1.1                          A bill for an act 
  1.2             relating to human services; establishing a mediation 
  1.3             process for day training and habilitation service 
  1.4             variance requests; establishing a day training and 
  1.5             habilitation rate structure pilot project; 
  1.6             establishing county responsibilities; extending a task 
  1.7             force; appropriating money; amending Minnesota 
  1.8             Statutes 2000, section 252.46, by adding a 
  1.9             subdivision; Laws 1999, chapter 152, section 4. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2000, section 252.46, is 
  1.12  amended by adding a subdivision to read: 
  1.13     Subd. 19a.  [VENDOR MEDIATION.] (a) A vendor may request 
  1.14  the commissioner to mediate after a county board's action on or 
  1.15  failure to consider a variance request that has been submitted 
  1.16  to the county under subdivision 6.  To obtain mediation 
  1.17  services, the vendor must file a written notice with the 
  1.18  commissioner and provide a copy to the county board.  For 
  1.19  mediation of a county board's action on a request, the notice 
  1.20  must be filed or received by the commissioner and county board 
  1.21  within 45 calendar days of the postmark date on the county's 
  1.22  notification to the vendor that a variance request has been 
  1.23  denied or granted.  For mediation on a request that the county 
  1.24  board has not considered, the notice may be filed not less than 
  1.25  90 nor more than 150 calendar days after the request was 
  1.26  submitted to the county if no county action has been taken.  The 
  1.27  notice must specify the reasons for the request for mediation, 
  2.1   the dollar amount in dispute, and the basis in statute or rule 
  2.2   for challenging the county board's decision or lack of action. 
  2.3      (b) Within 45 calendar days of receipt of the notice, the 
  2.4   commissioner must convene a reconciliation conference to attempt 
  2.5   to resolve the rate dispute.  The commissioner may mediate the 
  2.6   dispute, use a third-party mediator, or refer the issue to an 
  2.7   advisory panel of stakeholders to assist in resolving the rate 
  2.8   dispute. 
  2.9      (c) Within 30 days following the mediation, the county 
  2.10  shall make a final decision on the variance request and shall 
  2.11  notify the vendor and the commissioner of the decision. 
  2.12     Sec. 2.  Laws 1999, chapter 152, section 4, is amended to 
  2.13  read: 
  2.14     Sec. 4.  [REPORT.] 
  2.15     The task force shall present a report recommending a new 
  2.16  payment rate structure to the legislature by January 15, 2000, 
  2.17  and shall make recommendations to the commissioner of human 
  2.18  services regarding the implementation of the pilot project for 
  2.19  the individualized payment rate structure, so the pilot project 
  2.20  can be implemented by January 1, 2002, as required in section 
  2.21  3.  The task force expires on March 15, 2000 June 30, 2003. 
  2.22     Sec. 3.  [DAY TRAINING AND HABILITATION PAYMENT STRUCTURE 
  2.23  PILOT PROJECT.] 
  2.24     Subdivision 1.  [INDIVIDUALIZED PAYMENT RATE STRUCTURE.] No 
  2.25  later than January 1, 2002, the commissioner of human services 
  2.26  shall initiate a pilot project for the individualized payment 
  2.27  rate structure described in this section and section 4.  The 
  2.28  pilot project shall include actual transfers of funds, not 
  2.29  simulated transfers.  The pilot project may include all or some 
  2.30  of the vendors in up to eight counties, with no more than two 
  2.31  counties from the seven-county Minneapolis-St. Paul metropolitan 
  2.32  area.  
  2.33     Subd. 2.  [SUNSET.] The pilot project shall sunset upon 
  2.34  implementation of a new statewide rate structure to be 
  2.35  recommended by the task force described in subdivision 3, in its 
  2.36  report to the legislature on December 1, 2002.  The rates of 
  3.1   vendors participating in the pilot project must be modified to 
  3.2   be consistent with the new statewide rate structure, if 
  3.3   implemented.  The commissioner may grant a variance to any of 
  3.4   the provisions in Minnesota Statutes, sections 252.451, 
  3.5   subdivision 5, and 252.46, except subdivision 16, and Minnesota 
  3.6   Rules, part 9525.1290, subpart 1, items A and B, necessary to 
  3.7   implement the pilot project.  
  3.8      Subd. 3.  [TASK FORCE RESPONSIBILITIES.] The day training 
  3.9   and habilitation task force established under Laws 1999, chapter 
  3.10  152, shall evaluate the pilot project authorized under 
  3.11  subdivision 1, and by December 1, 2002, shall report to the 
  3.12  legislature with recommendations regarding whether the pilot 
  3.13  project individualized payment rate structure should be 
  3.14  implemented statewide and with recommendations for any 
  3.15  amendments that should be made before statewide implementation.  
  3.16  These recommendations shall be made in a report to the chairs of 
  3.17  the house health and human services policy and finance 
  3.18  committees and the senate health and family security committee 
  3.19  and finance division. 
  3.20     Subd. 4. [SETTLE-UP PROCEDURES.] For clients served on the 
  3.21  first and last day of each six-month period, vendors that have 
  3.22  been reimbursed under the pilot project individualized payment 
  3.23  rate structure may request a settle-up.  If the vendor 
  3.24  demonstrates that less reimbursement was received under the 
  3.25  payment rate system in the pilot project than the vendor would 
  3.26  have received had the vendor been reimbursed under Minnesota 
  3.27  Statutes, section 252.46, for providing the same type and amount 
  3.28  of services to the same clients during the preceding six months, 
  3.29  regardless of actual payment source, the commissioner shall 
  3.30  reimburse the vendor the amount of the difference in payment 
  3.31  amounts.  If a vendor qualifies for a settle-up under this 
  3.32  provision, the county board shall adjust the vendor's service 
  3.33  level and transportation values to eliminate the need for a 
  3.34  settle-up in the future.  The commissioner shall report all 
  3.35  settle-up requests to the day training and habilitation task 
  3.36  force for consideration of possible modifications in the 
  4.1   individualized payment rate structure under this section. 
  4.2      Subd. 5.  [RATE SETTING.] (a) The rate structure under this 
  4.3   section is intended to allow a county to authorize an individual 
  4.4   rate for each client in the vendor's program based on the needs 
  4.5   and expected outcomes of the individual client.  Rates shall be 
  4.6   based on an authorized package of services for each individual 
  4.7   over a typical time frame.  Rates may be established across 
  4.8   multiple sites run by a single vendor. 
  4.9      (b) With county concurrence, a vendor shall establish up to 
  4.10  four levels of service, A through D, based on the intensity of 
  4.11  services provided to an individual client of day training and 
  4.12  habilitation services.  Service level A shall be the highest 
  4.13  intensity of services, marked primarily, but not exclusively, by 
  4.14  a one-to-one client-to-staff ratio.  Service level D shall be 
  4.15  the lowest intensity of services.  The county shall document the 
  4.16  vendor's description of the type and amount of services 
  4.17  associated with each service level. 
  4.18     (c) For each vendor, a county board shall establish a 
  4.19  dollar value for one hour of service at each of the service 
  4.20  levels defined in paragraph (b).  In establishing these values 
  4.21  for existing vendors transitioning from the payment rate 
  4.22  structure under Minnesota Statutes, section 252.46, subdivision 
  4.23  1, the county board shall follow the formula and guidelines 
  4.24  developed by the day training and habilitation task force under 
  4.25  paragraph (e). 
  4.26     (d) A vendor may elect to maintain a per diem 
  4.27  transportation rate or may elect to establish up to five types 
  4.28  of transportation services:  public transportation, public 
  4.29  special transportation, nonambulatory transportation, 
  4.30  out-of-service area transportation, and ambulatory 
  4.31  transportation.  For vendors that elect to establish multiple 
  4.32  transportation services, the county board shall establish a 
  4.33  dollar value for a round trip on each type of transportation 
  4.34  service offered through the vendor.  With vendor concurrence, 
  4.35  the county may also establish a uniform one-way trip value for 
  4.36  some or all of the transportation service types. 
  5.1      (e) In conducting the pilot project, the county board shall 
  5.2   translate the vendor's existing program and transportation rates 
  5.3   to the rates and values in the pilot project by using the 
  5.4   conversion calculations for services and transportation approved 
  5.5   by the day training and habilitation task force established 
  5.6   under Laws 1999, chapter 152, and included in the task force's 
  5.7   recommendations to the legislature.  The conversion calculation 
  5.8   may be amended by the task force and any amendments shall become 
  5.9   effective upon notification to the pilot project counties from 
  5.10  the commissioner.  The calculation shall take the total 
  5.11  reimbursement dollars available to the vendor and divide by the 
  5.12  units of service expected at each service level.  In determining 
  5.13  the total reimbursement dollars available to a vendor, the 
  5.14  county board shall multiply the vendor's current per diem rate, 
  5.15  including any new rate increases, by the vendor's actual 
  5.16  utilization for the year prior to implementation of the pilot 
  5.17  project.  Vendors shall be allowed to allocate available 
  5.18  reimbursement dollars between service and transportation before 
  5.19  the vendor's service level and transportation values are 
  5.20  calculated. 
  5.21     Subd. 6.  [INDIVIDUAL RATE AUTHORIZATION.] (a) As part of 
  5.22  its annual authorization of services for each client under 
  5.23  Minnesota Statutes, section 252.44, paragraph (a), clause (1), 
  5.24  and Minnesota Rules, part 9525.0016, subpart 12, the county 
  5.25  shall authorize and document a service package and a 
  5.26  transportation package as follows: 
  5.27     (1) the service package shall include the amount and type 
  5.28  of services at each applicable service level to be provided to 
  5.29  the client over a package period.  An individual client may 
  5.30  receive services at multiple service levels over the course of 
  5.31  the package period.  The service package rate shall be the sum 
  5.32  of the amount of services at each level over the package period, 
  5.33  multiplied by the dollar value for each service level; 
  5.34     (2) the transportation package shall include the amount and 
  5.35  type of transportation services to be provided to the client 
  5.36  over the package period.  The transportation package rate shall 
  6.1   be the sum of the amount of transportation services, multiplied 
  6.2   by the dollar value associated with the type of transportation 
  6.3   service authorized for the client; 
  6.4      (3) the package period shall be established by the county, 
  6.5   and may be one week, two weeks, or one month; and 
  6.6      (4) the individual rate authorization may be reviewed and 
  6.7   modified by the county at any time and must be reviewed and 
  6.8   reauthorized by the county at least annually. 
  6.9      (b) For purposes of the pilot project, a service day under 
  6.10  Minnesota Statutes, sections 245B.06 and 252.44, includes any 
  6.11  day in which a client receives any reimbursable service from a 
  6.12  vendor or attends employment arranged by the vendor. 
  6.13     Subd. 7.  [BILLING FOR SERVICES.] The vendor shall bill 
  6.14  for, and shall be reimbursed for, the service package rate and 
  6.15  transportation package rate for the package period as authorized 
  6.16  by the county for each client in the vendor's program.  The 
  6.17  length of the package period shall not affect the timing or 
  6.18  frequency of vendors' submissions of claims for payment under 
  6.19  the Medicaid Management Information System II (MMIS) or its 
  6.20  successors. 
  6.21     Subd. 8.  [NOTIFICATION OF CHANGE IN CLIENT NEEDS.] The 
  6.22  vendor shall notify an individual client's case manager if the 
  6.23  vendor has knowledge of a material change in the client's needs 
  6.24  that may indicate a need for a change in service authorization.  
  6.25  Factors that would require such notice include, but are not 
  6.26  limited to, significant changes in medical status, residential 
  6.27  placement, attendance patterns, behavioral needs, or skill 
  6.28  functioning.  The vendor shall notify the case manager as soon 
  6.29  as possible but no later than 30 calendar days after becoming 
  6.30  aware of the change in needs.  The service authorization for the 
  6.31  client shall not change until the county authorizes a new 
  6.32  service and transportation package for the client. 
  6.33     Subd. 9.  [RATE MINIMUM.] Unless a variance is granted 
  6.34  under Minnesota Statutes, section 252.46, subdivision 6, the 
  6.35  minimum service level values for a vendor must be equal to the 
  6.36  service level values in effect on July 1 of the previous 
  7.1   calendar year, increased each July 1 by the annual percentage 
  7.2   change in the Employment Cost Index for Private Industry Workers 
  7.3   - Total Compensation as forecast by the commissioner of 
  7.4   finance's economic consultant, in the fourth quarter of the 
  7.5   calendar year preceding the start of each fiscal year.  The 
  7.6   minimum transportation values for all transportation services 
  7.7   except public transportation and public special transportation 
  7.8   for a vendor shall be equal to the transportation values in 
  7.9   effect on July 1 of the previous calendar year, increased each 
  7.10  July 1 by the annual percentage change in the Employment Cost 
  7.11  Index for Private Industry Workers - Total Compensation as 
  7.12  forecast by the commissioner of finance's economic consultant, 
  7.13  in the fourth quarter of the calendar year preceding the start 
  7.14  of each fiscal year.  The values for public transportation and 
  7.15  public special transportation for a vendor shall be adjusted to 
  7.16  reflect actual rate increases in public transportation or public 
  7.17  special transportation services used by that vendor as they 
  7.18  become effective.  County boards shall adjust provider contracts 
  7.19  as necessary to reflect these annual adjustments.  Minnesota 
  7.20  Statutes, section 252.46, subdivision 2, shall not apply to 
  7.21  vendors in the pilot project. 
  7.22     Sec. 4.  [COUNTY BOARD RESPONSIBILITIES.] 
  7.23     For each vendor with rates established under section 3, the 
  7.24  county board shall document the vendor's description of the type 
  7.25  and amount of services associated with each service level, the 
  7.26  vendor's service level values, the vendor's transportation 
  7.27  values, and the package period that will be used to determine 
  7.28  the rate for each individual client.  The county shall establish 
  7.29  a package period of one week, two weeks, or one month. 
  7.30     Sec. 5.  [FEDERAL APPROVAL.] 
  7.31     The commissioner shall seek any amendments to the state 
  7.32  Medicaid plan and any waivers necessary to permit implementation 
  7.33  of section 3 within the timelines specified. 
  7.34     Sec. 6.  [APPROPRIATIONS.] 
  7.35     (a) $....... is appropriated from the general fund to the 
  7.36  commissioner of human services for the biennium beginning July 
  8.1   1, 2001, to implement section 3 and to provide training and 
  8.2   assistance to participating counties and vendors.  Of this 
  8.3   amount, at least $....... shall be allocated to participating 
  8.4   counties to implement the pilot project. 
  8.5      (b) $....... is appropriated from the general fund to the 
  8.6   commissioner of human services for the biennium beginning July 
  8.7   1, 2001, to provide technical assistance to the task force 
  8.8   established in Laws 1999, chapter 152, section 1.