HF 3267

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/24/2022 05:54pm

A bill for an act
relating to human services; reorganizing provisions governing disability waiver
rate setting; requiring a report; amending Minnesota Statutes 2020, section
256B.4914, as amended.

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

Section 1.

Minnesota Statutes 2020, section 256B.4914, as amended by Laws 2021, First
Special Session chapter 7, article 13, sections 42 and 43, is amended to read:

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE
SETTING.

Subdivision 1.

Application.

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.

Subd. 2.

Definitions.

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

(b) "Commissioner" means the commissioner of human services.

(c) "Comparable occupations" means the occupations, excluding direct care staff, as
represented by the Bureau of Labor Statistics standard occupational classification codes
that have the same classification for:

(1) typical education needed for entry;

(2) work experience in a related occupation; and

(3) typical on-the-job training competency as the most predominant classification for
direct care staff.

(d) "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.

(e) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.

(f) "Direct care staff" means employees providing direct service to people receiving
services under this section. Direct care staff excludes executive, managerial, and
administrative staff.

(g) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.

(h) "Individual new text begin direct new text end staffing new text begin hours new text end " means the time spent as a one-to-one interaction
specific to an individual recipient by staff to provide direct support and assistance with
activities of daily living, instrumental activities of daily living, and training to participants,
and is based on the requirements in each individual's coordinated service and support plan
under section 245D.02, subdivision 4b; any coordinated service and support plan addendum
under section 245D.02, subdivision 4c; and an assessment tool. Provider observation of an
individual's needs must also be considered.

(i) "Lead agency" means a county, partnership of counties, or Tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.

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

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

deleted text begin (l) deleted text end new text begin (k) new text end "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.

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

deleted text begin (n) deleted text end new text begin (m) new text end "Shared new text begin direct new text end staffing new text begin hours new text end " means time spent by employees, not defined under
paragraph (f), providing or available to provide more than one individual with direct support
and assistance with activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (b); instrumental activities of daily living as defined under section 256B.0659,
subdivision 1, paragraph (i); ancillary activities needed to support individual services; and
training to participants, and is based on the requirements in each individual's coordinated
service and support plan under section 245D.02, subdivision 4b; any coordinated service
and support plan addendum under section 245D.02, subdivision 4c; an assessment tool; and
provider observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.

deleted text begin (o) deleted text end new text begin (n) new text end "Staffing ratio" means the number of recipients a service provider employee
supports during a unit of service based on a uniform assessment tool, provider observation,
case history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.

deleted text begin (p) "Unit of service" means the following:
deleted text end

deleted text begin (1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
deleted text end

deleted text begin (2) for day services under subdivision 7:
deleted text end

deleted text begin (i) for day training and habilitation services, a unit of service is either:
deleted text end

deleted text begin (A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
deleted text end

deleted text begin (B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and
deleted text end

deleted text begin (C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;
deleted text end

deleted text begin (ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
deleted text end

deleted text begin (iii) for day support services, a unit of service is 15 minutes; and
deleted text end

deleted text begin (iv) for prevocational services, a unit of service is a day or 15 minutes. A day unit of
service is six or more hours of time spent providing direct service;
deleted text end

deleted text begin (3) for unit-based services with programming under subdivision 8:
deleted text end

deleted text begin (i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and
deleted text end

deleted text begin (ii) for all other services, a unit of service is 15 minutes; and
deleted text end

deleted text begin (4) for unit-based services without programming under subdivision 9, a unit of service
is 15 minutes.
deleted text end

Subd. 3.

Applicable services.

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

(1) 24-hour customized living;

(2) adult day services;

(3) adult day services bath;

deleted text begin (4) companion services;
deleted text end

deleted text begin (5) deleted text end new text begin (4) new text end community residential services;

deleted text begin (6) deleted text end new text begin (5) new text end customized living;

deleted text begin (7) deleted text end new text begin (6) new text end day support services;

deleted text begin (8) day training and habilitation;
deleted text end

deleted text begin (9) deleted text end new text begin (7) new text end employment development services;

deleted text begin (10) deleted text end new text begin (8) new text end employment exploration services;

deleted text begin (11) deleted text end new text begin (9) new text end employment support services;

deleted text begin (12) deleted text end new text begin (10) new text end family residential services;

deleted text begin (13) housing access coordination;
deleted text end

deleted text begin (14) independent living skills;
deleted text end

deleted text begin (15) deleted text end new text begin (11) new text end individualized home supports;

deleted text begin (16) deleted text end new text begin (12) new text end individualized home supports with family training;

deleted text begin (17) deleted text end new text begin (13) new text end individualized home supports with training;

deleted text begin (18) in-home family support;
deleted text end

deleted text begin (19) deleted text end new text begin (14) new text end integrated community supports;

deleted text begin (20) deleted text end new text begin (15) new text end night supervision;

deleted text begin (21) personal support;
deleted text end

deleted text begin (22) deleted text end new text begin (16) new text end positive support services;

deleted text begin (23) deleted text end new text begin (17) new text end prevocational services;

deleted text begin (24) deleted text end new text begin (18) new text end residential support services;

deleted text begin (25) deleted text end new text begin (19) new text end respite services;

deleted text begin (26) structured day services;
deleted text end

deleted text begin (27) supported living services;
deleted text end

deleted text begin (28) deleted text end new text begin (20) new text end transportation services; and

deleted text begin (29) deleted text end new text begin (21) new text end other services as approved by the federal government in the state home and
community-based services new text begin waiver new text end plan.

Subd. 4.

Data collection for rate determination.

(a) Rates for applicable home and
community-based waivered services, including deleted text begin rate exceptions deleted text end new text begin customized rates new text end under
subdivision 12, are set by the rates management system.

(b) Data and information in the rates management system deleted text begin may deleted text end new text begin must new text end be used to calculate
an individual's rate.

(c) Service providers, with information from the deleted text begin community deleted text end new text begin coordinated service and new text end
support plan and oversight by lead agencies, shall provide values and information needed
to calculate an individual's rate deleted text begin into deleted text end new text begin in new text end the rates management system. The determination of
service levels must be part of a discussion with members of the support team as defined in
section 245D.02, subdivision 34. This discussion must occur prior to the final establishment
of each individual's rate. The values and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

(6) information to document variable levels of service qualification for variable levels
of reimbursement in each framework;

(7) shared or individualized arrangements for unit-based services, including the staffing
ratio;

(8) number of trips and miles for transportation services; and

(9) service hours provided through monitoring technology.

(d) Updates to individual data must include:

(1) data for each individual that is updated annually when renewing service plans; and

(2) requests by individuals or lead agencies to update a rate whenever there is a change
in an individual's service needs, with accompanying documentation.

(e) Lead agencies shall review and approve all services reflecting each individual's needs,
and the values to calculate the final payment rate for services with variables under
subdivisions 6 deleted text begin , 7, 8, and 9 deleted text end new text begin to 9a new text end for each individual. Lead agencies must notify the individual
and the service provider of the final agreed-upon values and rate, and provide information
that is identical to what was entered into the rates management system. If a value used was
mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead
agencies to correct it. Lead agencies must respond to these requests. When responding to
the request, the lead agency must consider:

(1) meeting the health and welfare needs of the individual or individuals receiving
services by service site, identified in their coordinated service and support plan under section
245D.02, subdivision 4b, and any addendum under section 245D.02, subdivision 4c;

(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and
(o); and meeting or exceeding the licensing standards for staffing required under section
245D.09, subdivision 1; and

(3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and
meeting or exceeding the licensing standards for staffing required under section 245D.31.

Subd. 5.

Base wage index deleted text begin and standard component values deleted text end new text begin ; establishment and
updates new text end .

(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 deleted text begin developing and deleted text end calculating the deleted text begin proposed deleted text end base wage, Minnesota-specific wages taken
from job descriptions and standard occupational classification (SOC) codes from the Bureau
of Labor Statistics as defined in deleted text begin the most recent edition of deleted text end the Occupational Handbook must
be used.

new text begin (b) The commissioner shall update the base wage index in subdivision 5a, publish these
updated values, and load them into the rate management system as follows:
new text end

new text begin (1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2019;
new text end

new text begin (2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2021; and
new text end

new text begin (3) on July 1, 2026, and every two years thereafter, based on wage data by SOC from
the Bureau of Labor Statistics available 30 months and one day prior to the scheduled update.
new text end

new text begin Subd. 5a. new text end

new text begin Base wage index; calculations. new text end

The base wage index must be calculated as
follows:

new text begin (1) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialist, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
new text end

new text begin (2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC
code 29-1141);
new text end

new text begin (3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical
nurses (SOC code 29-2061);
new text end

new text begin (4) for residential asleep-overnight staff, the minimum wage in Minnesota for large
employers, with the exception of asleep-overnight staff for family residential services, which
is 36 percent of the minimum wage in Minnesota for large employers;
new text end

deleted text begin (1) deleted text end new text begin (5) new text end for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for deleted text begin personal and deleted text end home
health new text begin and personal care new text end aide (SOC code deleted text begin 39-9021 deleted text end new text begin 31-1120 new text end ); 30 percent of the median wage
for nursing assistant (SOC code deleted text begin 31-1014 deleted text end new text begin 31-1131 new text end ); 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 deleted text begin 20 deleted text end new text begin 40 new text end percent of the median wage for home health new text begin and
personal care new text end aide (SOC code deleted text begin 31-1011 deleted text end new text begin 31-1120 new text end ); deleted text begin 20 percent of the median wage for personal
and home health aide (SOC code 39-9021); deleted text end 20 percent of the median wage for nursing
assistant (SOC code 31-1014); 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);

deleted text begin (2) deleted text end new text begin (6) new text end for adult day services, 70 percent of the median wage for nursing assistant (SOC
code deleted text begin 31-1014 deleted text end new text begin 31-1131 new text end ); and 30 percent of the median wage for new text begin home health and new text end personal
care aide (SOC code deleted text begin 39-9021 deleted text end new text begin 31-1120 new text end );

deleted text begin (3) deleted text end new text begin (7) new text end for deleted text begin day services, deleted text end day support services deleted text begin , deleted text end and prevocational services, 20 percent of
the median wage for nursing assistant (SOC code deleted text begin 31-1014 deleted text end new text begin 31-1131 new text end ); 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);

deleted text begin (4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;
deleted text end

deleted text begin (5) deleted text end new text begin (8) new text end for positive supports analyst staff, 100 percent of the median wage for new text begin substance
abuse, behavioral disorder, and new text end mental health deleted text begin counselors deleted text end new text begin counselor new text end (SOC code deleted text begin 21-1014 deleted text end new text begin
21-1018 new text end );

deleted text begin (6) deleted text end new text begin (9) new text end for positive supports professional staff, 100 percent of the median wage for
clinical counseling and school psychologist (SOC code 19-3031);

deleted text begin (7) deleted text end new text begin (10) new text end for positive supports specialist staff, 100 percent of the median wage for
psychiatric technicians (SOC code 29-2053);

deleted text begin (8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 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);
deleted text end

deleted text begin (9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
deleted text end

deleted text begin (10) deleted text end new text begin (11) new text end for deleted text begin in-home family support and deleted text end individualized home supports with family
training staff, 20 percent of the median wage for nursing aide (SOC code deleted text begin 31-1012 deleted text end new text begin 31-1131 new text end );
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);

deleted text begin (11) deleted text end new text begin (12) new text end for individualized home supports with training services 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);

deleted text begin (12) 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);
deleted text end

(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(16) for individualized home support new text begin without training new text end staff, 50 percent of the median
wage for deleted text begin personal and deleted text end home new text begin health and personal new text end care aide (SOC code deleted text begin 39-9021 deleted text end new text begin 31-1120 new text end );
and 50 percent of the median wage for nursing assistant (SOC code deleted text begin 31-1014 deleted text end new text begin 31-1131 new text end );

deleted text begin (17) 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 assistant
(SOC code 31-1014);
deleted text end

deleted text begin (18) deleted text end new text begin (17) new text end for night supervision staff, deleted text begin 20 deleted text end new text begin 40 new text end percent of the median wage for home health new text begin
and personal care new text end aide (SOC code deleted text begin 31-1011 deleted text end new text begin 31-1120 new text end ); deleted text begin 20 percent of the median wage for
personal and home health aide (SOC code 39-9021); deleted text end 20 percent of the median wage for
nursing assistant (SOC code deleted text begin 31-1014 deleted text end new text begin 31-1131 new text end ); 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); new text begin and
new text end

deleted text begin (19) deleted text end new text begin (18) new text end for respite staff, 50 percent of the median wage for deleted text begin personal and deleted text end home new text begin health
and personal new text end care aide (SOC code deleted text begin 39-9021 deleted text end new text begin 31-1131 new text end ); and 50 percent of the median wage
for nursing assistant (SOC code 31-1014) deleted text begin ; deleted text end new text begin .
new text end

deleted text begin (20) 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 assistant
(SOC code 31-1014);
deleted text end

deleted text begin (21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
deleted text end

deleted text begin (22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
deleted text end

deleted text begin (23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061) deleted text end .

deleted text begin (b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (6) program-related expense ratio: 1.3 percent; and
deleted text end

deleted text begin (7) absence and utilization factor ratio: 3.9 percent.
deleted text end

deleted text begin (c) Component values for family foster care are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) general administrative support ratio: 3.3 percent;
deleted text end

deleted text begin (6) program-related expense ratio: 1.3 percent; and
deleted text end

deleted text begin (7) absence factor: 1.7 percent.
deleted text end

deleted text begin (d) Component values for day training and habilitation, day support services, and
prevocational services are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) program plan support ratio: 5.6 percent;
deleted text end

deleted text begin (6) client programming and support ratio: ten percent;
deleted text end

deleted text begin (7) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (8) program-related expense ratio: 1.8 percent; and
deleted text end

deleted text begin (9) absence and utilization factor ratio: 9.4 percent.
deleted text end

deleted text begin (e) Component values for adult day services are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) program plan support ratio: 5.6 percent;
deleted text end

deleted text begin (6) client programming and support ratio: 7.4 percent;
deleted text end

deleted text begin (7) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (8) program-related expense ratio: 1.8 percent; and
deleted text end

deleted text begin (9) absence and utilization factor ratio: 9.4 percent.
deleted text end

deleted text begin (f) Component values for unit-based services with programming are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) program plan supports ratio: 15.5 percent;
deleted text end

deleted text begin (6) client programming and supports ratio: 4.7 percent;
deleted text end

deleted text begin (7) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (8) program-related expense ratio: 6.1 percent; and
deleted text end

deleted text begin (9) absence and utilization factor ratio: 3.9 percent.
deleted text end

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

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) program plan support ratio: 7.0 percent;
deleted text end

deleted text begin (6) client programming and support ratio: 2.3 percent;
deleted text end

deleted text begin (7) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (8) program-related expense ratio: 2.9 percent; and
deleted text end

deleted text begin (9) absence and utilization factor ratio: 3.9 percent.
deleted text end

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

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (6) program-related expense ratio: 2.9 percent; and
deleted text end

deleted text begin (7) absence and utilization factor ratio: 3.9 percent.
deleted text end

deleted text begin (i) The commissioner shall update the base wage index in paragraph (a), publish these
updated values, and load them into the rate management system as follows:
deleted text end

deleted text begin (1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2019;
deleted text end

deleted text begin (2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2021; and
deleted text end

deleted text begin (3) on July 1, 2026, and every two years thereafter, based on wage data by SOC from
the Bureau of Labor Statistics available 30 months and one day prior to the scheduled update.
deleted text end

deleted text begin (j) Beginning February 1, 2021, and every two years thereafter, the commissioner shall
report to the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over health and human services policy and finance an analysis of the
competitive workforce factor. The report must include recommendations to update the
competitive workforce factor using:
deleted text end

deleted text begin (1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
deleted text end

deleted text begin (2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
deleted text end

deleted text begin (3) workforce data as required under subdivision 10a, paragraph (g).
deleted text end

deleted text begin The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
deleted text end

new text begin Subd. 5b. new text end

new text begin Standard component value adjustments. new text end

deleted text begin (k) deleted text end The commissioner shall update
the deleted text begin framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); and paragraph (g), clause (6); subdivision 6, paragraphs (b), clauses (9) and
(10), and (e), clause (10); and subdivision 7, clauses (11), (17), and (18), deleted text end new text begin client and
programming support, transportation, and program facility cost component values as required
in subdivisions 6 to 9a new text end for changes in the Consumer Price Index. The commissioner shall
adjust these values higher or lower, publish these updated values, and load them into the
rate management system as follows:

(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the
previous update to the data available on December 31, 2019;

(2) on November 1, 2024, by the percentage change in the CPI-U from the date of the
previous update to the data available as of December 31, 2021; and

(3) on July 1, 2026, and every two years thereafter, by the percentage change in the
CPI-U from the date of the previous update to the data available 30 months and one day
prior to the scheduled update.

new text begin Subd. 5c. new text end

new text begin Removal of after-framework adjustments. new text end

deleted text begin (l) Upon the implementation of
the updates under paragraphs (i) and (k), rate adjustments authorized under section 256B.439,
subdivision 7; Laws 2013, chapter 108, article 7, section 60; and Laws 2014, chapter 312,
article 27, section 75, shall be removed from service rates calculated under this section.
deleted text end

deleted text begin (m) deleted text end Any rate adjustments applied to the service rates calculated under this section outside
of the cost components and rate methodology specified in this section shall be removed
from rate calculations upon implementation of the updates under deleted text begin paragraphs (i) and (k) deleted text end new text begin
subdivisions 5 and 5b new text end .

new text begin Subd. 5d. new text end

new text begin Unavailable data for updates and adjustments. new text end

deleted text begin (n) In this subdivision, deleted text end If
Bureau of Labor Statistics occupational codes or Consumer Price Index items new text begin specified in
subdivisions 5 or 5b new text end are unavailable in the future, the commissioner shall recommend to
the legislature codes or items to update and replace deleted text begin missing component values deleted text end .

new text begin Subd. 5e. new text end

new text begin Inflationary update spending requirement. new text end

deleted text begin (o) deleted text end new text begin (a) new text end At least 80 percent of
the marginal increase in revenue from the rate adjustment applied to the service rates
calculated under deleted text begin this section in paragraphs (i) and (k) deleted text end new text begin subdivisions 5 and 5b new text end beginning on
January 1, 2022, for services rendered between January 1, 2022, and March 31, 2024, must
be used to increase compensation-related costs for employees directly employed by the
program on or after January 1, 2022.

new text begin (b) new text end For the purposes of this deleted text begin paragraph deleted text end new text begin subdivision new text end , compensation-related costs include:

(1) wages and salaries;

(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;

(3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and

(4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to January 1, 2022, including retention and recruitment
bonuses and tuition reimbursement.

new text begin (c) new text end Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider,
or for persons paid by the provider under a management contract, do not count toward the
80 percent requirement under this deleted text begin paragraph deleted text end new text begin subdivision new text end .

new text begin (d) new text end A provider agency or individual provider that receives a rate subject to the
requirements of this deleted text begin paragraph deleted text end new text begin subdivision new text end shall prepare, and upon request submit to the
commissioner, a distribution plan that specifies the amount of money the provider expects
to receive that is subject to the requirements of this deleted text begin paragraph deleted text end new text begin subdivision new text end , including how
that money was or will be distributed to increase compensation-related costs for employees.
Within 60 days of final implementation of a rate adjustment subject to the requirements of
this deleted text begin paragraph deleted text end new text begin subdivision new text end , the provider must post the distribution plan and leave it posted
for a period of at least six months in an area of the provider's operation to which all direct
support professionals have access.

new text begin (e) This subdivision expires June 30, 2024.
new text end

Subd. 6.

deleted text begin Payments for deleted text end Residential support services new text begin ; generally new text end .

(a) For purposes of
this deleted text begin subdivision deleted text end new text begin section new text end , residential support services includes 24-hour customized living
services, community residential services, customized living services, family residential
services, deleted text begin foster care services, deleted text end new text begin and new text end integrated community supports deleted text begin , and supportive living
services daily deleted text end .

new text begin (b) A unit of service for residential support services is a day. Any portion of any calendar
day, within allowable Medicaid rules, where an individual spends time in a residential setting
is billable as a day. The number of days authorized for all individuals enrolling in residential
support services must include every day that services start and end.
new text end

new text begin (c) When the available shared staffing hours in a residential setting are insufficient to
meet the needs of an individual who enrolled in residential support services after January
1, 2014, then individual staffing hours shall be used.
new text end

new text begin Subd. 6a. new text end

new text begin Community residential services; component values and calculation of
payment rates. new text end

new text begin (a) Component values for community residential services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) general administrative support ratio: 13.25 percent;
new text end

new text begin (6) program-related expense ratio: 1.3 percent; and
new text end

new text begin (7) absence and utilization factor ratio: 3.9 percent.
new text end

(b) Payments for community residential services deleted text begin , corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services deleted text end
must be calculated as follows:

(1) determine the number of shared new text begin direct new text end staffing and individual direct deleted text begin staff deleted text end new text begin staffing new text end
hours to meet a recipient's needs provided on site or through monitoring technology;

(2) deleted text begin personnel deleted text end new text begin determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rate must be based on the
2009 Bureau of Labor Statistics Minnesota-specific rates or deleted text end rates derived by the commissioner
as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 and 5a new text end ;

(3) except for deleted text begin subdivision 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin subdivision 5a,
clauses (1) to (4) new text end , multiply the result of clause (2) by the product of one plus the competitive
workforce factor deleted text begin in subdivision 5, paragraph (b), clause (1) deleted text end ;

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of shared new text begin direct staffing new text end and individual direct deleted text begin staff deleted text end new text begin staffing new text end hours
provided on site or through monitoring technology and nursing hours by the appropriate
staff wages;

(6) multiply the number of shared new text begin direct staffing new text end and individual direct deleted text begin staff deleted text end new text begin staffing new text end hours
provided on site or through monitoring technology and nursing hours by the product of the
supervision span of control ratio deleted text begin in subdivision 5, paragraph (b), clause (2), deleted text end and the
appropriate deleted text begin supervision deleted text end new text begin supervisory staff new text end wage in subdivision deleted text begin 5, paragraph (a), clause (21) deleted text end new text begin
5a, clause (1) new text end ;

(7) combine the results of clauses (5) and (6), excluding any shared new text begin direct staffing new text end and
individual direct deleted text begin staff deleted text end new text begin staffing new text end hours provided through monitoring technology, and multiply
the result by one plus the employee vacation, sick, and training allowance ratio deleted text begin in subdivision
5, paragraph (b), clause (3) deleted text end . This is defined as the direct staffing cost;

(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared new text begin
direct staffing new text end and individual deleted text begin direct staff deleted text end hours provided through monitoring technology,
by one plus the employee-related cost ratio deleted text begin in subdivision 5, paragraph (b), clause (4) deleted text end ;

(9) for client programming and supports, deleted text begin the commissioner shall deleted text end add deleted text begin $2,179 deleted text end new text begin $2,260.21
divided by 365. The commissioner shall update the amount in this clause as specified in
subdivision 5b new text end ; deleted text begin and
deleted text end

(10) for transportation, if provided, deleted text begin the commissioner shall deleted text end add deleted text begin $1,680 deleted text end new text begin $1,742.62 divided
by 365 new text end , or deleted text begin $3,000 deleted text end new text begin $3,111.81 divided by 365 new text end if customized for adapted transport, based on
the resident with the highest assessed need. new text begin The commissioner shall update the amounts in
this clause as specified in subdivision 5b;
new text end

deleted text begin (c) The total rate must be calculated using the following steps:
deleted text end

deleted text begin (1) deleted text end new text begin (11) new text end subtotal deleted text begin paragraph (b), deleted text end clauses (8) to (10) deleted text begin , deleted text end and the direct staffing cost of any
shared new text begin direct staffing new text end and individual direct deleted text begin staff deleted text end new text begin staffing new text end hours provided through monitoring
technology that was excluded in clause (8);

deleted text begin (2) deleted text end new text begin (12) new text end sum the standard general deleted text begin and deleted text end administrative deleted text begin rate deleted text end new text begin support ratio new text end , the
program-related expense ratio, and the absence and utilization new text begin factor new text end ratio;

deleted text begin (3) deleted text end new text begin (13) new text end divide the result of clause deleted text begin (1) deleted text end new text begin (11) new text end by one minus the result of clause deleted text begin (2) deleted text end new text begin (12) new text end .
This is the total payment amount; and

deleted text begin (4) deleted text end new text begin (14) new text end adjust the result of clause deleted text begin (3) deleted text end new text begin (13) new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

deleted text begin (d) The payment methodology for customized living and 24-hour customized living
must be the customized living tool. The commissioner shall revise the customized living
tool to reflect the services and activities unique to disability-related recipient needs, and
adjust for regional differences in the cost of providing services.
deleted text end

deleted text begin The rate adjustments described in section 256S.205 do not apply to rates paid under this
section.
deleted text end

deleted text begin Customized living and 24-hour customized living rates determined under this section
shall not include more than 24 hours of support in a daily unit.
deleted text end deleted text begin deleted text end

deleted text begin The commissioner shall establish the following acuity-based customized living tool
input limits, based on case mix, for customized living and 24-hour customized living rates
determined under this section:
deleted text end

deleted text begin (1) no more than two hours of mental health management per day for people assessed
for case mixes A, D, and G;
deleted text end

deleted text begin (2) no more than four hours of activities of daily living assistance per day for people
assessed for case mix B; and
deleted text end

deleted text begin (3) no more than six hours of activities of daily living assistance per day for people
assessed for case mix D.
deleted text end

new text begin Subd. 6b. new text end

new text begin Family residential services; component values and calculation of payment
rates. new text end

new text begin (a) Component values for family residential services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) general administrative support ratio: 3.3 percent;
new text end

new text begin (6) program-related expense ratio: 1.3 percent; and
new text end

new text begin (7) absence factor: 1.7 percent.
new text end

new text begin (b) Payments for family residential services must be calculated as follows:
new text end

new text begin (1) determine the number of shared direct staffing and individual direct staffing hours
to meet a recipient's needs provided on site or through monitoring technology;
new text end

new text begin (2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;
new text end

new text begin (3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
new text end

new text begin (4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
new text end

new text begin (5) multiply the number of shared direct staffing and individual direct staffing hours
provided on site or through monitoring technology and nursing hours by the appropriate
staff wages;
new text end

new text begin (6) multiply the number of shared direct staffing and individual direct staffing hours
provided on site or through monitoring technology and nursing hours by the product of the
supervisory span of control ratio and the appropriate supervisory staff wage in subdivision
5a, clause (1);
new text end

new text begin (7) combine the results of clauses (5) and (6), excluding any shared direct staffing and
individual direct staffing hours provided through monitoring technology, and multiply the
result by one plus the employee vacation, sick, and training allowance ratio. This is defined
as the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staffing hours provided through monitoring technology, by one plus
the employee-related cost ratio;
new text end

new text begin (9) for client programming and supports, add $2,260.21 divided by 365. The
commissioner shall update the amount in this clause as specified in subdivision 5b;
new text end

new text begin (10) for transportation, if provided, add $1,742.62 divided by 365, or $3,111.81 divided
by 365 if customized for adapted transport, based on the resident with the highest assessed
need. The commissioner shall update the amounts in this clause as specified in subdivision
5b;
new text end

new text begin (11) subtotal clauses (8) to (10) and the direct staffing cost of any shared direct staffing
and individual direct staffing hours provided through monitoring technology that was
excluded in clause (8);
new text end

new text begin (12) sum the standard general administrative support ratio, the program-related expense
ratio, and the absence and utilization factor ratio;
new text end

new text begin (13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment rate; and
new text end

new text begin (14) adjust the result of clause (13) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text end

new text begin Subd. 6c. new text end

new text begin Integrated community supports; component values and calculation of
payment rates. new text end

deleted text begin (e) deleted text end new text begin (a) Component values for integrated community supports are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) general administrative support ratio: 13.25 percent;
new text end

new text begin (6) program-related expense ratio: 1.3 percent; and
new text end

new text begin (7) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (b) new text end Payments for integrated community deleted text begin support services deleted text end new text begin supports new text end must be calculated as
follows:

(1) new text begin determine the number of shared direct staffing and individual direct staffing hours
to meet a recipient's needs. new text end The base shared new text begin direct new text end staffing new text begin hours new text end must be eight hours divided
by the number of people receiving support in the integrated community support setting deleted text begin ; (2) deleted text end new text begin ,
and new text end the individual new text begin direct new text end staffing hours must be the average number of direct support hours
provided directly to the service recipient;

deleted text begin (3) the personnel deleted text end new text begin (2) determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rate must be based on
the most recent Bureau of Labor Statistics Minnesota-specific rates or deleted text end rates derived by the
commissioner as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 and 5a new text end ;

deleted text begin (4) deleted text end new text begin (3) new text end except for subdivision deleted text begin 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin 5a, clauses
(1) to (4) new text end , multiply the result of clause deleted text begin (3) deleted text end new text begin (2) new text end by the product of one plus the competitive
workforce factor deleted text begin in subdivision 5, paragraph (b), clause (1) deleted text end ;

deleted text begin (5) deleted text end new text begin (4) new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin (4) deleted text end new text begin (3) new text end ;

deleted text begin (6) deleted text end new text begin (5) new text end multiply the number of shared new text begin direct staffing new text end and individual direct deleted text begin staff deleted text end new text begin staffing new text end
hours in deleted text begin clauses (1) and (2) deleted text end new text begin clause (1) new text end by the appropriate staff wages;

deleted text begin (7) deleted text end new text begin (6) new text end multiply the number of shared new text begin direct staffing new text end and individual direct deleted text begin staff deleted text end new text begin staffing new text end
hours in deleted text begin clauses (1) and (2) deleted text end new text begin clause (1) new text end by the product of the supervisory span of control ratio
deleted text begin in subdivision 5, paragraph (b), clause (2), deleted text end and the appropriate supervisory new text begin staff new text end wage in
subdivision deleted text begin 5, paragraph (a), clause (21) deleted text end new text begin 5a, clause (1) new text end ;

deleted text begin (8) deleted text end new text begin (7) new text end combine the results of clauses deleted text begin (6) deleted text end new text begin (5) new text end and deleted text begin (7) deleted text end new text begin (6) new text end and multiply the result by one
plus the employee vacation, sick, and training allowance ratio deleted text begin in subdivision 5, paragraph
(b), clause (3) deleted text end . This is defined as the direct staffing cost;

deleted text begin (9) deleted text end new text begin (8) new text end for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio deleted text begin in subdivision 5, paragraph (b), clause (4) deleted text end ; deleted text begin and
deleted text end

deleted text begin (10) deleted text end new text begin (9) new text end for client programming and supports, deleted text begin the commissioner shall deleted text end add $2,260.21
divided by 365. new text begin The commissioner shall update the amount in this clause as specified in
subdivision 5b;
new text end

deleted text begin (f) The total rate must be calculated as follows:
deleted text end

deleted text begin (1) deleted text end new text begin (10) new text end add the results of deleted text begin paragraph (e), deleted text end clauses deleted text begin (9) deleted text end new text begin (8) new text end and deleted text begin (10) deleted text end new text begin (9) new text end ;

deleted text begin (2) deleted text end new text begin (11) new text end add the standard general deleted text begin and deleted text end administrative deleted text begin rate deleted text end new text begin support ratio new text end , the program-related
expense ratio, and the absence and utilization factor ratio;

deleted text begin (3) deleted text end new text begin (12) new text end divide the result of clause deleted text begin (1) deleted text end new text begin (10) new text end by one minus the result of clause deleted text begin (2) deleted text end new text begin (11) new text end .
This is the total payment amount; and

deleted text begin (4) deleted text end new text begin (13) new text end adjust the result of clause deleted text begin (3) deleted text end new text begin (12) new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

deleted text begin (g) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.
deleted text end

new text begin Subd. 6d. new text end

new text begin Payment for customized living. new text end

new text begin (a) The payment methodology for customized
living and 24-hour customized living must be the customized living tool. The commissioner
shall revise the customized living tool to reflect the services and activities unique to
disability-related recipient needs and adjust for regional differences in the cost of providing
services.
new text end

new text begin (b) The rate adjustments described in section 256S.205 do not apply to rates paid under
this section.
new text end

new text begin (c) Customized living and 24-hour customized living rates determined under this section
shall not include more than 24 hours of support in a daily unit.
new text end

new text begin (d) The commissioner shall establish the following acuity-based customized living tool
input limits, based on case mix, for customized living and 24-hour customized living rates
determined under this section:
new text end

new text begin (1) no more than two hours of mental health management per day for people assessed
for case mixes A, D, and G;
new text end

new text begin (2) no more than four hours of activities of daily living assistance per day for people
assessed for case mix B; and
new text end

new text begin (3) no more than six hours of activities of daily living assistance per day for people
assessed for case mix D.
new text end

Subd. 7.

deleted text begin Payments for deleted text end Day programs new text begin ; generally new text end .

deleted text begin Payments for services with deleted text end new text begin (a) For
the purposes of this section, new text end day programs deleted text begin including deleted text end new text begin include new text end adult day services, deleted text begin day treatment
and habilitation, deleted text end day support services, new text begin and new text end prevocational services deleted text begin , and structured day services
must be calculated as follows: deleted text end new text begin .
new text end

deleted text begin (1) determine the number of units of service and staffing ratio to meet a recipient's needs:
deleted text end

deleted text begin (i) deleted text end new text begin (b) new text end The staffing ratios for the units of service provided new text begin by a day program new text end to a recipient
in a typical week must be averaged to determine an individual's staffing ratio deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (ii) deleted text end new text begin (c) new text end The commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used new text begin by day programs new text end to determine staffing ratios deleted text begin under this
subdivision; deleted text end new text begin for day programs.
new text end

new text begin Subd. 7a. new text end

new text begin Adult day services; component values and calculation of payment rates. new text end

new text begin (a)
Component values for adult day services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 7.4 percent, updated as specified in subdivision
5b;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

new text begin (b) A unit of service for adult day services is either a day or 15 minutes. A day unit of
service is six or more hours of time spent providing direct service.
new text end

new text begin (c) Payments for adult day services must be calculated as follows:
new text end

new text begin (1) determine the number of units of service and the staffing ratio to meet a recipient's
needs;
new text end

(2) deleted text begin personnel deleted text end new text begin determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rates must be based on the
2009 Bureau of Labor Statistics Minnesota-specific rates or deleted text end rates derived by the commissioner
as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 and 5a new text end ;

(3) except for subdivision deleted text begin 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin 5a, clauses (1)
to (4) new text end , multiply the result of clause (2) by the product of one plus the competitive workforce
factor deleted text begin in subdivision 5, paragraph (d), clause (1) deleted text end ;

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of day program direct deleted text begin staff deleted text end new text begin staffing new text end hours and nursing hours by
the appropriate staff wage;

(6) multiply the number of day new text begin program new text end direct deleted text begin staff deleted text end new text begin staffing new text end hours by the product of the
deleted text begin supervision deleted text end new text begin supervisory new text end span of control ratio deleted text begin in subdivision 5, paragraph (d), clause (2), deleted text end
and the appropriate deleted text begin supervision deleted text end new text begin supervisory staff new text end wage in subdivision deleted text begin 5, paragraph (a),
clause (21) deleted text end new text begin 5a, clause (1) new text end ;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio deleted text begin in subdivision 5, paragraph (d), clause
(3) deleted text end . This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio deleted text begin in subdivision 5, paragraph (d), clause (5) deleted text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio deleted text begin in subdivision 5, paragraph (d), clause (4) deleted text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio deleted text begin in subdivision 5, paragraph (d), clause (6) deleted text end ;

(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs new text begin , updated as specified in subdivision 5b new text end ;

(12) for adult day bath services, add $7.01 per 15 minute unit;

(13) this is the subtotal rate;

(14) sum the standard general deleted text begin and deleted text end administrative rate new text begin support ratio new text end , the program-related
expense ratio, and the absence and utilization factor ratio;

(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount; new text begin and
new text end

(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services deleted text begin ; deleted text end new text begin .
new text end

deleted text begin (17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
deleted text end

deleted text begin (i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
deleted text end

deleted text begin (ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
deleted text end

deleted text begin (iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
deleted text end

deleted text begin (iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
deleted text end

deleted text begin (18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
deleted text end

deleted text begin (i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
deleted text end

deleted text begin (ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
deleted text end

deleted text begin (iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
deleted text end

deleted text begin (iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
deleted text end

new text begin Subd. 7b. new text end

new text begin Day support services; component values and calculation of payment
rates. new text end

new text begin (a) Component values for day support services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 10.37 percent, updated as specified in
subdivision 5b;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

new text begin (b) A unit of service for day support services is 15 minutes.
new text end

new text begin (c) Payments for day support services must be calculated as follows:
new text end

new text begin (1) determine the number of units of service and the staffing ratio to meet a recipient's
needs;
new text end

new text begin (2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;
new text end

new text begin (3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
new text end

new text begin (4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
new text end

new text begin (5) multiply the number of day program direct staffing hours and nursing hours by the
appropriate staff wage;
new text end

new text begin (6) multiply the number of day program direct staffing hours by the product of the
supervisory span of control ratio and the appropriate supervisory staff wage in subdivision
5a, clause (1);
new text end

new text begin (7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;
new text end

new text begin (8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;
new text end

new text begin (9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;
new text end

new text begin (10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;
new text end

new text begin (11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs, updated as specified in subdivision 5b;
new text end

new text begin (12) this is the subtotal rate;
new text end

new text begin (13) sum the standard general administrative rate support ratio, 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; and
new text end

new text begin (15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text end

new text begin Subd. 7c. new text end

new text begin Prevocational services; component values and calculation of payment
rates. new text end

new text begin (a) Component values for prevocational services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 10.37 percent, updated as specified in
subdivision 5b;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

new text begin (b) A unit of service for prevocational services is either a day or 15 minutes. A day unit
of service is six or more hours of time spent providing direct service.
new text end

new text begin (c) Payments for prevocational services must be calculated as follows:
new text end

new text begin (1) determine the number of units of service and the staffing ratio to meet a recipient's
needs;
new text end

new text begin (2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;
new text end

new text begin (3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
new text end

new text begin (4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
new text end

new text begin (5) multiply the number of day program direct staffing hours and nursing hours by the
appropriate staff wage;
new text end

new text begin (6) multiply the number of day program direct staffing hours by the product of the
supervisory span of control ratio and the appropriate supervisory staff wage in subdivision
5a, clause (1);
new text end

new text begin (7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;
new text end

new text begin (8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;
new text end

new text begin (9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;
new text end

new text begin (10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;
new text end

new text begin (11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs, updated as specified in subdivision 5b;
new text end

new text begin (12) this is the subtotal rate;
new text end

new text begin (13) sum the standard general administrative rate support ratio, 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; and
new text end

new text begin (15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text end

Subd. 8.

deleted text begin Payments for deleted text end Unit-based services with programming new text begin ; component values
and calculation of payment rates new text end .

deleted text begin Payments for deleted text end new text begin (a) For the purpose of this section, new text end
unit-based services with programming deleted text begin , including deleted text end new text begin include new text end employment exploration services,
employment development services, deleted text begin housing access coordination deleted text end new text begin employment support
services new text end , individualized home supports with family training, individualized home supports
with training, deleted text begin in-home family support, independent living skills training, deleted text end and deleted text begin hourly supported
living deleted text end new text begin positive support new text end services provided to an individual outside of any new text begin service plan for a new text end
day new text begin program new text end or residential new text begin support new text end service deleted text begin plan deleted text end new text begin .
new text end

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

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 15.5 percent;
new text end

new text begin (6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
5b;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 6.1 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (c) A unit of service for unit-based services with programming is 15 minutes.
new text end

new text begin (d) Payments for unit-based services with programming new text end must be calculated as follows,
unless the services are deleted text begin authorized deleted text end new text begin reimbursed new text end separately deleted text begin under subdivision 6 or 7 deleted text end new text begin as part of
a residential support services or day program payment rate new text end :

(1) determine the number of units of service to meet a recipient's needs;

(2) deleted text begin personnel deleted text end new text begin determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rate must be based on the
2009 Bureau of Labor Statistics Minnesota-specific rates or deleted text end rates derived by the commissioner
as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 and 5a new text end ;

(3) except for subdivision deleted text begin 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin 5a, clauses (1)
to (4) new text end , multiply the result of clause (2) by the product of one plus the competitive workforce
factor deleted text begin in subdivision 5, paragraph (f), clause (1) deleted text end ;

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the appropriate staff wage;

(6) multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the product of the deleted text begin supervision deleted text end new text begin
supervisory new text end span of control ratio deleted text begin in subdivision 5, paragraph (f), clause (2), deleted text end and the
appropriate deleted text begin supervision deleted text end new text begin supervisory staff new text end wage in subdivision deleted text begin 5, paragraph (a), clause (21) deleted text end new text begin
5a, clause (1) new text end ;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio deleted text begin in subdivision 5, paragraph (f), clause
(3) deleted text end . This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan deleted text begin supports deleted text end new text begin support new text end ratio deleted text begin in subdivision 5, paragraph (f), clause (5) deleted text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio deleted text begin in subdivision 5, paragraph (f), clause (4) deleted text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and deleted text begin supports deleted text end new text begin support new text end ratio deleted text begin in subdivision 5, paragraph (f), clause
(6) deleted text end ;

(11) this is the subtotal rate;

(12) sum the standard general deleted text begin and deleted text end administrative deleted text begin rate deleted text end new text begin support ratio new text end , the program-related
expense ratio, and the absence and utilization factor ratio;

(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;

(14) new text begin for services provided in a shared manner, divide the total payment in clause (13)
as follows:
new text end

new text begin (i) new text end for employment exploration services deleted text begin provided in a shared manner deleted text end , divide deleted text begin the total
payment amount in clause (13) deleted text end by the number of service recipients, not to exceed five deleted text begin . deleted text end new text begin ;
new text end

new text begin (ii) new text end for employment support services deleted text begin provided in a shared manner deleted text end , divide deleted text begin the total
payment amount in clause (13) deleted text end by the number of service recipients, not to exceed six deleted text begin . deleted text end new text begin ; and
new text end

new text begin (iii) new text end for deleted text begin independent living skills training, deleted text end individualized home supports with training deleted text begin , deleted text end
and individualized home supports with family training deleted text begin provided in a shared manner deleted text end , divide
deleted text begin the total payment amount in clause (13) deleted text end by the number of service recipients, not to exceed
two; and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

Subd. 9.

deleted text begin Payments for deleted text end Unit-based services without programming new text begin ; component values
and calculation of payment rates new text end .

deleted text begin Payments for deleted text end new text begin (a) For the purposes of this subdivision,
new text end unit-based services without programming deleted text begin , including deleted text end new text begin include new text end individualized home supports deleted text begin , deleted text end new text begin
without training and new text end night supervision deleted text begin , personal support, respite, and companion care deleted text end
provided to an individual outside of any new text begin service plan for a new text end day new text begin program new text end or residential new text begin support new text end
service deleted text begin plan deleted text end new text begin . Unit-based services without programming do not include respite.
new text end

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

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 7.0 percent;
new text end

new text begin (6) client programming and support ratio: 2.3 percent, updated as specified in subdivision
5b;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 2.9 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (c) A unit of service for unit-based services without programming is 15 minutes.
new text end

new text begin (d) Payments for unit-based services without programming new text end must be calculated as follows
unless the services are deleted text begin authorized deleted text end new text begin reimbursed new text end separately deleted text begin under subdivision 6 or 7 deleted text end new text begin as part of
a residential support services or day program payment rate new text end :

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

(2) deleted text begin personnel deleted text end new text begin determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rates must be based on the
2009 Bureau of Labor Statistics Minnesota-specific rate or deleted text end rates derived by the commissioner
as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 to 5a new text end ;

(3) except for subdivision deleted text begin 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin 5a, clauses (1)
to (4) new text end , multiply the result of clause (2) by the product of one plus the competitive workforce
factor deleted text begin in subdivision 5, paragraph (g), clause (1) deleted text end ;

(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);

(5) multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the appropriate staff wage;

(6) multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the product of the deleted text begin supervision deleted text end new text begin
supervisory new text end span of control ratio deleted text begin in subdivision 5, paragraph (g), clause (2), deleted text end and the
appropriate deleted text begin supervision deleted text end new text begin supervisory staff new text end wage in subdivision deleted text begin 5, paragraph (a), clause (21) deleted text end new text begin
5a, clause (1) new text end ;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio deleted text begin in subdivision 5, paragraph (g), clause
(3) deleted text end . This is defined as the direct staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio deleted text begin in subdivision 5, paragraph (g), clause (5) deleted text end ;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio deleted text begin in subdivision 5, paragraph (g), clause (4) deleted text end ;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio deleted text begin in subdivision 5, paragraph (g), clause (6) deleted text end ;

(11) this is the subtotal rate;

(12) sum the standard general deleted text begin and deleted text end administrative deleted text begin rate deleted text end new text begin support ratio new text end , the program-related
expense ratio, and the absence and utilization factor ratio;

(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;

new text begin (14) for individualized home supports without training provided in a shared manner,
divide the total payment amount in clause (13) by the number of service recipients, not to
exceed two; and
new text end

new text begin (15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for region differences in the cost of providing services.
new text end

new text begin Subd. 9a. new text end

new text begin Respite services; component values and calculation of payment rates. new text end

new text begin (a)
For the purposes of this section, respite services include respite services provided to an
individual outside of any service plan for a day program or residential support service.
new text end

new text begin (b) Component values for respite services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) general administrative support ratio: 13.25 percent;
new text end

new text begin (6) program-related expense ratio: 2.9 percent; and
new text end

new text begin (7) absence and utilization factor ratio: 3.9 percent.
new text end

new text begin (c) A unit of service for respite services is 15 minutes.
new text end

new text begin (d) Payments for respite services must be calculated as follows unless the service is
reimbursed separately as part of a residential support services or day program payment rate:
new text end

deleted text begin (14) for respite services, deleted text end new text begin (1) new text end determine the number of deleted text begin day deleted text end units of service to meet an
individual's needs;

deleted text begin (15) personnel deleted text end new text begin (2) determine the appropriate new text end hourly new text begin staff new text end wage deleted text begin rates must be based on
the 2009 Bureau of Labor Statistics Minnesota-specific rate or deleted text end rates derived by the
commissioner as provided in deleted text begin subdivision 5 deleted text end new text begin subdivisions 5 and 5a new text end ;

deleted text begin (16) deleted text end new text begin (3) new text end except for subdivision deleted text begin 5, paragraph (a), clauses (4) and (21) to (23) deleted text end new text begin 5a, clauses
(1) to (4) new text end , multiply the result of clause deleted text begin (15) deleted text end new text begin (2) new text end by the product of one plus the competitive
workforce factor deleted text begin in subdivision 5, paragraph (h), clause (1) deleted text end ;

deleted text begin (17) deleted text end new text begin (4) new text end for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause deleted text begin (16) deleted text end new text begin (3) new text end ;

deleted text begin (18) deleted text end new text begin (5) new text end multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the appropriate staff wage;

deleted text begin (19) deleted text end new text begin (6) new text end multiply the number of direct deleted text begin staff deleted text end new text begin staffing new text end hours by the product of the
supervisory span of control ratio deleted text begin in subdivision 5, paragraph (h), clause (2), deleted text end and the
appropriate deleted text begin supervision deleted text end new text begin supervisory staff new text end wage in subdivision deleted text begin 5, paragraph (a), clause (21) deleted text end new text begin
5a, clause (1) new text end ;

deleted text begin (20) deleted text end new text begin (7) new text end combine the results of clauses deleted text begin (18) deleted text end new text begin (5) new text end and deleted text begin (19) deleted text end new text begin (6) new text end , and multiply the result by
one plus the employee vacation, sick, and training allowance ratio deleted text begin in subdivision 5, paragraph
(h), clause (3) deleted text end . This is defined as the direct staffing rate;

deleted text begin (21) deleted text end new text begin (8) new text end for employee-related expenses, multiply the result of clause deleted text begin (20) deleted text end new text begin (7) new text end by one plus
the employee-related cost ratio deleted text begin in subdivision 5, paragraph (h), clause (4) deleted text end ;

deleted text begin (22) deleted text end new text begin (9) new text end this is the subtotal rate;

deleted text begin (23) deleted text end new text begin (10) new text end sum the standard general deleted text begin and deleted text end administrative deleted text begin rate deleted text end new text begin support ratio new text end , the
program-related expense ratio, and the absence and utilization factor ratio;

deleted text begin (24) deleted text end new text begin (11) new text end divide the result of clause deleted text begin (22) deleted text end new text begin (9) new text end by one minus the result of clause deleted text begin (23) deleted text end new text begin (10) new text end .
This is the total payment amount;

deleted text begin (25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
deleted text end

deleted text begin (26) deleted text end new text begin (12) new text end for respite deleted text begin care deleted text end services provided in a shared manner, divide the total payment
amount in clause deleted text begin (24) deleted text end new text begin (11) new text end by the number of service recipients, not to exceed three; and

deleted text begin (27) deleted text end new text begin (13) new text end adjust the result of deleted text begin clauses (13), (25), and (26) deleted text end new text begin clause (12) new text end by a factor to be
determined by the commissioner to adjust for regional differences in the cost of providing
services.

Subd. 10.

deleted text begin Updating payment values and additional deleted text end new text begin Evaluation of new text end information new text begin and
data new text end .

(a) The commissioner shall, within available resources, conduct research and gather
data and information from existing state systems or other outside sources on the following
items:

(1) differences in the underlying cost to provide services and care across the state; and

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

(b) deleted text begin No later than July 1, 2014, deleted text end The commissioner, in consultation with stakeholders,
shall deleted text begin begin the deleted text end review and deleted text begin evaluation of deleted text end new text begin evaluate new text end the following values already in subdivisions
6 to deleted text begin 9 deleted text end new text begin 9a new text end , or issues that impact all services, including, but not limited to:

(1) values for transportation rates;

(2) values for services where monitoring technology replaces staff time;

(3) values for indirect services;

(4) values for nursing;

(5) values for the facility use rate in day services, and the weightings used in the day
service ratios and adjustments to those weightings;

(6) values for workers' compensation as part of employee-related expenses;

(7) values for unemployment insurance as part of employee-related expenses;

(8) direct care workforce labor market measures;

(9) any changes in state or federal law with a direct impact on the underlying cost of
providing home and community-based services;

(10) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section; and

(11) different competitive workforce factors by service, as determined under subdivision
deleted text begin 5, paragraph (j) deleted text end new text begin 10b new text end .

(c) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (a) and (b) on
January 15, 2021, with a full report, and a full report once every four years thereafter.

(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement
changes to the regional adjustment factors once every six years. Prior to implementation,
the commissioner shall consult with stakeholders on the methodology to calculate the
adjustment.

deleted text begin (e) The commissioner shall provide a public notice via LISTSERV in October of each
year containing information detailing legislatively approved changes in:
deleted text end

deleted text begin (1) calculation values including derived wage rates and related employee and
administrative factors;
deleted text end

deleted text begin (2) service utilization;
deleted text end

deleted text begin (3) county and tribal allocation changes; and
deleted text end

deleted text begin (4) information on adjustments made to calculation values and the timing of those
adjustments.
deleted text end

deleted text begin The information in this notice must be effective January 1 of the following year.
deleted text end

deleted text begin (f) When the available shared staffing hours in a residential setting are insufficient to
meet the needs of an individual who enrolled in residential services after January 1, 2014,
then individual staffing hours shall be used.
deleted text end

deleted text begin (g) The commissioner shall collect transportation and trip information for all day services
through the rates management system.
deleted text end

deleted text begin (h) The commissioner, in consultation with stakeholders, shall study value-based models
and outcome-based payment strategies for fee-for-service home and community-based
services and report to the legislative committees with jurisdiction over the disability waiver
rate system by October 1, 2020, with recommended strategies to: (1) promote new models
of care, services, and reimbursement structures that require more efficient use of public
dollars while improving the outcomes most valued by the individuals served; (2) assist
clients and their families in evaluating options and stretching individual budget funds; (3)
support individualized, person-centered planning and individual budget choices; and (4)
create a broader range of client options geographically or targeted at culturally competent
models for racial and ethnic minority groups.
deleted text end

Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to deleted text begin 9 deleted text end new text begin 9a new text end reflect the cost to provide
the service. As determined by the commissioner, in consultation with stakeholders identified
in subdivision 17, a provider enrolled to provide services with rates determined under this
section must submit requested cost data to the commissioner to support research on the cost
of providing services that have rates determined by the disability waiver rates system.
Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

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

(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.

(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. deleted text begin The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.
deleted text end

(d) The commissioner shall analyze cost deleted text begin documentation in deleted text end new text begin data submitted under new text end paragraph
(a) and, in consultation with stakeholders identified in subdivision 17, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services new text begin once new text end every four years beginning January 1, 2021. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (c).

new text begin (e) new text end The commissioner shall release cost data in an aggregate form, and cost data from
individual providers shall not be released except as provided for in current law.

deleted text begin (e) deleted text end new text begin (f) new text end The commissioner, in consultation with stakeholders identified in subdivision 17,
shall develop and implement a process for providing training and technical assistance
necessary to support provider submission of cost documentation required under paragraph
(a).

deleted text begin (f) By December 31, 2020, providers paid with rates calculated under subdivision 5,
paragraph (b), shall identify additional revenues from the competitive workforce factor and
prepare a written distribution plan for the revenues. A provider shall make the provider's
distribution plan available and accessible to all direct care staff for a minimum of one
calendar year. Upon request, a provider shall submit the written distribution plan to the
commissioner.
deleted text end

new text begin Subd. 10b. new text end

new text begin Provider submission of labor market data. new text end

deleted text begin (g) deleted text end new text begin (a) new text end Providers enrolled to
provide services with rates determined under section 256B.4914, subdivision 3, shall submit
labor market data to the commissioner annually on or before November 1, including but
not limited to:

(1) number of direct care staff;

(2) wages of direct care staff;

(3) overtime wages of direct care staff;

(4) hours worked by direct care staff;

(5) overtime hours worked by direct care staff;

(6) benefits provided to direct care staff;

(7) direct care staff job vacancies; and

(8) direct care staff retention rates.

deleted text begin (h) deleted text end new text begin (b) new text end The commissioner shall publish annual reports on provider and state-level labor
market data, including but not limited to the data obtained under paragraph deleted text begin (g) deleted text end new text begin (a) new text end .

deleted text begin (i) deleted text end new text begin (c) new text end The commissioner may temporarily suspend payments to the provider if data
requested under paragraph deleted text begin (g) deleted text end new text begin (a) new text end is not received 90 days after the required submission date.
Withheld payments shall be made once data is received by the commissioner.

deleted text begin (j) deleted text end new text begin (d) new text end Providers who receive payment under this section for less than 25 percent of their
clients in the year prior to the report may attest to the commissioner in a manner determined
by the commissioner that they are declining to provide the data required under paragraph
deleted text begin (g) deleted text end new text begin (a) new text end and will not be subject to the payment suspension in paragraph deleted text begin (i) deleted text end new text begin (c) new text end .

new text begin Subd. 10c. new text end

new text begin Reporting and analysis of competitive workforce factor. new text end

new text begin (a) Beginning
February 1, 2021, and every two years thereafter, the commissioner shall report to the chairs
and ranking minority members of the legislative committees and divisions with jurisdiction
over health and human services policy and finance an analysis of the competitive workforce
factor.
new text end

new text begin (b) The report must include recommendations to update the competitive workforce factor
using:
new text end

new text begin (1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
new text end

new text begin (2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
new text end

new text begin (3) workforce data as required under subdivision 10b.
new text end

new text begin (c) The commissioner shall not recommend an increase or decrease of the competitive
workforce factor from the current value by more than two percentage points. If, after a
biennial analysis for the next report, the competitive workforce factor is less than or equal
to zero, the commissioner shall recommend a competitive workforce factor of zero.
new text end

deleted text begin Subd. 11. deleted text end

deleted text begin Payment implementation. deleted text end

deleted 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 section 256B.092 or 256B.49.
deleted text end

Subd. 12.

Customization of rates for individuals.

(a) 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 rate under subdivisions 6 deleted text begin , 7, 8, and 9 deleted text end new text begin to 9a new text end .
The customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per
hour for waiver recipients who meet the respective criteria as determined by the
commissioner.

(b) For the purposes of this section, "deaf and hard-of-hearing" means:

(1) the person has a developmental disability and an assessment score which indicates
a hearing impairment that is severe or that the person has no useful hearing;

(2) the person has a developmental disability and an expressive communications score
that indicates the person uses single signs or gestures, uses an augmentative communication
aid, or does not have functional communication, or the person's expressive communications
is unknown; and

(3) the person has a developmental disability and a communication score which indicates
the person comprehends signs, gestures, and modeling prompts or does not comprehend
verbal, visual, or gestural communication, or that the person's receptive communication
score is unknown; or

(4) the person receives long-term care services and has an assessment score that indicates
they hear only very loud sounds, have no useful hearing, or a determination cannot be made;
and the person receives long-term care services and has an assessment that indicates the
person communicates needs with sign language, symbol board, written messages, gestures,
or an interpreter; communicates with inappropriate content, makes garbled sounds or displays
echolalia, or does not communicate needs.

Subd. 13.

Transportation.

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.

Subd. 14.

Exceptions.

(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. Whether granted, denied, or
modified, the commissioner shall respond to all exception requests in writing. The
commissioner shall include in the written response the basis for the action and provide
notification of the right to appeal under paragraph (h).

(b) Lead agencies must act on an exception request within 30 days and notify the initiator
of the request of their recommendation in writing. A lead agency shall submit all exception
requests along with its recommendation to the commissioner.

(c) An application for a rate exception may be submitted for the following criteria:

(1) an individual has service needs that cannot be met through additional units of service;

(2) an individual's rate determined under subdivisions 6 deleted text begin , 7, 8, and 9 deleted text end new text begin to 9a new text end is so insufficient
that it has resulted in an individual receiving a notice of discharge from the individual's
provider; or

(3) an individual's service needs, including behavioral changes, require a level of service
which necessitates a change in provider or which requires the current provider to propose
service changes beyond those currently authorized.

(d) Exception requests must include the following information:

(1) the service needs required by each individual that are not accounted for in subdivisions
6 deleted text begin , 7, 8, and 9 deleted text end new text begin to 9a new text end ;

(2) the service rate requested and the difference from the rate determined in subdivisions
6 deleted text begin , 7, 8, and 9 deleted text end new text begin to 9a new text end ;

(3) a basis for the underlying costs used for the rate exception and any accompanying
documentation; and

(4) any contingencies for approval.

(e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.

(f) Individual disability waiver recipients, an interested party, or the license holder that
would receive the rate exception increase may request that a lead agency submit an exception
request. A lead agency that denies such a request shall notify the individual waiver recipient,
interested party, or license holder of its decision and the reasons for denying the request in
writing no later than 30 days after the request has been made and shall submit its denial to
the commissioner in accordance with paragraph (b). The reasons for the denial must be
based on the failure to meet the criteria in paragraph (c).

(g) The commissioner shall determine whether to approve or deny an exception request
no more than 30 days after receiving the request. If the commissioner denies the request,
the commissioner shall notify the lead agency and the individual disability waiver recipient,
the interested party, and the license holder in writing of the reasons for the denial.

(h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. When the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall issue
a temporary stay of demission, when requested by the disability waiver recipient, consistent
with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary
stay shall remain in effect until the lead agency can provide an informed choice of
appropriate, alternative services to the disability waiver.

(i) Providers may petition lead agencies to update values that were entered incorrectly
or erroneously into the rate management system, based on past service level discussions
and determination in subdivision 4, without applying for a rate exception.

(j) The starting date for the rate exception will be the later of the date of the recipient's
change in support or the date of the request to the lead agency for an exception.

(k) The commissioner shall track all exception requests received and their dispositions.
The commissioner shall issue quarterly public exceptions statistical reports, including the
number of exception requests received and the numbers granted, denied, withdrawn, and
pending. The report shall include the average amount of time required to process exceptions.

(l) Approved rate exceptions remain in effect in all cases until an individual's needs
change as defined in paragraph (c).

Subd. 15.

County or Tribal allocations.

(a) The commissioner shall establish a method
of tracking and reporting the fiscal impact of the disability waiver rates management system
on individual lead agencies.

(b) The commissioner shall make annual adjustments to lead agencies' home and
community-based waivered service budget allocations to adjust for rate differences and the
resulting impact on county allocations upon implementation of the disability waiver rates
system.

(c) Lead agencies exceeding their allocations shall be subject to the provisions under
sections 256B.0916, subdivision 11, and 256B.49, subdivision 26.

Subd. 17.

Stakeholder consultation and county training.

(a) The commissioner shall
continue consultation at regular intervals with the existing stakeholder group established
as part of the rate-setting methodology process and others, to gather input, concerns, and
data, to assist in the implementation of the rate payment system, and to make pertinent
information available to the public through the department's website.

(b) The commissioner shall offer training at least annually for county personnel
responsible for administering the rate-setting framework in a manner consistent with this
section.

(c) The commissioner shall maintain an online instruction manual explaining the
rate-setting framework. The manual shall be consistent with this section, and shall be
accessible to all stakeholders including recipients, representatives of recipients, county or
Tribal agencies, and license holders.

(d) The commissioner shall not defer to the county or Tribal agency on matters of
technical application of the rate-setting framework, and a county or Tribal agency shall not
set rates in a manner that conflicts with this section.

new text begin Subd. 18. new text end

new text begin Legislatively approved changes; public notice. new text end

new text begin (a) The commissioner shall
provide a public notice via LISTSERV in October of each year containing information
detailing legislatively approved changes in:
new text end

new text begin (1) calculation values including derived wage rates and related employee and
administrative factors;
new text end

new text begin (2) service utilization;
new text end

new text begin (3) county and Tribal allocation changes; and
new text end

new text begin (4) information on adjustments made to calculation values and the timing of those
adjustments.
new text end

new text begin (b) The information in this notice must be effective January 1 of the following year.
new text end

Sec. 2. new text begin DIRECTION TO COMMISSIONER; TRANSITION PROCESS.
new text end

new text begin (a) The commissioner of human services shall update references to statutes recodified
in this act when printed material is replaced and new printed material is obtained in the
normal course of business. The commissioner is not required to replace existing printed
material to comply with this act.
new text end

new text begin (b) The commissioner of human services shall update references to statutes recodified
in this act when online documents and websites are edited in the normal course of business.
The commissioner is not required to edit online documents and websites merely to comply
with this act.
new text end

new text begin (c) The commissioner of human services shall update references to statutes recodified
in this act when the home and community-based service waiver plans are updated in the
normal course of business. The commissioner is not required to update the home and
community-based service waiver plans merely to comply with this act.
new text end

Sec. 3. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the House Research Department; the Office
of Senate Counsel, Research, and Fiscal Analysis; and the Department of Human Services,
shall make necessary cross-reference changes and remove statutory cross-references in
Minnesota Statutes to conform with the recodification in this act. The revisor may make
technical and other necessary changes to sentence structure to preserve the meaning of the
text. The revisor may alter the coding in this act to incorporate statutory changes made by
other law in the 2022 regular legislative session. If a provision repealed in this act is also
amended in the 2022 regular legislative session by other law, the revisor shall merge the
amendment into the recodification, notwithstanding Minnesota Statutes, section 645.30.
new text end

Sec. 4. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 3 are effective July 1, 2022.
new text end