HF 2373

as introduced - 90th Legislature (2017 - 2018) Posted on 03/23/2017 04:40pm

A bill for an act
relating to human services; requiring home and community-based services providers
to document certain information and submit certain data; requiring the
commissioner of human services to study consolidating the four disability home
and community-based waivers; appropriating money; amending Minnesota Statutes
2016, sections 256B.4912, by adding subdivisions; 256B.4914, subdivision 5.

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

Section 1.

Minnesota Statutes 2016, section 256B.4912, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Service documentation and billing requirements. new text end

new text begin (a) Only a service provided
as specified in a federally approved waiver plan, as authorized under sections 256B.0913,
256B.0915, 256B.092, and 256B.49, is eligible for payment. As a condition of payment, a
home and community-based waiver provider must document each time a service was
provided to a recipient. Payment for a service not documented according to this subdivision
or not specified in a federally approved waiver plan shall be recovered by the department
under section 256B.064. For payment of a service, documentation must meet the standards
in this paragraph and paragraphs (b) to (i).
new text end

new text begin (b) The service delivered to a recipient must be documented in the provider's record of
service delivery.
new text end

new text begin (c) The recipient's name and recipient identification number must be entered on each
document.
new text end

new text begin (d) The provider's record of service delivery must be in English and must be legible
according to the standard of a reasonable person.
new text end

new text begin (e) The provider's record of service delivery must contain a statement that it is a federal
crime to provide false information on service billings for medical assistance or services
under a federally approved waiver plan, as authorized under sections 256B.0913, 256B.0915,
256B.092, and 256B.49.
new text end

new text begin (f) If an entry is a time-based service, each entry in the provider's record of service
delivery must contain:
new text end

new text begin (1) the date that the entry was made;
new text end

new text begin (2) the day, month, and year when the service was provided;
new text end

new text begin (3) the service name or description of the service provided;
new text end

new text begin (4) the start and stop times with a.m. and p.m. designations, except for case management
services as defined under sections 256B.092, subdivision 1a, and 256B.49, subdivision 13;
and
new text end

new text begin (5) the name, signature, and title, if any, of the provider of service. If the service is
provided by multiple staff members, the provider may designate a staff member responsible
for verifying services and completing the documentation required by this paragraph.
new text end

new text begin (g) For all other services, each record must contain:
new text end

new text begin (1) the date the entry of service delivery was made;
new text end

new text begin (2) the day, month, and year when the service was provided;
new text end

new text begin (3) a service name or description of the service provided; and
new text end

new text begin (4) the name, signature, and title, if any, of the person providing the service. If the service
is provided by multiple staff, the provider may designate a staff person responsible for
verifying services and completing the documentation required by this paragraph.
new text end

new text begin (h) If the service billed is transportation, each entry must contain the information from
paragraphs (a) to (d) and (f). A provider must:
new text end

new text begin (1) maintain odometer and other records pursuant to section 256B.0625, subdivision
17b, paragraph (b), clause (3), sufficient to distinguish an individual trip with a specific
vehicle and driver for a transportation service that is billed by mileage, except if the provider
is a common carrier as defined by Minnesota Rules, part 9505.0315, subpart 1, item B, or
a publicly operated transit system. This documentation may be collected and maintained
electronically or in paper form, but must be made available and produced upon request;
new text end

new text begin (2) maintain documentation demonstrating that a vehicle and a driver meet the standards
determined by the Department of Human Services on vehicle and driver qualifications;
new text end

new text begin (3) only bill a waivered transportation service if the transportation is not to or from a
health care service available through the Medicaid state plan; and
new text end

new text begin (4) only bill a waivered transportation service when the rate for waiver service does not
include transportation.
new text end

new text begin (i) If the service provided is equipment or supplies, the documentation must contain the
information from paragraphs (a) to (d) and:
new text end

new text begin (1) the recipient's assessed need for the equipment or supplies and the reason the
equipment or supplies are not covered by the Medicaid state plan;
new text end

new text begin (2) the type and brand name of equipment or supplies delivered to or purchased by the
recipient, including whether the equipment or supplies were rented or purchased;
new text end

new text begin (3) the quantity of supplies delivered or purchased;
new text end

new text begin (4) the shipping invoice or a delivery service tracking log or other documentation showing
the date of delivery that proves the equipment or supplies were delivered to the recipient
or a receipt if the equipment or supplies were purchased by the recipient; and
new text end

new text begin (5) the cost of equipment or supplies if the amount paid for the service depends on the
cost.
new text end

new text begin (j) A service defined as "adult day care" under section 245A.02, subdivision 2a, must
meet the documentation standards specified in paragraphs (a) to (e) and must comply with
the following:
new text end

new text begin (1) individual recipient's service records must contain the following:
new text end

new text begin (i) the recipient's needs assessment and current plan of care according to section
245A.143, subdivisions 4 to 7, or Minnesota Rules, part 9555.9700, if applicable; and
new text end

new text begin (ii) the day, month, and year the service was provided, including arrival and departure
times with a.m. and p.m. designations and the first and last name of the individual making
the entry; and
new text end

new text begin (2) entity records must contain the following:
new text end

new text begin (i) the monthly and quarterly program requirements in Minnesota Rules, part 9555.9710,
subparts 1, items E and H, and 3, 4, and 6, if applicable;
new text end

new text begin (ii) the names and qualifications of the registered physical therapists, registered nurses,
and registered dietitian who provide services to the adult day care or nonresidential program;
new text end

new text begin (iii) the location where the service was provided and, if the location is an alternate
location than the primary place of service, the record must contain the address, or the
description if the address is not available, of both the origin and destination location and
the length of time at the alternate location with a.m. and p.m. designations, and a list of
participants who went to the alternate location; and
new text end

new text begin (iv) documentation that the program is maintaining the appropriate staffing levels
according to licensing standards and the federally approved waiver plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2016, section 256B.4912, is amended by adding a subdivision
to read:

new text begin Subd. 12. new text end

new text begin Annual data submission. new text end

new text begin (a) As determined by the commissioner, a provider
of home and community-based services for the elderly under section 256B.0915, home and
community-based services for people with developmental disabilities under section 256B.092,
and home and community-based services for people with disabilities under section 256B.49
shall submit data to the commissioner on the following:
new text end

new text begin (1) wages of workers;
new text end

new text begin (2) hours worked;
new text end

new text begin (3) benefits paid and accrued;
new text end

new text begin (4) staff retention rates;
new text end

new text begin (5) amount of overtime paid;
new text end

new text begin (6) amount of travel time paid;
new text end

new text begin (7) vacancy rates; and
new text end

new text begin (8) other related data requested by the commissioner.
new text end

new text begin (b) The commissioner may adjust reporting requirements for a self-employed worker.
new text end

new text begin (c) This subdivision also applies to a provider of personal care assistance services under
section 256B.0625, subdivision 19a; community first services and supports under section
256B.85; consumer support grants under section 256.476; nursing services and home health
services under section 256B.0625, subdivision 6a; home care nursing services under section
256B.0625, subdivision 7; or day training and habilitation services for residents of
intermediate care facilities for persons with developmental disabilities under section
256B.501.
new text end

new text begin (d) A provider shall submit the data annually on a date specified by the commissioner.
The commissioner shall give a provider at least 30 calendar days to submit the data. If a
provider fails to timely submit the requested data, medical assistance reimbursement may
be delayed.
new text end

new text begin (e) Individually identifiable data submitted to the commissioner in this section are
considered private data on an individual, as defined by section 13.02, subdivision 12.
new text end

new text begin (f) The commissioner shall analyze data annually for workforce assessments and how
the data impact service access.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:

Subd. 5.

Base wage index and standard component values.

(a) 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 Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide (SOC
code 31-1012); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
percent of the median wage for social and human services aide (SOC code 21-1093);

(2) for day services, 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 60
percent of the median wage for social and human services aide (SOC code 21-1093);

(3) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in a
family foster care setting, the wage is $2.80 per hour;

(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(7) for supportive living services staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(8) for housing access coordination staff, 50 percent of the median wage for community
and social services specialist (SOC code 21-1099); and 50 percent of the median wage for
social and human services aide (SOC code 21-1093);

(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);

(10) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

(11) for supported employment staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(12) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012);

(13) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
percent of the median wage for social and human services aide (SOC code 21-1093);

(14) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
attendants (SOC code 31-1012);

(15) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012);

(16) for supervisory staff, the basic wage is $17.43 per hour with exception of the
supervisor of behavior analyst and behavior specialists, which must be $30.75 per hour;

(17) for registered nurse, the basic wage is $30.82 per hour; and

(18) for licensed practical nurse, the basic wage is $18.64 per hour.

(b) Component values for residential support services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 3.3 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence factor: 1.7 percent.

(d) Component values for day services for all services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 5.6 percent;

(5) client programming and support ratio: ten percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 1.8 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(e) Component values for unit-based services with programming are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan supports ratio: 3.1 percent;

(5) client programming and supports ratio: 8.6 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(f) Component values for unit-based services without programming except respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 3.1 percent;

(5) client programming and support ratio: 8.6 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(g) Component values for unit-based services without programming for respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 6.1 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system. This adjustment occurs every five
years. For adjustments in 2021 and beyond, the commissioner shall use the data available
on December 31 of the calendar year five years prior.

(i) On July 1, 2017, the commissioner shall update the framework components in
paragraphs (b) to (g); subdivision 6, clauses (8) and (9); and subdivision 7, clauses (16) and
(17), for changes in the Consumer Price Index. The commissioner will adjust these values
higher or lower by the percentage change in the Consumer Price Index-All Items, United
States city average (CPI-U) from January 1, 2014, to January 1, 2017. The commissioner
shall publish these updated values and load them into the rate management system. This
adjustment occurs every five years. For adjustments in 2021 and beyond, the commissioner
shall use the data available on January 1 of the calendar year four years prior and January
1 of the current calendar year.

new text begin (j) The commissioner must ensure that wage values and component values in subdivisions
5 to 9 reflect the cost to provide a service. As determined by the commissioner, a provider
enrolled to provide services with rates determined under this section must submit business
cost data to the commissioner in concurrence with the five-year provider revalidation cycle.
Reporting elements include, but are not limited to:
new text end

new text begin (1) worker wage costs;
new text end

new text begin (2) benefits paid;
new text end

new text begin (3) supervisor wage costs;
new text end

new text begin (4) executive wage costs;
new text end

new text begin (5) vacation, sick, and training time paid;
new text end

new text begin (6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end

new text begin (7) administrative costs paid;
new text end

new text begin (8) program costs paid;
new text end

new text begin (9) transportation costs paid;
new text end

new text begin (10) vacancy rates; and
new text end

new text begin (11) other data relating to costs required to provide services requested by the
commissioner.
new text end

new text begin (k) A provider must submit cost component data with provider revalidation and
reenrollment required under section 256B.04, subdivision 22. If a provider fails to submit
required reporting data, the commissioner may disenroll the provider.
new text end

new text begin (l) The commissioner shall conduct a random audit of data submitted under paragraph
(j) to ensure data accuracy.
new text end

new text begin (m) The commissioner shall analyze cost documentation in paragraph (j) and submit
recommendations on component value and inflationary factor adjustments to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e).
new text end

new text begin (n) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend codes
or items to update and replace missing component values.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4. new text begin APPROPRIATION; WAIVER CONSOLIDATION STUDY.
new text end

new text begin $110,000 in fiscal year 2018 and $140,000 in fiscal year 2019 are appropriated from the
general fund to the commissioner of human services to conduct a study on consolidating
the four disability home and community-based services waivers into one program. The
commissioner of human services shall submit recommendations to the chairs and ranking
minority members of the legislative committees with oversight over health and human
services by January 15, 2019. This is a onetime appropriation.
new text end