HF 823

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 03/31/2017 07:17pm

A bill for an act
relating to human services; reforming the elderly waiver program; requiring a
report; appropriating money; amending Minnesota Statutes 2016, sections
256B.056, subdivision 5; 256B.0911, subdivision 3a; 256B.0915, subdivisions 3a,
3e, 3h, 5, by adding subdivisions; 256B.439, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2016, section 256B.056, subdivision 5, is amended to read:

Subd. 5.

Excess income.

new text begin (a) new text end A person who has excess income is eligible for medical
assistance if the person has expenses for medical care that are more than the amount of the
person's excess income, computed by deducting incurred medical expenses from the excess
income to reduce the excess to the income standard specified in subdivision 5c. The person
shall elect to have the medical expenses deducted at the beginning of a one-month budget
period or at the beginning of a six-month budget period. The commissioner shall allow
persons eligible for assistance on a one-month spenddown basis under this subdivision to
elect to pay the monthly spenddown amount in advance of the month of eligibility to the
state agency in order to maintain eligibility on a continuous basis. If the recipient does not
pay the spenddown amount on or before the 20th of the month, the recipient is ineligible
for this option for the following month. The local agency shall code the Medicaid
Management Information System (MMIS) to indicate that the recipient has elected this
option. The state agency shall convey recipient eligibility information relative to the
collection of the spenddown to providers through the Electronic Verification System (EVS).
A recipient electing advance payment must pay the state agency the monthly spenddown
amount on or before the 20th of the month in order to be eligible for this option in the
following month.

new text begin (b) A person who is eligible for medical assistance and receiving services under section
256B.0915 shall be eligible to pay the person's monthly spenddown or waiver obligation
amount due to a provider of the person's choice. The state, or other payer acting on behalf
of the state, shall deduct that amount from the provider's claims for each month.
new text end

Sec. 2.

Minnesota Statutes 2016, section 256B.0911, subdivision 3a, is amended to read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services and home care nursing. The commissioner shall
provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, person-centered assessment. The assessment must
include the health, psychological, functional, environmental, and social needs of the
individual necessary to develop a community support plan that meets the individual's needs
and preferences.

(d) The assessment must be conducted in a face-to-face interview with the person being
assessed and the person's legal representative. At the request of the person, other individuals
may participate in the assessment to provide information on the needs, strengths, and
preferences of the person necessary to develop a community support plan that ensures the
person's health and safety. Except for legal representatives or family members invited by
the person, persons participating in the assessment may not be a provider of service or have
any financial interest in the provision of services. For persons who are to be assessed for
elderly waiver customized living new text begin or adult day new text end services under section 256B.0915, with the
permission of the person being assessed or the person's designated or legal representative,
the client's current or proposed provider of services may submit a copy of the provider's
nursing assessment or written report outlining its recommendations regarding the client's
care needs. The person conducting the assessment must notify the provider of the date by
which this information is to be submitted. This information shall be provided to the person
conducting the assessment prior to the assessment. For a person who is to be assessed for
waiver services under section 256B.092 or 256B.49, with the permission of the person being
assessed or the person's designated legal representative, the person's current provider of
services may submit a written report outlining recommendations regarding the person's care
needs prepared by a direct service employee with at least 20 hours of service to that client.
The person conducting the assessment or reassessment must notify the provider of the date
by which this information is to be submitted. This information shall be provided to the
person conducting the assessment and the person or the person's legal representative, and
must be considered prior to the finalization of the assessment or reassessment.

(e) The person or the person's legal representative must be provided with a written
community support plan within 40 calendar days of the assessment visit, regardless of
whether the individual is eligible for Minnesota health care programs.

new text begin (f) For a person being assessed for elderly waiver services under section 256B.0915, a
provider who submitted information under paragraph (d) shall receive a copy of the draft
assessment and have an opportunity to submit additional information to the assessor before
the assessment is final. The provider shall also receive a copy of the final written community
support plan when available, the case mix level, and the Residential Services Workbook.
new text end

new text begin (g) new text end The written community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including all available
options for case management services and providers;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.

deleted text begin (f) deleted text end new text begin (h) new text end A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.

deleted text begin (g) deleted text end new text begin (i) new text end The person has the right to make the final decision between institutional placement
and community placement after the recommendations have been provided, except as provided
in section 256.975, subdivision 7a, paragraph (d).

deleted text begin (h) deleted text end new text begin (j) new text end The lead agency must give the person receiving assessment or support planning,
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;

(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);

(5) information about Minnesota health care programs;

(6) the person's freedom to accept or reject the recommendations of the team;

(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;

(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

deleted text begin (i) deleted text end new text begin (k) new text end Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, community access for disability inclusion, community
alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
and 256B.49 is valid to establish service eligibility for no more than deleted text begin 60 deleted text end new text begin 90 new text end calendar days
after the date of assessment.

deleted text begin (j) deleted text end new text begin (l) new text end The effective eligibility start date for programs in paragraph (i) can never be prior
to the date of assessment. If an assessment was completed more than deleted text begin 60 deleted text end new text begin 90 new text end days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph deleted text begin (i) deleted text end new text begin
(k) new text end cannot be prior to the date the most recent updated assessment is completed.

Sec. 3.

Minnesota Statutes 2016, section 256B.0915, subdivision 3a, is amended to read:

Subd. 3a.

Elderly waiver cost limits.

(a) Effective on deleted text begin the first day of the state fiscal
year in which the resident assessment system as described in section 256B.438 for nursing
home rate determination is implemented and deleted text end the first day of each deleted text begin subsequent deleted text end state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. new text begin If a legislatively authorized increase
is service specific, the monthly cost limit shall be adjusted based on the overall average
increase to the affected program.
new text end

(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:

(1) no dependencies in activities of daily living; or

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).

(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).

(d) deleted text begin Effective July 1, 2013, deleted text end The monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph (g), shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).

(e) Effective deleted text begin July 1, 2016 deleted text end new text begin January 1, 2018 new text end , and each deleted text begin July deleted text end new text begin January new text end 1 thereafter, the monthly
cost limits for elderly waiver services in effect on the previous deleted text begin June 30 deleted text end new text begin December 31 new text end shall
be increased by the difference between any legislatively adopted home and community-based
provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1 or since the previous deleted text begin July deleted text end new text begin January new text end 1 and
the average statewide percentage increase in nursing facility operating payment rates under
deleted text begin sections 256B.431, 256B.434, and 256B.441 deleted text end new text begin chapter 256R new text end , effective the previous January
1. This paragraph shall only apply if the average statewide percentage increase in nursing
facility operating payment rates is greater than any legislatively adopted home and
community-based provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1, or occurring since
the previous deleted text begin July deleted text end new text begin January new text end 1.

Sec. 4.

Minnesota Statutes 2016, section 256B.0915, subdivision 3e, is amended to read:

Subd. 3e.

Customized living service rate.

(a) Payment for customized living services
shall be a monthly rate authorized by the lead agency within the parameters established by
the commissioner. The payment agreement must delineate the amount of each component
service included in the recipient's customized living service plan. The lead agency, with
input from the provider of customized living services, shall ensure that there is a documented
need within the parameters established by the commissioner for all component customized
living services authorized.

(b) The payment rate must be based on the amount of component services to be provided
utilizing component rates established by the commissioner. Counties and tribes shall use
tools issued by the commissioner to develop and document customized living service plans
and rates.

(c) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale. Customized
living services must not include rent or raw food costs.

new text begin (d) The commissioner shall include a nursing component service that includes, but is
not limited to injections, catheterizations, wound care, infections, and diabetic and foot care.
The hourly unit service payment shall be based on the registered nurses component rate.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end With the exception of individuals described in subdivision 3a, paragraph (b), the
individualized monthly authorized payment for the customized living service plan shall not
exceed 50 percent of the deleted text begin greater of either the deleted text end statewide deleted text begin or any of the geographic groups' deleted text end
weighted average monthly nursing facility rate of the case mix resident class to which the
elderly waiver eligible client would be assigned under Minnesota Rules, parts 9549.0051
to 9549.0059, less the maintenance needs allowance as described in subdivision 1d, paragraph
(a). deleted text begin Effective deleted text end On July 1 of deleted text begin the state fiscal deleted text end new text begin each new text end year deleted text begin in which the resident assessment system
as described in section 256B.438 for nursing home rate determination is implemented and
July 1 of each subsequent state fiscal year deleted text end , the individualized monthly authorized payment
for the services described in this clause shall not exceed the limit which was in effect on
June 30 of the previous state fiscal year updated annually based on legislatively adopted
changes to all service rate maximums for home and community-based service providers.

new text begin (f) The monthly customized living service rate for a client may be increased temporarily
in lieu of the client being admitted to a hospital. The temporary increase shall cover additional
nursing and home care services needed to avoid hospitalization. A provider shall
communicate client need to the case manager in a form and manner prescribed by the
commissioner.
new text end

new text begin (g) Based on responses to questions 45 and 51 of the Minnesota long-term care
consultation assessment form, the elderly waiver payment for customized living services
includes a cognitive and behavioral needs factor for a client determined to have either:
new text end

new text begin (1) wandering or orientation issues; or
new text end

new text begin (2) anxiety, verbal aggression, physical aggression, repetitive behavior, agitation,
self-injurious behavior, or behavior related to property destruction.
new text end

new text begin An additional 15 percent is applied to the component service rates if the total monthly hours
of customized living services divided by 30.4 is less than 3.62. A client assessed as both
"oriented" and "behavior requires no intervention" or "no behaviors" shall not receive a
cognitive and behavioral needs factor.
new text end

deleted text begin (e) Effective July 1, 2011, deleted text end new text begin (h) new text end The individualized monthly payment for the customized
living service plan for individuals described in subdivision 3a, paragraph (b), must be the
monthly authorized payment limit for customized living for individuals classified as case
mix A, reduced by 25 percent. This rate limit must be applied to all new participants enrolled
in the program on or after July 1, 2011, who meet the criteria described in subdivision 3a,
paragraph (b). This monthly limit also applies to all other participants who meet the criteria
described in subdivision 3a, paragraph (b), at reassessment.

new text begin (i) The payment rate for a client qualifying for customized living services equals 120
percent of the statewide average 24-hour residential services rate for the first 62 days and
equals the rate established by the responsible case manager for the 63rd and subsequent
days.
new text end

deleted text begin (f) deleted text end new text begin (j) new text end Customized living services are delivered by a provider licensed by the Department
of Health as a class A or class F home care provider and provided in a building that is
registered as a housing with services establishment under chapter 144D. Licensed home
care providers are subject to section 256B.0651, subdivision 14.

deleted text begin (g) deleted text end new text begin (k) new text end A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available under
the service rate limits described in paragraph deleted text begin (d) deleted text end new text begin (e) new text end , nor for additional units of any allowable
component service beyond those approved in the service plan by the lead agency.

deleted text begin (h) deleted text end new text begin (l) new text end Effective deleted text begin July 1, 2016 deleted text end new text begin January 1, 2018 new text end , and each deleted text begin July deleted text end new text begin January new text end 1 thereafter,
individualized service rate limits for customized living services under this subdivision shall
be increased by the difference between any legislatively adopted home and community-based
provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1 or since the previous deleted text begin July deleted text end new text begin January new text end 1 and
the average statewide percentage increase in nursing facility operating payment rates under
sections 256B.431 deleted text begin , deleted text end new text begin and new text end 256B.434 deleted text begin , deleted text end and deleted text begin 256B.441 deleted text end new text begin chapter 256R new text end , effective the previous
January 1. This paragraph shall only apply if the average statewide percentage increase in
nursing facility operating payment rates is greater than any legislatively adopted home and
community-based provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1, or occurring since
the previous deleted text begin July deleted text end new text begin January new text end 1.

Sec. 5.

Minnesota Statutes 2016, section 256B.0915, subdivision 3h, is amended to read:

Subd. 3h.

Service rate limits; 24-hour customized living services.

(a) The payment
rate for 24-hour customized living services is a monthly rate authorized by the lead agency
within the parameters established by the commissioner of human services. The payment
agreement must delineate the amount of each component service included in each recipient's
customized living service plan. The lead agency, with input from the provider of customized
living services, shall ensure that there is a documented need within the parameters established
by the commissioner for all component customized living services authorized. The lead
agency shall not authorize 24-hour customized living services unless there is a documented
need for 24-hour supervision.

(b) For purposes of this section, "24-hour supervision" means that the recipient requires
assistance due to needs related to one or more of the following:

(1) intermittent assistance with toileting, positioning, or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) for all new participants enrolled in the program on or after July 1, 2011, and all other
participants at their first reassessment after July 1, 2011, dependency in at least three of the
following activities of daily living as determined by assessment under section 256B.0911:
bathing; dressing; grooming; walking; or eating when the dependency score in eating is
three or greater; and needs medication management and at least 50 hours of service per
month. The lead agency shall ensure that the frequency and mode of supervision of the
recipient and the qualifications of staff providing supervision are described and meet the
needs of the recipient.

(c) The payment rate for 24-hour customized living services must be based on the amount
of component services to be provided utilizing component rates established by the
commissioner. Counties and tribes will use tools issued by the commissioner to develop
and document customized living plans and authorize rates.

(d) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale.

(e) The individually authorized 24-hour customized living payments, in combination
with the payment for other elderly waiver services, including case management, must not
exceed the recipient's community budget cap specified in subdivision 3a. Customized living
services must not include rent or raw food costs.

(f) The individually authorized 24-hour customized living payment rates shall not exceed
the 95 percentile of statewide monthly authorizations for 24-hour customized living services
in effect and in the Medicaid management information systems on March 31, 2009, for each
case mix resident class under Minnesota Rules, parts 9549.0051 to 9549.0059, to which
elderly waiver service clients are assigned. When there are fewer than 50 authorizations in
effect in the case mix resident class, the commissioner shall multiply the calculated service
payment rate maximum for the A classification by the standard weight for that classification
under Minnesota Rules, parts 9549.0051 to 9549.0059, to determine the applicable payment
rate maximum. Service payment rate maximums shall be updated annually based on
legislatively adopted changes to all service rates for home and community-based service
providers.

(g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner may
establish alternative payment rate systems for 24-hour customized living services in housing
with services establishments which are freestanding buildings with a capacity of 16 or fewer,
by applying a single hourly rate for covered component services provided in either:

(1) licensed corporate adult foster homes; or

(2) specialized dementia care units which meet the requirements of section 144D.065
and in which:

(i) each resident is offered the option of having their own apartment; or

(ii) the units are licensed as board and lodge establishments with maximum capacity of
eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
subparts 1, 2, 3, and 4, item A.

(h) Twenty-four-hour customized living services are delivered by a provider licensed
by the Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.
Licensed home care providers are subject to section 256B.0651, subdivision 14.

(i) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available under
the service rate limits described in paragraph (e), nor for additional units of any allowable
component service beyond those approved in the service plan by the lead agency.

(j) Effective deleted text begin July 1, 2016 deleted text end new text begin January 1, 2018 new text end , and each deleted text begin July deleted text end new text begin January new text end 1 thereafter,
individualized service rate limits for 24-hour customized living services under this
subdivision shall be increased by the difference between any legislatively adopted home
and community-based provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1 or since the previous
deleted text begin July deleted text end new text begin January new text end 1 and the average statewide percentage increase in nursing facility operating
payment rates under deleted text begin sections 256B.431, 256B.434, and 256B.441 deleted text end new text begin chapter 256R new text end , effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on deleted text begin July deleted text end new text begin January new text end 1, or occurring
since the previous deleted text begin July deleted text end new text begin January new text end 1.

Sec. 6.

Minnesota Statutes 2016, section 256B.0915, subdivision 5, is amended to read:

Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client shall
receive an initial assessment of strengths, informal supports, and need for services in
accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client
served under the elderly waiver must be conducted at least every 12 months deleted text begin and at other
times when the case manager determines that there has been significant change in the client's
functioning. This may include instances where the client is discharged from the hospital deleted text end .
There must be a determination that the client requires nursing facility level of care as defined
in section 256B.0911, subdivision 4e, at initial and subsequent assessments to initiate and
maintain participation in the waiver program.

(b) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility level of care
determination will be accepted for purposes of initial and ongoing access to waiver service
payment.

new text begin (c) The lead agency shall conduct a change-in-condition reassessment before the annual
reassessment in cases where a client's condition changed due to a major health event, an
emerging need or risk, worsening health condition, or cases where the current services do
not meet the client's needs. A change-in-condition reassessment may be initiated by the lead
agency, or it may be requested by the client or requested on the client's behalf by another
party, such as a provider of services. The lead agency shall complete a change-in-condition
reassessment no later than 20 calendar days from the request. The lead agency shall conduct
these assessments in a timely manner and expedite urgent requests. The lead agency shall
evaluate urgent requests based on the client's needs and risk to the client if a reassessment
is not completed.
new text end

Sec. 7.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Payment rates; application. new text end

new text begin The payment methodologies in subdivisions 12
to 15 apply to elderly waiver and elderly waiver customized living under this section,
alternative care under section 256B.0913, essential community supports under section
256B.0922, community access for disability inclusion customized living, brain injury
customized living, and elderly waiver foster care and residential care.
new text end

Sec. 8.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:

new text begin Subd. 12. new text end

new text begin Payment rates; establishment. new text end

new text begin (a) The commissioner shall use standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook and data from the most recent and
available nursing facility cost report to establish rates and component rates every January
1 using Minnesota-specific wages taken from job descriptions.
new text end

new text begin (b) In creating the rates and component rates, the commissioner shall establish a base
wage calculation for each component service and value and add the following factors:
new text end

new text begin (1) payroll taxes and benefits;
new text end

new text begin (2) general and administrative;
new text end

new text begin (3) program plan support;
new text end

new text begin (4) registered nurse management and supervision; and
new text end

new text begin (5) social worker supervision.
new text end

Sec. 9.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:

new text begin Subd. 13. new text end

new text begin Payment rates; base wage index. new text end

new text begin (a) Base wages are calculated for customized
living, foster care, and residential care component services as follows:
new text end

new text begin (1) the home management and support services base wage equals 33.33 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 33.33 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for food preparation workers (SOC code 35-2021); and
33.34 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
for maids and housekeeping cleaners (SOC code 37-2012);
new text end

new text begin (2) the home care aide base wage equals 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for home health aides (SOC code
31-1011); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014);
new text end

new text begin (3) the home health aide base wage equals 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061); and 80 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); and
new text end

new text begin (4) the medication setups by licensed practical nurse base wage equals ten percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061); and 90 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141).
new text end

new text begin (b) Base wages are calculated for the following services as follows:
new text end

new text begin (1) the chore services base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for landscaping and groundskeeping
workers (SOC code 37-3011);
new text end

new text begin (2) the companion services base wage equals 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for personal and home care aides (SOC
code 39-9021); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for maids and housekeeping cleaners (SOC code 37-2012);
new text end

new text begin (3) the homemaker services and assistance with personal care base wage equals 60
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
personal and home care aide (SOC code 39-9021); 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for maids and housekeeping cleaners (SOC code 37-2012);
new text end

new text begin (4) the homemaker services and cleaning base wage equals 60 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012);
new text end

new text begin (5) the homemaker services and home management base wage equals 60 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012);
new text end

new text begin (6) the in-home respite care services base wage equals five percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for nursing assistants (SOC code 31-1014); and 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061); and
new text end

new text begin (7) the out-of-home respite care services base wage equals five percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
(SOC code 29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061).
new text end

new text begin (c) Base wages are calculated for the following values as follows:
new text end

new text begin (1) the registered nurse base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141); and
new text end

new text begin (2) the social worker base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
workers (SOC code 21-1022).
new text end

new text begin (d) If any of the SOC codes and positions are no longer available, the commissioner
shall, in consultation with stakeholders, select a new SOC code and position that is the
closest match to the previously used SOC position.
new text end

Sec. 10.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:

new text begin Subd. 14. new text end

new text begin Payment rates; factors. new text end

new text begin The commissioner shall use the following factors:
new text end

new text begin (1) the payroll taxes and benefits factor is the sum of net payroll taxes and benefits
divided by the sum of all salaries for all nursing facilities on the most recent and available
cost report;
new text end

new text begin (2) the general and administrative factor is the sum of net general and administrative
expenses minus administrative salaries divided by total operating expenses for all nursing
facilities on the most recent and available cost report;
new text end

new text begin (3) the program plan support factor is defined as the direct service staff needed to provide
support for the home and community-based service when not engaged in direct contact with
clients. Based on the 2016 Non-Wage Provider Costs in Home and Community-Based
Disability Waiver Services Report, this factor equals 12.8 percent;
new text end

new text begin (4) the registered nurse management and supervision factor equals 15 percent of the
registered nurse value; and
new text end

new text begin (5) the social worker supervision factor equals 15 percent of the social worker value.
new text end

Sec. 11.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:

new text begin Subd. 15. new text end

new text begin Payment rates; component rates. new text end

new text begin (a) For the purposes of this subdivision,
the "adjusted base wage" for a position equals the position's base wage plus:
new text end

new text begin (1) the position's base wage multiplied by the payroll taxes and benefits factor;
new text end

new text begin (2) the position's base wage multiplied by the general and administrative factor; and
new text end

new text begin (3) the position's base wage multiplied by the program plan support factor.
new text end

new text begin (b) For medication setups by licensed nurse, registered nurse, and social worker services,
the component rate for each service equals the respective position's adjusted base wage.
new text end

new text begin (c) For home management and support services, home care aide, and home health aide
services, the component rate for each service equals the respective position's adjusted base
wage plus the registered nurse management and supervision factor.
new text end

new text begin (d) The home management and support services component rate shall be used for payment
for socialization and transportation component rates under elderly waiver customized living.
new text end

new text begin (e) The 15-minute unit rates for chore services and companion services are calculated
as follows:
new text end

new text begin (1) sum the adjusted base wage for the respective position and the social worker factor;
and
new text end

new text begin (2) divide the result of clause (1) by four.
new text end

new text begin (f) The 15-minute unit rates for homemaker services and assistance with personal cares,
homemaker services and cleaning, and homemaker services and home management are
calculated as follows:
new text end

new text begin (1) sum the adjusted base wage for the respective position and the registered nurse
management and supervision factor; and
new text end

new text begin (2) divide the result of clause (1) by four.
new text end

new text begin (g) The 15-minute unit rate for in-home respite care services is calculated as follows:
new text end

new text begin (1) sum the adjusted base wage for in-home respite care services and the registered nurse
management and supervision factor; and
new text end

new text begin (2) divide the result of clause (1) by four.
new text end

new text begin (h) The in-home respite care services daily rate equals the in-home respite care services
15-minute unit rate multiplied by 18.
new text end

new text begin (i) The 15-minute unit rate for out-of-home respite care is calculated as follows:
new text end

new text begin (1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and supervision factor; and
new text end

new text begin (2) divide the result of clause (1) by four.
new text end

new text begin (j) The out-of-home respite care services daily rate equals the out-of-home respite care
services 15-minute unit rate multiplied by 18.
new text end

new text begin (k) The individual community living support rate is calculated as follows:
new text end

new text begin (1) sum the adjusted base wage for the home care aide rate in subdivision 13, paragraph
(a), clause (2), and the social worker factor; and
new text end

new text begin (2) divide the result of clause (1) by four.
new text end

new text begin (l) The home delivered meals rate equals $9.30. Beginning July 1, 2018, the commissioner
shall increase the home delivered meals rate every July 1 by the percent increase in the
nursing facility dietary per diem using the two most recent nursing facility cost reports.
new text end

new text begin (m) The adult day services rate is based on the home care aide rate under subdivision
13, paragraph (a), clause (2), plus the additional factors in subdivision 14, except that the
general and administrative factor used shall be 20 percent. The nonregistered nurse portion
of the rate shall be multiplied by 0.25, to reflect a staffing ratio of one caregiver to four
clients, and divided by four to determine the 15-minute unit rate. The registered nurse portion
is divided by four to determine the 15-minute unit rate and $0.63 per 15-minute unit is added
to cover the cost of meals.
new text end

new text begin (n) The adult day services bath 15-minute unit rate is the same as the calculation of the
adult day services 15-minute unit rate without the adjustment for staffing ratio.
new text end

new text begin (o) If a bath is authorized for an adult day services client, at least two 15-minute units
must be authorized to allow for adequate time to meet client needs. Adult day services may
be authorized for up to 48 units, or 12 hours, per day based on client and family caregiver
needs.
new text end

Sec. 12.

Minnesota Statutes 2016, section 256B.439, is amended by adding a subdivision
to read:

new text begin Subd. 2b. new text end

new text begin Performance measures for elderly waiver customized living. new text end

new text begin The
commissioner shall develop performance measures for housing with services establishments
that are enrolled in the elderly waiver program as a provider of customized living or 24-hour
customized living. According to methods determined by the commissioner in consultation
with stakeholders and experts, the commissioner shall develop the following performance
measures:
new text end

new text begin (1) an annual customer satisfaction survey measure for assisted living residents and
family members using a validated survey tool and set of questions chosen by the
commissioner in consultation with stakeholders;
new text end

new text begin (2) a measure utilizing level 3 or 4 citations from Department of Health home care survey
findings and substantiated Office of Health Facility Complaints findings against a home
care agency;
new text end

new text begin (3) a home care staff retention measure; and
new text end

new text begin (4) a measure that scores a provider's staff according to their level of training and
education.
new text end

Sec. 13. new text begin DIRECTION TO COMMISSIONER; ADULT DAY SERVICES STAFFING
RATIOS.
new text end

new text begin The commissioner of human services shall study the staffing ratio for adult day services
clients and shall provide the chairs and ranking minority members of the house of
representatives and senate committees with jurisdiction over adult day services with
recommendations to adjust staffing ratios based on client needs by January 1, 2018.
new text end

Sec. 14. new text begin DIRECTION TO COMMISSIONER; EVALUATION OF RATE
METHODOLOGY.
new text end

new text begin (a) The commissioner of human services, in consultation with stakeholders, shall conduct
a study to evaluate the following:
new text end

new text begin (1) base wages in Minnesota Statutes, section 256B.0915, subdivision 13, to determine
if the standard occupational classification codes for each rate and component rate are an
appropriate representation of staff who deliver such services; and
new text end

new text begin (2) factors in Minnesota Statutes, section 256B.0915, subdivision 14, and adjusted base
wage calculations in Minnesota Statutes, section 256B.0915, subdivision 15, to determine
if the factors and calculations appropriately address nonwage provider costs.
new text end

new text begin (b) By January 1, 2019, the commissioner shall submit a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services policy
and finance on the changes to the rate methodology in Minnesota Statutes, section 256B.0915,
based on the results of the evaluation. Where feasible, the report shall address the impact
of the new rates on the workforce situation and client access to services. The report must
include any changes to the rate calculations that the commissioner recommends.
new text end

Sec. 15. new text begin APPROPRIATION; PERFORMANCE MEASURES FOR ELDERLY
WAIVER CUSTOMIZED LIVING.
new text end

new text begin $5,000,000 in fiscal year 2018 is appropriated from the general fund to the commissioner
of human services for purposes of developing performance measures for elderly waiver
customized living under Minnesota Statutes, section 256B.439, subdivision 2b. This is a
onetime appropriation.
new text end

Sec. 16. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the House Research Department, Office of
Senate Counsel, Research, and Fiscal Analysis, and Department of Human Services shall
prepare legislation for the 2018 legislative session to recodify laws governing the elderly
waiver program in Minnesota Statutes, chapter 256B.
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