subsidies available under the Affordable Care Act (ACA); Medicaid funding; and other funding sources identified by the commissioner that support coverage or care redesign.

Section 4 (256.15, subd. 1) makes a conforming change to this section, by adding a reference to participating entities for purposes of state agency liens.

Section 5 (256B.02, subd. 17) modifies the definition of the Affordable Care Act.

Section 6 (256B.02, subd. 18) defines “caretaker relative” as a relative of a child under the age of 19 with whom the child is living and who assumes primary responsibility for the child’s care.

Section 7 (256B.02, subd. 19) defines “insurance affordability program” as one of the following programs:  medical assistance; a program that provides advance payments of premium tax credits; MinnesotaCare, and a basic health plan.

Section 8 (256B.04, subd. 18) requires the commissioner to accept applications by telephone, mail, in-person, online, and other common electronic means.  Also, requires the commissioner to determine potential eligibility for other insurance affordability programs that an individual may be eligible for if the individual submits an application or at renewal is determined not to be eligible for medical assistance.

Section 9 (256B.055, subd. 3a) modifies this section to conform to the ACA in terms of defining a dependent child as under the age of 19.

Section 10 (256B.055, subd. 6) requires the commissioner to accept self-attestation of pregnancy unless the commissioner has information that is not reasonably compatible with the attestation.

Section 11 (256B.055, subd. 10) modifies this section to clarify that an infant is eligible if less than two years of age and is in a family with income equal to or less than 275% of FPG.

Section 12 (256B.055, subd. 15) modifies this section to clarify that adults without children must not otherwise be eligible or enrolled in the supplemental security income program.

Section 13 (256B.055, subd. 17) extends medical assistance coverage to any person under the age of 26 who was in foster care on the date the person turned 18 years of age, and who was enrolled in medical assistance while in foster care.

Section 14 (256B.056, subd. 1) aligns the residency requirement with the federal regulations under the Affordable Care Act (ACA).

Section 15 (256B.056, subd. 1c) makes a coordinating change to conform to the ACA for the families with children income methodology.

Section 16 (256B.056, subd. 3) clarifies that the asset limitations only apply to certain individuals. (Amends the headnote.)

Section 17 (256B.056, subd. 4) specifies that a child under the age of 19 is eligible for medical assistance with income up to 275% of FPG, and a child age 19 to 20 is eligible for medical assistance with income up to 133% of FPG.

Section 18 (256B.056, subd. 5c) clarifies that the spenddown income standard for parents and caretaker relatives, pregnant women, infants, and children ages two through 20 is 133% of federal poverty guidelines (FPG).  Also strikes obsolete language.

Section 19 (256B.056, subd. 7a) requires the commissioner to make an annual redetermination of eligibility based on information contained in the enrollee’s file and other information available to the commissioner.  If the commissioner does not have adequate information, the commissioner must provide the enrollee with a renewal form containing eligibility information available to the commissioner and permit the enrollee to submit the form with corrections or additional information and sign the form via any of the modes of submission permitted.  Permits any enrollee who is terminated for failure to complete the renewal process to submit the form and any required information within four months after termination and have coverage reinstated without a lapse.  Continues to require renewal every six months for individuals who are eligible due to a spenddown.

Section 20 (256B.056, subd. 10) requires the commissioner to utilize information obtained through the electronic service established by the Secretary of the US Department of Health and Human Services and other available electronic data sources.  Requires the commissioner to establish standards to define when information obtained electronically is reasonably compatible with information provided by applicants and enrollees, including the use of self-attestation to accomplish real time determinations and maintain program integrity.

Section 21 (256B.057, subd. 1) modifies eligibility for infants up to the age of two and inserts the modified adjusted gross income (MAGI) income methodology as required under the ACA.

Section 22 (256B.057, subd. 8) modifies the income eligibility methodology for children under the age of two by referring to the modified adjusted gross income methodology (MAGI).      

Section 23 (256B.057, subd. 10) makes a conforming change, by changing an internal statutory reference.

Section 24 (256B.057, subd. 12) requires the commissioner to establish a process to qualify hospitals that are medical assistance providers to determine presumptive eligibility for applicants who may be eligible under MAGI methodology.

Section 25 (256B.06, subd. 4) specifies that certain noncitizens who are lawfully present and who are pregnant women who are ineligible for federally funded medical assistance because of immigration status and who otherwise meet the eligibility requirements of chapter 256B are eligible for medical assistance to the extent federal funds are available under title XXI of SSA and SCHIP.

Section 26 (256B.0755, subdivision 3) requires the health care delivery system demonstration projects applying for approval to indicate how its services will be coordinated with other services that are being provided by other providers, county agencies and other organizations in the local service area, and indicate how it will engage other providers,counties, and organizations,including county-based purchasing plans that provide services to patients of the health care delivery system on issues related to local populations, including local needs, priorities, and public health goals.  The delivery system must also describe how local providers, counties, organizations, and other relevant purchasers were consulted in developing the application to participate in the demonstration project.

Section 27 (256B.694) continues to permit the commissioner to contract with a single health plan with county-based purchasing plans to serve certain state public health care program enrollees.

Section 28 (256L.01, subdivision 1b) defines the “Affordable Care Act” in chapter 256L.

Section 29 (256L.01, subdivision 3a) defines "family" in chapter 256L to conform to ACA definition.

Section 30 (256L.01, subdivision 5) defines “household income” in chapter 256L as having the meaning provided in the ACA.

Section 31 (256L.01, subdivision 6) defines the "Minnesota Insurance Marketplace" in chapter 256L.

Section 32 (256L.01, subdivision 7) defines “participating entity” in chapter 256L to include a health plan company, a county-based purchasing plan, an accountable care organization, an organization or other entity operating a health care delivery systems demonstration project authorized under section 256B.0755, an entity operating a county integrated health care delivery network pilot project authorized under section 256B.0756, or a network of health care providers established to offer services under MinnesotaCare.

Section 33 (256L.02, subdivision 2) modifies this section to require the commissioner to ensure that information on medical programs are on a Web site.

Section 34 (256L.02, subd. 6) Paragraph (a) requires the commissioner of human services to seek federal approval to implement the MinnesotaCare program as a basic health program.  Requires the commissioner to seek to include, in any agreement with the Centers for Medicare and Medicaid Services (CMS), procedures to ensure that federal funding is predictable, stable, and sufficient to sustain ongoing operation of the program.  Requires the procedures to address the timing of payments, payment reconciliation, enrollee risk adjustment, and minimizing state financial risk.  Requires the commissioner of human services to consult with the commissioner of management and budget when developing the basic health plan proposal to be submitted to the federal government.

Paragraph (b) requires the commissioner of human services, in consultation with the commissioner of management and budget, to work with the CMS to establish a process for the reconciliation and adjustment of federal payments that balances state and federal liability over time.  Requires the commissioner to request that the state and enrollees be held harmless in the reconciliation process for three years to allow the state to develop a statistically valid methodology to predict enrollment trends and their effect on federal payments.

Section 35 (256L.02, subdivision 7) specifies that MinnesotaCare shall be considered a public health care program for purposes of chapter 62V.

Section 36 (256L.03, subdivision 1) states that the covered health services shall include the current MinnesotaCare benefits beginning January 1, 2014, except that inpatient hospital services will be included with no cost sharing.

Section 37 (256L.03, subdivision 1a) makes a coordinating change to conform with the ACA, by removing references to pregnant women.

Section 38 (256L.03, subdivision 3) eliminates the inpatient hospital benefit cap, effective January 1, 2014.

Section 39 (256L.03, subdivision 4a) requires health coverage provided through the MinnesotaCare program to have a medical loss ratio of at least 85 percent. (ACA requirement)

Section 40 (256L.03, subdivision 5) eliminates the cost-sharing requirements for inpatient hospital services, effective January 1, 2014. (Ten percent deductible and $10,000 benefit cap)

Section 41 (256L.03, subdivision 6) makes corresponding changes in the definition of "state agency" to refer to "participating entities."

Section 42 (256L.04, subdivision 1) modifies the income eligibility limit for families with children to between 133 percent and 200 percent of FPG.

Section 43 (256L.04, subdivision 1c) states that an individual who is eligible for coverage under the MinnesotaCare program is not considered a qualified individual under the ACA, and is not eligible for enrollment in a qualified health plan offered through the Minnesota Insurance Marketplace.

Section 44 (256L.04, subdivision 7) modifies the income eligibility limit for single adults between 133 percent and 200 percent of FPG.

Section 45 (256L.04, subdivision 8) makes conforming changes to conform to the ACA and strikes obsolete language.

Section 46 (256L.04, subdivision 10) specifies that lawfully present noncitizens who are ineligible for medical assistance are eligible for MinnesotaCare up to 200 percent for families with children and for single adults.  Specifies that a nonimmigrant as defined in federal law is eligible for MinnesotaCare.

Section 47 (256L.04, subdivision 12) specifies that enrollees and applicants residing in a correctional or detention facility are eligible for MinnesotaCare while awaiting disposition of charges.

Section 48 (256L.04, subdivision 14) specifies that individuals eligible for medical assistance are not eligible for MinnesotaCare, and that the commissioner shall coordinate eligibility and coverage to ensure seamless access.

Section 49 (256L.05, subdivision 1) specifies that applicants may submit their applications online, in person, by mail, or by phone in accordance with the ACA and by any other means by which MA applications may be submitted, and may be submitted through the Minnesota Insurance Marketplace or through the MinnesotaCare program.

Section 50 (256L.05, subdivision 2) requires the commissioner and the county agencies to use electronic verification through the Minnesota Insurance Marketplace as the primary method of income verification and may require an individual to submit additional verification to the extent permitted under the ACA.

Section 51 (256L.05, subdivision 3) makes coordinating changes to coordinate with ACA in terms of the effective date of coverage.

Section 52 (256L.05, subdivision 3c) makes a technical change removing obsolete language, and clarifies that retroactive coverage does not apply once eligibility for MinnesotaCare is conducted by MNsure's eligibility system.

Section 53 (256L.06, subdivision 3) eliminates the four-month waiting period to reenroll, for persons disenrolled for nonpayment of premium or who voluntarily disenroll. 

Section 54 (256L.07, subdivision 1) makes coordinating modifications to conform with the ACA.  Specifies that individuals with income over 200 percent of FPG are not eligible for MinnesotaCare.

Section 55 (256L.07, subdivision 2) makes coordinating modifications to the "access to employer subsidized insurance" language to conform with the ACA, by referring to employer coverage as defined in federal law.

Section 56 (256L.07, subdivision 3) makes coordinating modifications to the "other health coverage" language to conform with the ACA.

Section 57 (256L.09, subdivision 2) requires an individual be a resident of the state in order to be eligible for coverage under the MinnesotaCare program as provided under the ACA.

Section 58 (256L.11, subdivision 1) states that payments to providers are at the same rates and conditions established under MA, except as otherwise provided.

Section 59 (256L.11, subdivision 3) makes coordinating changes to inpatient hospital rates specifying that the rate paid is the medical assistance rate.

Section 60 (256L.12, subd. 1) makes a conforming change to the selection of vendors section, specifying that managed-care like entities as defined in the ACA may be considered to deliver the basic health plan.

Section 61 (256L.121, subdivision 1) requires the commissioner to establish a competitive process for entering into contracts with participating entities.  Coverage through these health plans must be available to enrollees beginning January 1, 2015.  This subdivision also requires the commissioner to the extent feasible to ensure that enrollees have a choice of coverage from more than one participating entity within a geographic area.

Subdivision 2 requires the participating entities as a condition of contract to document to the commissioner the provision of culturally and linguistically appropriate services, including marketing materials to MinnesotaCare enrollees.

Subdivision 3 requires the commissioner to coordinate the administration of the MinnesotaCare with MA and other state-administered health care programs to maximize efficiency and improve the continuity of care.

Section 62 (256L.15, subdivision 1) makes coordinating modifications to conform with the ACA, by removing references to pregnant women and children under the age of two.

Section 63 (256L.15, subdivision 2) modifies premiums by removing premium determination based on the enrollment of the number of family members and establishing a premium amount for each person in the household who is 21 years of age or older.  Also decreases the premiums by 10%, and specifies that children 20 years of age and younger do not pay premiums.

Section 64 requires the Commissioners of Revenue and Management and Budget, in consultation with the Commissioner of Human Services, to conduct an assessment of the health care access fund as part of the state revenue and expenditure forecast in November of 2016, to determine whether state funding will be required after December 31, 2019, for the administration of the MinnesotaCare program.  The results of the assessment must be reported to the Governor and Legislature by January 15, 2017, along with recommendations for continuing state revenue for the health care access fund if additional state funding is needed.

Section 65, paragraph (a), requires the commissioner of health to collect from health carriers in the individual and small group markets data required for conducting risk adjustment with standard risk adjusters, for service dates beginning October 1, 2013, through December 31, 2014.

Paragraph (b) requires the commissioner to assess the extent to which the data collected under paragraph (a) are sufficient for developing and operating a state alternative risk adjustment methodology consistent with applicable federal rules.

Paragraph (c) provides the commissioner of health with the authority to use identified data to validate and audit a statistically valid sample of data for each health carrier in the individual and small group markets.

Paragraph (d) states that if the data is sufficient for developing and operating a state alternative risk and adjustment methodology, the commissioners of health and human services, in consultation with the  commissioner of commerce, and the Board of MNsure, shall study whether a state-based risk adjustment would be more cost-effective and perform better than risk adjustment conducted by federal agencies.

Paragraph (e) requires the commissioner, as part of the study, to contract with entities that do not have an economic interest in the outcome of a state-based risk adjustment and have demonstrated expertise in actuarial science or health economics and with designing and implementing risk adjustment models.

Paragraph (f) states that the commissioner shall report findings to the legislature, in an interim report by March 15, 2014, and a final report by October 1, 2015.

Paragraph (g) requires the Board of MNsure to apply for federal funding available under the ACA to fund the work required under this section.

Paragraph (h) defines the Board of MNsure as the board established under section 62V.03, and defines the Affordable Care Act. 

Section 66 requires the commissioner of human services to seek federal authority to allow persons under the age of 65 participating in a home and community-based services waiver to continue to disregard spousal income and assets, in place of spousal impoverishment provisions under ACA.

Section 67 is a Revisor's instruction to coordinate with the repealers, and to change the term "Minnesota Insurance Marketplace" to "MNsure."

Section 68 (Repealer):  Paragraph (a) repeals the following provisions, effective January 1, 2014, sections 256L.01, subdivision 4a (definition of gross income); 256L.031 (Healthy Minnesota Contribution Program); 256L.04, subds. 1b (children with incomes greater than 275 percent FPG), 9 (reference to General Assistance Medical Care); and 10a (deeming of sponsor income and resources); 256L.05, subd. 3b (reapplication after a lapse); 256L.07, subds. 1 (general requirements); 5 (voluntary disenrollment for members of the military), 8 (automatic eligibility for foster care and other children), and 9 (eligibility for firefighters and ambulance attendants); 256L.11, subds. 5 (payment for inpatient hospital services for children), and 6 (payment for inpatient hospital services for enrollees over 18); and 256L.17 (as set requirements).

Paragraph (b) repeals sections 256B.055, subds. 3 (MA coverage until March 31, 1998, for AFDC-related pregnant women), subd. 5 (pregnant women); and 10b (MA for children under age two; sections remains in effect until the reform waiver expires),  256B.056, subd. 5b (requiring certain recipients not residing in a long-term facility to verify their income every six months), 256B.057, subds. 1c (no asset test for pregnant women), and 2 (children eligible at 150 percent FPG: use of six-month budget periods.)  Effective January 1, 2014.

 

ARTICLE 2: CONTINGENT REFORM 2020; REDESIGNING HOME AND COMMUNITY-BASED SERVICES

Section 1 (144.0724, subdivision 4) allows assessments for determining nursing facility level of care to include: the nursing facility preadmission screening process; preadmission screenings completed by the Senior LinkAge Line, Disability Linkage Line, or other organizations under contract with the Minnesota Board on Aging; and the level of care determination process.

Section 2 (144.351) requires the Department of Human Services (DHS) to conduct a onetime critical access study due by August 15, 2015, on the local capacity and availability of home and community-based services (HCBS) for older adults and people with disabilities.

Section 3 (148E.065, subdivision 4a) specifies that cities, counties, and state agencies are not required to have licensed social workers assisting older adults and people with disabilities with long-term care counseling.

Section 4 (256.01, subdivision 2) adds to the list of the specific powers of the Commissioner of Human Services the designation of the Senior LinkAge Line and Disability Linkage Line as the state’s Aging and Disability Resource Centers under federal law.

Section 5 (256.01, subdivision 24) designates the Disability Linkage Line as a state Aging and Disability Resource Center under federal law, requires that it be available during business hours through a toll-free number and the Internet, and adds nursing facility preadmission screening to its list of duties.

Section 6 (256.975, subdivision 7) designates the Senior LinkAge Line as a state Aging and Disability Resource Center under federal law; requires the Senior LinkAge Line to receive referrals from nursing facility staff and residents, and to identify and contact residents deemed appropriate for discharge after developing criteria in consultation with DHS.

Section 7 (256.975, subdivision 7a) adds a subdivision to conform Medicaid-certified nursing facility preadmission screening activities to federal law by requiring everyone seeking admission to be screened regardless of income, assets, or funding sources with certain exceptions; establishes the criteria and process for preadmission screening; states that the purpose of the screening is to determine if the potential resident meets the nursing facility level of care criteria. This section is effective October 1, 2013.

Section 8 (256.975, subdivision 7b) adds a new subdivision listing exemptions to federal nursing facility preadmission screening requirements, and allowing emergency nursing facility admission without screening under conditions listed in the subdivision; requires nursing facilities to provide all admitted people written information on their right to request and receive long-term care consultation services. This section is effective October 1, 2013.

Section 9 (256.975, subdivision 7c) adds a new subdivision allowing nursing facility admission screening to be conducted by telephone or face-to-face interviews and requires the Senior LinkAge Line to identify each individual’s need for a telephone or face-to-face interview. This section is effective October 1, 2013.

Section 10 (256.975, subdivision 7d) adds a subdivision requiring DHS to provide preadmission screening funding to the Minnesota Board on Aging. This section is effective October 1, 2013.

Section 11 (256.9754, subdivision 3a) adds a subdivision requiring the Minnesota Department of Health (MDH) to give priority to grantees of community services development grants for older adults if technology is used as part of a proposal; the Department of Transportation must also give priority to community services development grantees when distributing transportation-related funds to create options for older adults.

Section 12 (256.9754, subdivision 3b) adds a subdivision allowing MDH to waive state laws and rules on a time-limited basis if it is determined that community services development grantees require a waiver in order to achieve the demonstration project goals.

Section 13 (256.9754, subdivision 5) requires DHS to give preference when awarding community services development grants to areas identified with service needs in the Balancing Long-Term Care Services and Supports report due to the Legislature by August 15, 2013.

Section 14 (256B.021, subdivision 4a) adds a subdivision requiring DHS to evaluate projects intended to: offer more flexible and updated community support services; improve information and assistance to inform long-term care decisions; and implement nursing facility level of care criteria.

Section 15 (256B.021, subdivision 6) adds a subdivision creating a demonstration project, upon federal approval, to provide navigation, employment supports, and benefits planning services to a targeted group of Medical Assistance (MA) recipients beginning July 1, 2014.

Section 16 (256B.021, subdivision 7) adds a subdivision creating a demonstration project, upon federal approval, to provide service coordination, outreach, in-state, tenancy support, and community living assistance to a targeted group of MA recipients beginning July 1, 2014.

Section 17 (256B.0911, subdivision 1) updates cross-references.

Section 18 (256B.0911, subdivision 1a) removes a reference to federally mandated preadmission screening activities, as the subdivisions cited are repealed (but language replaced); updates a cross-reference.

Section 19 (256B.0911, subdivision 3a) updates a cross-reference; requires lead agencies to provide DHS-provided materials to individuals receiving assessment or support planning on the need and purpose of preadmission screening; requires lead agencies to forward to the long-term care options counselor information to complete the level of care determinations if the individual selects nursing facility placement.

Section 20 (256B.0911, subdivision 4d) modifies preadmission screening funding for individuals under 65 years of age for Medicaid-certified nursing facility admission directly from a hospital, effective October 1, 2013.

Section 21 (256B.0911, subdivision 4e) adds a subdivision requiring level of care determinations for nursing facilities, hospitals, and intermediate care facilities in accordance with criteria developed by DHS, until the level of care changes made in 2008 are implemented in 2014 for individuals 21 years of age and older, and in 2019 for individuals under 21.

Section 22 (256B.0911, subdivision 6) eliminates the requirement that nursing facilities pay the county fee for long-term care consultation services and requires the alternative payment methodology to include the use of appropriate time studies and the state financing of nonfederal share as part of the state’s MA program effective October 1, 2013.

Section 23 (256B.0911, subdivision 7) updates cross-references to incorporate changes in this article.

Section 24 (256B.0913, subdivision 4) updates a cross-reference.

Section 25 (256B.0915, subdivision 5) updates a cross-reference.

Section 26 (256B.0917, subdivision 1a) adds a subdivision stating the purpose of SAIL projects is to make strategic changes in the long-term services and supports for older adults and lists the goals of these projects.

Section 27 (256B.0917, subdivision 1b) adds a new subdivision listing definitions applicable to Minnesota Statutes, section 256B.0917.

Section 28 (256B.0917, subdivision 1c) adds a new subdivision directing DHS to contract, through a request for proposal (RFP) process, with eldercare development partnerships capable of providing statewide service development and assistance.

Section 29 (256B.0917, subdivision 6) requires DHS to create projects to increase caregiver support and respite care services administered by nonprofit agencies and chosen through an RFP process.

Section 30 (256B.0917, subdivision 7a) adds a new subdivision requiring DHS to create projects to provide services and supports to older adults and their informal caregivers, administered by HCBS providers and chosen through an RFP process.

Section 31 (256B.0917, subdivision 13) modifies the preference for awarding community service grants to not only areas where nursing facilities have closed but to areas identified in the Balancing Long-Term Care Services and Supports report.

Section 32 (256B.439, subdivision 3) specifies that consumer surveys of long-term care services are for nursing facility services.

Section 33 (256B.439, subdivision 3a) adds a subdivision requiring DHS and MDH to work with existing DHS advisory groups to develop recommendations for creating an HCBS report card, with a report due to the Legislature by August 1, 2014, and report cards available July 1, 2015.

Section 34 (256B.439, subdivision 4) requires DHS and MDH to publicly disseminate the long-term care quality profiles through the Senior LinkAge Line and Disability Linkage Line.

Section 35 (256B.441, subdivision 13) removes long-term care consultation fees from the definition of “external fixed costs” for nursing facilities effective September 30, 2013.

Section 36 (256B.441, subdivision 53) removes long-term care consultation fees from the definition of “external fixed costs” for nursing facilities effective September 30, 2013.

Section 37 (256B.49, subdivision 12) updates a cross-reference.

Section 38 (256B.49, subdivision 14) updates a cross-reference.

Section 39 (256B.69, subdivision 8) exempts prepaid health plans from long-term care preadmission screening requirements.

Section 40 (256I.05, subdivision 1o) adds a subdivision modifying the group residential housing statute, by prohibiting a county from negotiating a supplementary rate for an individual who is eligible for the federal Housing Stability Services and who resides in a certain setting.

Section 41 (626.557, subdivision 4) allows the common entry point (CEP) to accept electronic reports of abuse, neglect, or exploitation submitted through a Web-based reporting system, established by the commissioner.

Section 42 (626.557, subdivision 9) requires the commissioner to establish a CEP effective July 1, 2014. Current law allows each county to designate a common entry point. New language in paragraph (g) requires that the CEP have access to the centralized database to immediately identify prior reports. New paragraph (h) requires CEP staff to refer calls that do not allege abuse or neglect to other organizations, in an effort to resolve the reporter’s concerns. New paragraph (i) provides that the CEP must be operated so the commissioner can perform the duties under this section. New paragraph (j) requires the Commissioner of Health and Human Services to collaborate on the creation of a triage system for investigations.

Section 43 (626.557, subdivision 9e) requires the commissioner to conduct an outreach campaign to promote the CEP for reporting vulnerable adult maltreatment.

Section 44 makes this article contingent upon federal approval.

Section 45 repeals a provision related to federal grants to establish a common entry point (section 245A.655), repeals several subdivisions relating to long-term care consultation (section 256B.0911, subdivisions 4a, 4b, 4c) and repeals several subdivisions in section 256B.0917 (subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12) related to the Seniors’ Agenda for Independent Living (SAIL).

 

ARTICLE 3: SAFE AND HEALTHY DEVELOPMENT OF CHILDREN

Section 1 (119B.011, subd. 19b) defines the term “student parent.”  This section is effective November 11, 2013.

Section 2 (119B.02, subd. 7) requires the Commissioner of Human Services to biennially survey prices charged by child care providers to determine the 75th percentile for like-care arrangements in county price clusters.  This section is effective February 3, 2014.

Section 3 (119B.025, subd. 1) provides that a family has met the child care eligibility redetermination requirement if the necessary forms and verifications are received within 30 days of the date due, and assistance is payable retroactively from the due date.   This section is effective August 4, 2014.

Section 4 (119B.03, subd. 4) provides that student parents are a funding priority when determining basic sliding fee funding disbursement.  This section is effective November 11, 2013.

Section 5 (119B.05, subd. 1) adds student parent as an eligible participant for MFIP child care assistance.  This section is effective November 11, 2013.

Section 6 (119B.13, subd. 1) modifies the formula for determining child care assistance subsidies beginning February 3, 2014.  The maximum rate paid for child care assistance in a county price cluster is the greater of the 25th percentile of the 2011 child care provider rate survey or the maximum rate effective November 28, 2011.

Section 7 (119B.13, subd. 1a) inserts the term “county price clusters” to a provision related to child care rates for legal nonlicensed family child care providers.   This section is effective February 3, 2014.

Section 8 (119B.13, subd. 3a) modifies the child care provider rate differential that is tied to accreditation, by requiring the commissioner to accept applications from accrediting organizations beginning in July, 2013, and annually thereafter.  The provider rate differential must be paid to centers with an accreditation from an approved organization.  The commissioner must publish the approved accreditation organizations, reassess them every two years, and notify the organization and affected centers with a 90-day notice if the organization no longer meets the criteria.

Section 9 (119B.13, subd. 3b) requires a family child care provider or child care center be paid a 15 percent differential for a three-star Parent Aware rating and a 20 percent differential for a four-star Parent Aware rating.  This section is effective March 3, 2014.

Section 10 (119B.13, subd. 3c) allows a licensed child care provider or a license-exempt center to be paid up to the applicable weekly maximum rate if the following conditions are met:  the provider is caring for a child birth to five years, the provider is eligible for a rate differential, and the applicant qualifies for at least 30 hours of care per week under the basic sliding fee program, MFIP child care, or the employment and training program.   This section is effective August 4, 2014.

Section 11 (119B.13, subd. 6) allows the county to withhold the provider’s authorization or payment for up to three months beyond the time the condition was corrected.  This section is effective February 3, 2014.

Section 12 (119B.13, subd. 7) modifies reimbursement provided under state child care assistance programs to child providers and license-exempt centers, to:

  • raise the limit, from ten to 25, on the number of days per year that providers can be reimbursed for full-day absent days of a child;
  • retain a ten day limit for consecutive full-day absent days; and
  • establish an exemption from the limit for some documented medical conditions.

This section is effective February 1, 2014.

Section 13 (245A.07, subd. 2a) provides that when the commissioner determines there is reasonable cause to order the temporary immediate suspension of a child care license based on a violation of safe sleeping requirements, the commissioner is not required to demonstrate that an infant died or was injured as a result of the violation.

Section 14 (245A.1435).  Paragraph (a) requires a licensed child care provider to place an infant to sleep on the infant’s back unless a signed statement is on file from the infant’s physician directing an alternate sleep position.  Allows an infant who is able to roll over independently to remain on its stomach after being placed to sleep on its back if the infant is at least six months old or the parents have signed a statement that the infant rolls over at home.

Paragraph (b) requires the license holder to place an infant in a crib with a firm mattress covered by a tight fitted sheet.  Prohibits anything from being placed in the crib with an infant, except for a pacifier, as defined in the Code of Federal Regulations.

Paragraph (c) provides that if an infant falls asleep before being placed in the crib, the license holder must move the infant to a crib as soon as practical. 

Paragraph (d) allows swaddling of an infant under specified conditions.

Sections 15 (245A.144)  and 16 (245A.1444) amend child foster care providers and chemical dependency treatment programs, respectively, that care for infants or service clients with infants, by changing the term “sudden infant death syndrome” to “sudden unexpected infant death” and “shaken baby syndrome” to “abusive head trauma.”

Section 17 (245A.1446) provides guidelines for disinfecting a diaper changing surface.

Section 18 (245A.147) relates to family child care infant sleep supervision requirements.

Subdivision 1 encourages license holders to monitor sleeping infants in-person every 30 minutes.  For infants in their first four months of care and infants who have an upper respiratory infection, the license holder is encouraged to make these checks every 15 minutes.

Subdivision 2  encourages license holders to use and maintain an audio or visual monitoring device to monitor each sleeping infant in care during all hours of sleep.

Section 19 (245A.152).  Paragraph (a) requires license holders to provide written notice to parents whether the license holder has liability insurance.

Paragraph (b) provides that if the license holder has insurance the parents must be informed that they can inspect the certificate of insurance, the date of expiration or next renewal of the policy, and upon the policy expiration date, whether the policy has lapsed or been renewed.  If the policy was renewed, the license holder is required to inform the parents of the new expiration date.

Paragraph (c) requires a license holder who does not have liability insurance to inform parents annually of this fact.

Paragraph (d) requires license holders to notify parents of any change in insurance status.

Paragraph (e) requires the license holder to make the certificate of insurance available to the commissioner and to county licensors.

Paragraph (f) instructs license holders to document, with a signature of the parent or guardian, that the parent or guardian received the notices required by this section.

Section 20 (245A.40, subd. 5) changes the term “sudden infant death syndrome” to “sudden unexpected infant death” and “shaken baby syndrome” to “abusive head trauma.”

Section 21 (245A.50, subdivision 2) changes the training requirement for child growth and development from two hours of training to four hours of child growth and development and behavior guidance training prior to initial licensure and before caring for children.  Defines “behavior guidance training.”  Requires annual child growth and development and behavior guidance training.

Subdivision 3 requires first aid training to be repeated every two years.

Subdivision 4 requires CPR training to include CPR techniques for infants and children.  Requires training to be repeated every two years; the current requirement is every three years.  Strikes the option of video CPR training and requires training developed by the American Heart Association or American Red Cross, or nationally recognized, evidence based guidelines.

Subdivision 5 updates terminology.  Strikes the option of video training.  Requires in-person training to occur every two years; in alternate years video training is required.  Currently training is required every five years.

Subdivision 7 changes the requirement for annual training from eight to 16 hours.  Clarifies that the training requirements in subdivisions 2 to 6 count toward the 16-hour training requirement.

Subdivision 9 adds that effective July 1, 2014, all family child care license holders and adult caregivers must have at least six hours of training on supervising for safety prior to licensure and before caring for children.  At least two hours of this training must be repeated annually.

Subdivision 10 requires county licensing staff to accept training from the Minnesota Center for Professional Development.

Subdivision 11 requires the commissioner to establish statewide accessible training before imposing new training requirements on providers.

Section 22 (252.27, subd. 2a) modifies the parental contribution for TEFRA services.  TEFRA is a federal program for children under the age of 19 who have a disability determination and need a certain level of care to stay at home.  Parents are required to pay a parental fee for services.  The modification discontinues the parental fee schedule under paragraph (j), and reinstates the fee schedule in paragraph (b), which is effective July 1, 2013.  This section also discontinues the parental fee for households with income less than 275% of federal poverty guidelines, which is effective January 1, 2014.

Section 23 (256.98, subd. 8) changes the disqualification periods for child care assistance programs found guilty of wrongfully obtaining assistance. The disqualifications must be for periods of one year and two years for the first and second offenses, and permanent disqualification for subsequent violations.  Under current law, disqualifications are for three months, six months, and two years for the first, second and third offenses, respectively, and a permanent disqualification for a subsequent violation.  This section is effective February 3, 2014.

Section 24 (256J.08, subd. 24) modifies the definition of “disregard” in the MFIP program, which provides that the disregard for ongoing eligibility is 50 percent of gross earned income, upon approval from the United States Department of Agriculture.  This section is effective October 1, 2014, or upon federal approval.

Section 25 (256J.21, subd. 2)  clarifies that payments for the housing assistance grants under section 256J.35, paragraph (a),  are excluded in determining a family’s income for purposes of MFIP eligibility.

Section 26 (256J.21, subd. 3) modifies the MFIP initial income test, requiring the applicant to be below the family wage level, instead of the transitional standard of assistance, in order to be eligible for MFIP.   This section is effective October 1, 2014, or upon federal approval.

Section 27 (256J.24, subd. 5) strikes a reference to the MFIP family cap, which is repealed in this article.

Section 28 (256J.24, subd. 7) modifies the family wage level, which rewards working families.  This section is effective October 1, 2014, or upon federal approval.

Section 29 (256J.35) adds a new paragraph (a) establishing an MFIP housing assistance grant of $110 per month, beginning July 1, 2015.

Section 30 (256J.621) suspends the work participation cash benefits program effective December 1, 2014, but allows the commissioner to reinstate the program if the state does not meet the federal TANF work participation rate.  The commissioner is required to notify the chairs of the human services committees of the potential federal penalty and the commissioner’s plans to reinstate the program within 30 days of the date the commissioner receives notification from the federal government that the state failed to meet the work participation rate.

Section 31 (256J.626, subd. 7) modifies the TANF performance-based funds beginning in fiscal year 2016.  A county that performs above its range of expected performance on the self-support index receives an additional allocation of 2.5 percent.  A county that performs below the self-support index may have the allocation decreased by 2.5 percent.

Section 32 (256J.78) allows the commissioner to pursue TANF demonstration projects or waivers of TANF requirements to develop a more results-oriented MFIP.  The commissioner is required to report to the Legislature by March 1, 2014, regarding the process of the waiver or demonstration project. This section is effective the day following final enactment.

Section 33 (256K.45) changes the title of the act from “Runaway and Homeless Youth Act” to the “Homeless Youth Act.”

Subdivision 1 establishes the grant program for providers who are committed to serving homeless youth to reduce the incidence of homelessness among youth.

Subdivision 2 requires a biennial report, which provides meaningful information that includes the area of the state with the greatest need, details about grants made, the distribution of funds throughout the state, follow-up information, if available, on the status of homeless youth, and outcomes for populations served to determine the effectiveness of the program and the use of funds.

Subdivision 4 clarifies that the emergency shelter program is for runaway and homeless youth. 

Subdivision 6 modifies the distribution of funding, by striking the sentence that allows up to four percent of the funds to be used for monitoring and evaluating homeless youth programs.  The funds may be expended on capacity building to meet the greatest need on a statewide basis.

Section 34 (256M.40, subd. 1) modifies the Vulnerable Children and Adults Act formula by retaining the 2013 formula for future years, and precluding the commissioner changing the formula or recommending a change to the legislature without public review and input.

Section 35 (257.0755, subd. 1) clarifies that an ombudsperson is to act independently but in collaboration with the community-specific board that appointed the ombudsperson.

Section 36 (259A.20, subd. 4) allows child care reimbursements under the adoption assistance program if the caregiver is unemployed due to a disability.

Section 37 (260B.007, subd. 6) strikes language that would allow a 16 or 17 year old to be charged with being hired, offering to be hired, or agreeing to be hired by another to engage in sexual penetration or contact.  (A juvenile acting as a patron or promoter could still be charged).  Effective August 1, 2014.

Section 38 (260B.007, subd. 16) exempts from the definition of “juvenile petty offense” a juvenile charged with a misdemeanor-level prostitution offense when acting as a patron.  This means the juvenile would receive an adjudication of delinquency, rather than be adjudicated as a petty offender.  Effective August 1, 2014.

Section 39 (260C.007, subd. 6) amends the definition of a "child in need of protection or services" by striking a reference to juveniles engaged in prostitution.  This would no longer be an offense under section 1.  Replaces the reference to “sexually exploited youth.”  Effective August 1, 2014.

Section 40 (260C.007, subd. 31) adds that a youth who has been the victim of a third degree sexual offense crime is a sexually exploited youth.  Provides an immediate effective date.

Section 41 (518A.60) adds paragraph (f), which allows child support services to be discontinued for a case with arrears under certain circumstances, if the children for which the order was established are emancipated.  Paragraph (g) requires the public authority to provide a notice to the obligor and obligee, and paragraph (h) provides that the case remain open if the obligee responds and provides information that the outstanding arrearage could reasonably lead to a collection.

Section 42 (Laws 1998, ch. 407, art. 6, section 116) prohibits the commissioner from subsidizing retailers for EBT SNAP transactions. This section is effective 30 days after the commissioner notifies retailers of the termination of their agreement with the state.

Section 43 (Laws 2011, First Special Session chapter 9, article 1, section 3) changes the effective date of this section from January 1, 2013 to July 1, 2014, and makes this section effective retroactively from January 1, 2013.  This section limits child care assistance payments when a child in care is related to an employee of the provider or to the provider.

Section 44 (Direction to commissioners; income and asset exclusion).  Paragraph (a) prohibits the commissioner of human services from considering conditional cash transfers made to families participating in a family independence project as income or assets for purposes of determining eligibility for specified public assistance programs.

Paragraph (b) prohibits the commissioner of human services from considering conditional cash transfers made to families participating in a family independence project as income or assets for purposes of determining medical assistance or MinnesotaCare eligibility. An exception is made for individuals whose eligibility is calculated using modified adjusted gross income.

Paragraph (c) prohibits the MHFA commissioner from considering conditional cash transfers made to families participating in a family independence project as income or assets for purposes of determining eligibility for housing assistance programs.

Paragraph (d) defines “conditional cash transfer” and “family independence demonstration.”

Paragraph (e) instructs the citizen’s league to submit a report to the legislature on the outcomes of the demonstration project.

Section 45 (Reduction of Youth Homelessness) requires the Minnesota Interagency Council on Homelessness to recommend strategies to reduce the number of youth experiencing or at risk of homelessness.  Lists factors the council must consider in developing its strategies.  Requires the council to provide an update to the legislature by December 1, 2014.

Section 46 (Housing Assistance Grants) makes the housing assistance grants under section 256J.35, paragraph (a), a forecasted program.

Section 47 (Plan for Group Residential Housing Specialty Rate and Banked Beds) requires the commissioner to review the statewide number and status of group residential housing beds with rates in excess of the MSA rate, including banked beds.  The commissioner shall study the type and amount of supplemental services delivered, and develop a plan for rate setting criteria and efficient use of beds.  The plan is due no later than February 1, 2014.

Section 48 (Repealer).  Paragraph (a) repeals the MFIP family cap effective July 1, 2015.  Paragraph (b) repeals a diversion program for 16 and 17 year old juvenile prostitutes, effective the day following final enactment.

ARTICLE 4: STREGENTHENING CHEMICAL AND MENTAL HEALTH SERVICES

Section 1 (245.462, subd. 20) modifies the definition of “mental illness” to include schizoaffective disorder, and defines case management to include adults age 21 or younger who were eligible for case management as a child.

Section 2  (245.4661, subd. 5) requires the commissioner to issue a request for proposals for regions in which a need has been identified for Minnesota specialty treatment services, which are defined as intensive rehabilitative mental health treatment services (IRTS).

Section 3 (245.4661, subd. 6) allows the commissioner to transfer funds for grants to providers who were awarded grants through the RFP process, to participate in mental health specialty treatment services.

Section 4 (245.4682, subd. 2) strikes references to children’s mental health grants.

Section 5 modifies the definition of mental health practitioner.

Section 6 (245.4875, subd. 8) allows case management for transition services if the person is requesting the services and if the services are medically necessary.

Section 7 (245.4881, subd. 1) requires case management services be offered under certain circumstances, and requires the development of a transition plan before discontinuing case management services for children age 17 and 21, which includes a plan for health insurance, housing, education, employment and treatment.

Section 8 (246.18, subd. 8) modifies the state-operated services account established in the 2010 special session, requiring new revenue generated by the new state-operated services listed in this section be deposited into this account. The new language allows the commissioner to access the funds to provide services to transition individuals from institutions to the community, for grants to providers participating in mental health specialty treatment services, and to fund the operation of Intensive Residential Treatment Services (IRTS) in Willmar.  

Section 9 (246.18, subd. 9) allows the commissioner to transfer state mental health grant funds to the account in the previous section for noncovered allowable costs of a provider certified and licensed to provide intensive rehabilitative mental health services under state-operated services.

Section 10 (246.54), Subdivision 1 increases the county portion for the cost of care at a regional treatment center or state nursing home for a county resident from 50 percent to 75 percent for any days over 60.  Subdivision 2 excludes services at the Minnesota Security Hospital from subdivision 1.  Adds that for state-operated forensic transition services at the security hospital, the county share is 50 percent of the cost of care, unless the state receives payments from other sources in excess of 50 percent of the cost of care.  In those cases, a county is responsible for only the remaining amount.

Section 11 (253B.10, subd. 1) modifies the commitment act to require the commissioner to prioritize patients being admitted from jail or a correctional institution who are ordered to be confined to a state hospital, under civil commitment, found guilty by reason of mental illness, or civilly committed after dismissal of criminal charges.

Section 12 (254B.13) modifies the chemical health care pilot project, specifies eligibility for navigator pilot program.

Section 13 (254B.14) establishes a continuum of care pilot project for chemical health care, to improve the effectiveness and efficiency of the service continuum for chemically dependent individuals, while reducing duplicity and promoting scientifically supported practices.

Section 14  (256.478)  requires the commissioner to make available home and community-based services transition grants to serve individuals who do not meet MA eligibility criteria, but who otherwise meet the criteria established for people being discharged from Anoka Metro Regional Treatment Center or the Minnesota Security Hospital in St. Peter.  Authorizes the commissioner to transfer funds between certain accounts. Makes this section effective July 1, 2013.

Section 15 (256B.0616) establishes the mental health certified family peer specialist as a service covered under medical assistance, upon federal approval.

Section 16 (256B.0623, subd. 2) adds parenting skills under the adult rehabilitative mental health services.

Section 17 (256B.0625, subd. 48) adds psychologist and advanced practice registered nurse certified in psychiatric mental health to the MA providers allowed to provide consultation to primary care providers.

Section 18 (256B.0625, subd. 56) modifies the medical service coordination benefit under medical assistance, by adding in-reach community based service coordination through a hospital emergency department or inpatient psychiatric unit.  This section also specifies in-reach community based service coordination for children and young adults with serious emotional disturbance.

Section 19 (256B.0625, subd. 61) adds family psychoeducation services to the list of services covered under medical assistance, subject to federal approval.

Section 20 (256B.0625, subd. 62) adds mental health clinical care consultation to the list of services covered under medical assistance, subject to federal approval.

Section 21 (256B.092, subd. 13)  requires the commissioner to make available additional DD waiver allocations and additional necessary resources to assure timely discharge from the Anoka Metro Regional Treatment Center and the Minnesota Security Hospital in St. Peter for people who meet specified criteria.  Specifies additional waiver allocations must meet federal cost-effectiveness requirements and any corporate foster care home developed under this subdivision must be considered an exception within the foster care moratorium.  Makes this section effective July 1, 2013.

Section 22 (256B.0943, subd. 1) modifies children’s therapeutic services and supports (CTSS), by defining the term “mental health service plan development.”

Section 23 (256B.0943, subd. 2) modifies children’s therapeutic services and supports (CTSS), by including mental health service plan development, clinical care consultation, family psychoeducation, and family peer specialist, to the list of services covered under CTSS.

Section 24 (256B.0943, subd. 7) references the new level II behavioral aide under section 256B.0943, subdivision 8a.

Section 25 (256B.0943, subd. 8a) requires the Commissioner of Human Service, in collaboration with children’s mental health providers and the Board of Trustees of the Minnesota State Colleges and Universities, to develop a certificate program for level II mental health behavioral aide.

Section 26  (256B.0946), Subdivision 1  requires, for eligible children with mental illness who reside in family foster care settings, medical assistance to cover specified intensive treatment services: psychotherapy, crisis assistance, psychoeducation services, clinical care consultation, and certain service delivery payment requirements.

Subdivision 1a defines terms.

Subdivision 2 defines an eligible recipient as an individual, from birth through age 20, who is placed in a licensed foster home and has received a diagnostic assessment and an evaluation of level of care needed.

 Subdivision 3 requires providers to be certified by the state, have a service provision contract with a county board or reservation tribal council, and demonstrate the ability to provide services.

Subdivision 4 lists the service delivery requirements a provider must meet in order to be reimbursed for services.

Subdivision 6, Paragraph (a) lists the services that are not covered by medical assistance as components of intensive treatment in foster care and permits these services to be billed separately.  Paragraph (b) lists the services that are not eligible for medical assistance reimbursement while the child is receiving intensive treatment in foster care.

Subdivision 7 requires the commissioner to establish a single per-client encounter rate for intensive treatment in foster care services.

Section 27 (256B.49, subd. 24) requires the commissioner to make available additional waiver allocations and additional necessary resources to assure timely discharge from the Anoka Metro Regional Treatment Center and the Minnesota Security Hospital in St. Peter for people who meet specified criteria.  Specifies additional waiver allocations must meet federal cost-effectiveness requirements and any corporate foster care home developed under this subdivision must be considered an exception within the foster care moratorium.  Makes this section effective July 1, 2013.

Section 28 (256B.761) allows the commissioner to restructure coverage policy and rates to improve access to adult rehabilitation mental health services and related mental health support services.   The increased costs is transferred from the adult mental health grants and is a permanent base adjustment.

Section 29 (Child and Adolescent Behavioral Health Services) requires the Commissioner of Human Services, in consultation with providers, advocates, and other interested parties, to develop recommendations and legislation for state-operated child and adolescent behavioral health services facility that meets the requirements under this section.

Section 30 (Pilot Provider Input Survey of Pediatric Services and Children’s Mental Health Services)  requires the Commissioner of Human Services to initiate a provider survey of providers of pediatric services and children’s mental health services to identify and measure issues related to the management of medical assistance. The survey question must focus on seven key business functions.  The report is due January 15, 2014.

Section 31 (Mentally Ill and Dangerous Commitments Stakeholders Group)  establishes the mentally ill and dangerous commitments stakeholders group, to develop recommendations for the Legislature that address issues raised in February 2013 Office of the Legislative Auditor report.  The recommendations are due by January 15, 2014.

Section 32 (State assistance to counties; transitions for high needs populations)  Paragraph (a) requires the commissioner to assist counties to assure timely discharge of patients from AMRTC and the MSH when a county does not have provider resources or appropriate placement available.  Requires the commissioner to give special consideration to uninsured individuals with complex needs.

Paragraph (b) instructs the commissioner to offer metropolitan area residents about their geographic placement preferences before making a placement.

 

ARTICLE 5: DEPARTMENT OF HUMAN SERVICES PROGRAM INTEGRITY AND OFFICE OF INSPECTOR GENERAL

Section 1 (13.461, subd. 6) amends the Data Practices Act to clarify that data related to child care fraud investigations are governed under Minnesota Statutes, section 245E.01, subdivision 15.

Section 2 (243.166, subd.7) amends the statute governing sex offender registration data to authorize access to the data by the Commissioner of Human Services for purposes of completing background studies under the licensing law.

Section 3 (245C.04) requires the Commissioner of Human Services to develop and implement an electronic process for the regular transfer of new criminal case information that is added to the Minnesota court information system.  It would include only information that relates to individuals who have been the subject of a background study and remain affiliated with the agency that initiated the study.  System requirements are specified.

Section 4 (245C.08, subd. 1) amends background study requirements for studies conducted by the Department of Human Services to add reviewing information regarding registration as a sex offender.  In addition, the commissioner must review criminal case information received under the new provisions contained in section 3.

Section 5 (245E.01) adds a new section governing child care provider and recipient fraud investigations within the child care assistance program. This section requires the department to investigate alleged or suspected financial misconduct by providers and errors related to payments, issue determinations after an investigation is completed, and allow for an appeal of the determination.

Section 6 (256B.04, subd. 21) allows the commissioner to pursue Medicaid provider recoveries through new recovery mechanisms.  This section requires all suppliers of durable medical equipment, prosthetics, orthotics, and supplies operating in Minnesota and receiving MA funds to purchase a surety bond that is annually renewed, and designates the DHS as an obligee. Specifies the amount of the performance bond DHS may require a provider to purchase a performance surety bond as a condition of enrollment.   This section is effective the day following final enactment.

Section 7 (256B.04, subd. 22) requires the commissioner to collect and retain federally required nonrefundable application fees to pay for provider screening activities in accordance with federal regulations.  Specifies the enrollment application procedures, the application fee amount, and the providers who are exempt from the fee.

Section  8 (256B.0624, subd. 1a) allow the commissioner to impose a fine on a vendor of medical care under Minnesota Statutes, chapter 256B, for failure to correct errors in the maintenance of records for which a fine was imposed and for missing required documentation.

Section  9 (256B.064, subd. 1b) allows the commissioner to impose a fine on a vendor of medical care under Minnesota Statutes, chapter 256B, for failure to correct errors in the maintenance of records for which a fine was imposed and for missing required documentation.

Section  10 (256B.064, subd. 2) allows the commissioner to impose a fine on a vendor of medical care under Minnesota Statutes, chapter 256B, for failure to correct errors in the maintenance of records for which a fine was imposed and for missing required documentation.

Section 11 (256B.0659, subd. 21) requires all personal care assistance provider agencies to show proof of surety bond.  This section is effective the day following final enactment.

Section 12 (299C.093) modifies the Bureau of Criminal Apprehension chapter of law, allowing the Commissioner of Human Services to access data for purposes of performing a background study, consistent with section 2.

Sections 13 to 16 modify the State-County Results, Accountability, and Service Delivery Redesign Act.

Section 13 (402A.10) adds new definitions.

Section 14 (402A.12)  requires the commissioner to implement, by January 1, 2014, a performance management system for essential human services, that includes performance measures and standards consistent with the recommendations of the Steering Committee in the December 2012 report the Legislature. 

Section 15 (402A.16) requires the commissioner to convene a Human Services Performance Council to advise the commissioner on the implementation and operation of the performance system for human services.  This section specifies the duties and membership of the council, and the duties of the commissioner and county or services delivery authority.

Section 16 (402A.18) modifies the conditions that must be met prior to imposing remedies on a county or services delivery authority that does not meet minimum performance standards.

Section 17 (Instructions to the Commissioner)  instructs the commissioner, in collaboration with labor organizations, to develop clear and consistent standards for state-operated services programs to address staffing shortages, identify and help resolve work safety issues, and elevate the use and visibility of performance measures and objectives related to overtime use.

 

 ARTICLE 6: HEALTH CARE

Section 1 (245.03, subd. 1) authorizes the Commissioner of Human Services to appoint up to two deputy commissioners.

Section 2 (256.9657, subd. 3) makes a conforming change to the surcharge payment change made in section 3.

Section 3 (256.9657, subd. 4) requires the hospital surcharge to be paid in nine monthly installments due on the 15th of the month beginning October 15, 2014, through June 15 of the following year, and the monthly payment must be equal to the annual surcharge divided by nine.  Also requires the HMO and community-integrated network surcharge due in July through  September 2014 for revenue earned in calendar year 2012, to be paid in a lump sum on June 15, 2014.  On June 15, 2014, each HMO and community integrated service network shall pay the surcharge payment in a lump sum for revenue earned in calendar year 2013. On June 15, 2015, and each June 15 thereafter, the surcharge based on revenues earned in the previous calendar year shall be paid in a lump sum on June 15 of each year.

Section 4 (256.969, subd. 29) increases the payment rates to hospitals to cover the increase to the newborn screening fee that goes toward providing family support services in the early hearing detection and intervention program.

Section 5 (256B.04, subd. 22) requires the commissioner to enter into an interagency agreement with the Commissioner of Corrections to recover the state cost attributable to Medical Assistance (MA) eligibility for inmates admitted to a medical institution on an inpatient basis. The amount transferred must include state MA costs and administrative costs.

Section 6 (256B.055, subd. 14) specifies that MA covered services received by an inmate of a public institution who otherwise meets the medical assistance eligibility requirements are covered under medical assistance while the inmate is an inpatient of a medical institution.

Section 7 (256B.06, subd. 4) continues to cover dialysis services provided in a hospital or free-standing dialysis facility and surgery and the administration of chemotherapy, radiation, and related services necessary to treat cancer under emergency medical assistance for noncitizens regardless of immigration status.  This section states that recipients of emergency MA are eligible for coverage of elderly waiver services and coverage of rehabilitative services provided in a nursing facility, subject to available funding and assessment requirements.

Section 8 (256B.0625, subd. 9) expands MA dental coverage for adults, to include:

(1) house calls or extended care facility calls for on-site delivery of covered services;

(2) behavioral management, when additional staff time is required and sedation is not used;

(3) oral or IV sedation, if the covered service cannot be performed safely without it or would need to be performed under general anesthesia in a hospital or surgical center; and

(4) prophylaxis, in accordance with an individualized treatment plan, but no more than four times per year.

Section 9 (256B.0625, subd. 13) requires MA to cover drugs acquired through the federal 340B Drug Pricing Program and dispensed by 340B-covered entities and ambulatory pharmacies under common ownership of the 340B-covered entity.

Section 10 (256B.0624, subd. 13e) Paragraph (a) requires the actual acquisition cost of a drug acquired through the federal 340B Drug Pricing Program to be estimated at wholesale acquisition cost minus 40 percent, for purposes of MA payment.

Paragraph (d) allows payment for drugs administered in an outpatient setting to be at the lower of the specialty pharmacy rate or the maximum allowable cost  (in addition to the lower of the usual and customary cost or 106 percent of the average sales price, as under current law).  Requires the commissioner to discount the payment rate for drugs obtained through the federal 340B Drug Discount Program by 20 percent.  Requires payment for drugs administered in an outpatient setting to be made to the administering facility or the practitioner.  Provides that a retail or specialty pharmacy dispensing a drug for administration in an outpatient setting is not eligible for direct reimbursement.

Section 11 (256B.0625, subd. 28b) extends medical assistance coverage to doula services provided by a certified doula effective July 1, 2014, or upon federal approval, whichever is later.

Section 12(256B.0625, subd. 31) states that an electronic tablet may be considered a durable medical equipment if the electronic tablet is to be used as an augmentative and alternative communication system.  To be covered by medical assistance, the device must be locked in order to prevent use not related to communication.

Section 13 (256B.0625, subd. 31b) requires the commissioner to implement a point of sale preferred diabetic testing supply program by January 1, 2014.  Medical assistance coverage for diabetic testing supplies shall conform to the limitations to this program.  This section also authorizes the commissioner to enter into a contract with a vendor for the purpose of participating in a preferred diabetic testing supply list and supplemental rebate program.

Section 14 (256B.0625, subd. 39) eliminates medical assistance coverage for the administration of pediatrics vaccines covered under the pediatric vaccine administration program.

Section 15 (256B.0625, subd. 58) eliminates medical assistance payment for an EPSDT screening for vaccines that are available at no cost to the provider.

Section 16 (256B.0625, subd. 61) permits the payment for mental health services and dental services provided to a patient by a clinic or health care provider that are provided on the same day as other covered services furnished by the same provider.

Section 17 (256B.0631, subd. 1) permits the Hennepin County pilot program to waive the medical assistance co-payments and states that the value of the waived co-payments shall not be included as part of the capitation payment amount under the pilot program.

Section 18 (256B.0756) makes minor changes to the Hennepin County innovative health care delivery network pilot program, including permitting the commissioner to identify individuals to be enrolled in the pilot program by zip code and whether they would benefit from enrolling in the pilot program.  This section also lifts the pilot program enrollment cap and strikes obsolete language permitting the county to transfer funds to support the nonfederal share of payments.

Section 19 (256B.196, subd. 2) requires the commissioner to determine an upper payment limit for ambulance services affiliated with Hennepin County Medical Center and the city of St. Paul that is based on the average commercial rate or be determined using another method acceptable to the Centers for Medicare and Medicaid Services.  Requires the commissioner to inform Hennepin County and the city of St. Paul of the periodic intergovernmental transfers necessary to match the federal Medicaid payments available in order to make supplementary payments to Hennepin County Medical Center equal and the city of St. Paul to the difference between the established medical assistance payment for ambulance services and the upper payment limit.

Section 20 (256B.69, subd. 5c) increases the amount that is transferred by the commissioner to the medical education research cost fund (MERC) by $12,608,000 per year.

Section 21 (256B.69, subd. 5i) specifies that certain managed care plan and county-based purchasing plan administrative expenses are not allowable for rate setting purposes.

Section 22 (256B.69, subd. 9c) requires managed care plans and county-based purchasing plans to provide on an quarterly basis specified information on state public programs.

Section 23 (256B.69, subd. 31) requires the commissioner to reduce the maximum aggregate trend increases paid to managed care plans and county-based purchasing plans by $47,000,000 in state and federal funds for calendar year 2014.

Section 24 (256B.69, subd. 35) requires the commissioner to conduct a supplemental recovery program for third-party liabilities not covered by managed care plans and county-based purchasing plans for state public health programs.

Section 25 (256B.76, subd. 1) increases the fee-for-service payment rates for physician and professional services by 5 percent effective September 1, 2014.

Section 26 (256B.76, subd. 2) increases payment rates for dental services by five percent effective January 1, 2014.

Section 27 (256B.76, subd. 4) increases the critical access dental payments by 5 percent beginning July 1, 2013, and expands the critical access dental provider designation to include city-owned and operated hospital based dental clinics and to private practicing dentists if the dentist’s office is located within a health shortage area, if more than 50 percent of the dentist’s patient encounters per year are with patients who are uninsured or covered by medical assistance or MinnesotaCare, the dentist does not restrict access or services because the patient’s financial limitations or coverage status, and the level of service provided by the dentist is critical to maintaining adequate levels of access with the service area in which the dentist operates.

Section 28 (256B.76, subd. 7) states that the payment for primary care services and immunization administration services on or after January 1, 2013, through December 31, 2014, shall be increased to meet the federal payment requirements.

Section 29 (256B.764) increases the family planning rates by 20 percent for services provided by a community clinic effective July 1, 2013.  Requires the rates to managed care plans and county based purchasing plans to reflect this increase.

Section 30 (256B.766) increases the fee-for-service payment rates for ambulatory surgery centers, medical supplies, and durable medical equipment not subject to a volume purchase contract, prosthetics and orthotics, hospice services, rental dialysis services, laboratory services, public health nursing services, eyeglasses and hearing aids not subject to volume purchase contract and outpatient hospital facility fees by three percent effective September 1, 2014.

Section 31 (256B.767) modifies the payment rates for durable medical equipment, prosthetics, orthotics, or supplies provided on or after July 1, 2013, through June 30, 2014, that are subject to rates established under Medicare's National Competitive Bidding Program by stating that the rates shall be equal to the rates that would apply to the same item if not subject to the competitive bidding program.

Section 32 modifies the transfer language that was enacted earlier this session in Laws 2013, chapter 1, chapter 6, that transfers funds from the health care access fund to the general fund for the medical assistance costs associated with adding the 19 and 20 year olds and parent and relative caretaker populations with income between 100 and 138 percent of FPG.

Section 33 requires the Commissioner of Human Services to identify alternatives and make recommendations for providing coordinated and cost-effective health care and coverage to individuals who are eligible for emergency medical assistance or are uninsured and ineligible for other state public health care programs, have an income below 400 percent of FPG, and are ineligible for premium credits through MNsure.  Requires the commissioner to issue a request for information to help identify options for coverage of medically necessary services.  Requires the RFI to be issued by August 1, 2013, with the information submitted to the commissioner by October 1, 2013, and requires this plan to be submitted to the legislature by July 15, 2013.

Section 34 requires the Commissioner of Human Services to issue a request for information (RFI) to identify and develop options for a program to provide emergency medical assistance recipients with coverage for medically necessary services not eligible for federal financial participation.  Requires the RFI to be issued by August 1, 2013, and specifies criteria for the RFI.  Requires the commissioner, based on responses to the RFI, to submit recommendations on providing this coverage for emergency medical assistance recipients to legislative chairs by January 15, 2014.

Section 35 requires the Commissioner of Human Services to study and make recommendations to the legislature on the current oral health and dental services delivery system for the state public health care programs to improve access and ensure cost effective delivery of services.  The study must include modifying the delivery of services and reimbursement systems including modifications to the critical access dental provider payments, and the recommendations must be submitted to the legislature by December 15, 2013.

 

ARTICLE 7: CONTINUING CARE

Section 1 (144.0724, subdivision 6) allows nursing facilities to apply for a reduction in their penalty amount (for not submitting assessment data, or submitting it late) if the penalty is one percent or more of the facility's total operating costs.

Section 2 (144A.071, subdivision 4b) modifies the time period for nursing facilities to place beds on layaway status from one year to six months.

Section 3 (245A.03, subdivision 7) modifies the exceptions to the corporate foster care moratorium and removes obsolete language; authorizes the Department of Human Services (DHS) to manage statewide capacity, including adjusting the capacity available to each county, and adjusting statewide available capacity to meet statewide needs; changes the annual due date of certain information regarding overall capacity DHS is required to provide; modifies exemptions from decreased licensed capacity for certain residential settings.

Section 4 (252.291, subdivision 2b) adds a new subdivision directing the Minnesota Department of Health (MDH) to certify one additional bed in an intermediate care facility for persons with developmental disabilities (ICF/DD) in Nicollet County.

Section 5 (256.9657, subdivision 3a) modifies the ICF/DD license surcharge effective July 1, 2013.

Section 6 (256B.0915, subdivision 3a) makes a cross-reference change and modifies the monthly cost limit of waiver services for ventilator-dependent individuals.

Section 7 (256B.0915, subdivision 3j) creates the Individual Community Living Support (ICLS) service for the Elderly Waiver.

Section 8 (256B.0916, subdivision 11) creates a new subdivision making county and tribal agencies responsible for spending in excess of the home and community-based waiver allocation made by DHS; requiring agencies that spend in excess of the allocation made by the commissioner to submit a corrective action plan to DHS; and specifying the information that must be included in the plan.

Section 9 (256B.092, subdivision 7) requires case managers to assist developmental disability (DD) waiver clients in the transition to a less restrictive living setting, if determined appropriate during the assessment or reassessment process and upon federal approval.

Section 10 (256B.092, subdivision 11) updates a cross-reference.

Section 11 (256B.092, subdivision 12) modifies the statewide priorities for the developmental disabilities home and community-based waiver; authorizes DHS to transfer funds between counties, groups of counties, and tribes to accommodate statewide priorities and resource needs while accounting for a necessary base level reserve amount for each county, group of counties, or tribe; removes obsolete language.

Section 12 (256B.092, subdivision 14) adds a new subdivision providing DD waiver recipients services with a mental health or behavioral professional within 30 days of hospital discharge; and listing the duties of the mental health or behavioral professional.

Section 13 (256B.0922) creates a new section, “ESSENTIAL COMMUNITY SUPPORTS,” moving essential community supports grants provisions out of an obsolete section, and expanding the supports for individuals 65 years of age or older no longer meeting the new nursing facility level of care criteria but would otherwise qualify for the Alternative Care program, effective January 1, 2014.

Section 14 (256B.0949) creates a new section, “AUTISM EARLY INTENSIVE INTERVENTION BENEFIT,” creating a new benefit under the MA state plan to provide early intensive intervention to child with an Autism Spectrum Disorder diagnosis, with certain subdivisions effective July 1, 2013, and others effective upon federal approval but no earlier than March 1, 2014.

Sections 15 through 22 modify the Region 10 quality assurance system.

Section 15 (256B.095) removes the expiration date of June 30, 2014, for the Region 10 quality assurance system for persons with developmental disabilities.

Section 16 (256B.0951, subdivision 1) removes the expiration date of June 30, 2014, for the Quality Assurance Commission.

Section 17 (256B.0951, subdivision 4) applies the scope of the alternative quality assurance licensing system for those with all disabilities, not just developmental disabilities.

Section 18 (256B.092, subdivision 1) requires providers, not just counties, to notify MDH and the DHS of an intent to join the alternative quality assurance licensing system.

Section 19 (256B.0952, subdivision 5) modifies language to allow noncounty members of quality assurance teams to receive compensation for serving on the teams.

Section 20 (256B.0955) applies the scope of the alternative quality assurance licensing system for those with all disabilities, not just developmental disabilities, effective July 1, 2013.

Section 21 (256B.097, subdivision 1) adds conforming language to include home and community-based service (HCBS) providers licensed under Minnesota Statutes, chapter 245D.

Section 22 (256B.097, subdivision 3) extends certain requirements for the State Quality Council from its first two years (2011 to 2013) to its first four years.

Section 23 (256B.431, subdivision 44) corrects calculation errors involving property rate increases for nursing facility construction projects in Dakota and McLeod Counties, and allows a boarding care facility in Hennepin County to qualify for a nursing facility rate increase for an elevator upgrade project.

Section 24 (256B.434, subdivision 4) continues the suspension of inflation adjustments through October 1, 2016, under the alternative payment system for nursing facilities.

Section 25 (256B.434, subdivision 19a) creates a new subdivision providing a 5 percent rate increase for nursing facilities beginning September 1, 2013. A portion of the rate increase (3.75 percent) is provided automatically, with the possibility of additional increases based on quality measures calculated in a report card produced by DHS; also requires 75 percent of the automatic increase be used for direct staff wages and benefits.

Section 26 (256B.434, subdivision 19b) creates a new subdivision providing a 3.2 percent rate increase for nursing facilities beginning October 1, 2015. A portion of the rate increase (2.4 percent) is provided automatically, with the possibility of additional increases based on quality measures calculated in a report card produced by DHS; also requires 75 percent of the automatic increase be used for direct staff wages and benefits.

Section 27 (256B.437, subdivision 6) reinstates the planned closure rate adjustment, providing an incentive for nursing facilities to decertify beds.

Section 28 (256B.439, subdivision 1) requires DHS and MDH to develop and implement long-term care quality profiles for all nursing facilities no later than July 1, 2014.

Section 29 (256B.439, subdivision 2) renames the subdivision headnote to distinguish nursing facility quality measurement tools from HCBS tools, and makes a technical change.

Section 30 (256B.439, subdivision 2a) adds a subdivision requiring DHS to identify quality measurement tools for HCBS.

Section 31 (256B.439, subdivision 3a) adds a subdivision requiring DHS, following the identification of quality measurement tools in subdivision 2a, to conduct surveys of HCBS consumers to develop provider quality profiles.

Section 32 (256B.439, subdivision 5) adds a subdivision requiring DHS to develop an incentive-based grant program for HCBS providers.

Section 33 (256B.439, subdivision 6) adds a subdivision requiring DHS to determine a quality score for each HCBS provider based on the quality measures established in subdivisions 1 and 2a.

Section 34 (256B.439, subdivision 7) adds a subdivision requiring DHS to determine the quality add-on payment for HCBS providers based on the quality score established in subdivision 6 by July 1, 2015.

Section 35 (256B.441, subdivision 44) modifies the nursing facility quality score calculation beginning July 1, 2013, and allows DHS in cooperation with MDH to adjust the quality score formula once a year, effective July 1 of each year.

Section 36 (256B.441, subdivision 46b) adds a subdivision requiring DHS to determine the quality add-on payment rate increase for nursing facilities, based on their quality scores, effective September 1, 2013.

Section 37 (256B.441, subdivision 46c) adds a subdivision requiring DHS to develop a quality improvement incentive payment program for nursing facilities, using 0.8 percent of all operating payments as the available funding pool, with rates adjusted beginning October 1, 2015.

Section 38 (256B.49, subdivision 11a) allows DHS to transfer funds between counties, groups of counties, and tribes to accommodate statewide priorities and resource needs while accounting for a necessary base level reserve amount for each county, group of counties, and tribe; modifies the statewide priorities for the CAC, CADI, and BI waivers; and removes obsolete language.

Section 39 (256B.49 subdivision 14) removes a paragraph yet to take effect modifying the frequency of assessments and reassessments for waiver recipients meeting certain criteria.

Section 40 (256B.49, subdivision 15) updates a cross-reference.

Section 41 (256B.49, subdivision 25) adds a new subdivision providing CAC, CADI, and BI waiver recipients services with a mental health or behavioral professional within 30 days of hospital discharge; and listing the duties of the mental health or behavioral professional.

Section 42 (246B.49, subdivision 26) adds a subdivision making county and tribal agencies responsible for spending in excess of the home and community-based waiver allocation made by DHS; requiring agencies that spend in excess of the allocation made by DHS to submit a corrective action plan to DHS; and specifying the information that must be included in the plan.

Section 43 (256B.492) exempts individuals receiving waiver services who are in the Housing Opportunities for Persons with AIDS Program from residency ratio restrictions in community living settings.

Section 44 (256B.493) updates a cross-reference.

Section 45 (256B.501, subdivision 14) adds a new subdivision decertifying three beds in an ICF/DD in Cottonwood County and providing for a rate increase.

Section 46 (256B.501, subdivision 14) adds a subdivision requiring DHS to increase the total operating payment rate for each ICF/DD facility by $7.81 per day beginning June 1, 2013, and prohibiting the increase from being subject to any annual percentage increase.

Section 47 (256B.5012, subdivision 15) adds a subdivision providing a one percent rate increase on April 1, 2014, for ICF/DDs.

Section 48 (256B.69, subdivision 32a) adds a subdivision requiring managed care plans and county-based purchasing plans, as a condition of contract under PMAP, to implement strategies that facilitate access for young children to have periodic developmental screenings and that those who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, with the goal of meeting milestones by age five; and specifying data the plans must report to DHS.

Section 49 (256B.85) creates a new section, COMMUNITY FIRST SERVICES AND SUPPORTS. The entire section is effective upon receiving federal approval.

Subdivision 1 establishes the Community First Services and Supports (CFSS) program’s basis and scope, and replaces the personal care assistance (PCA) program, contingent upon federal approval.

Subdivision 2 lists the definitions applicable to the CFSS section.

Subdivision 3 provides who is eligible (and not eligible) for CFSS, including people receiving certain MA services, Alternative Care recipients, certain HCBS waiver recipients, among others.

Subdivision 4 states that CFSS participation does not restrict access to other services provided under the state plan MA benefit or other services provided under the Alternative Care program.

Subdivision 5 establishes the CFSS assessment process.

Subdivision 6 outlines the CFSS delivery plan requirements, including: that it be a “person-centered planning process” as defined in subdivision 2, and outlined in paragraph (c); and that DHS establishes the format and criteria.

Subdivision 7 lists the services covered under CFSS, including:

·    assistance with activities of daily living (ADL), instrumental activities of daily (IADL), and health-related procedures and tasks as defined in subdivision 2;

·    assistance in allowing participants to complete ADLs, IADLs and health-related procedures and tasks on their own;

·    expenditures on services, supports, environmental modifications, and goods—including assistive technology—to allow participants greater independence;

·    behavioral observations, redirections, and assessments;

·    back-up systems and technological devices such as pagers or other electronic devices to ensure service and support continuity;

·    costs of transitioning to less-restrictive living settings; and

·    support specialist services, as defined in subdivision 2.

Subdivision 8 requires DHS to create a home care rating methodology for determining the amount of CFSS for each participant.

Subdivision 9 lists services and goods not covered under CFSS, including:

·    those not authorized by a certified assessor or included in the CFSS service delivery plan;

·    those provided prior to authorization or approval of the CFSS service delivery plan;

·    those that duplicate other paid services in the CFSS service delivery plan;

·    those that supplant unpaid supports on a voluntary basis, chosen by the participant;

·    those that do not meet the participant’s needs;

·    those available through other funding streams;

·    those not directly benefiting the participant;

·    fees incurred by the participant, such as co-pays and legal fees;

·    insurance, except for those related to employee coverage;

·    room and board costs, not including transition costs in subdivision 7;

·    any goods, service, or support not related to an assessed need;

·    special education and related services under certain federal laws;

·    technological devices, not including those listed  in subdivision 7;

·    medical supplies and equipment;

·    environmental modifications, not including those listed in subdivision 7;

·    expenses related to training the participant or others exceeding $500 a year;

·    experimental treatments;

·    goods and services covered by MA state plan services, including medications, premiums, and co-pays, among others;

·    membership dues, unless necessary and appropriate to treat, improve, or maintain the participant’s physical condition;

·    vacation expenses;

·    vehicle maintenance or enhancement not related to the disability, health condition, or need; and

·    recreational event-related costs.

Subdivision 10 requires DHS to develop policies and procedures to ensure provider integrity and financial accountability, and establishes provider qualifications and requirements, including:

·    enrolling as an MA health care programs provider;

·    complying with MA enrollment requirements;

·    demonstrating compliance with CFSS policies;

·    complying with background study requirements;

·    verifying and maintaining participants’ service and expense records;

·    refraining from agency-initiated contact or marketing activity to potential participants, guardians, family members. or participants’ representatives;

·    paying support workers and specialists based on actual service hours provided;

·    complying with all federal and state payroll tax laws;

·    paying unemployment and liability insurance, taxes, and workers’ compensation;

·    entering into written agreements with participants and their representatives assigning roles and responsibilities before goods, services, and supports are provided;

·    reporting suspected neglect and abuse appropriately; and

·    providing participants with a copy of their service-related rights.

Subdivision 11 specifies the agency-provider model (defined in subdivision 2) characteristics, including allowing participants a role in selecting and dismissing support workers, and sharing CFSS services; and requiring agency-providers to use 72.5 percent of MA-generated revenue towards supporting worker wages and benefits.

Subdivision 12 specifies initial enrollment requirements for CFSS provider agencies, including providing:

·    current contact information;

·    proof of surety bond coverage;

·    proof of fidelity bond coverage;

·    proof of workers’ compensation insurance coverage;

·    proof of liability insurance coverage;

·    a description of the agency’s organizational structure, including the names of owners, managing employees, staff, board of  directors, and their affiliations to other service providers;

·    copies of the agency’s written policies and procedures;

·    copies of forms used by the agency in the daily course of business;

·    training requirements of the agency’s staff;

·    documentation of training completed by staff;

·    documentation of the agency’s marketing practices;

·    disclosure of ownership, leasing, or management of all residential properties currently or potentially used for home care services;

·    documentation of adherence to the MA-generated revenue requirement in subdivision 11; and

·    documentation that demonstrates the agency does not prevent former employees from working for a CFSS participant , via a signed agreement, in order to allow CFSS participants the right to choose their service provider.

Subdivision 13 specifies the budget model (defined in subdivision 2) characteristics, including:

·    allowing CFSS participants to directly employ workers and purchase other goods and services;

·    describing the role of the financial management services (FMS) contractor in assisting participants in managing their budgets and payment responsibilities;

·    allowing participants’ representatives the authority to manage the participants budget, if agreed to by the participant;

·    preventing FMS contractors from providing CFSS services;

·    outlining FMS contractor duties and responsibilities; and

·    outlining DHS’s duties and responsibilities.

Subdivision 14 lists the participants’ responsibilities under the budget model.

Subdivision 15 establishes documentation requirements for all support services provided to CFSS participants in both agency-provider and budget models.

Subdivision 16 lists support worker requirements, including background studies, training, and ability to provide the services and supports according to the CFSS participants’ service delivery plan, among others; and lists circumstances where DHS may deny or terminate support worker employment with the provider agency or CFSS participant.

Subdivision 17 requires DHS to develop qualifications, requirements, and payment rates for support specialists.

Subdivision 18 establishes budget allocation parameters for both the agency-provider and budget models.

Subdivision 19 requires DHS to provide the support necessary to ensure CFSS participants are able to manage their care and budgets, if applicable.

Subdivision 20 requires that CFSS participants must be provided the support and information necessary to choose and manage their services, and lists participants’ service-related rights including:

·    person-centered planning;

·    the range and scope of individual choices;

·    the process of changing plans, services, and budgets;

·    the grievance process;

·    individual rights;

·    identifying and assessing appropriate services;

·    risks and responsibilities; and

·    risk management.

Subdivision 21 requires DHS create a Development and Implementation Council, with a majority of members being individuals with disabilities, elderly individuals, and their representatives, to assist in the development and implementation of CFSS.

Subdivision 22 requires DHS to establish quality assurance and risk management measures for use in developing and implementing CFSS.

Subdivision 23 allows DHS immediate access to the agency provider or FMS contractor’s documents and office space (during regular business hours) without prior notice when investigating possible MA overpayment.

Subdivision 24 requires CFSS agency-providers to initiate background studies on its owners, managing employees, support specialists, and support workers, and bars agency-providers from CFSS enrollment if certain conditions related to the background studies are not met.

Subdivision 25 requires DHS to consult the Development and Implementation Council to work with stakeholders to develop recommendations to modify several CFSS provisions in order to promote self-direction, with a report due to the Legislature November 15, 2013.

This section is effective upon federal approval but no earlier than April 1, 2014.

Section 50 (256D.44, subdivision 5) exempts individuals receiving general assistance who are in the Housing Opportunities for Persons with AIDS Program from residency ratio restrictions in community living settings.

Section 51 (Laws 2011, First Special Session, ch. 9, art. 10, Sec. 3, subd. 3, as amended by Laws 2012, ch. 247, art. 4, Sec. 4) specifies that a provision reducing rates for congregate living for individuals with lower needs does not apply to individuals whose primary diagnosis is mental illness and who are living in foster care settings where the license holder is also a provider of assertive community treatment or adult rehabilitative mental health services, a certified mental health center or a certified mental health clinic, or a provider of intensive residential treatment services; effective August 1, 2013.

Section 52 (Laws 2012, chapter 247, article 6, section 4) adds language stating that an appropriation to the Board of Nursing Home Administrators was onetime.

Section 53 requires DHS to consult with specified stakeholders to develop recommendations on concentration limits on HCBS settings; requires the recommendations to be consistent with Minnesota’s Olmstead Plan; and requires recommendations and proposed legislation to the Legislature by February 1, 2014.

Section 54 requires DHS and MDH to ensure that autism service providers receive training in culturally appropriate approaches to serving certain minority communities, and other cultural groups experiencing a disproportionate incidence of autism.

Section 55 directs DHS to seek a federal approval to allow HCBS waiver recipients under age 65 to continue to use the disregard of the nonassisted spouse’s income and assets, instead of the spousal impoverishment provisions in the Affordable Care Act.

Section 56 requires DHS to apply to the Centers for Medicare and Medicaid Services, by January 1, 2014, for a waiver to provide applied behavioral analysis services to children with ASD and related conditions under the MA program; effective the day after final enactment.

Section 57 requires DHS to meet with stakeholders to develop recommendations to seek federal approval to increase the asset limit for individuals eligible for medical assistance not living in an institution, with recommendations due to the Legislature by February 1, 2014.

Section 58 requires DHS to produce reports to the Legislature—a preliminary report on October 1, 2014, and a final report on February 15, 2015—on the impact of the nursing facility level of care changes to be implemented on January 1, 2014.

Section 59 requires DHS to develop recommendations for assistive technology equipment funding, due to the Legislature on February 1, 2014.

Section 60 provides for a one percent rate increase on April 1, 2014, for the following providers: HCBS waivers, nursing services and home health services, personal care services, private duty nursing, day training and habilitation services, alternative care services, living skills training providers, and semi-independent living services; and the following grants: consumer support, family support, housing access, self-advocacy, and technology.

Section 61 requires DHS to submit for federal approval by December 31, 2013, permission to modify the financial management of HCBS waivers to provide a state-administered safety net when costs for an individual increase above an identified threshold.

Section 62 requires DHS to develop and promote a shared living model for HCBS waiver recipients, with any required federal approval submitted December 31, 2013.

Section 63 requires DHS to seek federal approval to implement the Money Follows the Person grant by December 1, 2013.

Section 64 repeals sections 256B.0917, subdivision 14 (essential community supports grants in SAIL section); 256B.096, subdivisions 1 through 4 (statewide quality assurance system); 256B.14, subd. 3a (MA spousal contribution); and Laws 2011, First Special Session ch. 9, art. 7, section 54, as amended by Laws 2012, ch. 247, art. 4, section 42, and Laws 2012, ch. 298, section 3 (1.67 percent rate cut for ICF/DDs and following providers: HCBS waivers, nursing services and home health services, personal care services, private duty nursing, day training and habilitation services, alternative care services, living skills training providers, and semi-independent living services; and the following grants: consumer support, family support, housing access, self-advocacy, and technology).

 

ARTICLE 8: WAIVER PROVIDER STANDARDS

Section 1 (13.461, subdivision 7c) adds the recording-keeping requirements of home and community-based services waivers license holders under Minnesota Statutes, chapter 245D, subject to certain provisions in the Government Data Practices chapter.

Section 2 (145C.01, subdivision 7) adds community residential settings to the definition of “health care facility” in the Health Care Directives chapter.

Section 3 (243.166, subdivision 4b) removes the word “developmental,” requiring potential recipients of residential services with nondevelopmental disabilities to disclose their status as a registered predatory offender.

Section 4 (245.8251) creates a new section, “POSITIVE SUPPORT STRATEGIES AND EMERGENCY MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS,” requiring DHS to adopt rules on the use of positive support, safety interventions, and emergency use of manual restraints in programs licensed under chapter 245D; and to develop data collection elements, with stakeholder input, specific to incidents of emergency use of manual restrain, and report data, as determined by the commissioner.

Section 5 (245.91) defines the term “emergency use of manual restraint” in the ombudsman for mental health and developmental disabilities section of law.

Sections 6 and 7 (245.94, subdivisions 2 and 2a) adds references relating to the reporting requirement of the use of manual restraints.

Section 8 (245A.02, subdivision 10) strikes obsolete language, changes a cross-reference, and applies persons with all disabilities (not just developmental disabilities) and those 65 years of age or older to the definition of nonresidential program.

Section 9 (245A.02, subdivision 12) changes a cross-reference, and applies persons with all disabilities (not just developmental disabilities) and those 65 years of age or older to the definition of nonresidential program.

Section 10 (245A.03, subdivision 7) adds community residential setting licenses to the list of licenses subject to the moratorium, and adds references to community residential settings. Clarifies that the decrease in statewide licensed capacity when a resident moves out only applies to adult settings.

Section 11 (245A.03, subdivision 8) corrects a cross-reference.

Section 12 (245A.03, subdivision 9) adds a reference to 245B successor licensing requirements.

Section 13 (245A.042, subdivision 3) clarifies language related to DHS's authority to issue correction orders and makes a cross-reference change.

Section 14 (245A.08, subdivision 2a) requires the county attorney to defend DHS's orders for sanctions in consolidated contested case hearings involving community residential settings.

Section 15 (245A.10) adds a licensing fee schedule for home and community based services and supports licensed programs, to be paid annually, based on revenues from the provision of services.

Subdivision 1 states that no application or license fee will be charged for community residential settings, except as provided in subdivision 2.

Subdivision 2 allows a county agency to charge a fee to recover the actual cost of inspection for licensing the physical plant of a community residential setting.

Subdivision 3 requires an applicant for an initial day services facility license to submit a $250 application fee with each new license, and allows applicants for a license to provide HCBS waiver services to persons with disabilities or to persons age 65 and older to submit an application to provide services statewide.

Subdivision 4 establishes the new license fee schedule for services licensed under chapter 245D, and removes obsolete language.

Section 16 (245A.11, subdivision 2a) makes technical language changes, consistent with other changes made in this article, related to community residential settings.

Section 17 (245A.11, subdivision 7) requires transfer of a variance granted under this subdivision when an adult foster home license holder converts to a community residential setting license under chapter 245D.

Section 18 (245A.11, subdivision 7a) updates terminology and strikes obsolete language.

Section 19 (245A.11, subdivision 7b) updates terminology and strikes obsolete language.

Section 20 (245A.11, subdivision 8) strikes references to child foster care and to residential support services, and adds a cross-reference to the definition of community residential setting.

Section 21 (245A.16, subdivision 1) prohibits county agencies from granting variances for community residential setting licenses. Adds new paragraph (f) requiring the commissioner to consider the role and duties of the counties when implementing chapter 245D.

Section 22 (245D.02) adds and modifies definitions.

Section 23 (245D.03) modifies the “APPLICABILITY AND EFFECT” section, effective January 1, 2014.

Subdivision 1 modifies the list of services governed by the licensing standards in this chapter by stating that this chapter governs the provisions of basic support services and intensive support services, and defines the terms.

Subdivision 2 modifies standards related to foster care services; exempts license holders providing services in supervised living facilities, residential services to person in an ICF/DD, and homemaker services from certain standards; specifies nothing in this chapter prohibits a license holder from concurrently serving persons without disabilities or people who are or are not age 65 or older, provided all relevant standards are met.

Subdivision 3 corrects a cross-reference

Subdivision 4 is deleted.

Subdivision 5 allows an applicant or license holder to apply for program certification.

Section 24 (245D.04) modifies the “SERVICE RECIPIENT RIGHTS” section, effective January 1, 2014, modifying terminology, a person’s service-related rights, and a person’s protection-related rights.

Section 25 (245D.05) modifies the “HEALTH SERVICES” section, effective January 1, 2014, defining and specifying responsibilities of medication setup, medication assistance, and medication administration.

Section 26 (245D.051) creates a new section, “PSYCHOTROPIC MEDICATION USE AND MONITORING,” listing the requirements for psychotropic medication administration, and procedures for license holders to follow when a person refuses to take psychotropic medication.

Section 27 (245D.06) modifies the “PROTECTION STANDARDS” section, effective January 1, 2014.

Subdivision 1 makes technical and conforming changes; specifies when incident reviews must be conducted and what must be included in the review; requires license holders to report the emergency use of manual restraint of a person to DHS within 24 hours of the occurrence; specifies reporting requirements when a death or serious injury occurs at an ICF/DD.

Subdivision 2 modifies the list of duties license holders must perform related to environment and safety.

Subdivision 3 is deleted.

Subdivision 4 specifies when authorization must be received and other license holder duties when the license holder assists a person with the safekeeping of funds or other property; removes language prohibiting license holders from being appointed a guardian or conservator of a person receiving services from the license holder; specifies license holder duties upon the transfer or death of a person.

Subdivision 5 prohibits license holders from using chemical restraints, mechanical restraints, manual restraints, time out, seclusion or any other aversive or deprivative procedure as a substitute for adequate staffing, a behavioral or therapeutic program to reduce or eliminate behavior, as punishment, or for staff convenience.

Subdivision 6 is related to restricted procedures.

Subdivision 7 specifies permitted actions and procedures. Instructional techniques and intervention procedures are permitted on an intermittent or continuous basis.

Subdivision 8 requires license holders to develop a positive support transition plan for a person who requires intervention in order to maintain safety.

Section 28 (245D.061) creates a new section, “EMERGENCY USE OF MANUAL RESTRAINTS,” effective January 1, 2013.

Subdivision 1 specifies standards for emergency use of manual restraints.

Subdivision 2 provides conditions for emergency use of manual restraint.

Subdivision 3 lists the restrictions when implementing emergency use of manual restraint.

Subdivision 4 provides monitoring requirements related to emergency use of manual restraint.

Subdivision 5 requires the staff person to report within three calendar days to the designated coordinator the use of manual restraint, and specifies the information that must be in the report.

Subdivision 6  requires license holders to complete and document an internal review of each report of emergency use of manual restraint within five working days, lists the information that must be evaluated as part of the review, and requires a corrective action plan to be developed and implemented if any lapses in performance are found.

Subdivision 7 requires license holders to consult with the expanded support team following the emergency use of manual restraint.

Subdivision 8 requires license holders to develop, document, and implement policies and procedures for the emergency use of manual restraints, and specifies the information that must be included in the policy and procedures.

Section 29 (245D.07) modifies this section, and changes the title to “SERVICES PLANNING AND DELIVERY,” effective January 1, 2014.

Subdivision 1 makes technical changes

Subdivision 1a requires license holders to provide services in response to the person’s identified needs and preferences as specified in the coordinated service and support plan, the plan addendum, and with provider standards, and lists the principles that must guide provision of services.

Subdivision 2 specifies timelines for developing the coordinated service and support plan addendum based on the coordinated service and support plan, and makes conforming changes.

Section 30 (245D.071) creates a new section, “SERVICE PLANNING AND DELIVERY; INTENSIVE SUPPORT SERVICES,” effective January 1, 2014.

Subdivision 1 specifies the requirements license holders providing intensive support services must meet.

Subdivision 2 requires license holders to develop, document, and implement an abuse prevention plan prior to or upon initiating services.

Subdivision 3 specifies the timelines and processes license holders must follow for developing the coordinated service and support plan addendum for a person.

Subdivision 4 requires service outcomes and supports to be developed by the license holder and included in the coordinated service and support plan addendum; requires the license holder to document the supports and lists the information that must be included in the documentation; requires the license holder to obtain dated signatures from the person or the person’s legal representative and case manager to document completion and approval of the plan addendum.

Subdivision 5 specifies the process for progress reviews.

Section 31 (245D.081) creates a new section, “PROGRAM COORDINATION, EVALUATION AND OVERSIGHT,” effective January 1, 2014.

Subdivision 1 lists license holder responsibilities related to program coordination and evaluation.

Subdivision 2 requires delivery and evaluation of services provided by the license holder to be coordinated by a designated staff person; lists activities for which the designated coordinator must provide supervision, support, and evaluation; lists education and training requirements for designated coordinators.

Subdivision 3 requires license holders to designate a managerial staff person or persons to provide program management and oversight of the services provided by the license holder; lists the responsibilities of the designated manager; specifies the education, training, and supervisory experience necessary to be a designated manager.

Section 32 (245D.09) modifies the “STAFFING STANDARDS” section, effective January 1, 2014.

Subdivision 1 modifies staffing requirements.

Subdivision 2 modifies terminology.

Subdivision 3 makes conforming language changes and modifies staff qualifications.

Subdivision 4 modifies orientation requirements.

Subdivision 4a modifies requirements related to orientation to individual service recipient needs.

Subdivision 5 modifies annual training requirements for direct support staff.

Subdivision 5a allows alternative sources of training and specifies requirements for license holders related to documenting alternative sources of training.

Subdivision 6 modifies license holder requirements related to subcontractors and temporary staff.

Subdivision 7 modifies terminology and requires license holders to ensure that a background study has been completed and to maintain documentation that applicable requirements have been met.

Subdivision 8 requires license holders to develop a staff orientation and training plan documenting when and how compliance with orientation and training requirements will be met.

Section 33 (245D. 091) creates a new section, “INTERVENTION SERVICES,” effective January 1, 2014

Subdivision 1 specifies that certain employees of licensed programs providing specified services do not have to hold a separate license under this chapter; and individuals who are not providing services as an employee of a licensed program must obtain a license according to this chapter. 

Subdivision 2 lists qualifications for behavior professionals, as defined in the BI and CADI waiver plans.

Subdivision 3 lists qualifications for behavior analysts, as defined in the BI and CADI waiver plans.

Subdivision 4 lists qualifications for behavior specialists, as defined in the BI and CADI waiver plans.

Subdivision 5 lists qualifications for an individual providing specialist services, as defined in the DD waiver plan.

Section 34 (245D. 095) creates a new section, “RECORD REQUIREMENTS,” effective January 1, 2014, outlining the record keeping requirements for providers licensed under Chapter 245D.

Section 35 (245D.10) modifies the “POLICIES AND PROCEDURES” section, effective January 1, 2014.

Subdivision 1 modifies license holder policy and procedure requirements.

Subdivision 2 requires the complaint process to promote service recipient rights.

Subdivision 3 modifies requirements related to policies and procedures for service suspension and service termination.

Subdivision 4 modifies license holder requirements related to making available current written policies and procedures.

Section 36 (245D.11) creates a new section, “POLICIES AND PROCEDURES; INTENSIVE SUPPORT SERVICES,” effective January 1, 2014.

Subdivision 1 requires license holders providing intensive support services to establish, enforce, and maintain required policies and procedures.

Subdivision 2 requires license holders to establish policies and procedures that promote health and safety, and lists health and safety requirements.

Subdivision 3 requires license holders to establish policies and procedures that promote service recipient rights by ensuring data privacy according to the Minnesota Government Data Practices Act and the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Subdivision 4 requires license holders to establish policies and procedures that promote continuity of care by ensuring certain admission or service initiation criteria are met.

Section 37 (245D.21) creates a new section, “FACILITY LICENSURE REQUIREMENTS AND APPLICATION PROCESS,” effective January 1, 2104; defining “facility” and specifying requirements related to inspections and code compliance.

Section 38 (245D.22) creates a new section, “FACILITY SANITATION AND HEALTH,” effective January 1, 2014.

Subdivision 1 requires license holders to maintain the interior and exterior of buildings used by the facility in good repair and in a sanitary and safe condition; requires license holders to correct building and equipment deterioration, safety hazards, and unsanitary conditions.

Subdivision 2 requires license holders to ensure that service sites owned or leased by the license holder are free from hazards that would threaten the health or safety of a person receiving services; and lists requirements that must be met.

Subdivision 3 requires certain controlled substances to be stored in a locked storage area permitting access only by persons and staff authorized to administer the medication, and requires medications to be disposed of according to EPA recommendations.

Subdivision 4 requires staff people trained in first aid to be available onsite and, when required in a person’s coordinated service and support plan, cardiopulmonary resuscitation; requires facilities to have first aid kits readily available; specifies the items with which first aid kits must be equipped.

Subdivision 5 requires license holders to have a written plan for responding to emergencies to ensure the safety of persons in the facility and lists information that must be included in the plan.

Subdivision 6 requires each facility to have a flashlight and a portable radio or TV that do not require electricity and can be used if a power failure occurs.

Subdivision 7 requires each facility to have a noncoin operated telephone that is readily accessible; requires a list of emergency numbers to be posted in a prominent location; specifies the numbers that must be included on the list of emergency numbers; and requires the names and telephone numbers of each person’s representative, physician, and dentist to be readily available.

Section 39 (245D.23) creates a new section, “COMMUNITY RESIDENTIAL SETTINGS; SATELLITE LICENSURE REQUIREMENTS AND APPLICATION PROCESS,” effective January 1, 2014.

Subdivision 1 requires license holders providing residential support services to obtain a separate satellite license for each community residential setting located at separate addresses when the settings are to be operated by the same license holder; specifies a community residential setting is a satellite of the HCBS license; specifies community residential settings are permitted single-family use homes, and requires DHS to notify the local municipality where the residence is located of the approved license.

Subdivision 2 requires license holders to notify the local agency within 24 hours of the onset of changes in a residence resulting from construction, remodeling, or damages requiring repairs that require a building permit or may affect a licensing requirement.

Subdivision 3 specifies requirements for license holders who have been granted an alternate overnight supervision technology adult foster care license.

Section 40 (245D.24) creates a new section, “COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL PLANT AND ENVIRONMENT,” effective January 1, 2014.

Subdivision 1 requires the residence to meet the definition of a dwelling unit in a residential occupancy.

Subdivision 2 requires the living area to be provided with an adequate number of furnishings for the usual functions of daily living and social activities; requires the dining area to be furnished to accommodate meals shared by all persons living in the residence; and requires furnishings to be in good repair and functional to meet the daily needs of the persons living in the residence.

Subdivision 3 requires persons receiving services to mutually consent to sharing a bedroom with one another; specifies no more than two people receiving services may share one bedroom; and specifies size, furnishings, and other requirements bedrooms must meet.

Section 41 (245D.25) creates a new section, “COMMUNITY RESIDENTIAL SETTINGS; FOOD AND WATER,” effective January 1, 2014; outlining food and nutrition requirements for community residential settings.

Section 42 (245D.26) creates a new section, “COMMUNITY RESIDENTIAL SETTINGS; SANITATION AND HEALTH,” effective January 1, 2014; outlining requirements related to:  goods provided by the license holder, personal items, pets and service animals, smoking and weapons.

Section 43 (245D.27) creates a new section, “DAY SERVICES FACILITIES; SATELLITE LICENSURE REQUIREMENTS AND APPLICATION PROCESS,” effective January 1, 2014; requiring license holders providing day services to apply for separate licenses for each facility-based service site when the license holder is the owner, lessor, or tenant of the service site at which services are provided more than 30 days within any 12-month period, and allowing a day services program to operate multiple licensed day service facilities in one or more counties in the state.

Section 44 (245D.28) creates a new section, “DAY SERVICES FACILITIES; PHYSICAL PLANT AND SPACE REQUIREMENTS,” effective January 1, 2014; specifying facility capacity and useable space requirements for day services facilities, and requires each person to be provided space for storage of personal items for the person’s own use while receiving services at the facility.

Section 45 (245D.29) creates a new section, “DAY SERVICES FACILITIES; HEALTH AND SAFETY REQUIREMENTS,” effective January 1, 2014; outlining food safety procedures for the license holder to follow, and requirements for when an individual becomes ill; also requires license holders to put in writing safety procedures.

Section 46 (245D.31) creates a new section, “DAY SERVICES FACILITIES; STAFF RATIO AND FACILITY COVERAGE,” effective January 1, 2014.

Subdivision 1 makes this section apply only to facility-based day services.

Subdivision 2 lists factors that affect the number of direct support staff members license holders are required to have on duty at the facility at a given time; and requires DHS to consider these factors in determining license holders' compliance with staffing requirements and whether the staff ratio requirement for each person receiving services accurately reflects the person’s need for staff time.

Subdivision 3 specifies the process for the case manager to determine the staff ratio assigned to each person receiving services and requires documentation of how the ratio was determined.

Subdivision 4 specifies the conditions under which a person must be assigned a staff ratio of one to four.

Subdivision 5 specifies the conditions under which a person must be assigned a staff ratio of one to eight.

Subdivision 6 requires a person who does not have any of the characteristics described in subdivisions 4 and 5 to be assigned a staff ratio of one to six.

Subdivision 8 requires only direct support staff to be counted as staff members in calculating the staff to participant ratio, and allows volunteers to be counted under certain circumstances.

Subdivision 9 requires license holders to increase the number of direct support staff persons present at any one time beyond the number required if necessary under specified circumstances.

Subdivision 10 prohibits one direct support staff member from being assigned responsibility for supervision and training of more than ten persons receiving supervision and training, except as otherwise stated in each person’s risk management plan; and requires a direct support staff member to be assigned to supervise the center in the absence of the director or a supervisor.

Subdivision 11 allows multifunctional programs to count other employees of the organization besides direct support staff of the day service facility in calculating the staff to participant ratio, if the employee is assigned to the day services facility for a specified amount of time during which the employee is not assigned to another organization or program.

Section 47 (245D.32) creates a new section, “ALTERNATIVE LICENSING INSPECTIONS,” effective January 1, 2014.

Subdivision 1 allows community residential setting and day services facility license holders to request approval for an alternative licensing inspection when all services provided under the license holder’s license are accredited and certain other requirements are met.

Subdivision 2 requires DHS to accept a three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities as a qualifying accreditation.

Subdivision 3 specifies the process for requesting approval of an alternative inspection.

Subdivision 4 requires license holders approved for alternative licensing inspection to maintain compliance with all licensing standards, prohibits DHS from performing routine licensing inspections, and requires DHS to investigate complaints and take action as provided for in human services licensing statutes.

Subdivision 5 specifies that DHS retains the responsibility to investigate alleged or suspected maltreatment of a minor or a vulnerable adult.

Subdivision 6 allows DHS to terminate or deny subsequent approval of an alternative licensing inspection if DHS makes certain determinations.

Subdivision 7 prohibits appeals of DHS's decision that the conditions for approval for an alternative licensing inspection have not been met.

Subdivision 8 excludes certain licensed HCBS providers from being approved for an alternative licensing inspection.

Section 48 (245D.33) creates a new section, “ADULT MENTAL HEALTH CERTIFICATION STANDARDS,” effective January 1, 2014; requiring DHS to issue a mental health certification for services licensed under this chapter when a license holder is determined to have met certain requirements; makes this certification voluntary for license holders; requires the certification to be printed on the license and identified on DHS's public Web site; lists the requirements for certification; requires license holders seeking this certification to request it on forms and in the manner prescribed by DHS; allows DHS to issue correction orders, orders of conditional license, or sanctions if DHS finds that a license holder has failed to comply with the certification requirements; and prohibits appeals when a certification is denied or removed based on a determination that the certification requirements have not been met.

Sections 49 and 51 (256B.092, subdivision 1a, 256B.49, subdivision 13) require case managers to participate in the development and ongoing evaluation of the plan for a person who needs a positive support transition plan under chapter 245D.

Section 50 (256B.092, subdivision 11) modifies the types of settings than can provide residential support services and the criteria residential support services must meet.

Section 52 (256B.4912, subdivision 1) adds cross-references and modifies provider qualifications beginning January 1, 2014.

Section 53 (256B.4912, subdivision 7) adds cross-references and requires newly enrolled HCBS providers to ensure that at least one controlling individual has completed training on waiver and related program billing within six months of enrollment.

Section 54 (256B.4912, subdivision 8) adds a subdivision requiring facilities and services licensed under chapter 245D to submit data regarding the use of emergency use of manual restraint.

Section 55 (256B.4912, subdivision 9) adds a subdivision defining “controlling individual,” “managerial officer,” and “owner” for this section.

Section 56 (256B.4912, subdivision 10 ) adds a subdivision listing the information and documentation all HCBS waiver providers must provide to DHS at the time of enrollment and within 30 days of a request.

Section 57 (626.557, subdivision 9) strikes the requirement for the common entry point to report allegations of maltreatment to the county when the report involves services licensed under chapter 245D.

Section 58 (626.5572, subdivision 13) states that DHS is the lead investigative agency for reports involving vulnerable adults who are receiving HCBS subject to chapter 245D.

Section 59. (Report on transfer of vulnerable adult maltreatment investigation duties.) Requires the commissioner to provide a report to the chairs and ranking minority members recommending how maltreatment investigations, conducted by the commissioner, should be funded and at what amount.

Section 60. (Integrated licensing system for home care and home and community-based services.)   requires MDH and DHS to jointly develop an integrated licensing system for providers of both home care services and for HCBS; lists components that must be included in the integrated licensing system; requires that before the implementation of the integrated licensing system, licensed home care providers be allowed to provide home and community-based services without obtaining a HCBS license; and lists conditions that apply to these providers.

Section 61 repeals, effective January 1, 2014, obsolete provisions in chapter 245B, and repeals section 245D.08 (record requirements).

 

ARTICLE 9

WAIVER PROVIDER STANDARDS TECHNICAL CHANGES

This article contains technical modifications related to the changes made in article 8.

 

ARTICLE 10

 HEALTH-RELATED LICENSING BOARDS

Section 1 (148B.17, subd. 2) decreases the fees imposed by the Board of Marriage and Family Therapy.

Section 2 (151.19, subd. 1) modifies the pharmacy licensure requirements to specify a separate license for in-state pharmacies and out-of-state pharmacies.

Section 3 (151.19, subd. 3) requires a person or establishment not licensed as a pharmacy or a practitioner to register with the Board of Pharmacy before engaging in the retail sale or distribution of federally restricted medical gases and establishes requirements for the registration.

Section 4 (151.252) modifies the licensure requirements for drug manufacturers.

Section 5 (151.37, subd. 4) authorizes a licensed pharmacy to dispense or distribute drugs to be used by or to be administered to patients enrolled in a bona fide research study that is being conducted pursuant to either an investigational new drug application approved by the FDA or that has been approved by an institutional review board.

Section 6 (151.47, subd. 1) modifies the licensure requirements for wholesale drug distributors.  Requires out-of-state drug wholesalers to be licensed or registered by the state in which they are physically located before a license will be issued or renewed by the board.  Requires the facility to pass an inspection conducted by an authorized representative of the board before the board will issue or renew a license.

Section 7 (151.47, subd. 3)  specifies that it is unlawful for any person engaged in wholesale drug distribution to sell drugs to a person located within the state or to receive drugs in reverse distribution from a person located within the state, except as provided in chapter 151.

Section 8 (151.49) makes technical changes to the application procedures for licensure renewal.

Section 9 (214.075) establishes criminal background checks for health-related licensing boards.

Subdivision 1 states that by January 1, 2018, the health-related licensing boards shall require applicants to submit to a criminal history records check of state data completed by the Bureau of Criminal Apprehension (BCA) and a national criminal history records check, including a search of the records of the FBI.

Subdivision 2 states that a health-related licensing board may request a licensee to submit to a criminal history records check and a national criminal history records check if the board has reasonable cause to believe that a licensee has been charged with or convicted of a crime.

Subdivision 3 requires a licensee or applicant to submit a completed criminal history records check consent form and a full set of fingerprints to the board.  The applicant or licensee is responsible for the fees associated with the fingerprints, consent form, and background check.  The fees for the background check shall be set by the BCA and FBI and are not refundable.

Subdivision 4 states that a board shall not issue a license to an applicant, if the applicant refuses to submit to a criminal background check or to submit fingerprints within 90 days after submission of an application for licensure.  Any fees paid by the applicant are forfeited.  Failure of a licensee to submit to a criminal background check is grounds for disciplinary action by the board.

Subdivision 5 requires the boards to submit applicant and licensee fingerprints to the BCA.  The BCA is required to perform a check for state criminal justice information and then forward the fingerprints to the FBI to perform a check for national criminal justice information.  The BCA must report back to the board on the results of both the state and national criminal justice information checks.

Subdivision 6 permits the boards to require an alternative method of criminal history checks for an applicant or licensee who has submitted at least three sets of fingerprints that have been unreadable by the BCA or the FBI.

Subdivision 7 provides the applicant or licensee an opportunity to complete or challenge the accuracy of the criminal history information reported to the board before the board can take action based on a criminal conviction.

Subdivision 8 requires the boards to establish a plan for completing criminal background checks of all licensees who were licensed before January 1, 2018, the plan must be developed no later than January 1, 2017, and may be contingent upon the implementation of a system by the BCA or FBI in which new crimes that an applicant or licensee commits after an initial background check are flagged in the BCA’s or FBI’s database and reported back to the board.

Section 10 (214.12, subd. 4) requires the boards that regulate professions that serve caregivers at risk of depression or their children to provide educational materials to licensees on parental depression and its effect on children if unaddressed.

Section 11 (214.40, subd. 1) adds dental therapists and advanced dental therapists to the providers that are covered under the volunteer health care provider program.

Section 12 provides that if the Department of Health is not reviewed by the Sunset Advisory Commission, the commissioner shall require occupational therapy practitioners, speech-language pathologists, audiologists, and hearing instrument dispensers to submit to a criminal history background check. 

Section 13 repeals sections 151.19, subd. 2 (nonresident pharmacies); 151.25 (registration of manufacturers); 151.45 (wholesale drug distributor advisory task force); 151.47, subd.2 (wholesale drug distributor licensing conformance to federal law); and 151.48 (out-of-state wholesale distributor licensing). 

ARTICLE 11: HOME CARE PROVIDERS

Section 1 (13.381, subdivision 2) updates a cross-reference.

Section 2 (13.381, subdivision 10) clarifies that data regarding home care and hospice providers background studies are governed by section 144A.476, subdivision 1.

Section 3 (144.051, subdivision 3) creates a new subdivision specifying what data collected from home care providers falls under the definition of “private data on individuals.”

Section 4 (144.051, subdivision 4) creates a new subdivision specifying what data collected from home care providers falls under the definition of “public data.”

Section 5 (144.051, subdivision 5) creates a new subdivision specifying what data collected from home care providers falls under the definition of “confidential data on individuals.”

Section 6 (144.051, subdivision 6) allows the Minnesota Department of Health (MDH) to share private or confidential data, except Social Security numbers, to the appropriate state, federal and local government agency and law enforcement office for investigation or enforcement efforts.

Section 7 (144A.43) lists definitions applicable to sections 144.699, subdivision 2 and 144A.43 to 144A.482.

Section 8 (144A.44) modifies the “HOME CARE BILL OF RIGHTS” section.

Section 9 (144A.45) modifies the “REGULATIONS OF HOME CARE SERVICES” section.

Section 10 (144A.471) creates a new section “HOME CARE PROVIDER AND HOME CARE SERVICES.”

Subdivision 1 requires home care service providers to be licensed by MDH.

Subdivision 2 defines and describes “direct home care service.”

Subdivision 3 defines and describes “regularly engaged.”

Subdivision 4 states it is a misdemeanor to operate home care services without a license.

Subdivision 5 requires a home care provider to have a basic or comprehensive home care license.

Subdivision 6 requires providers of assistive tasks services be licensed under the basic home care license, and defines and describes “assistive tasks.”

Subdivision 7 outlines the requirements for comprehensive home care licensure.

Subdivision 8 lists the exemptions from home care service licensure.

Subdivision 9 lists the exclusions from home care licensure.

Section 11 (144A.472) creates a new section, “HOME CARE PROVIDER LICENSE; APPLICATION AND RENEWAL,” describing the license application and renewal process, including the fee schedule.

Section 12 (144A.473) creates a new section, “ISSUANCE OF TEMPORARY LICENSE AND LICENSE RENEWAL,” describing the temporary license application and renewal process.

Section 13 (144A.474) creates a new section “SURVEYS AND INVESTIGATIONS.”

Subdivision 1 requires MDH to survey each home care provider.

Subdivision 2 lists and describes the various types of home care provider surveys: initial full survey, core survey, full survey, and follow-up survey.

Subdivision 3 describes the core survey process.

Subdivision 4 allows the surveys to be conducted without advance notice.

Subdivision 5 requires home care providers to provide accurate survey information.

Subdivision 6 requires home care providers to provide MDH with a list of current and past clients upon request.

Subdivision 7 allows surveyors to visit or interview clients without the home care provider’s knowledge.

Subdivision 8 describes the correction orders process for license holders not in compliance with sections 144A.43 to 144A.482.

Subdivision 9 describes the follow-up survey process for providers with Level III or IV violations.

Subdivision 10 creates a performance incentive of ten percent off the home care provider license fee for no violations in the core or full survey.

Subdivision 11 creates a fine structure and process for home care provider license violations.

Subdivision 12 establishes and outlines the correction order reconsideration process.

Subdivision 13 outlines the home care surveyor training requirements.

Section 14 (144A.475) creates a new section, “ENFORCEMENT.”

Subdivision 1 lists the conditions that would allow MDH to refuse to grant a temporary license or renew a license, suspend or revoke a license or impose a conditional license.

Subdivision 2 lists the terms for license suspension or conditional licensure.

Subdivision 3 requires MDH to notify license holders prior to suspending, revoking or refusing to renew a license.

Subdivision 4 describes the time limit for appeals of civil penalties.

Subdivision 5 requires suspension or revocation of licensure to include a plan to transfer affected clients to other home care providers; requires home care providers under suspension or revocation to provide MDH certain client information.

Subdivision 6 prevents owners and managerial officials of home care provider agencies whose license has been denied renewal or revoked from receiving a home care provider license, or given special status as an enrolled PCA provider by DHS, for at least five years.

Subdivision 7 outlines the request for hearing process.

Subdivision 8 allows informal conference between home care providers or license applicants and MDH.

Subdivision 9 allows MDH to bring action in district court to enjoin a person who is involved in the management, operation or control of a home care provider agency (or employee of an agency) from illegally engaging in home care services.

Subdivision 10 gives the Commissioner of Health subpoena power in matters pending under home care services sections of law.

Section 15 (144A.476) creates a new section, “BACKGROUND STUDIES.”

Subdivision 1 requires background studies of owners and managerial official prior to issuance of a temporary license or license renewal, and allows for a reconsideration if any individual is disqualified; defines owners and managerial officials of home care providers.

Subdivision 2 requires background studies on all employees, contractors and volunteers of a home care provider.

Section 16 (144A.477) creates a new section, “COMPLIANCE.”

Subdivision 1 requires MDH to administer surveys to licensees at the same time as Medicare certification surveys, if feasible.

Subdivision 2 allows comprehensive home care services license holders to meet several state license regulations if they are also certified to participate in Medicare as a home health agency; lists the applicable state regulations.

Section 17 (144A.478) creates a new section, “INNOVATION VARIANCE,” allowing specified alternatives to requirements Chapter 144A if certain conditions and application procedures are met; also describes the granting and denial process, revocation and denial of renewal process due  to violations.

Section 18 (144A.479) creates a new section, “HOME CARE PROVIDERS RESPONSIBILITIES; BUSINESS OPERATIONS,” listing home care provider requirements for  its  business operations, including: license display, advertising, quality management, provider restrictions, handling of clients’ finances and property, reporting of maltreatment of vulnerable adults and children, and employee record keeping.

Section 19 (144A.4791) creates a new section, “HOME CARE PROVIDER RESPONSIBILITIES WITH RESPECT TO CLIENTS.”

Subdivision 1 requires home care providers to provide information on the Home Care Bill of Rights under 144A.44, along with information on how to file a complaint.

Subdivision 2 requires home care providers serving clients with Alzheimer’s disease or other dementia-related conditions to provide information on the training of employees to clients, families and others requesting the information.

Subdivision 3 requires home care providers to inform clients of their level of licensure—basic or comprehensive—and obtain written acknowledgement that the information was provided to the client.

Subdivision 4 prevents home care providers from accepting clients if they do not have the proper staff to serve them.

Subdivision 5 requires home care providers to refer clients to another health service if it is believe they are in need of different care, and assist clients in obtaining new care.

Subdivision 6 describes the process for initiation of home care services.

Subdivision 7 describes the process for providing an initial individualized review for clients using services provided by a basic home care provider.

Subdivision 8 describes the process for providing an initial individualized review for clients using services provided by a comprehensive home care provider.

Subdivision 9 outlines the process to be followed by home care providers for finalizing and implementing client’s written service plans.

Subdivision 10 outlines the process and responsibilities to be followed by home care providers if they terminate a service plan.

Subdivision 11 outlines the client complaint and investigation process.

Subdivision 12 requires home care providers to have a written disaster and emergency preparedness plan.

Subdivision 13 outlines the procedures to be followed by employees of home care providers if clients request discontinuation of life-sustaining treatment.

Section 20 (144A.4792) creates a new section, “MEDICATION MANAGEMENT,” outlining processes and procedures for comprehensive home care providers who provide medication management services, including requirements for prescription, nonprescription and over-the-counter medication.

Section 21 (144A.4793) creates a new section, “TREATMENT AND THERAPY MANAGEMENT SERVICES,” outlining the processes and procedures for comprehensive home care providers who provide treatment and therapy management services, including administration and documentation requirements.

Section 22 (144A.4794) creates a new section, “CLIENT RECORD REQUIREMENTS,” outlining the client record requirements, including the content of the information in the records, records transfers and records retention.

Section 23 (144A.4795) creates a new section, “HOME CARE PROVIDER RESPONSIBILITIES; STAFF,” outlining home care provider responsibilities with regard to staff training requirements for licensed health professionals and nurses, unlicensed personnel, contractors and temporary staff.

Section 24 (144A.4796) creates a new section, “ORIENTATION AND ANNUAL TRAINING REQUIREMENTS,” outlining the licensing regulations and requirements training for all staff providing and supervising basic and comprehensive home care services.

Section 25 (144A.4797) creates a new section, “PROVISION OF SERVICES.”

Subdivision 1 requires basic home care providers to have a person available to staff for consultation on client’s or their provisions of service; requires comprehensive home care providers to have a registered nurse available to staff for consultation, and have the appropriately licensed health professional available if performing services such as therapies.

Subdivision 2 establishes supervision requirements for staff performing basic home health services.

Subdivision 3 establishes supervision requirements for staff performing delegated nursing or therapy home care tasks.

Subdivision 4 requires supervision activities documentation in personnel records.

Subdivision 5 provides an exemption to this section for individuals licensed as home care providers.

Section 26 (144A.4798) creates a new section, “EMPLOYEE HEALTH STATUS,” requiring home care providers to establish and maintain a tuberculosis prevention and control program according the Centers for Disease and Control and Prevention’s (CDC) most current guidelines, and follow current federal or state guidelines for prevention, control and reporting of HIV, hepatitis B and C viruses, and other communicable diseases.

Section 27 (144A.4799) creates a new section, “DEPARTMENT OF HEALTH LICENSED HOME CARE PROVIDER ADVISORY COUNCIL,” creating an advisory council to provide advice to MDH on home care provider regulations.

Section 28 (144A.481) creates a new section, “HOME CARE LICENSING IMPLEMENTATION FOR NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES,” allowing for temporary licenses to be issued to new licensees, and procedures and timelines for current licensees to receive new licenses under Chapter 144A.

Section 29 (144A.482) creates a new section, “REGISTRATION OF HOME MANAGEMENT PROVIDERS,” defining home management services, requiring home management services providers to receive a certificate from MDH, and establishing certification fees and requirements.

Section 30 requires MDH to submit to the legislature on home care licensing due each October 1 beginning in 2015, and to study the correction order appeal process with a report due to the legislature by February 1, 2016.

Section 31 requires MDH and DHS to develop an integrated licensing system for providers of home care services under Chapter 144A and home and community-based services waivers licensed under Chapter 245D, requiring only one license where there is jurisdictional overlap and outlining the process for how the two departments will coordinate the oversight of other licensees. A joint recommendations report is due to the legislature by February 15, 2014.

Section 32 requires MDH to study the correction order appeal process with a report due to the legislature by February 1, 2016.

Section 33 repeals sections 144A.46 (current home care provider licensing section) and 144A.461 (current home management provider certification section); also repeals several Minnesota Rules (parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 4668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040; 4668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100; 4668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160; 4668.0170; 4668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220; 4668.0230; 4668.0240; 4668.0800; 4668.0805; 4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830; 4668.0835; 4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870; 4669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; and 4669.0050) related to home care licensure now codified in statute.

ARTICLE 12: HEALTH DEPARTMENT

Section 1 (16A.724, subd. 2) transfers $1,000,000 each year from the health care access fund to the medical education and research costs (MERC) fund to be distributed as grants to family medicine residency programs located outside of the seven-county metropolitan area.

Section 2 (43A.23) requires the state employee group insurance program to provider coverage for autism spectrum disorders effective January 1, 2016, or the date of the next collective bargaining agreement.

Section 3 (62A.3094) requires health plans issued to large employers to provide coverage for autism spectrum disorder.

Subd. 1.  Definitions.  Defines the term “autism spectrum disorders” to include autism and related conditions.  Defines the term “health plan” to include all private sector health coverage, both individual and group, that the state can regulate.  Defines “medically necessary care” for purposes of this section.  Defines “mental health professional” in the same manner as it is defined in the Children’s Mental Health Act.

Subd. 2.  Optional coverage required.  Requires health plans offered to large employers to provide benefits related to autism spectrum disorders.  Prohibits health plans from refusing to renew, issue, or otherwise terminating an enrollee’s insurance coverage due to the enrollee having an autism spectrum disorder. Prohibits health plans from requiring an updated treatment plan more often than every six months, unless the health plan and treating provider agree to a more frequent schedule for updates. Requires an independent progress evaluation to be conducted by a mental health professional to determine whether progress is being made.

Subd. 3.  No effect on other law.  Provides that nothing in this section limits mental health coverage required under Minnesota Statutes, section 62Q.47.

Subd. 4.  State health care programs.  Provides that the coverage requirements in this section do not affect the benefits available under medical assistance, and MinnesotaCare.

Effective date:  Makes the law effective January 1, 2014, and applies to health plans offered, sold, or issued, or renewed on or after that date.

Section 4 (62J.692, subd. 1) expands the definition of clinical medical education program to include dental therapists, advanced dental therapists, psychologists, clinical social workers, community paramedics, and community health workers.

Section 5 (62J.692, subd. 3) expands the definition of clinical medical education program to include dental therapists, advanced dental therapists, psychologists, clinical social workers, community paramedics, and community health workers

Section 6 (62J.692, subd. 4) modifies the distribution formula by reducing the supplemental public program volume factor, by ten percent for fiscal years 2014 and 2015, and, by eliminating it in fiscal year 2016 and thereafter; limiting eligibility to training sites with more than 0.1 FTEs, and raising the minimum grants from $1000 to $5000.  This section also limits the use of the funds to expenses related to the clinical training program costs.

Section 7 (62J.692, subd. 5) requires the training sites to include in the grant verification report a training site expenditure report.

Section 8 (62J.692, subd. 9) removes a reference to the advisory committee.

Section 9 (62J.692, subd. 11) specifies that if federal approval is not granted for the new distribution formula, described in section 6, that the supplemental public program volume factor will continue to be used.

Section 10 (62Q.19) extends essential community provider designation to children’s hospitals and affiliated specialty clinics effective the day following final enactment.

Section 11 (103I.005) adds a definition of bored geothermal health exchanger.

Section 12 (103I.521) clarifies that the fees from chapter 103I (wells and borings) are to be deposited in the state government special revenue fund.

Section 13 (144.123, subd. 1) authorizes the commissioner to enter into a contractual agreement to recover costs incurred for analysis for diagnostic purposes and that funds generated under this agreement must be deposited into a special account and are appropriated to the commissioner for purposes of providing the services in the contracts.

Section 14 (144.125, subd. 1) increases the fees to support the newborn screening program from $106 to $135.  An additional $15 is added to this fee to offset the cost of the support services provided under section 144.966 (early hearing detection and intervention program) and requires the fee revenue to be deposited in the general fund.

Section 15 (144.1251) requires newborn screening for critical congenital heart disease.

Subdivision 1 requires hospitals and birthing centers that provide maternity and newborn care services to provide screening for congenital heart disease to all newborns before discharge using pulse oximetry screening.  The screening is required to occur before discharge and 24 hours after birth, or if discharge occurs before 24 hours, as close as possible to discharge.  Results of the screening must be reported to the Department of Health.

Subdivision 2 requires the Department of Health to:

(1) communicate the screening protocol and requirements, and provide educational materials;

(2) make information and forms available to facilities and providers;

(3) provide training;

(4) establish mechanisms for data collection, reporting, follow-up diagnostic results, and the establishment of a CCHD registry;

(5) coordinate the implementation of universal standardized screening; and

(6) act as a resource for providers, and develop and implement policies for early medical and developmental intervention services and long-term follow-up services.

Sections 16 to 29 make modifications to the vital records statutes.

Section 16 (144.212) adds the following definitions:  authorized representative; certification item; correction; court of competent jurisdiction; disclosure; legal representative; local issuance office; record; and verification.

Section 17 (144.213) changes the name of the office of the state registrar to the office of vital records.  Specifies that local issuance offices that fail to comply with statutes or rules or to properly train employees may have their issuance privileges and access to the vital records system revoked.  Specifies that the state registrar is authorized to prepare typewritten, photographic, electronic or other reproductions of original records and fillies to preserve vital records.  Requires the state registrar to establish, designate, and eliminate offices; direct the activities of all persons engaged in the activities pertaining to the operation of vital statistics; develop and conduct training programs to promote uniformity of policy and procedure; and prescribe, furnish and distribute all required forms and prescribe other means for transmission of data that will accomplish the purpose of complete, accurate and timely reporting and registration.

Section 18 (144.2131) specifies the duties for the state registrar to provide security of the vital records system.

Section 19 (144.215, subd. 3) removes reference to a declaration of parentage.

Section 20 (144.215, subd. 4) changes the reference to vital records.

Section 21 (144.216, subd. 1) changes the reference to vital records.

Section 22 (144.217, subd. 2) specifies that a person may petition the appropriate court in the county in which the birth allegedly occurred if a delayed record of birth is rejected.

Section 23 (144.218, subd. 5) removes reference to a declaration of parentage.

Section 24 (144.2181) specifies the process to amend or correct a vital record.

Section 25 (144.225, subd. 1) removes reference to local registrar.

Section 26 (144.225, subd. 4) makes a technical change.

Section 27 (144.225, subd. 7) changes reference from local registrar to local issuance officer.

Section 28 (144.225, subd. 8) changes reference from local registrant to local issuance office.

Section 29 (144.226) specifies that a fee may be charged for the administrative review and processing of a request for a certified record.  Requires the fees to be payable at the time of application.  Specifies that the fee is for reviewing and processing a request.  Makes other minor technical changes.

Sections 30 to 32 establish criteria for comprehensive stroke centers.

Section 30 (144.492) defines the following terms:  commissioner, joint commission, and stroke.

Section 31 (144.493) establishes the criteria for "comprehensive stroke centers," "primary stroke centers," and "acute stroke ready hospitals." 

Section 32 (144.494) restricts the use of "stroke center" in a hospital's name without Minnesota Department of Health's (MDH) designation, and establishes the process for MDH-designation for hospitals meeting the specified criteria.

Section 33 (144.554) authorizes the commissioner to collect a fee for the review and approval of architectural, mechanical, and electrical plans and specifications submitted before construction begins a project relative to new buildings, additions or remodeling or alterations of existing buildings for hospitals, nursing homes, boarding care homes, residential hospices, supervised living facilities, freestanding outpatient surgical centers, end stage renal disease facilities.  Sets fees.

Section 34 (144.966, subd. 2) extends the newborn hearing screening advisory committee until June 30, 2019.

Section 35 (144.966, subd. 3a) modifies the family support and assistance services provided to families with children who are deaf or have a hearing loss, including individualized deaf or hard-of-hearing mentors and specifies that participation in these services is voluntary.

Sections 36 to 41 modify laboratory accreditation requirements.

Section 36 (144.98, subd. 3) reduces a number of the accreditation fees for environmental laboratories.

Section 37 (144.98, subd. 5) specifies that the fees are deposited in the state government special revenue fund.

Section 38 (144.98, subd. 10) requires the commissioner to establish a selection committee to recommend approval of qualified laboratory assessors and assessment bodies.

Section 39 (144.98, subd. 11) requires the selection committee to determine assessor and assessment body application requirements, the frequency of application submittal, and the application review schedule.

Section 40 (144.98, subd. 12) specifies the requirements that an assessor must meet to be approved by the commissioner.

Section 41 (144.98, subd. 13) requires a laboratory that is accredited or seeking accreditation that requires an assessment by the commissioner must select an assessor, group of assessors, or an assessment body for the published list of approved assessors or assessment bodies.

Section 42 (144.99, subd. 4) authorizes the commissioner to issue to a certified lead firm or person performing regulated lead work an administrative penalty order imposing a penalty of a t least $5000 per violation per day, not to exceed $10,000 for each violation.

Section 43 (145.4716) directs the commissioner to establish a director of child sex trafficking prevention.  Outlines the duties of the director, including providing training, maintaining information, applying for federal funding, managing grants, providing oversight, conducting evaluations, and developing policies.

Section 44 (145.4717) directs the commissioner, through the director of child sex trafficking prevention, to provide grants for regional navigators serving six regions of the state to coordinate resources and services for sexually exploited youth.  Provides that each regional navigator must develop and annually submit a work plan to the director outlining a needs and resource assessment, grant goals and outcomes, and grant activities.

Section 45 (145.4718) requires the director to conduct or contract for a comprehensive evaluation of the statewide program for sexually exploited youth.  The first evaluation must be completed by June 30, 2015, and submitted to MDH by September 1, 2015, and then be conducted every two years thereafter.

Section 46 (145.906) requires the commissioner to review the materials and information related to postpartum depression to determine their effectiveness in a way that reduces racial health disparities as reported in postpartum information reported in surveys of maternal attitudes and experiences.  The commissioner shall make necessary changes and ensure that women of color receive the information.

Section 47 (145.907) defines maternal depression.

Section 48 (145.986) makes modifications to the state health improvement program (SHIP).

Subdivision 1a requires grantee to address the health disparities and inequities that exist within the grantee’s community.  Also, authorizes the commissioner to award funding for evidence-based strategies targeted at reducing other risk factors that are associated with chronic disease and may impact public health.  The commissioner is required to develop criteria and procedures to allocate funding.

Subdivision 3 requires the commissioner to award contracts to appropriate entities to assist in training and provide technical assistance to grantees.  Specifies the areas of technical assistance and training that can be covered under these contracts.

Subdivision 4 changes the biennial evaluation that is required to be conducted by the commissioner to one evaluation.  It also requires grantees to collect, monitor, and submit to the commissioner baseline and annual data and provide information to improve the quality and impact of community health improvement strategies.  It also authorizes the commissioner to award contracts to appropriate entities to assist in designing and implementing evaluation systems.

Subdivision 5 requires the commissioner, as part of the biennial report submitted to the legislature, to include the grantee’s progress toward achieving the measurable outcomes and to provide information on grants in which a corrective action plan has been required in terms of the type of plan action, and the progress made toward meeting the outcomes. Also, strikes obsolete language.

Section 49 (145A.17, subd. 1) expands the targeted families in the family home visiting programs to include families with a serious mental health disorder, including maternal depression.

Sections 50 to 96 establish licensing requirements for alkaline hydrolysis facilities in chapter 149A.

Section 97 (257.75, subd. 7) changes the office of the state registrar to the office of vital records.

Section 98 (260C.635, subd. 1) changes the office of the state registrar to the office of vital records.

Section 99 (517.001) specifies the definition of local registrar in chapter 517 (marriage).

Section 100 modifies the task force on prematurity by reducing the numbers of members to 11, by removing certain items that the task force was required to consider, and by extending the deadline for submission of the final report and expiration of the task force from January 2013 to January 2015.  Makes other technical changes. 

Section 101 requires the Commissioner of Health to review the statutory requirements for preparation and embalming rooms and develop legislation that provides appropriate safety and health protection for funeral home locations that are branch locations where deceased bodies are present.

Section 102 requires the commissioner of health to consult with certain stakeholders and submit a report by February 1, 2014, on a plan to advance health equity in Minnesota.

Section 103 requires the Commissioner of Commerce, in consultation with the Commissioner of Health, health carriers, and consumer advocates, to study guaranteed  renewability of health plans in the individual market and assess the need for statutory provisions related to permitting the discontinuance or modification of health plan coverage in the individual market by a health carrier.

Section 104 requires the Commissioner of Health, in consultation with commerce and human services, to study methodologies for determining appropriate levels for capital reserves of health maintenance organizations and requirements for reducing capital reserves to the recommended maximum levels.

Section 105 requires the Commissioner of Commerce by August 15, 2013, to study and report to the legislature on reasonable and efficient options for coverage for high-quality, medically necessary evidence-based treatment of autism spectrum disorders for children up to age 18.

Section 106 requires the Commissioner of Commerce by December 31, 2014, to request that the U.S. Department of Human Services include autism services in the state’s essential health benefits when the next benefit set is selected in 2016.

Section 107 requires the Attorney General to give a written legal opinion on whether a health plan is required to provide coverage of treatment for mental health and mental health-related illnesses, including autism spectrum disorders and any other mental health condition.

Section 108 instructs the Revisor to substitute the term “vertical heat exchanger” to “bored geothermal heat exchanger.”

Section 109 repeals the following sections:

Paragraph (a) 62J.693 (medical research);103I.005, subd.20 (vertical heat exchanger); 149A.025 (alkaline hydrolysis); 149A.20, subd.8 (fees); 149A.30, subd.2 (fees); 149A.40,subd.8 (renewal fees); 149A.45, subd.6 (fees); 149A.50, subd.6 (initial licensure and inspection fees); 149A.51, subd.7 (period of licensure); 149A.52, subd.5a (initial licensure and inspection fees);149A.53, subd.9 (renewal and inspection fees); and 485.14 (vital statistics, records received for preservation) effective July 1, 2013.

Paragraph (b) 144.123, subd. 2 (fees for diagnostic laboratory services) effective July 1, 2014.

ARTICLE 13:

PAYMENT METHODOLOGIES FOR HOME AND COMMUNITY-BASED SERVICES

Section 1 (252.41, subdivision 3) removes language regarding county contracts to conform to the statewide rate setting methodology created in this bill, effective January 1, 2014.

Section 2 (252.42) updates a cross-reference.

Section 3 (252.43) removes language regarding county contracts  and updates cross-references to conform to the statewide rate setting methodology created in this bill, effective January 1, 2014.

Section 4 (252.44) removes language regarding county contracts  and updates cross-references to conform to the statewide rate setting methodology created in this bill, effective January 1, 2014.

Section 5 (252.45) makes language and cross-reference changes to conform to the statewide rate setting methodology created in this bill, effective January 1, 2014.

Section 6 (252.46, subdivision 1a) adds a cross-reference.

Section 7 (256B.4912, subdivision 2) adds a cross-reference.

Section 8 (256B.4912, subdivision 3) adds “staff compensation” and “staffing and supervisory patterns” to the list of items the home and community-based services (HCBS) waivers payment methodologies must address.

Section 9 (256B.4913, subdivision 4a) creates a new subdivision allowing the Department of Human Services (DHS) to adjust, with certain exemptions, individual reimbursement rates by no more than one-half percent during the initial implementation period, and one year after, then no more than one percent annually for the following three years.

Section 10 (256B.4913, subdivision 5) allows DHS to work with other groups, in addition to the existing stakeholder group, to assist in the implementation of the new rate payment system.

Section 11 (256B.4913, subdivision 6) modifies the implementation of a new payment methodology and directs lead agencies to enter person-specific data into a rate management system developed by DHS. Requires all new services and renewed individual service plans to use the waiver rate system beginning January 1, 2014, and requires all data entered by December 31, 2014. Adjustments to lead agency budgets for HCBS waiver plans must be made by January 1, 2014.

Section 12 (256B.4914) creates a new section, “HOME AND COMMUNITY-SERVICES WAIVERS; RATE SETTING.”

Subdivision 1 applies section 256B.4914 to services under the Developmental Disabilities (DD), Community Alternatives for Disabled Individuals (CADI), Community Alternative Care (CAC), and Brain Injury (BI) waivers.

Subdivision 2 establishes definitions applicable to this section.

Subdivision 3 lists the services under the DD, CADI, CAC, and BI waivers applicable to the payment methodologies established in this section, including:

  • 24 hour customized living
  • Adult day care
  • Adult day care bath
  • Behavioral programming
  • Companion Services
  • Customized living
  • Day training and habilitation (DT&H)
  • Housing access coordination
  • Independent living skills
  • In-home family support
  • Night supervision
  • Personal support
  • Prevocational services
  • Residential care services
  • Residential support services
  • Respite services
  • Structured day services
  • Supported employment services
  • Supported living services
  • Transportation services

Subdivision 4 requires providers to enter data into the rates management system in order for DHS to collect data for rate determination.

Subdivision 5 establishes the base wage index (using the Standard Occupational Classification System from the Bureau of Labor Statistics) and standard component values (i.e., employee vacation and sick allowance) to calculate payment rates.

Subdivision 6 calculates the payment methodology for residential support services using the base wage index and standard component values established in subdivision 5.

Subdivision 7 calculates the payment methodology for day programs using the base wage index and standard component values established in subdivision 5.

Subdivision 8 calculates the payment methodology for unit-based services with programming using the base wage index and standard component values established in subdivision 5.

Subdivision 9 calculates the payment methodology for unit-based services without programming using the base wage index and standard component values established in subdivision 5.

Subdivision 10 instructs DHS to work with stakeholders to develop and implement uniform procedures to change terms and update or adjust values used to calculate payments; requires DHS to continue working with stakeholders in an ongoing basis to refine the values; requires DHS to submit: a report preliminary results and data to the Legislature on January 15, 2015, implementation status update on January 15, 2016, full report on January 15, 2017, another full report on January 15, 2019, then every hour years afterwards.

Subdivision 11 states that payment rates under the statewide payment methodology created in this section, once implemented, supersede rates established by county contracts for HCBS waivers.

Subdivision 12 creates an enhanced, customized rate for deaf or hard-of-hearing individuals of $2.50 per hour.

Subdivision 13 instructs DHS to require transportation services purchased be cost-effective and limited to market rates.

Subdivision 14 allows DHS to identify individuals with exception needs that cannot be met under the new rate setting methodology and allows DHS to create an alternative payment system for the individual.

Subdivision 15 required DHS, upon full implementation of the rate setting methodology, to track and report the fiscal impact of the waiver rates system on individual counties and tribes; and requires DHS to make annual adjustment to counties and tribes’ home and community-based waivered service budget allocations to adjust for rate differences, and the impact on county allocations upon the system’s implementation.

Subdivision 16 requires DHS to make the necessary adjustments to ensure this new rate setting methodology is budget neutral when compared with current law.

Section 13 gives DHS the authority to manage HCBS waiver programs within federally required parameters during the rate setting methodology transition, and includes implementation procedures if CMS requires rate setting methodology changes.

Section 14 repeals sections, subdivisions and Rules (sections 252.40; 252.46; subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16, 17, 18, 19, 20, and 21; 256B.4913 subdivisions 1, 2, 3 and 4 256B.501 subdivision 8) related to implementing the new rate setting methodology created in this section, or are now obsolete or replaced in this bill, effective January 1, 2014.

ARTICLE 14: HEALTH AND HUMAN SERVICES APPROPRIATION

Article 14 provides the appropriations under the jurisdiction of the Health and Human Services division.

ARTICLE 15: REFORM 2020 CONTINGENT APPROPRIATION

Article 15 provides the appropriations for language that is contingent on federal approval.

ARTICLE 16: HUMAN SERVICES FORECAST ADJUSTMENTS

Article 16 provides the forecast adjustments related to the Department of Human Services.

ARTICLE 17: NORTHSTAR CARE FOR CHILDREN PROGRAM

Article 17 establishes the Northstar Care for Children Program, which consolidates the current foster care, relative care assistance, and adoption assistance programs, into one program.  The 3 existing programs provide monthly payments on behalf of children that are disparate. The Northstar Care for Children provides a uniform assessment to determine the needs of the child, and the monthly amount is provided based on the child’s needs.  Children age 6 and younger receive a lower benefit, and children in the existing program are grandfathered in, unless specifically transitioned into Northstar.  This article contains modification to existing statute, and establishes a new chapter of law, 256N, for the new Northstar program.

 

JW/KC/DL:tg

 

 

 

 
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