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HF 1586

as introduced - 88th Legislature (2013 - 2014) Posted on 03/14/2013 02:32pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; modifying payment methodologies for home and
community-based services waivers; amending Minnesota Statutes 2012, sections
256B.0916, subdivision 2; 256B.092, subdivision 4; 256B.49, subdivision 17;
256B.4913; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2012, section 256B.0916, subdivision 2, is amended to
read:


Subd. 2.

Distribution of funds; partnerships.

(a) Beginning with fiscal year 2000,
the commissioner shall distribute all funding available for home and community-based
waiver services for persons with developmental disabilities to individual counties or to
groups of counties that form partnerships to jointly plandeleted text begin,deleted text endnew text begin andnew text end administerdeleted text begin, and authorize
funding
deleted text endnew text begin services new text end for eligible individuals. The commissioner shall encourage counties to
form partnerships that have a sufficient number of recipients and funding to adequately
manage the risk and maximize use of available resources.

(b) deleted text beginCounties must submit a request for funds and a plan for administering the program
as required by the commissioner. The plan must identify the number of clients to be served,
their ages, and their priority listing based on:
deleted text end new text beginUpon implementation of rate methodologies
under section 256B.4914, the commissioner shall adjust the allocation methodology to
lead agencies for home and community-based waivered service allocations to reflect the
cost per recipient in their respective counties with disabilities in need of the level of care
provided in an intermediate care facility for individuals with developmental disabilities,
nursing facility, or a hospital as determined by the methodology in section 256B.4914.
new text end

deleted text begin (1) requirements in Minnesota Rules, part 9525.1880; and
deleted text end

deleted text begin (2) statewide priorities identified in section 256B.092, subdivision 12.
deleted text end

deleted text begin The plan must also identify changes made to improve services to eligible persons and to
improve program management.
deleted text end

deleted text begin (c) In allocating resources to counties, priority must be given to groups of counties
that form partnerships to jointly plan, administer, and authorize funding for eligible
individuals and to counties determined by the commissioner to have sufficient waiver
capacity to maximize resource use.
deleted text end

deleted text begin (d) Within 30 days after receiving the county request for funds and plans, the
commissioner shall provide a written response to the plan that includes the level of
resources available to serve additional persons.
deleted text end

deleted text begin (e) Counties are eligible to receive medical assistance administrative reimbursement
for administrative costs under criteria established by the commissioner.
deleted text end

Sec. 2.

Minnesota Statutes 2012, section 256B.092, subdivision 4, is amended to read:


Subd. 4.

Home and community-based services for developmental disabilities.

(a) The commissioner shall make payments to approved vendors participating in the
medical assistance program to pay costs of providing home and community-based
services, including case management service activities provided as an approved home and
community-based service, to medical assistance eligible persons with developmental
disabilities who have been screened under subdivision 7 and according to federal
requirements. Federal requirements include those services and limitations included in the
federally approved application for home and community-based services for persons with
developmental disabilities and subsequent amendments.

(b) deleted text beginEffective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40,
deleted text end The commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental
disabilities deleted text beginauthorized but not receiving those services as of June 30, 1995,deleted text end based upon the
deleted text beginaverage resource need of persons with similar functional characteristics. To ensure service
continuity for service recipients receiving home and community-based waivered services
for persons with developmental disabilities prior to July 1, 1995, the commissioner shall
make available to the county of financial responsibility home and community-based
waivered services resources based upon fiscal year 1995 authorized levels.
deleted text endnew text begin number of
recipients served and average cost for services per recipient under section 256B.4913:
new text end

new text begin (1) on January 1, 2014, the cost for services is based on projected expenditures for
all individuals and services under section 256B.4913; and
new text end

new text begin (2) on January 1, 2017, the cost for services is based on historical expenditures for
all individuals and services under section 256B.4913.
new text end

deleted text begin (c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.
deleted text end

Sec. 3.

Minnesota Statutes 2012, section 256B.49, subdivision 17, is amended to read:


Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure that the
average per capita expenditures estimated in any fiscal year for home and community-based
waiver recipients does not exceed the average per capita expenditures that would have
been made to provide institutional services for recipients in the absence of the waiver.

(b) The commissioner shall deleted text beginimplement on January 1, 2002, one or more
aggregate, need-based methods for allocating
deleted text endnew text begin allocate new text end to local agencies the home and
community-based waivered service resources available to support recipients with
disabilities in need of the level of care provided in a nursing facility or a hospital. deleted text beginThe
commissioner shall allocate resources to single counties and county partnerships in a
manner that reflects consideration of
deleted text endnew text begin Each allocation shall be based on the number of
recipients and average cost for services under section 256B.4913. Allocations shall be
made to single counties or county partnerships
new text end:

(1) deleted text beginan incentive-based payment process for achieving outcomesdeleted text endnew text begin on January 1, 2014,
the average cost for services is determined based on projected expenditures
new text end;new text begin and
new text end

(2) deleted text beginthe need for a state-level risk pool;deleted text endnew text begin on January 1, 2017, the cost for services is
based on historical expenditures for all individuals and services under section 256B.4913.
new text end

deleted text begin (3) the need for retention of management responsibility at the state agency level; and
deleted text end

deleted text begin (4) a phase-in strategy as appropriate.
deleted text end

deleted text begin (c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:
deleted text end

deleted text begin (1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or
deleted text end

deleted text begin (2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
deleted text end

deleted text begin (d)deleted text endnew text begin (c)new text end Beginning July 1, 2001, medically necessary private duty nursing services
will be authorized under this section as complex and regular care according to sections
256B.0651 to 256B.0656 and 256B.0659. The rate established by the commissioner for
registered nurse or licensed practical nurse services under any home and community-based
waiver as of January 1, 2001, shall not be reduced.

deleted text begin (e)deleted text endnew text begin (d) new text end Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
services, the county must negotiate a revised per diem rate for room and board and waiver
services that reflects the legislated rate reduction and results in an overall average per
diem reduction for all foster care recipients in that home. The revised per diem must allow
the provider to maintain, as much as possible, the level of services or enhanced services
provided in the residence, while mitigating the losses of the legislated rate reduction.

Sec. 4.

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


256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.

deleted text begin Subdivision 1. deleted text end

deleted text begin Research period and rates. deleted text end

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

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

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

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

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

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

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

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

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

deleted text begin Subd. 2. deleted text end

deleted text begin Framework values. deleted text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

deleted text begin Subd. 3. deleted text end

deleted text begin Data collection. deleted text end

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

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

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

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

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

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

Subd. 4.

Rate stabilization adjustment.

deleted text beginBeginningdeleted text endnew text begin (a) The commissioner of
human services shall adjust individual reimbursement rates by no more than one percent
per year, effective
new text end January 1, deleted text begin2014, the commissioner shall adjust individual rates
determined by
deleted text endnew text begin 2016. Rates will be adjusted using new text end the new payment methodology so
that the new new text beginunit new text endrate varies no more than one percent per year from the rate effective
on December deleted text begin31deleted text endnew text begin 1 new text end of the prior calendar year. This adjustment is made annually deleted text beginand is
effective for
deleted text end three calendar years from the date of implementation. This subdivision
expires deleted text beginJanuary 1, 2017deleted text endnew text begin December 31, 2019new text end.

new text begin (b) Rate stabilization adjustment applies to services that are authorized in each
recipient's annual service review.
new text end

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

Subd. 5.

Stakeholder consultation.

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

Subd. 6.

Implementation.

new text beginOn January 1, 2016, new text endthe commissioner deleted text beginmaydeleted text endnew text begin shall
new text end implement changes deleted text beginno sooner than January 1, 2014,deleted text end to payment rates for individuals
receiving home and community-based waivered services after the enactment of legislation
that establishes specific payment methodology frameworks, processes for rate calculations,
and specific values to populate the deleted text beginpayment methodology frameworksdeleted text endnew text begin disability waiver
rates system, under section 256B.4914
new text end.

Sec. 5.

new text begin [256B.4914] HOME AND COMMUNITY-BASED WAIVERS; RATE
SETTING.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The payment methodologies in this section apply to
home and community-based services waivers under sections 256B.092 and 256B.49.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

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

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

new text begin (d) "Customized living tool" means a methodology for setting service rates
that delineates and documents the amount of each component service included in a
recipient's customized living service plan, which must be approved by the recipient's
full interdisciplinary team.
new text end

new text begin (e) "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.
new text end

new text begin (f) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.
new text end

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

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

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

new text begin Subd. 3. new text end

new text begin Applicable services. new text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

new text begin Subd. 4. new text end

new text begin Data collection for rate determination. new text end

new text begin (a) Rates for all applicable home
and community-based waivered services, including rate exceptions under subdivision 13,
are set via the rate management system.
new text end

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

new text begin (c) Service providers, in consultation with lead agencies, shall enter values and
information needed to calculate an individual's rate into the rate management system.
These values and information include:
new text end

new text begin (1) individual staffing hours;
new text end

new text begin (2) shared staffing hours;
new text end

new text begin (3) staffing ratios;
new text end

new text begin (4) information to document variable levels of service qualification for variable
levels of reimbursement in each framework;
new text end

new text begin (5) number of trips and miles for transportation services;
new text end

new text begin (6) individual nursing hours, for registered nursing and licensed practical nursing;
new text end

new text begin (7) shared nursing hours, for registered nursing and licensed practical nursing;
new text end

new text begin (8) shared or individualized arrangements for unit-based services, including the
staffing ratio; and
new text end

new text begin (9) the type of vehicle an individual requires.
new text end

new text begin (d) Updates to individual data shall include:
new text end

new text begin (1) data for each individual shall be updated annually when renewing service
plans; and
new text end

new text begin (2) individuals or providers may request an update to a rate whenever there is a
change in an individual's service needs, with accompanying documentation.
new text end

new text begin (e) Lead agencies shall review and approve values to calculate the final rate for
each individual:
new text end

new text begin (1) lead agencies shall provide the underlying values used to calculate an individual's
rate to service providers upon request; and
new text end

new text begin (2) if the values used differ from the initial values submitted, lead agencies must
notify the individual and the service provider. That notification will include the original
values, the final values, and justification for any adjustments.
new text end

new text begin (f) Appeals of rate determination:
new text end

new text begin (1) all aspects of rate determination are subject to appeals under section 256B.049;
and
new text end

new text begin (2) service providers may appeal a rate determination with lead agencies if any
value used to calculate an individual's rate was different than what was submitted. Lead
agencies shall review these requests within 30 calendar days.
new text end

new text begin Subd. 5. new text end

new text begin Base wage index and standard component values. new text end

new text begin (a) The base wage
index is established to determine staffing costs associated with providing services to
individuals receiving home and community-based services.
new text end

new text begin (b) The commissioner shall calculate the base wage using a composite of wages
taken from job descriptions and standard occupational codes (SOC) from the Bureau of
Labor Statistics, as defined by values in the Occupational Outlook Handbook in 2009 for
Minnesota. These wages will be entered into the rate management system. The base
wage index shall be calculated as follows:
new text end

new text begin (1) for day services, 20 percent of the median wage for nursing aide (SOC code
31-1012); 20 percent of the median wage for psychiatric technicians (SOC code 29-2053);
and 60 percent of the median wage for social and human services workers (SOC code
21-1093);
new text end

new text begin (2) for residential direct-care staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
31-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
new text end

new text begin (3) for residential asleep overnight staff, the wage will be $7.66 per hour;
new text end

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

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

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

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

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

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

new text begin (10) for independent living skills staff, 100 percent of the median for community
social service specialists (SOC code 21-1099);
new text end

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

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

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

new text begin (14) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9032); and 50 percent of the median wage for nursing aides, orderlies, and
attendants (SOC code 31-1012);
new text end

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

new text begin (16) for supervisory staff, 53 percent of the median wage for medical and health
services managers (SOC code 11-9111);
new text end

new text begin (17) for licensed practical nursing staff, 100 percent of the median wage for licensed
practical and licensed vocational nurses (SOC code 29-2061); and
new text end

new text begin (18) for registered nursing staff, 100 percent of the median wage for registered
nurses (SOC code 29-1111).
new text end

new text begin (c) The values for other components for calculating rates are defined as:
new text end

new text begin (1) the hours of supervisory time included is 11 percent of each shared and individual
hour of service;
new text end

new text begin (2) the total add-on for employee-related expenses is 23.6 percent. Of that amount:
new text end

new text begin (i) 11.56 percent is for the cost of taxes and workers' compensation; and
new text end

new text begin (ii) 12.04 percent is for the cost of other benefits, including health insurance, dental
insurance, life insurance, short-term disability insurance, long-term disability insurance,
vision, retirement, and tuition reimbursement;
new text end

new text begin (3) the add-on for the cost of employee vacation time, sick time, and training time is
10.3 percent;
new text end

new text begin (4) the add-on for the cost of staff time for program plan support is 5.6 percent;
new text end

new text begin (5) the add-on for general administrative costs is 13.25 percent;
new text end

new text begin (6) the add-on for program-related expenses is 1.3 percent; and
new text end

new text begin (7) the add-on for absence and utilization factors is 6.0 percent.
new text end

new text begin (d) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(b) based on the release of the December 31 data of the most recent year from the
Bureau of Labor Statistics, and publish the base wage index on the beginning of the
upcoming state fiscal year on July 1. The updated staffing wages will be updated in the
rate management system. This adjustment occurs every five years.
new text end

new text begin (e) On July 1, 2017, the commissioner shall update the framework components in
paragraph (c) for increases in the Consumer Price Index every five years. The commissioner
will adjust these values by the percentage change in the Consumer Price Index-All Items
(United States city average)(CPI-U) over the same period. The updated values will be
loaded in the rate management system. This adjustment occurs every five years.
new text end

new text begin Subd. 6. new text end

new text begin Payments for residential support services. new text end

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

new text begin (b) For supervision provided with direct staff, rates shall be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours and shared and direct nursing
hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
new text end

new text begin (6) combine the figures calculated in clauses (4) and (5), and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (7) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
new text end

new text begin (9) for individuals who had previously received an adjustment to rates under section
256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
new text end

new text begin (10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
new text end

new text begin (11) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (6) to (10);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin (c) For supervision provided by remote monitoring technology, rates shall be
calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours and shared and direct nursing
hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
This is defined as the direct staffing cost;
new text end

new text begin (6) for client programming and supports, add $2,179 per year adjusted to a daily rate;
new text end

new text begin (7) for individuals who had previously received an adjustment to rates under section
256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
new text end

new text begin (8) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
new text end

new text begin (9) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (5) to (8);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii). This is the total
payment amount; and
new text end

new text begin (10) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin (d) For supervision provided with direct staff in a family foster care setting, rates
shall be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5, to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours and shared and direct nursing
hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
new text end

new text begin (6) combine the figures calculated in clauses (4) and (5) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (7) for employee-related expenses, multiply the direct staffing cost by one plus
two-thirds of the add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
new text end

new text begin (9) for individuals who had previously received an adjustment to rates under section
256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
new text end

new text begin (10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
adapted vehicle, or $3,000 for a full-size adapted van per year adjusted to an hourly rate;
new text end

new text begin (11) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (6) to (10);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus two-thirds of the total in item (ii) for
the total payment amount; and
new text end

new text begin (12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin Subd. 7. new text end

new text begin Payments for day programs. new text end

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

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours by the appropriate staff
wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
new text end

new text begin (6) for program plan support, multiply the result of clause (5) by one plus the add-on
in subdivision 5, paragraph (c);
new text end

new text begin (7) combine the figures calculated in clauses (5) and (6) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one
plus ten percent;
new text end

new text begin (10) for program facility costs, add $31.69 per week adjusted for staffing ratios
entered in the rate management system under subdivision 5;
new text end

new text begin (11) for transportation to and from each individual's residence, add a base of $5.00,
plus:
new text end

new text begin (i) for a one-way trip between zero and ten miles, $7.00 for a vehicle without a lift
and $7.77 for a vehicle with a lift;
new text end

new text begin (ii) for a one-way trip between 11 and 20 miles, $7.87 for a vehicle without a lift and
$10.27 for a vehicle with a lift;
new text end

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

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

new text begin (v) the mileage rate used in these calculations will be adjusted by January 1 of
each year by the same percentage change in the IRS mileage rate compared to the IRS
mileage rate for the previous year;
new text end

new text begin (12) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (7) to (11);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (13) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin (b) Adult day bath is reimbursed at $7.01 per 15-minute unit.
new text end

new text begin Subd. 8. new text end

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

new text begin (a) Payments for
unit-based services with programming include behavior programming, housing access
coordination, in-home family support, independent living skills training, hourly supported
living services, and supported employment provided to an individual outside of any day or
residential service plan. Services, including the use of monitoring technology, are included.
new text end

new text begin (b) The rate for individual services must be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours by the appropriate staff
wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
If the supervision wage is lower than for direct staff, substitute the direct staff wage in
subdivision 5;
new text end

new text begin (6) for program plan support, multiply the result of clause (5) by one plus the add-on
in subdivision 5, paragraph (c);
new text end

new text begin (7) combine the figures calculated in clauses (5) and (6) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one
plus 8.6 percent;
new text end

new text begin (10) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (7) to (9);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin (c) The rate for shared services must be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours by the appropriate staff
wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
If the supervision wage is lower than for direct staff, substitute the direct staff wage in
subdivision 5;
new text end

new text begin (6) for program plan support, multiply the result of clause (5) by one plus the add-on
in subdivision 5, paragraph (c);
new text end

new text begin (7) combine the figures calculated in clauses (5) and (6) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one
plus 8.6 percent;
new text end

new text begin (10) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (7) to (9);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin Subd. 9. new text end

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

new text begin (a) Payments
for unit-based services without programming include night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan. Services, including the use of monitoring technology, are included.
new text end

new text begin (b) The rate for individual services must be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours by the appropriate staff
wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
new text end

new text begin (6) for program plan support, multiply the result of clause (5) by one plus the add-on
in subdivision 5, paragraph (c);
new text end

new text begin (7) combine the figures calculated in clauses (5) and (6) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one
plus 6.1 percent;
new text end

new text begin (10) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (7) to (9);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin (c) The rate for shared services must be calculated as follows:
new text end

new text begin (1) units of service are taken from the rate management system;
new text end

new text begin (2) personnel hourly wage rates are defined by the base wage index in subdivision
5 to define the direct-care rate;
new text end

new text begin (3) if an individual qualifies for the add-on customization for deaf and
hard-of-hearing language accessibility under subdivision 12, add the customization
rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
customized direct-care rate;
new text end

new text begin (4) multiply the number of shared and direct staff hours by the appropriate staff
wage in subdivision 5 or the customized direct-care rate;
new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
new text end

new text begin (6) for program plan support, multiply the result of clause (5) by one plus the add-on
in subdivision 5, paragraph (c);
new text end

new text begin (7) combine the figures calculated in clauses (5) and (6) and multiply the result by
one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
(c), to define the direct staffing cost;
new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
add-on for employee-related costs in subdivision 5, paragraph (c);
new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one
plus 6.1 percent;
new text end

new text begin (10) the total rate shall be calculated using the following steps:
new text end

new text begin (i) the subtotal of clauses (7) to (9);
new text end

new text begin (ii) the sum of the standard general and administrative rate, the program-related
expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
new text end

new text begin (iii) divide the result of item (i) by one minus the total in item (ii) for the total
payment amount; and
new text end

new text begin (11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
as defined in subdivision 14.
new text end

new text begin Subd. 10. new text end

new text begin Updating payment values and additional information. new text end

new text begin (a) The
commissioner shall develop and implement uniform procedures to refine terms and update
recommended changes to values used to calculate payment rates in this section.
new text end

new text begin (b) The commissioner shall work with stakeholders to assess efficacy of values
and payment rates. The commissioner shall report back to the legislature with proposed
changes for component values.
new text end

new text begin (c) By February 15, 2015, the commissioner shall work with stakeholders to jointly
collect and analyze data on the following topics:
new text end

new text begin (1) that rates produced are sufficient to enlist enough providers so that care and
services are available under the plan at least to the extent that the care and services are
available to the general public in the geographic areas as required by section 1902(a)(3)(A)
of the Social Security Act;
new text end

new text begin (2) the cost of an increase in the state or federally required minimum wage and
the impact on services;
new text end

new text begin (3) the cost of complying with the insurance requirements under the Patient
Protection and Affordable Care Act, Public Law 111-148, and the impact on services;
new text end

new text begin (4) the impact of the methodology under section 256B.4914 on spending by county.
The commissioner shall compare spending prior to and post implementation;
new text end

new text begin (5) a survey of providers to determine differences in the underlying cost of care
to measure if differences exist by region;
new text end

new text begin (6) the utilization of transportation services for unit-based services;
new text end

new text begin (7) detailed data on the number of trips, mileage, and utilization of transportation
in all-day services; and
new text end

new text begin (8) the occurrence of shared arrangements for unit-based services.
new text end

new text begin (d) The commissioner shall report to the chairs and ranking minority members of the
senate and house of representatives committees and divisions with primary jurisdiction
over health and human services and finance by February 15, 2015, either with legislation
or a detailed explanation of why no legislation is recommended to address these topics.
new text end

new text begin Subd. 11. new text end

new text begin Payment implementation. new text end

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

new text begin Subd. 12. new text end

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

new text begin For persons determined to have
higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8, and 9. The
customization rate with respect to deaf and hard-of-hearing persons shall be $2.50 per hour
for waiver recipients who meet the respective criteria as determined by the commissioner.
new text end

new text begin Subd. 13. new text end

new text begin Rates for individuals with exceptional needs. new text end

new text begin (a) Rates determined
under subdivisions 6, 7, 8, and 9 are eligible for a rate exception under this subdivision.
new text end

new text begin (b) Lead agencies shall consider exception requests by an individual or a provider
agency.
new text end

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

new text begin (1) an individual has service needs that cannot be met through additional units
of service; or
new text end

new text begin (2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
individual being discharged.
new text end

new text begin (d) Exception requests to lead agencies will include the following information:
new text end

new text begin (1) the level of services needs required by each individual that are not accounted
for in subdivisions 6, 7, 8, and 9;
new text end

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

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

new text begin (4) the duration of the rate exception; and
new text end

new text begin (5) any contingencies for approval.
new text end

new text begin (e) Lead agencies shall review exception requests, attach their recommendation, and
forward the request to the commissioner for approval.
new text end

new text begin (f) The commissioner shall evaluate and approve rate exceptions, approve a
modified rate exception, or reject the rate exception request. Within 30 calendar days,
the commissioner shall notify individual and service providers, and provide justification
for each rate exception decision.
new text end

new text begin (g) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.
new text end

new text begin (h) All aspects of the rate exception process are subject to appeals under section
256B.49.
new text end

new text begin Subd. 14. new text end

new text begin Budget neutrality adjustment. new text end

new text begin The commissioner shall calculate the
total spending for all home and community-based waiver services under the payments as
defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
for services in one particular subdivision differs, there will be a percentage adjustment
to increase or decrease individual rates for the services defined in each subdivision so
aggregate spending matches projections under current law.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end