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S.F. No. 1034 - Omnibus Health and Human Services Finance Bill - The Second Engrossment
 
Author: Senator Tony Lourey
 
Prepared By: Joan White, Senate Counsel (651/296-3814)
 
Date: April 22, 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Section 2 (254B.04, subd. 1) makes a conforming change due to a repealed section.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 (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 5 (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 6 (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 7 (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 8 (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 9 (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 10 (256B.055, subd. 15) modifies the adults without children eligibility category.

Section 11 (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 12 (256B.056, subd. 1) aligns the residency requirement with the federal regulations under the Affordable Care Act (ACA).

Section 13 (256B.056, subd. 1c) makes a coordinating change to conform to the ACA for the family with children income methodology.

Section 14 (256B.056, subd. 3) clarifies that the asset limitations only apply to certain individuals.

Section 15 (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 16 (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 17 (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 18 (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 19 (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 20 (256B.057, subd. 10) makes a conforming change.

Section 21 (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 22 (256B.059, subd. 1) modifies the definition of institutionalized spouse and continuous period of institutionalization to reference the elderly waiver and alternative care programs.

Section 23 (256B.06, subd. 4) specifies that certain noncitizens who are lawfully present and who are not children or pregnant women and who otherwise meet the eligibility  requirements of chapter 256B are eligible for medical assistance without federal financial  participation.

Section 24 (256B.0755, subdivision 3) requires the health care delivery system demonstration projects applying for approval to demonstrate how its services will be coordinated with other services that are being provided by other providers and county agencies in the service area, and document how other providers and counties will provide services to attributed patients and how it will address local needs, priorities, and public health goals.

Section 25 (256B.694) continues to permit the commissioner to contract with a single health plan to serve certain rural areas. 

Section 26 (256L.01, subdivision 1b) defines the “Affordable Care Act” in chapter 256L.

Section 27 (256L.01, subdivision 3a) defines "family" in chapter 256L to conform to ACA definition.

Section 28 (256L.01, subdivision 5) defines “household income” in chapter 256L as having the meaning provided in the ACA.

Section 29 (256L.01, subdivision 6) defines the "Minnesota Insurance Marketplace" in chapter 256L.

Section 30 (256L.01, subdivision 8) 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 31 (256L.02, subdivision 2) modifies this section to require the commissioner to ensure that information on medical programs are on a Web site.

Section 32 (256L.02, subdivision 6) requires the commissioner to seek federal approval to implement the MinnesotaCare program as a basic health plan program.

Section 33 (256L.02, subdivision 7) specifies that MinnesotaCare shall be considered a public health care program for purposes of chapter 62V.

Section 34 (256L.03, subdivision 1) states that the covered health services shall include the current MinnesotaCare benefits and nonemergency medical transportation services beginning January 1, 2014.

Section 35 (256L.03, subdivision 1a) makes a coordinating change to conform with the ACA.

Section 36 (256L.03, subdivision 3) eliminates the inpatient hospital benefit cap, effective January 1, 2014.

Section 37 (256L.03, subdivision 4b) requires health coverage provided through the MinnesotaCare program to have a medical loss ratio of at least 85 percent. (ACA requirement)

Section 38 (256L.03, subdivision 5) eliminates the cost-sharing requirements for inpatient hospital services, effective January 1, 2014.

Section 39 (256L.03, subdivision 6) makes corresponding changes.

Section 40 (256L.04, subdivision 1) modifies the income eligibility limit for families with children to between 133 percent and 200 percent of FPG the income limit of 133 percent of FPG.

Section 41 (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 42 (256L.04, subdivision 7) modifies the income eligibility limit for single adults between 133 percent and 200 percent of FPG.

Section 43 (256L.04, subdivision 8) makes conforming changes to conform to the ACA and strikes obsolete language.

Section 44 (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 45 (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 46 (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 47 (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 48 (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 49 (256L.05, subdivision 3) makes coordinating changes to coordinate with ACA in terms of the effective date of coverage.

Section 50 (256L.05, subdivision 3c) makes a technical change removing obsolete language.

Section 51 (256L.06, subdivision 3) removes reference to disenrollment for failure to pay premiums. (conforming to ACA)

Section 52 (256L.07, subdivision 1) makes coordinating modifications to conform with the ACA.  Specifies that families and individuals with income over 200 percent of FPG are not eligible for MinnesotaCare.

Section 53 (256L.07, subdivision 2) makes coordinating modifications to the "access to employer subsidized insurance" language to conform with the ACA.

Section 54 (256L.07, subdivision 3) makes coordinating modifications to the "other health coverage" language to conform with the ACA.

Section 55 (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 56 (256L.11, subdivision 1) states that payments to providers are at the same rates and conditions established under MA, except as otherwise provided.

Section 57 (256L.11, subdivision 3) makes coordinating changes to inpatient hospital rates specifying that the rate paid is the medical assistance rate.

Section 58 (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 59 (256L.15, subdivision 1) makes coordinating modifications to conform with the ACA.

Section 60 (256L.15, subdivision 2) modifies premiums by reducing current premiums by 50 percent, beginning January 1, 2014.

Section 61 modifies the effective date for the addition of the definition of the ACA that was enacted in Laws 2013, chapter 1, section 1.

Section 62 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 63 is a Revisor's instruction to coordinate with the repealers.

Section 64 Paragraphs (a) and (b) repeals a number of MinnesotaCare sections.  Paragraph (c) repeals sections 256B.055 subd. 3 (AFDC families); subd. 5 (pregnant women); and 10b (children/ MN health care reform waiver); 256B.056, subd. 5b (individuals with low income); 256B.057, subd. 1c (no asset test for pregnant women); subd. 2 (children).

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 organization 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 new 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 new 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 new 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 to incorporate changes made in Sections 6, 7, 8, 9, and 20.

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 the preadmission screening requirement for individuals from 65 years of age to 60 years of age for 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 as of 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.0913, subdivision 17) adds a new subdivision establishing Essential Community Supports Grants for individuals 65 years of age or older who do not meet the nursing facility level of care criteria but would otherwise qualify for the Alternative Care program.

Section 26 (256B.0915, subdivision 5) updates a cross-reference to incorporate the new subdivision created in Section 21.

Sections 27 through 32 replace repealed Senior’s Agenda for Independent Living (SAIL) Projects language.

Section 27 (256B.0917, subdivision 1a) adds a new 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 28 (256B.0917, subdivision 1b) adds a new subdivision listing definitions applicable to Minnesota Statutes, section 256B.0917.

Section 29 (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 30 (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 31 (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 32 (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 33(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 34(256B.439, subdivision 2) makes a technical change.

Section 35(256B.439, subdivision 3) specifies that consumer surveys of long-term care services are for nursing facility services.

Section 36(256B.439, subdivision 3a) adds a subdivision requiring DHS and MDH to incorporate long-term care quality profiles into a report card maintained by the Minnesota Board on Aging.

Section 37(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 38 (256B.441, subdivision 13) removes long-term care consultation fees from the definition of “external fixed costs” for nursing facilities only until September 30, 2013.

Section 39 (256B.441, subdivision 53) removes long-term care consultation fees from the definition of “external fixed costs” for nursing facilities only until September 30, 2013.

Section 40 (256B.49, subdivision 12) updates a cross-reference.

Section 41 (256B.49, subdivision 14) updates a cross-reference.

Section 42 (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 those of 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.

The effective date of this section is January 1, 2014, or upon federal approval, whichever is later.

Section 43 (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.

Sections 44 to 46 modify the Vulnerable Adult Act.

Section 44 (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 45 (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 46 (626.557, subdivision 9e) requires the commissioner to conduct an outreach campaign to promote the CEP for reporting vulnerable adult maltreatment.

Section 47 makes this article contingent upon federal approval.

Section 48 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 related to the Seniors’ Agenda for Independent Living (SAIL). 

Article 3:  Safe and Healthy Development of Children,

Youth, and Families

Section 1 (119B.05, subd. 1) allows 20 hours of MFIP child care for child-only cases in which the caregiver is receiving Supplemental Security Income for a disability related to depression or other serious mental illness and the child is five years or younger.

Section 2 (119B.13, subd. 1) increases the child care provider rate by two percent.

Section 3 (119B.13, subd. 7) modifies the child care assistance statute limiting the number of days a provider may be reimbursed when the child is absent from child care.  The bill increases from ten to 25 the number of days a provider may be reimbursed, or not more than ten consecutive days. 

Sections 4 – 12 modify the DHS licensing Act.

Section 4 (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 5 (245A.1435) requires a note from the infant’s physician in order for the child care license holder to place the infant in an alternative sleeping arrangement, and changes the term “sudden infant death syndrome” to “sudden unexpected infant death”. New paragraph (c) clarifies instances where the infant falls asleep before being placed in a crib.

Sections 6, 7, and 11 (245A.144; 245A.1444; 245A.40, subd. 5) change the term “sudden infant death syndrome” to “sudden unexpected infant death” and “shaken baby syndrome” to “abusive head trauma.”

Section 8 (245A.1446) provides guidelines for disinfecting a diaper changing surface.

Section 9 (245A.147) adds a new section of law regarding infant sleep supervision for family child care providers.  Generally, the child care license holders are encouraged to check on infants every 30 minutes, and every 15 minutes for the first four months the infant is in the provider’s care and if the infant has an upper respiratory infection.  The license holder must also use and maintain an audio or visual monitoring device to monitor each infant.

Section 10 (245A.152) adds a new section of law requiring child care license holders to maintain insurance coverage.

Section 12 (245A.50) modifies family child care training requirements to include training on behavior guidance, which is defined in subdivision 2, and to require first aid training be repeated every two years in subdivision 3, and require that the CPR training include techniques for infants and children in subdivision 4.  Also in subdivision 4, specifies what CPR training meets the requirement.  Subdivision 5 requires abusive head trauma training at least once every year, instead of every five years.   Subdivision 7 increases training hours from eight to 16 hours of training annually.   This section also adds new subdivisions 9, 10, and 11. 

Subdivision 9 requires at least six hours of approved training on supervising for safety prior to initial licensure, and before caring for children, and at least two hours annually, thereafter.  “Supervising for safety” is defined in this subdivision, and must be developed by the commissioner by January 1, 2014. 

Subdivision 10 requires county licensing staff to accept training approved by the Minnesota Center for Professional Development, as specified in this subdivision.   New training requirements must not be imposed on providers until the commissioner establishes statewide accessibility to training. 

Section 13 (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 this paragraph (j), and reinstates the fee schedule in paragraph (b).

Section 14 (256.82, subd. 3) requires current foster care rates to remain in effect until December 13, 2015.

Section 15 (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, 2013, or upon federal approval.

Section 16 (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, 2013, or upon federal approval.

Section 17 (256J.24, subd. 5) strikes a reference to the MFIP family cap, which is repealed in this article.

Section 18 (256J.24, subd. 5a) increases the MFIP transitional standard by 16 percent effective October 1, 2015.

Section 19 (256J.24, subd. 7) modifies the initial income test for MFIP eligibility by using the family wage level instead of transitional standard.  This section is effective October 1, 2013, or upon federal approval.

Section 20 (256J.621) suspends the work participation cash benefits program effective December 1, 2013,  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 21 (256J.626, subd. 7) modifies the TANF performance-based funds.  A county that performs within or above its range of expected performance on the self-support index must receive an additional allocation of five percent.  The current formula allocates 2.5 for meeting the TANF work participation rate and 2.5 for the self-support index.

Section 22 (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 23 (256K.45) changes the title of the act from “Runaway and Homeless Youth Act” to the “Homeless Youth Act.”

Subdivision 2 modifies the report to the Legislature.

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 24 (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.

Sections 25 (257.85, subd. 11) and 26 (259A.05, subd. 5) make relative custody assistance and adoption assistance forecasted programs.

Section 27 (259A.20, subd. 4) allows child care reimbursements under the adoption assistance program if the caregiver is unemployed due to a disability.

Section 28 (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 29 (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 30 (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 31 (260C.007, subd. 31) corrects an oversight in the definition of "sexually exploited youth" by adding a citation that was missed in a sequence.  The sequence lists first-, second-, fourth-, and fifth-degrees of criminal sexual conduct, but misses the third-degree crime.  This section is effective the day following final enactment.

Section 32 (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.  The public authority must provide a notice to the obligor and obligee, and must keep the case open if the obligee responds and provides information that the outstanding arrearage could reasonably lead to a collection.

Section 33 discontinues the EBT transaction state subsidy to retailers when the federal government discontinues the federal subsidy.

Section 34 prohibits the Commissioners of Human Services and Housing Finance Agency from counting conditional cash transfers provided under the family independence demonstration as income for purposes of the public programs listed in the bill.  The family independence demonstration is a demonstration project that is sponsored and will be implemented by the Citizens League.  The language is time limited, and expires three years after the family independence demonstration begins.

Section 35 requires the Commissioner of Human Services, in consultation with interested and affected parties listed in this section, to analyze benefits and services available to children in foster care, relative custody assistance, and adoption assistance, and to establish a uniform set of benefits, with a report due January 15, 2014.

Section 36, paragraph (a) repeals the MFIP family cap effective July 1, 2014.  Paragraph (b) repeals a diversion program for 16 and 17 year old juvenile prostitutes.  This would no longer be an offense under section 1.  This section is effective the day following final enactment.

Article 4:  Strengthening 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 a reference to children’s mental health grants, which has the effect of reducing funding to counties for children’s mental health grants, which under the Governor's budget, DHS is using the pay for the nonfederal share of the new care consultation benefit.

Section 5 (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 6 (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 7 (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, and for grants to providers participating in mental health specialty treatment services.  

Section 8 (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 9 (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 confined to a state hospital, under civil commitment, found guilty by reason of mental illness, or civilly committed after dismissal of criminal charges.

Section 10 (254B.13) modifies the chemical health care pilot project, specifies eligibility for navigator pilot program.

Section 11 (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 12 (256B.0616) establishes the mental health certified family peer specialist as a service covered under medical assistance, upon federal approval.

Section 13 (256B.0623, subd. 2) adds parenting skills under the rehabilitative mental health services.

Section 14 (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 15 (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 16 (256B.0625, subd. 61) adds family psychoeducation services to the list of services covered under medical assistance, subject to federal approval.

Section 17 (256B.0625, subd. 62) adds mental health clinical care consultation to the list of services covered under medical assistance, subject to federal approval.

Sections 18 and 19 (256B.0943, subds. 1 and 2) modifies children’s therapeutic services and supports (CTSS), by defining the term “mental health service plan development,” and including that benefit, in addition to clinical care coordination, family psychoeducation, and family peer specialist, to the list of services covered under CTSS.

Sections 20 and 21 (256B.0943, subds. 7 and 8a) establish a certificate program for level II mental health behavioral aide.

Section 22 (256B.0946) modifies the intensive treatment in foster care section of law, by adding definitions, and modifying eligibility and services.

Section 23 (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 24 (256I.05, subd. 1e) strikes a supplementary rate increase for a group residential housing provider that was to go into effect on July 1, 2013.

Section 25 requires the Commissioner of Human Services, in consultation with interested 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 26 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 1, 2014.

Section 27 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.

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 history 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 history information received under the new provisions contained in section 3.

Section 5 (245C.32, subd. 2) requires the commissioner to recover costs for background studies under Minnesota Statutes, section 524.5-118 (sections 2 and 3) through a $100 fee for an individual who has not lived outside Minnesota for the past ten years, and $115 for an individual who has resided outside the state for any period during the ten years preceding the background study.

Section 6 (245E.01) adds a new section governing child care provider and recipient fraud investigations within the child care assistance program.

Subdivision 1 contains the definitions.

Subdivision 2 requires the department to investigate alleged or suspected financial misconduct by providers and errors related to payments.  Recipients, employees, and staff may be investigated when evidence shows that their conduct is related to the financial misconduct of a provider, license holder, or controlling individual.

Subdivision 3 governs the scope of the investigation and the activities to be conducted.

Subdivision 4 requires the department to issue determinations after its investigation is completed.

Subdivision 5 authorizes the department to take one or more specified actions or sanctions.

Subdivision 6 provides that a provider, license holder, controlling individual, employee, staff person, or recipient has an affirmative duty to provide access upon request to information.  Other procedural requirements and administrative provisions are included.

Subdivision 7 provides that it is unlawful for a provider, license holder, controlling individual, or recipient to engage in specified conduct involving fraud.

Subdivision 8 contains record retention requirements and governs maintenance of records.

Subdivision 9 contains factors to be considered by the department in determining the administrative sanctions to be imposed.

Subdivision 10 requires written notice of the administrative sanction and specifies the contents of the notice, service requirements, and the effective date of a proposed sanction.

Subdivision 11 governs appeal of a department sanction in cases where the department does not pursue a criminal action but imposes an administrative sanction. 

Subdivision 12 provides for consolidation of hearings regarding financial misconduct sanctions and licensing sanctions.

Subdivision 13 authorizes monetary recovery in cases where a provider has been paid improperly.  Methods for obtaining monetary recovery are specified.

Subdivision 14 provides that a person who makes a good faith report or testifies in an action or proceeding in which financial misconduct is alleged and is not involved in the misconduct is immune from civil or criminal liability that results by reason of the person’s report or testimony.  Good faith is presumed.  In cases where a person was involved in the misconduct, the department may consider the person’s report and assistance in the investigation as a mitigating factor in pursuit of civil, criminal, or administrative remedies.

Subdivision 15 provides that data related to an investigation under this section is treated as all other data under the welfare data statute and has the same classification as licensing date.

Subdivision 16 allows the department to use extrapolation in calculation an amount in a monetary recovery.

Subdivision 17 provides that unless a timely and proper appeal is received by the department’s Office of Inspector General, Financial Fraud, Abuse Division, the administrative determination of sanction is considered a final department determination. 

Subdivision 18 provides that overpayment recoveries under this section are excluded from the county recovery provisions under the law.

Sections 7 (256B.04, subd. 21) and 12 (256B.0659, subd. 21) allow the commissioner to pursue Medicaid provider recoveries through new recovery mechanisms.  The sections require all suppliers of durable medical equipment, prosthetics, orthotics, and supplies to name DHS as an obligee on all surety performance bonds required under federal law. DHS may require a provider to purchase a performance surety bond as a condition of enrollment.   Section 10 requires all personal care assistance provider agencies to show proof of surety bond.  This section is effective the day following final enactment.

Section 8 (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 law.

Section 9 (256B.0624, subd. 1a), 10 (256B.064, subd. 1b), and 11 (256B.064, subd. 2) 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 13 (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.

Section 14 (524.5-118) relates to the appointment of a guardian or conservator, by requiring a background study every two years, instead of every five years, and requires criminal history data for a guardian or conservator who has not resided in the state for the previous ten years, instead of five years.  This section also adds that the background study must include licensing data related to a professional license directly related to the responsibilities of a professional fiduciary that has been denied, conditioned, suspended, revoked, or canceled.

Section 15 (524.5-118) provides the procedure related to the court requesting licensing agency data from the Commissioner of Human Services.

Sections 16 and 18 (524.5-303; 524.5-403) amend the statutes relating to the petition requesting the appointment of a guardian or conservator, respectively, by adding that the petition must include whether the proposed guardian or conservator, or employee exercising powers and duties:

·    has ever applied for or held a professional license, and information regarding the license;

·    has ever been found civilly liable for fraud, misrepresentation, misappropriation, theft or conversion;

·    has ever filed for bankruptcy protection;

·    has any outstanding civil monetary judgments;

·    has ever had an order for protection or restraining order issued against the proposed guardian or conservator; or

·    has been convicted of a crime.

Sections 17 and 19 (524.5-316; 524.5-420) modify the sections of law regarding monitoring of guardianships or conservators, respectively.  The new language requires the guardian to report to the court in writing within 30 days of the occurrence of any of the events listed under the new paragraph.  If the guardian or conservator fails to comply, the court may decline to appoint the person as a guardian or conservator or remove the person as a guardian or conservator.

Section 20 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) increases the surcharge on health maintenance organizations by .88 percent to a total of 1.48 percent effective July 1, 2013, until June 30, 2015.

Section 3 (256.969, subd. 3a) increases the fee for service payment rate for inpatient hospital services by 1.4 percent beginning January 1, 2015.

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.055, subd. 14) specifies that medical assistance 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 6 (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 also authorizes the payment of follow up care and alternative services that would not otherwise be paid for if the commissioner determines that the services, if provided, would directly prevent a medical emergency from immediately arising.

Section 7 (256B.04, subd. 18) extends medical assistance coverage to doula services provided by a certified doula effective July 1, 2014, or upon federal approval, whichever is later.

Section 8 (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 9 (256B.0625, subd. 31b) requires the commissioner to implement a point of sale preferred diabetic testing supply program by January 1, 2014.  Medial 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 10 (256B.0625, subd. 39) eliminates medical assistance coverage for the administration of pediatrics vaccines covered under the pediatric vaccine administration program.

Section 11 (256B.0625, subd. 58) eliminates medical assistance payment for an EPSDT screening for vaccines that are available at no cost to the provider.

Section 12 (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 13 (256B.0631, subd. 1) requires the commissioner to waive the collection of the medical assistance family deductible.  This section also permits the Hennepin County pilot program to waive the medical assistance co-payments and states that the value of the waived copayments shall not be included as part of the payment system under the pilot program.

Section 14 (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 15 (256B.196, subd. 2) requires the commissioner to determine an upper payment limit for ambulance services affiliated with Hennepin County Medical Center 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 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 to the difference between the established medical assistance payment for ambulance services and the upper payment limit.

Section 16 (256B.69, subd. 5c) increases the amount that is transferred by the commissioner to the medical education research cost fund (MERC) by $6.4 million per year.

Section 17 (256B.69, subd. 31)extends the limits to the trend increases for the rates paid to managed care plans and county-based purchasing plans for calendar years 2016 and 2017 and adds to the reduction to the increases beginning in calendar year 2014 through 2017.

Section 18 (256B.69, subd. 34) requires the commissioner to establish risk corridors for each managed care plan and county-based purchasing plan that is calculated annually based on the calendar year’s net underwriting gain or loss.

Section 19 (256B.76, subd. 1) increases the fee-for-service payment rates for physician and professional services by 5 percent effective January 1, 2015.

Section 20 (256B.76, subd. 2) increases payment rates for dental service by five percent effective January 1, 2015.

Section 21 (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 22 (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 23 (256B.764) increases the family planning rates by 20 percent for services provided by a community clinic.  Requires the rates to managed care plans and county based purchasing plans to reflect this increase.

Section 24 (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 by three percent effective January 1, 2015.

Section 25 requires the Commissioner of Human Services to convene a workgroup to develop a plan to provide coordinated and cost-effective health care and coverage to individuals who are eligible for emergency medical assistance and requires this plan to be submitted to the legislature by July 15, 2013.

Section 26 modifies the transfer language that was enacted earlier this session is 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 27 requires the Commissioner of Human Services to study and make recommendations to the legislature on changes to standardize the medical assistance reimbursement rates for prescription drugs obtained through the 340B program and dispensed to medical assistance enrollees.

Section 28 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.

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 (245A.03, subdivision 7) modifies the exceptions to the corporate foster care moratorium and  removes obsolete language; authorizes 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 3 (252.291, subdivision 2b) adds a new subdivision directing the Minnesota Department of Health (MDH) to certify one additional bed in an ICF/DD in Nicollet County.

Section 4 (256B.0625, subdivision 13e) modifies specialty pharmacy rate provisions.

Section 5 (256B.0915, subdivision 3a) makes a cross-reference change and modifies the monthly cost limit of waiver services for ventilator-dependent individuals.

Section 6 (256B.0915, subdivision 3j) creates the Individual Community Living Support (ICLS) service for the Elderly Waiver.

Section 7 (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 8 (256B.092, subdivision 11) makes a cross-reference change.

Section 9 (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 10 (256B.092, subdivision 14) adds a new subdivision providing certain home and community-based services (HCBS) recipients to receive a consultation with a mental health professional or a behavioral professional within 30 days of discharge; and listing the duties of the mental health or behavioral professional.

Sections 11 through 18 modify the Region 10 quality assurance system

Section 11 (256B.095) removes the expiration date of June 30, 2014 for the quality assurance system for persons with developmental disabilities in Dodge, Fillmore, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, and Winona counties.

Section 12 (256B.0951, subdivision 1) removes the expiration date of June 30, 2014, for the Quality Assurance Commission.

Section 13 (256B.0951, subdivision 4) applies the scope of the alternative quality assurance licensing system for those with all disabilities, not just developmental disabilities.

Section 14 (256B.092, subdivision 1) requires providers, not just counties, to notify MDH and the Department of Human Services (DHS) of intent to join the alternative quality assurance licensing system.

Section 15 (256B.0952, subdivision 5) modifies language to allow noncounty members of quality assurance teams to receive compensation for serving on the teams.

Section 16 (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 17 (256B.097, subdivision 1) adds conforming language to include home and community-based service providers licensed under chapter 245D.

Section 18 (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 19 (256B.431, subdivision 44) corrects calculation errors involving property rate increases for nursing facility construction projects in Dakota and McLeod counties.

Section 20 (256B.434, subdivision 4) continues the suspension of inflation adjustments through October 1, 2016, under the alternative payment system for nursing facilities.

Section 21 (256B.437, subdivision 6) reinstates the planned closure rate adjustment, providing an incentive for nursing facilities to decertify beds.

Section 22 (256B.441, subdivision 53) modifies the external fixed costs calculation for nursing facility payment rates, effective June 1, 2013.

Section 23 (256B.441, subdivision 55) reinstates the rebasing, with modifications, of nursing facility payment rates on October 1, 2013, and on October 1, 2015.

Section 24 (256B.441, subdivision 56) removes conflicting language holding nursing facilities harmless under rebasing, ensuring that no facility receives a rate decrease with the implementation of rebasing.

Section 25 (256B.441, subdivision 62) makes conforming language changes to reinstate rebasing of nursing facility payment rates.

Section 26 (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; and removes obsolete language.

Section 27 (256B.49, subdivision 15) makes a cross-reference change.

Section 28 (256B.49, subdivision 25) adds a new subdivision providing certain HCBS recipients to receive a consultation with a mental health professional or a behavioral professional within 30 days of discharge; and listing the duties of the mental health or behavioral professional.

Section 29 (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 30 (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 31 (256B.493) makes a cross-reference change.

Section 32 (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 33 (256B.5012, subdivision 14) increases the total operating payment rate for ICF/DDs.

Section 34 (256B.5012, subdivision 15) provides for a one percent rate increase on January 1, 2015, and another one percent rate increase on July 1, 2015, for ICF/DDs.

Section 35 (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 36 (Laws 2011, First Special Session chapter 9, article 7, section 39, subdivision 14) removes a paragraph yet to take effect requiring assessments and reassessments for waiver recipients meeting certain criteria.

Section 37 (Laws 2012, chapter 247, article 6, section 4) adds language stating that an appropriation to the Board of Nursing Home Administrators was onetime.

Section 38 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 39 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 40 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 41 requires DHS to develop recommendations for assistive technology equipment funding, due to the Legislature on February 1, 2014.

Section 42 provides for a one percent rate increase on January 1, 2015, and another one percent rate increase on July 1, 2015, 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 43 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 44 requires DHS to develop and promote a shared living model for HCBS waiver recipients, with any required federal approval submitted December 31, 2013.

Section 45 requires DHS to seek federal approval to implement the Money Follows the Person federal grant by December 1, 2013.

Section 46 repeals section 256B.096, subdivisions 1 (scope), 2 (stakeholder advisory group), 3 (annual survey of service recipients), and 4 (improvements for incident reporting, investigation, analysis, and follow-up); 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, a 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 the Department of Human Services (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 consult with stakeholders and collect data on the use of aversive and controlled procedures from providers who will be licensed under chapter 245D.

Section 5 (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 6 (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 7 (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.

Section 8 (245A.03, subdivision 8) makes a cross-reference change.

Section 9 (245A.042, subdivision 3) clarifies language related to DHS's authority to issue correction orders and makes a cross-reference change.

Section 10 (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 11 (245A.10) makes changes to license fees, effective July 1, 2013.

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; adds that initial application fees in this subdivision do not include the temporary license surcharge under section 16E.22, and strikes obsolete language.

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

Section 12 (245A.11, subdivision 2a) makes technical changes allowing this section to apply to community residential settings.

Section 13 (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 14 (245A.11, subdivision 7a) updates terminology and strikes obsolete language.

Section 15 (245A.11, subdivision 7b) updates terminology and strikes obsolete language.

Section 16 (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 17 (245A.16, subdivision 1) prohibits county agencies from granting variances for community residential setting licenses.

Section 18 (245D.02) adds and modifies definitions applicable to chapter 245D.

Section 19 (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.

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 repealed.

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

Section 20 (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 21 (245D.05) modifies the “HEALTH SERVICES” section, effective January 1, 2014, defining and specifying responsibilities of medication setup, medication assistance, and medication administration.

Section 22 (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 23 (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 repealed.

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 restraint practices, manual restraints, time out, or seclusion as a substitute for adequate staffing, a behavioral or therapeutic program to reduce or eliminate behavior, as punishment, or for staff convenience; and defines “chemical restraint” and “mechanical restraint practice.”

Section 24 (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 defines “manual restraint” and “mechanical restraint.”

Subdivision 3 lists the conditions that must be met for emergency use of manual restraint.

Subdivision 4 requires physical contact or instructional techniques to use the least restrictive alternative possible to meet the needs of the person and allows them to be used under specified conditions; specifies when restraint may be use as therapeutic conduct; requires a plan to be developed for using restraint as therapeutic conduct.

Subdivision 5 lists prohibitions regarding emergency use of manual restraint procedures.

Subdivision 6 requires the license holder to monitor a person’s health and safety during an emergency use of manual restraint, and requires license holders to complete a monitoring form for each incident involving the emergency use of manual restraint.

Subdivision 7 requires the staff person who implemented the emergency use of a manual restraint to report each incident involving the emergency use of manual restraint; specifies the information that must be included in the incident report; requires each single incident of emergency use of manual restraint to be reported separately.

Subdivision 8 requires license holders to complete an internal review of each report of emergency use of manual restraint, 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 9 requires license holders to consult with the expanded support team following the emergency use of manual restraint.

Subdivision 10 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 25 (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 26 (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 27 (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 28 (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 29 (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 30 (245D. 095) creates a new section, “RECORD REQUIREMENTS,” effective January 1, 2014, outlining the record keeping requirements for providers licensed under Chapter 245D.

Section 31 (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 32 (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 33 (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 34 (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 35 (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 36 (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 37 (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 38 (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 39 (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 40 (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 41 (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 42 (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 7 specifies the steps for determining the number of direct support service staff required to meet the combined staff ratio requirements of the persons present at any one time.

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 43 (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 44 (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.

Section 45 (256B.092, subdivision 11) modifies the types of settings than can provide residential support services and the criteria residential support services must meet.

Section 46 (256B.4912, subdivision 1) adds cross-references and modifies provider qualifications beginning January 1, 2014.

Section 47 (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 48 (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 49 (256B.4912, subdivision 9) adds a subdivision defining “controlling individual,” “managerial officer,” and “owner” for this section.

Section 50 (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 51 (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 52 (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 53 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 54 repeals, effective January 1, 2014, sections 245B.01 (rule consolidation); 245B.02 (definitions); 245B.03 (applicability and effect); 245B.031 (accreditation, alternative inspection, and deemed compliance); 245B.04 (consumer rights); 245B.05, subd. 1, 2, 3, 5, 6, and 7 (consumer protection standards); 245B.055 (staffing for DT&H services); 245B.06 (service standards); 245B.07 (management standards); and 245B.08 (compliance strategies); also repeals section 245D.08 (record requirements).

Article 9: Waiver Provider Standards Technical Changes

The entire article makes technical, language, and cross-reference changes to conform with the changes from Article 8.

Article 10 Health-Related Licensing Boards

Section 1 (13.411, subd. 7) specifies in chapter 13 that criminal history record information obtained by a health-related licensing board is classified in section 214.075.

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

Section 3 (151.01, subd. 27) modifies the definition of the practice of pharmacy in terms of the standing orders or protocol that a pharmacist has with a physician to administer vaccines and immunizations.  

Section 4 (151.19, subd. 1) modifies the pharmacy licensure requirements to specify a separate license for in-state pharmacies and out-of-state pharmacies.

Section 5 (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 6 (151.252) modifies the licensure requirements for drug manufacturers.

Section 7 (151.26, subd. 1) specifies that any professional sample that is provided to a dispenser for dispensing must be prepared and distributed pursuant to federal regulations.

Section 8 (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 9 (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 10 (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 11 (151.49) makes technical changes to the application procedures for licensure renewal.

Section 12 (152.126) makes modifications to the prescription monitoring program.

Subdivision 1 includes tramadol and butalbital to the definition of controlled substance.

Subdivision  3 adds a representative of an association of medical examiners and coroners to the program's advisory committee.

Subdivision . 4 changes the references to certain long-term care facilities.

Subdivision permits the board to transfer data into a database that may only be used by the authorized staff of the board for purposes of administering, operating, and maintaining the program and conducting trend analyses and other studies that are necessary to evaluate the effectiveness of the program.

Subdivision 6 permits access to the data by a prescriber who is providing other medical treatment for which access to the data may be necessary; by a dispenser who is providing other pharmaceutical care for which access to the data may be necessary;  a licensed pharmacist who is providing pharmaceutical care for which access to the data may be necessary or when consulted by a prescriber who is requesting data that relates to a current patient or who is providing other medical treatment; and a coroner or medical examiner.  This subdivision also authorizes the board to participate in an interstate prescription monitoring program data exchange program provided that permissible users in other states may have access to the data only as allowed in this section.

Subdivision 8 strikes obsolete language.

Subdivision  10 adds the Board of Veterinary Medicine to the boards that share in the cost for the operation of the program.

Section 13 (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.

Subd. 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, paragraph (a), classifies the state criminal history record information obtained by the board as private data on individuals, and classifies the national criminal history record information obtained by a board as confidential data on individuals.

Subdivision  8 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  9 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 14 (214.12, subd. 4) requires the boards that regulate professions that serve caregivers at risk of depression or their children to educational materials to licensees on parental depression and its effect on children if unaddressed.

Section 15 (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 16 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 17 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 REQUIREMENT,” 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

Sections 1 to 7 (62J.692) modify the medical education and research cost fund.

Sections 1 and 2  (62J.692 subd. 1 and 2) expand 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 3 (62J.692, subd. 3) modifies the distribution formula by eliminating the supplemental public program volume factor, 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 4 (62J.692, subd. 5) requires the training sites to include in the grant verification report a training site expenditure report.

Section 5 (62J.692, subd. 7a) specifies that $1,000,000 of the funds from the tobacco tax shall be distributed by the commissioner for primary care development grants to teaching institutions and clinical training sites to increase the availability of primary care providers.

Section 6 (62J.692, subd. 9) removes a reference to the advisory committee.

Section 7 (62J.692, subd. 11) specifies that if federal approval is not granted for this new distribution formula, that the supplemental public program volume factor will continue to be used.

Section 8 (62Q.19) extends essential community provider designation to children’s hospitals and affiliated specialty clinics.

Section 9 (103I.005) adds a definition of bored geothermal health exchanger.

Section 10 (103I.521) clarifies that the fees from chapter 103I (wells and borings) are to be deposited in the state government special revenue fund.

Sections 11 to 13 amend the newborn screening program.

Section 11(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 12 (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 shall be deposited in the general fund.

Section 13 (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) provide training;

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

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

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

Sections 14 to 26 make changes to the vital records statutes.

Section 14 (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 15 (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 16 (144.2131) specifies the duties for the state registrar to provide security of the vital records system.

Section 17 (144.215,subd. 3) removes reference to a declaration of parentage.

Section 18 (144.215, subd. 4) changes the reference to vital records.

Section 19 (144.216, subd. 1) changes the reference to vital records.

Section 20 (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 21 (144.218, subd. 5) removes reference to a declaration of parentage.

Section 22 (144.2181) specifies the process to amend or correct a vital record.

 Section 23 (144.225, subd. 1) removes reference to local registrar.

Section 24 (144.225, subd. 4) makes a technical change.

Section 25 (144.225, subd. 7) changes reference from local registrar to local issuance officer.

Section 26 (144.225, subd. 8) changes reference from local registrant to local issuance office.

Section 27 (144.226) specifies that a fee may be charged for a search for a vital record that cannot be issued.  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 28 to 30 authorize certain hospitals to be designated stroke hospitals.

Section 28 (144.492) defines the following terms:  commissioner, joint commission, and stroke.

Section 29 (144.493) establishes the criteria for "comprehensive stroke centers," "primary stroke centers," and "acute stroke ready hospitals." 

Section 30 (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 31 (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 32 (144.966, subd. 2) extends the newborn hearing screening advisory committee until June 30, 2019.

Section 33 (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 34 to 39 make changes to the accreditation of environmental laboratories.

Section 34 (144.98, subd. 3) reduces a number of the accreditation fees for environmental laboratories.

Section 35 (144.98, subd. 5) specifies that the fees are deposited in the state government special revenue fund.

Section 36 (144.98, subd. 10) requires the commissioner to establish a selection committee to recommend approval of qualified laboratory assessors and assessment bodies.

Section 37 (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 38 (144.98, subd. 12) specifies the requirements that an assessor must meet to be approved by the commissioner.

Section 39 (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 40 (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 41 (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 42 (145.907) defines maternal depression.

Section 43 (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 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 44 (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 45 to 92 establish licensing requirements for alkaline hydrolysis facilities in chapter 149A.

Section 93 (257.75, subd. 7) changes the office of the state registrar to the office of vital records.

Section 94 (260C.635, subd. 1) changes the office of the state registrar to the office of vital records.

Section 95 (517.001) specifies the definition of local registrar in chapter 517 (marriage).

Section 96 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 97 instructs the revisor to substitute the term “vertical heat exchanger” to “bored geothermal heat exchanger.”

Section 98, paragraph (a), repeals 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).

Paragraph (b) repeals 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 (256B.4912, subdivision 2) adds a cross-reference.

Section 2 (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 3 (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 percent annually between calendar years 2016 and 2019, including rates for services in a recipient’s service plan approved prior to calendar year 2016.

Section 4 (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 5 (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 6 (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 with recommendations to the Legislature on February 15, 2014, and 2015, then biennially each February 15 until 2021, at which time the report is due every four years.

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.

Subdivision 17 outlines the two year phase-in process for the new rate setting methodology, beginning January 1, 2014.

Section 7 repeals (section 256B.4913 subdivisions 1, 2, 3 and 4) subdivisions related to implementing the new rate setting methodology created in this section that are now obsolete or replaced in this bill.

 

 

 

 

 

 

 
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