HF 1448

as introduced - 88th Legislature (2013 - 2014) Posted on 03/18/2013 04:51pm

A bill for an act
relating to human services; modifying payment methodologies for home and
community-based services; amending Minnesota Statutes 2012, sections
256B.4912, subdivisions 2, 3; 256B.4913.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
read:

Subd. 2.

Payment methodologies.

(a) The commissioner shall establish new text begin , as defined
under section 256B.4913, new text end statewide payment methodologies that meet federal waiver
requirements for home and community-based waiver services for individuals with
disabilities. The payment methodologies must abide by the principles of transparency
and equitability across the state. The methodologies must involve a uniform process of
structuring rates for each service and must promote quality and participant choice.

(b) As of January 1, 2012, counties shall not implement changes to established
processes for rate-setting methodologies for individuals using components of or data
from research rates.

Sec. 2.

Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:

Subd. 3.

Payment requirements.

The payment methodologies established under
this section shall accommodate:

(1) supervision costs;

(2) deleted text begin staffing patterns deleted text end new text begin staff compensation new text end ;

new text begin (3) staffing and supervisory patterns;
new text end

deleted text begin (3) deleted text end new text begin (4) new text end program-related expenses;

deleted text begin (4) deleted text end new text begin (5) new text end general and administrative expenses; and

deleted text begin (5) deleted text end new text begin (6) new text end consideration of recipient intensity.

Sec. 3.

Minnesota Statutes 2012, section 256B.4913, is amended to read:

256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.

deleted text begin Subdivision 1. deleted text end

deleted text begin Research period and rates. deleted text end

deleted text begin (a) For the purposes of this
section, "research rate" means a proposed payment rate for the provision of home
and community-based waivered services to meet federal requirements and assess the
implications of changing resources on the provision of services and "research period"
means the time period during which the research rate is being assessed by the commissioner.
deleted text end

deleted text begin (b) The commissioner shall determine and publish initial frameworks and values to
generate research rates for individuals receiving home and community-based services.
deleted text end

deleted text begin (c) The initial values issued by the commissioner shall ensure projected spending
for home and community-based services for each service area is equivalent to projected
spending under current law in the most recent expenditure forecast.
deleted text end

deleted text begin (d) The initial values issued shall be based on the most updated information and cost
data available on supervision, employee-related costs, client programming and supports,
programming planning supports, transportation, administrative overhead, and utilization
costs. These service areas are:
deleted text end

deleted text begin (1) residential services, defined as corporate foster care, family foster care, residential
care, supported living services, customized living, and 24-hour customized living;
deleted text end

deleted text begin (2) day program services, defined as adult day care, day training and habilitation,
prevocational services, structured day services, and transportation;
deleted text end

deleted text begin (3) unit-based services with programming, defined as in-home family support,
independent living services, supported living services, supported employment, behavior
programming, and housing access coordination; and
deleted text end

deleted text begin (4) unit-based services without programming, defined as respite, personal support,
and night supervision.
deleted text end

deleted text begin (e) The commissioner shall make available the underlying assessment information,
without any identifying information, and the statistical modeling used to generate the
initial research rate and calculate budget neutrality.
deleted text end

new text begin Subd. 1a. new text end

new text begin Application. new text end

new text begin The payment methodologies in this section apply to home
and community-based services waivers under sections 256B.092 and 256B.49. This
section does not change existing waiver policies and procedures.
new text end

new text begin Subd. 1b. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
new text end

new text begin (d) "Customized living tool" means a methodology for setting service rates which
delineates and documents the amount of each component service included in a recipient's
customized living service plan.
new text end

new text begin (e) "Disability Waiver Rates System" means a statewide system which establishes
rates that are based on uniform processes and captures the individualized nature of waiver
services and recipient needs.
new text end

new text begin (f) "Median" means the amount that divides distribution into two equal groups, half
above the median and half below the median.
new text end

new text begin (g) "Payment" or "rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
new text end

new text begin (h) "Rates management system" means a Web-based software application that uses
a framework and component values, as determined by the commissioner, to establish
service rates.
new text end

new text begin (i) "Recipient" means a person receiving home and community-based services
funded under any of the disability waivers.
new text end

new text begin Subd. 1c. new text end

new text begin Applicable services. new text end

new text begin Applicable services are those authorized under the
state's home and community-based services waivers under sections 256B.092 and 256B.49,
including as defined in the federally approved home and community-based services plan:
new text end

new text begin (1) 24-hour customized living;
new text end

new text begin (2) adult day care;
new text end

new text begin (3) adult day care bath;
new text end

new text begin (4) behavioral programming;
new text end

new text begin (5) companion services;
new text end

new text begin (6) customized living;
new text end

new text begin (7) day training and habilitation;
new text end

new text begin (8) housing access coordination;
new text end

new text begin (9) independent living skills;
new text end

new text begin (10) in-home family support;
new text end

new text begin (11) night supervision;
new text end

new text begin (12) personal support;
new text end

new text begin (13) prevocational services;
new text end

new text begin (14) residential care services;
new text end

new text begin (15) residential support services;
new text end

new text begin (16) respite services;
new text end

new text begin (17) structured day services;
new text end

new text begin (18) supported employment services;
new text end

new text begin (19) supported living services;
new text end

new text begin (20) transportation services; and
new text end

new text begin (21) other services as approved by the federal government in the state home and
community-based services plan.
new text end

deleted text begin Subd. 2. deleted text end

deleted text begin Framework values. deleted text end

deleted text begin (a) The commissioner shall propose legislation with
the specific payment methodology frameworks, process for calculation, and specific
values to populate the frameworks by February 15, 2013.
deleted text end

deleted text begin (b) The commissioner shall provide underlying data and information used to
formulate the final frameworks and values to the existing stakeholder workgroup by
January 15, 2013.
deleted text end

deleted text begin (c) The commissioner shall provide recommendations for the final frameworks
and values, and the basis for the recommendations, to the legislative committees with
jurisdiction over health and human services finance by February 15, 2013.
deleted text end

deleted text begin (d) The commissioner shall review the following topics during the research period
and propose, as necessary, recommendations to address the following research questions:
deleted text end

deleted text begin (1) underlying differences in the cost to provide services throughout the state;
deleted text end

deleted text begin (2) a data-driven process for determining labor costs and customizations for staffing
classifications included in each rate framework based on the services performed;
deleted text end

deleted text begin (3) the allocation of resources previously established under section 256B.501,
subdivision 4b;
deleted text end

deleted text begin (4) further definition and development of unit-based services;
deleted text end

deleted text begin (5) the impact of splitting the allocation of resources for unit-based services for those
with programming aspects and those without;
deleted text end

deleted text begin (6) linking assessment criteria to future assessment processes for determination
of customizations;
deleted text end

deleted text begin (7) recognition of cost differences in the use of monitoring technology where it is
appropriate to substitute for supervision;
deleted text end

deleted text begin (8) implications for day services of reimbursement based on a unit rate and a daily
rate;
deleted text end

deleted text begin (9) a definition of shared and individual staffing for unit-based services;
deleted text end

deleted text begin (10) the underlying costs of providing transportation associated with day services; and
deleted text end

deleted text begin (11) an exception process for individuals with exceptional needs that cannot be met
under the initial research rate, and an alternative payment structure for those individuals.
deleted text end

deleted text begin (e) The commissioner shall develop a comprehensive plan based on information
gathered during the research period that uses statistically reliable and valid assessment
data to refine payment methodologies.
deleted text end

deleted text begin (f) The commissioner shall make recommendations and provide underlying data and
information used to formulate these research recommendations to the existing stakeholder
workgroup by January 15, 2013.
deleted text end

deleted text begin Subd. 3. deleted text end

deleted text begin Data collection. deleted text end

deleted text begin (a) The commissioner shall conduct any necessary
research and gather additional data for the further development and refinement of payment
methodology components. These include but are not limited to:
deleted text end

deleted text begin (1) levels of service utilization and patterns of use;
deleted text end

deleted text begin (2) staffing patterns for each service;
deleted text end

deleted text begin (3) profiles of individual service needs; and
deleted text end

deleted text begin (4) cost factors involved in providing transportation services.
deleted text end

deleted text begin (b) The commissioner shall provide this information to the existing stakeholder
workgroup by January 15, 2013.
deleted text end

deleted text begin Subd. 4. deleted text end

deleted text begin Rate stabilization adjustment. deleted text end

deleted text begin Beginning January 1, 2014, the
commissioner shall adjust individual rates determined by the new payment methodology
so that the new rate varies no more than one percent per year from the rate effective
on December 31 of the prior calendar year. This adjustment is made annually and is
effective for three calendar years from the date of implementation. This subdivision
expires January 1, 2017.
deleted text end

new text begin Subd. 4a. new text end

new text begin Rate stabilization adjustment. new text end

new text begin (a) The commissioner of human services
shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
January 1, 2014. Rates must be adjusted using the new payment methodology so that the
new unit rate varies no more than 1.0 percent per year from the rate effective December
1 of the prior calendar year. This adjustment is made annually for three calendar years
from the date of implementation.
new text end

new text begin (b) Rate stabilization adjustment applies to services that are authorized in a
recipient's service plan prior to January 1, 2014.
new text end

new text begin (c) Exemptions shall be made only when there is a significant change in the
recipient's assessed needs which results in a service authorization change. Exemption
adjustments shall be limited to the difference in the authorized framework rate specific to
change in assessed need. Exemptions shall be managed within lead agencies' budgets per
existing allocation procedures which govern county waiver budget allocation.
new text end

new text begin (d) This subdivision expires January 1, 2017.
new text end

Subd. 5.

Stakeholder consultation.

The commissioner shall continue consultation
on regular intervals new text begin , new text end with the existing stakeholder group established as part of the
rate-setting methodology process new text begin and others new text end to gather input, concerns, and data, deleted text begin and
exchange ideas for deleted text end new text begin to assist in new text end the deleted text begin legislative proposals for deleted text end new text begin full implementation of new text end the new
rate payment system and new text begin to new text end make pertinent information available to the public through
the department's Web site.

Subd. 6.

Implementation.

new text begin (a) new text end The commissioner deleted text begin may deleted text end new text begin shall new text end implement changes
deleted text begin no sooner than deleted text end new text begin on new text end January 1, 2014, to payment rates for individuals receiving home and
community-based waivered services after the enactment of legislation that establishes
specific payment methodology frameworks, processes for rate calculations, and specific
values to populate the deleted text begin payment methodology frameworks deleted text end new text begin disability waiver rates system new text end .

new text begin (b) Rates shall be determined using component values as provided under this
section. Lead agencies, in consultation with provider agencies, shall enter person-specific
information into a rate management system developed by the commissioner. The rate
management system must calculate rates that lead agencies must use as the basis for
authorizing services on behalf of disability waiver recipients subject to the requirements
of subdivision 4.
new text end

new text begin (c) On January 1, 2014, all new service authorizations must use the disability waiver
rates system. Beginning January 1, 2014, all renewing individual service plans must use the
disability waiver rates system as reassessment and reauthorization occurs. By December
31, 2014, data for all recipients must be entered into the disability waiver rates system.
new text end

new text begin (d) Beginning January 1, 2014, through implementation, the commissioner shall
make adjustments to lead agency waiver budgets per the federally approved home and
community-based services waiver plans for people with disabilities as authorized under
sections 256B.092 and 256B.49.
new text end

new text begin Subd. 7. new text end

new text begin Uniform payment methodology. new text end

new text begin The commissioner shall determine
a uniform methodology to meet the individualized service plan for recipients with
disabilities as funded under the waiver plan for home and community-based services
under sections 256B.092 and 256B.49. The commissioner shall use the component values,
with consideration of recipient needs, to determine the service payment rate under this
section. The payment methodology for customized living, 24-hour customized living, and
residential care services shall be the customized living tool. Revisions to the customized
living tool shall be made to reflect services and activities unique to disability-related
recipient needs.
new text end

new text begin Subd. 8. new text end

new text begin Payments for residential services. new text end

new text begin (a) Payments for residential support
services as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:
new text end

new text begin (1) Determine the number of units of service to meet a recipient's needs.
new text end

new text begin (2) Personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
national and Minnesota-specific rates or rates derived by the commissioner as provided in
paragraph (c). This is defined as the direct care rate.
new text end

new text begin (3) For a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 15, add the customization rate provided in subdivision 15
to the result of clause (2). This is defined as the customized direct care rate.
new text end

new text begin (4) Multiply the number of residential services direct staff hours by the appropriate
staff wage in paragraph (c) or the customized direct care rate.
new text end

new text begin (5) Multiply the number of direct staff hours by the product of the supervision
span of control ratio in paragraph (d), clause (1), and the supervision wage in paragraph
(c), clause (5).
new text end

new text begin (6) Combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in paragraph (d), clause (2).
This is defined as the direct staffing cost.
new text end

new text begin (7) For employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in paragraph (d), clause (3).
new text end

new text begin (8) For client programming and supports, the commissioner shall add $2,179 per
year adjusted to an hourly rate.
new text end

new text begin (9) For transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport per year adjusted to an hourly rate.
new text end

new text begin (b) The total rate shall be calculated using the following steps:
new text end

new text begin (1) Subtotal paragraph (a), clauses (7) to (9).
new text end

new text begin (2) Sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio.
new text end

new text begin (3) Divide the result of clause (1) by one minus the result of clause (2). This is
the total payment amount.
new text end

new text begin (c)(1) The base wage index is established to determine staffing costs associated with
providing services to individuals receiving home and community-based services. For
purposes of developing and calculating the proposed base wage, Minnesota-specific wages
taken from job descriptions and standard occupational classification (SOC) codes from
the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
clauses (2) to (5).
new text end

new text begin (2) The base wage index for residential direct basic care services is:
new text end

new text begin (i) 50 percent of the median wage for personal and home health aide (SOC code
39-9021);
new text end

new text begin (ii) 30 percent of the median wage for nursing aide (SOC code 31-1012); and
new text end

new text begin (iii) 20 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (3) The base wage index for residential direct care intensive services is:
new text end

new text begin (i) 20 percent of the median wage for home health aide (SOC code 31-1011);
new text end

new text begin (ii) 20 percent of the median wage for personal and home health aide (SOC code
39-9021);
new text end

new text begin (iii) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (iv) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and
new text end

new text begin (v) 20 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (4) When residential direct care basic services are provided during normal sleeping
hours, the basic wage is $7.66 per hour, except in a family foster care setting the wage is
$2.80 per hour.
new text end

new text begin (5) For supervisory staff, the basic wage is $17.43 per hour.
new text end

new text begin (d) Component values for residential support services, excluding family foster
care, are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) general administrative support ratio: 13.25 percent;
new text end

new text begin (5) program-related expense ratio: 1.3 percent; and
new text end

new text begin (6) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (e) Component values for family foster care are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) general administrative support ratio: 3.3 percent; and
new text end

new text begin (5) program-related expense ratio: 1.3 percent.
new text end

new text begin (f) The commissioner shall revise the wage rates in the manner provided in
subdivision 12.
new text end

new text begin Subd. 9. new text end

new text begin Payments for day programs. new text end

new text begin (a) Payments for services with day
programs, including adult day care, day treatment and habilitation, prevocational services,
and structured day services must be calculated as follows:
new text end

new text begin (1) Determine the number of units of service to meet a recipient's needs.
new text end

new text begin (2) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in paragraph (b).
new text end

new text begin (3) For a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 15, add the customization rate provided in subdivision 15
to the result of clause (2). This is defined as the customized direct care rate.
new text end

new text begin (4) Multiply the number of day program direct staff hours by the appropriate staff
wage in paragraph (b) or the customized direct care rate.
new text end

new text begin (5) Multiply the number of day direct staff hours by the product of the supervision
span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
(b), clause (3).
new text end

new text begin (6) Combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
This is defined as the direct staffing rate.
new text end

new text begin (7) For program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in paragraph (c), clause (4).
new text end

new text begin (8) For employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in paragraph (c), clause (3).
new text end

new text begin (9) For client programming and supports, multiply the result of clause (8) by one
plus the client programming and support ratio in paragraph (c), clause (5).
new text end

new text begin (10) For program facility costs, add $8.30 per week with consideration of staffing
ratios to meet individual needs.
new text end

new text begin (11) For adult day bath services, add $7.01 per 15 minute unit.
new text end

new text begin (12) This is the subtotal rate.
new text end

new text begin (13) Sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio.
new text end

new text begin (14) Divide the result of clause (12) by one minus the result of clause (13). This is
the total payment amount.
new text end

new text begin (15) For transportation provided as part of day training and habilitation, add a base
of $2.52 plus:
new text end

new text begin (i) $2.50 for a trip between zero to ten miles without a lift or $7.05 with a lift;
new text end

new text begin (ii) $7.75 for a trip between 11 and 20 miles without a lift or $22.16 with a lift;
new text end

new text begin (iii) $17.75 for a trip between 21 and 50 miles without a lift and $50.76 with a lift;
new text end

new text begin (iv) $25.50 for a trip of 51 miles or more without a lift and $72.93 with a lift; and
new text end

new text begin (v) divide by six for a shared trip.
new text end

new text begin (b)(1) The base wage index is established to determine staffing costs associated with
providing services to individuals receiving home and community-based services. For
purposes of developing and calculating the proposed base wage, Minnesota-specific wages
taken from job descriptions and standard occupational classification (SOC) codes from
the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
clauses (2) and (3).
new text end

new text begin (2) The base wage index for direct services is:
new text end

new text begin (i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and
new text end

new text begin (iii) 60 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (3) For supervisory staff, the base wage index is $17.43 per hour.
new text end

new text begin (c) Component values for day services for all services are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) program plan support ratio: 5.6 percent;
new text end

new text begin (5) client programming and support ratio: 10 percent;
new text end

new text begin (6) general administrative support ratio: 13.25 percent;
new text end

new text begin (7) program-related expense ratio: 1.8 percent; and
new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (d) The commissioner shall revise the wage rates in the manner provided in
subdivision 12.
new text end

new text begin Subd. 10. new text end

new text begin Payments for unit-based with program services. new text end

new text begin (a) Payments for
unit-based with program services, including behavior programming, housing access
coordination, in-home family support, independent living skills training, hourly supported
living services, and supported employment provided to an individual outside of any day or
residential service plan must be calculated as follows, unless the services are authorized
separately under subdivisions 8 and 9:
new text end

new text begin (1) Determine the number of units of service to meet a recipient's needs.
new text end

new text begin (2) Personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in paragraph (b).
new text end

new text begin (3) For a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 15, add the customization rate provided in subdivision 15
to the result of clause (2). This is defined as the customized direct care rate.
new text end

new text begin (4) Multiply the number of direct staff hours by the appropriate staff wage in
paragraph (b) or the customized direct care rate.
new text end

new text begin (5) Multiply the number of direct staff hours by the product of the supervision
span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
(b), clause (10).
new text end

new text begin (6) Combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
This is defined as the direct staffing rate.
new text end

new text begin (7) For program plan support, multiply the result of clause (6) by one plus the
program plan supports ratio in paragraph (c), clause (4).
new text end

new text begin (8) For employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in paragraph (c), clause (3).
new text end

new text begin (9) For client programming and supports, multiply the result of clause (8) by one
plus the client programming and supports ratio in paragraph (c), clause (5).
new text end

new text begin (10) This is the subtotal rate.
new text end

new text begin (11) Sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio.
new text end

new text begin (12) Divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount.
new text end

new text begin (b)(1) The base wage index is established to determine staffing costs associated with
providing services to individuals receiving home and community-based services. For
purposes of developing and calculating the proposed base wage, Minnesota-specific wages
taken from job descriptions and standard occupational classification (SOC) codes from
the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
clauses (2) to (10).
new text end

new text begin (2) The base wage index for a behavior program analyst is 100 percent of the median
wage for mental health counselor (SOC code 21-1014).
new text end

new text begin (3) The base wage index for a behavior program professional is 100 percent of the
median wage for clinical counseling and school psychologist (SOC code 19-3031).
new text end

new text begin (4) The base wage index for a behavior program specialist is 100 percent of the
median wage for psychiatric technician (SOC code 29-2053).
new text end

new text begin (5) The base wage index for hourly supportive living services is:
new text end

new text begin (i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and
new text end

new text begin (iii) 60 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (6) The base wage index for housing access coordinator services is:
new text end

new text begin (i) 50 percent of the median wage for community and social services specialist
(SOC code 21-1099); and
new text end

new text begin (ii) 50 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (7) The base wage index for in-home family support services is:
new text end

new text begin (i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (ii) 30 percent of the median wage for community social service specialist (SOC
code 21-1099);
new text end

new text begin (iii) 40 percent of the median wage for social and human services aide (SOC code
21-1093); and
new text end

new text begin (iv) ten percent of the median wage for psychiatric technician (SOC code 29-2053).
new text end

new text begin (8) The base wage index for independent living skills is:
new text end

new text begin (i) 40 percent of the median wage for community social service specialist (SOC
code 21-1099);
new text end

new text begin (ii) 50 percent of the median wage for social and human services aide (SOC code
21-1093); and
new text end

new text begin (iii) ten percent of the median wage for psychiatric technician (SOC code 29-2053).
new text end

new text begin (9) The base wage index for supported employment services is:
new text end

new text begin (i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and
new text end

new text begin (iii) 60 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (10) For a supervisor, the base wage index is $17.43 per hour with the exception of the
supervision of behavior analysts and behavior specialists which shall be $30.75 per hour.
new text end

new text begin (c) Component values for unit-based with program services are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) program plan supports ratio: 3.1 percent;
new text end

new text begin (5) client programming and supports ratio: 8.6 percent;
new text end

new text begin (6) general administrative support ratio: 13.25 percent;
new text end

new text begin (7) program-related expense ratio: 6.1 percent; and
new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (d) The commissioner shall revise the wage rates in the manner provided in
subdivision 12.
new text end

new text begin Subd. 11. new text end

new text begin Payments for unit-based without program services. new text end

new text begin (a) Payments
for unit-based without program services including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivisions 8 and 9:
new text end

new text begin (1) For all services except respite, determine the number of units of service to meet
a recipient's needs.
new text end

new text begin (2) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in paragraph (b).
new text end

new text begin (3) For a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 15, add the customization rate provided in subdivision 15
to the result of clause (2). This is defined as the customized direct care rate.
new text end

new text begin (4) Multiply the number of direct staff hours by the appropriate staff wage in
paragraph (b) or the customized direct care rate.
new text end

new text begin (5) Multiply the number of direct staff hours by the product of the supervision
span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
(b), clause (6).
new text end

new text begin (6) Combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
This is defined as the direct staffing rate.
new text end

new text begin (7) For program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in paragraph (c), clause (4).
new text end

new text begin (8) For employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in paragraph (c), clause (3).
new text end

new text begin (9) For client programming and supports, multiply the result of clause (8) by one
plus the client programming and support ratio in paragraph (c), clause (5).
new text end

new text begin (10) This is the subtotal rate.
new text end

new text begin (11) Sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio.
new text end

new text begin (12) Divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount.
new text end

new text begin (13) For respite services, determine the number of daily units of service to meet an
individual's needs.
new text end

new text begin (14) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in paragraph (b).
new text end

new text begin (15) For a recipient requiring deaf and hard-of-hearing customization under
subdivision 15, add the customization rate provided in subdivision 15 to the result of
clause (14). This is defined as the customized direct care rate.
new text end

new text begin (16) Multiply the number of direct staff hours by the appropriate staff wage in
paragraph (b).
new text end

new text begin (17) Multiply the number of direct staff hours by the product of the supervisory
span of control ratio in paragraph (d), clause (1), and the supervision wage in paragraph
(b), clause (6).
new text end

new text begin (18) Combine the results of clauses (16) and (17) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in paragraph (d), clause (2).
This is defined as the direct staffing rate.
new text end

new text begin (19) For employee-related expenses, multiply the result of clause (18) by one plus
the employee-related cost ratio in paragraph (d), clause (3).
new text end

new text begin (20) This is the subtotal rate.
new text end

new text begin (21) Sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio.
new text end

new text begin (22) Divide the result of clause (20) by one minus the result of clause (21). This is
the total payment amount.
new text end

new text begin (b)(1) The base wage index is established to determine staffing costs associated
with providing services to recipients receiving home and community-based services. For
purposes of developing and calculating the proposed base wage, Minnesota-specific wages
taken from job descriptions and standard occupational classification (SOC) codes from
the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
clauses (2) to (6):
new text end

new text begin (2) The base wage index for adult companion staff is:
new text end

new text begin (i) 50 percent of the median wage for personal and home care aide (SOC code
39-9021); and
new text end

new text begin (ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
code 31-1012).
new text end

new text begin (3) The base wage index for night supervision staff is:
new text end

new text begin (i) 20 percent of the median wage for home health aide (SOC code 31-1011);
new text end

new text begin (ii) 20 percent of the median wage for personal and home health aide (SOC code
39-9021);
new text end

new text begin (iii) 20 percent of the median wage for nursing aide (SOC code 31-1012);
new text end

new text begin (iv) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and
new text end

new text begin (v) 20 percent of the median wage for social and human services aide (SOC code
21-1093).
new text end

new text begin (4) The base wage index for respite staff is:
new text end

new text begin (i) 50 percent of the median wage for personal and home care aide (SOC code
39-9021); and
new text end

new text begin (ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
code 31-1012).
new text end

new text begin (5) The base wage index for personal support staff is:
new text end

new text begin (i) 50 percent of the median wage for personal and home care aide (SOC code
39-9021); and
new text end

new text begin (ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
code 31-1012).
new text end

new text begin (6) The base wage index for supervisory staff is $17.43 per hour.
new text end

new text begin (c) Component values for unit-based services without programming except respite
are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) program plan support ratio: 3.1 percent;
new text end

new text begin (5) client programming and support ratio: 8.6 percent;
new text end

new text begin (6) general administrative support ratio: 13.25 percent;
new text end

new text begin (7) program-related expense ratio: 6.1 percent; and
new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (d) Component values for unit-based services without programming for respite are:
new text end

new text begin (1) supervisory span of control ratio: 11 percent;
new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) general administrative support ratio: 13.25 percent;
new text end

new text begin (5) program-related expense ratio: 6.1 percent; and
new text end

new text begin (6) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (e) The commissioner shall revise the wage rates in the manner provider in
subdivision 12.
new text end

new text begin Subd. 12. new text end

new text begin Updating or changing payment values. new text end

new text begin (a) The commissioner shall
develop and implement uniform procedures to refine terms and update or adjust values
used to calculate payment rates in this section. For calendar year 2014, the commissioner
shall use the values, terms, and procedures provided in this section.
new text end

new text begin (b) The commissioner shall work with stakeholders to assess efficacy of values
and payment rates. The commissioner shall report back to the legislature with proposed
changes for component values and recommendations for revisions on the schedule
provided in paragraphs (c) and (d).
new text end

new text begin (c) The commissioner shall work with stakeholders to continue refining a
subset of component values, which are to be referred to as interim values, and report
recommendations to the legislature by February 15, 2014. Interim component values are:
transportation rates for day training and habilitation; transportation for adult day, structured
day, and prevocational services; geographic difference factor; day program facility rate;
services where monitoring technology replaces staff time; shared services for independent
living skills training; and supported employment and billing for indirect services.
new text end

new text begin (d) The commissioner shall report and make recommendations to the legislature on:
February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
2021, reports shall be provided on a four-year cycle.
new text end

new text begin (e) The commissioner shall provide a public notice via list serve in October of each
year beginning October 1, 2014. The notice shall contain information detailing legislatively
approved changes in: calculation values including derived wage rates and related employee
and administrative factors; services utilization; county and tribal allocation changes
and; information on adjustments to be made to calculation values and timing of those
adjustment. Information in this notice shall be effective January 1 of the following year.
new text end

new text begin Subd. 13. new text end

new text begin Payment implementation. new text end

new text begin Upon implementation of the payment
methodologies under this section, those payment rates supersede rates established in county
contracts for recipients receiving waiver services under sections 256B.092 and 256B.49.
new text end

new text begin Subd. 14. new text end

new text begin Transportation. new text end

new text begin The commissioner shall require that the purchase
of transportation services be cost-effective and be limited to market rates where the
transportation mode is generally available and accessible.
new text end

new text begin Subd. 15. new text end

new text begin Customization of rates for individuals. new text end

new text begin For persons determined to have
higher needs based on being deaf or hard-of-hearing, the direct care costs must be increased
by an adjustment factor prior to calculating the price under subdivisions 8 to 11. The
customization rate with respect to deaf or hard-of-hearing persons shall be $2.70 per hour
for waiver recipients who meet the respective criteria as determined by the commissioner.
new text end

new text begin Subd. 16. new text end

new text begin Exceptions. new text end

new text begin (a) In a format prescribed by the commissioner, lead
agencies must identify individuals with exceptional needs that cannot be met under the
disability waiver rate system. The commissioner shall use that information to evaluate
and, if necessary, approve an alternative payment rate for those individuals.
new text end

new text begin (b) Lead agencies must submit exceptions requests to the state. Requests must
include information specifying: the extraordinary needs of the individual that are not
accounted for in payment methodology; the effort and costs required to meet those needs;
and recommendations from the lead agency regarding the request. Requests must be
reviewed and determinations made by the state. Approved exceptions must be managed
within the lead agencies' budgets.
new text end

new text begin Subd. 17. new text end

new text begin Budget neutrality adjustment. new text end

new text begin (a) The commissioner shall calculate the
total spending for all home and community-based waiver services under the payments as
defined in subdivisions 8 to 11, and total forecasted spending under current law for the
fiscal year beginning July 1, 2013. If total forecasted spending under subdivisions 8
to 11 is projected to be higher than under current law, the commissioner shall adjust
the rate by the percentage needed to adjust spending in each category to the same level
as projected under current law.
new text end

new text begin (b) The commissioner shall make any legislatively authorized changes to provider
rates that are beyond subdivision 12 in this subdivision.
new text end