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HF 2153

as introduced - 91st Legislature (2019 - 2020) Posted on 03/07/2019 02:47pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying the elderly waiver payment rates; requiring
a report; amending Minnesota Statutes 2018, section 256B.0915, subdivisions 11,
12, 13, 14, 15, 16; repealing Minnesota Statutes 2018, section 256B.0915,
subdivision 17.

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

Section 1.

Minnesota Statutes 2018, section 256B.0915, subdivision 11, is amended to
read:


Subd. 11.

Payment rates; application.

The payment methodologies in subdivisions 12
to 16 apply tonew text begin:
new text end

new text begin (1)new text end elderly waiver and elderly waiver customized livingnew text begin and foster carenew text end under this sectiondeleted text begin,deleted text endnew text begin;
new text end

new text begin (2)new text end alternative care under section 256B.0913deleted text begin,deleted text endnew text begin;
new text end

new text begin (3) new text endessential community supports under section 256B.0922deleted text begin, and community access for
disability inclusion customized living, brain injury customized living, and elderly waiver
foster care and residential care
deleted text endnew text begin; and
new text end

new text begin (4) the following services, to the extent these services are covered under the home and
community-based services waivers under sections 256B.092 and 256B.49:
new text end

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

new text begin (ii) chore services;
new text end

new text begin (iii) home-delivered meals;
new text end

new text begin (iv) homemaker/assistance with personal care;
new text end

new text begin (v) homemaker/cleaning; and
new text end

new text begin (vi) homemaker/home managementnew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0915, subdivision 12, is amended to read:


Subd. 12.

Payment ratesnew text begin implementationnew text end; deleted text beginphase-indeleted text endnew text begin inflationary adjustmentnew text end.

new text begin(a)
new text enddeleted text begin Effective January 1, 2019,deleted text end All rates and deleted text beginrate componentsdeleted text endnew text begin component ratesnew text end for services under
subdivision 11 shall be deleted text beginthe sum of ten percent ofdeleted text end the rates calculated under subdivisions 13
to 16 deleted text beginand 90 percent of the rates calculated using the rate methodology in effect as of June
30, 2017
deleted text end.

new text begin (b) On January 1, 2020, and every two years thereafter, the commissioner shall update
the base wage index in subdivision 14 based on the most recently available Bureau of Labor
Statistics Minneapolis-St. Paul-Bloomington, MN-WI MetroSA data.
new text end

new text begin (c) On January 1, 2020, and every two years thereafter, the commissioner shall update
the payroll tax and benefit factor in subdivision 15 based on the most recently available
nursing facility cost report data.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0915, subdivision 13, is amended to read:


Subd. 13.

Payment rates; establishment.

(a) When establishing the base wages
according to subdivision 14, the commissioner shall use standard occupational classification
(SOC) codes from the Bureau of Labor Statistics as defined in the edition of the Occupational
Handbook published immediately prior to deleted text beginJanuary 1, 2019deleted text endnew text begin the implementation or
recalculation of rates
new text end, using Minnesota-specific wages taken from job descriptions.

(b) deleted text beginBeginning January 1, 2019, and every January 1 thereafter,deleted text end The commissioner shall
establish factors, component rates, and rates according to subdivisions 15 and 16, using
base wages established according to deleted text beginparagraph (a) anddeleted text end subdivision 14.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 4.

Minnesota Statutes 2018, section 256B.0915, subdivision 14, is amended to read:


Subd. 14.

Payment rates; base wage index.

(a) Base wages are calculated for customized
livingdeleted text begin,deleted text endnew text begin andnew text end foster deleted text begincare, and residentialdeleted text end care component services as follows:

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

(2) the home care aide base wage equals deleted text begin50deleted text endnew text begin 75new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for home health aides (SOC code
31-1011); and deleted text begin50deleted text endnew text begin 25new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014);

(3) the home health aide base wage equals deleted text begin20deleted text endnew text begin 33.33new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061); deleted text beginand 80deleted text endnew text begin 33.33new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); andnew text begin 33.34 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for home health aides (SOC code 31-1011); and
new text end

(4) the medication setups by licensed practical nurse base wage equals deleted text begintendeleted text endnew text begin 25new text end percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed
practical and licensed vocational nurses (SOC code 29-2061); and deleted text begin90deleted text endnew text begin 75new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
(SOC code 29-1141).

(b) Base wages are calculated for the following services as follows:

(1) the chore services base wage equals deleted text begin100deleted text endnew text begin 50new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for landscaping and groundskeeping
workers (SOC code 37-3011);new text begin and 50 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012);
new text end

(2) the companion services base wage equals deleted text begin50deleted text endnew text begin 80new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for personal and home care aides (SOC
code 39-9021); and deleted text begin50deleted text endnew text begin 20new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012);

(3) the deleted text beginhomemaker services and assistancedeleted text endnew text begin homemaker/assistancenew text end with personal care
base wage equals deleted text begin60deleted text endnew text begin 50new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for personal and home care aide (SOC code 39-9021); deleted text begin20deleted text endnew text begin and 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014); deleted text beginand 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012);
deleted text end

(4) the deleted text beginhomemaker services and cleaningdeleted text endnew text begin homemaker/cleaningnew text end base wage equals deleted text begin60
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
personal and home care aide (SOC code 39-9021); 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); and 20
deleted text endnew text begin 100new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for maids and housekeeping cleaners (SOC code 37-2012);

(5) the deleted text beginhomemaker services and home managementdeleted text endnew text begin homemaker/home managementnew text end base
wage equals deleted text begin60deleted text endnew text begin 50new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for personal and home care aide (SOC code 39-9021); deleted text begin20deleted text endnew text begin and 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014); deleted text beginand 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012);
deleted text end

(6) the in-home respite care services base wage equals deleted text beginfivedeleted text endnew text begin 15new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
(SOC code 29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for deleted text beginnursing assistants (SOC code 31-1014)deleted text endnew text begin home health aides (SOC code
31-1011)
new text end; and deleted text begin20deleted text endnew text begin tennew text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);

(7) the out-of-home respite care services base wage equals deleted text beginfivedeleted text endnew text begin 15new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
(SOC code 29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for deleted text beginnursing assistants (SOC code 31-1014)deleted text endnew text begin home health aides (SOC code
31-1011)
new text end; and deleted text begin20deleted text endnew text begin tennew text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);
deleted text begin and
deleted text end

(8) the individual community living support base wage equals deleted text begin20deleted text endnew text begin 60new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for deleted text beginlicensed practical
and licensed vocational nurses (SOC code 29-2061)
deleted text endnew text begin social and human services aide (SOC
code 21-1093)
new text end; and deleted text begin80deleted text endnew text begin 40new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for nursing assistants (SOC code 31-1014)deleted text begin.deleted text endnew text begin; and
new text end

new text begin (9) the adult day service base wage equals 75 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for home health aides (SOC code
31-1011); and 25 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014).
new text end

(c) Base wages are calculated for the following values as follows:

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

(2) the deleted text beginsocial workerdeleted text endnew text begin unlicensed supervisornew text end base wage equals 100 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for deleted text beginmedical and public
health social
deleted text endnew text begin supervisor of personal servicenew text end workers (SOC code deleted text begin21-1022deleted text endnew text begin 39-1021new text end).

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.0915, subdivision 15, is amended to read:


Subd. 15.

Payment rates; factors.

The commissioner shall use the following factors:

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

(2) the general and administrative factor is deleted text beginthe sum of net general and administrative
expenses minus administrative salaries divided by total operating expenses for all nursing
facilities on the most recent and available cost report
deleted text endnew text begin 14.4 percentnew text end;

(3) the program plan support factor is deleted text begin12.8deleted text endnew text begin tennew text end percentnew text begin for the following servicesnew text end to cover
the cost of direct service staff needed to provide support for the deleted text beginhome and community-baseddeleted text end
service when not engaged in direct contact with clientsnew text begin:
new text end

new text begin (i) adult day servicenew text end;

new text begin (ii) customized living; and
new text end

new text begin (iii) foster care;
new text end

new text begin (4) the program plan support factor is 15.5 percent for the following services to cover
the cost of direct service staff needed to provide support for the service when not engaged
in direct contact with clients:
new text end

new text begin (i) chore services;
new text end

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

new text begin (iii) homemaker/assistance with personal care;
new text end

new text begin (iv) homemaker/cleaning;
new text end

new text begin (v) homemaker/home management;
new text end

new text begin (vi) in-home respite care;
new text end

new text begin (vii) individual community living support; and
new text end

new text begin (viii) out-of-home respite care;
new text end

new text begin (5) the facility and equipment factor for adult day services is 16.2 percent;
new text end

new text begin (6) the food, supplies, and transportation factor for adult day services is 24 percent;
new text end

new text begin (7) the supplies and transportation factor for the following services is 1.56 percent:
new text end

new text begin (i) chore services;
new text end

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

new text begin (iii) homemaker/assistance with personal care;
new text end

new text begin (iv) homemaker/cleaning;
new text end

new text begin (v) homemaker/home management;
new text end

new text begin (vi) in-home respite care;
new text end

new text begin (vii) individual community living support; and
new text end

new text begin (viii) out-of-home respite care;
new text end

new text begin (8) the absence factor for the following services is 4.5 percent:
new text end

new text begin (i) adult day service;
new text end

new text begin (ii) chore services;
new text end

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

new text begin (iv) homemaker/assistance with personal care;
new text end

new text begin (v) homemaker/cleaning;
new text end

new text begin (vi) homemaker/home management;
new text end

new text begin (vii) in-home respite care;
new text end

new text begin (viii) individual community living support; and
new text end

new text begin (ix) out-of-home respite care;
new text end

deleted text begin (4)deleted text endnew text begin (9)new text end the registered nurse management and supervision factor equals 15 percent of the
product of the position's base wage and the sum of the factors in deleted text beginclauses (1) to (3)deleted text endnew text begin clause
(1)
new text end; and

deleted text begin (5)deleted text endnew text begin (10)new text end the deleted text beginsocial workerdeleted text endnew text begin unlicensed supervisornew text end supervision factor equals 15 percent of
the product of the position's base wage and the sum of the factors in deleted text beginclauses (1) to (3)deleted text endnew text begin clause
(1)
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 6.

Minnesota Statutes 2018, section 256B.0915, subdivision 16, is amended to read:


Subd. 16.

Payment rates; component rates.

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

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

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

deleted text begin (3)deleted text endnew text begin (2)new text end the position's base wage multiplied by thenew text begin applicablenew text end program plan support factornew text begin;
and
new text end

new text begin (3) the position's base wage multiplied by the absence factor, if applicablenew text end.

(b) For medication setups by licensed nurse, new text beginthe new text endregistered nursedeleted text begin, and social worker
services
deleted text endnew text begin management and supervision factor, and the unlicensed supervisor supervision
factor
new text end, the component rate deleted text beginfor each servicedeleted text endnew text begin or factor valuenew text end equals the respective position's
adjusted base wage.

(c) For home management and support services, home care aide, and home health aide
services, the component rate for each service equals thenew text begin sum of thenew text end respective position's
adjusted base wage deleted text beginplusdeleted text endnew text begin andnew text end the registered nurse management and supervision factornew text begin
multiplied by the general and administrative factor and multiplied by the applicable factors
in subdivision 15, clauses (5) to (7)
new text end.

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

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

(1) sum the adjusted base wage for the respective position and the deleted text beginsocial workerdeleted text endnew text begin
unlicensed supervisor supervision
new text end factornew text begin and multiply the result by the general and
administrative factor and by the applicable factors in subdivision 15, clauses (5) to (7)
new text end; and

(2) divide the result of clause (1) by four.

(f) The 15-minute unit rates for deleted text beginhomemaker services and assistancedeleted text endnew text begin homemaker/assistancenew text end
with personal care, deleted text beginhomemaker services and cleaningdeleted text endnew text begin homemaker/cleaningnew text end, and deleted text beginhomemaker
services and home management
deleted text endnew text begin homemaker/home managementnew text end are calculated as follows:

(1) sum the adjusted base wage for the respective position and the deleted text beginregistered nurse
management and
deleted text endnew text begin unlicensed supervisornew text end supervision factornew text begin and multiply the result by the
general and administrative factor and by the applicable factors in subdivision 15, clauses
(5) to (7)
new text end; and

(2) divide the result of clause (1) by four.

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

(1) sum the adjusted base wage for in-home respite care services and the registered nurse
management and supervision factornew text begin and multiply the result by the general and administrative
factor and by the applicable factors in subdivision 15, clauses (5) to (7)
new text end; and

(2) divide the result of clause (1) by four.

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

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

(1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and supervision factornew text begin and multiply the result by the general and
administrative factor and by the applicable factors in subdivision 15, clauses (5) to (7)
new text end; and

(2) divide the result of clause (1) by four.

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

(k) The individual community living support rate is calculated as follows:

(1) sum the adjusted base wage for deleted text beginthe home care aide rate in subdivision 14, paragraph
(a), clause (2), and the social worker
deleted text endnew text begin individual community living support and the registered
nurse management and supervision
new text end factornew text begin and multiply the result by the general and
administrative factor and by the applicable factors in subdivision 15, clauses (5) to (7)
new text end; and

(2) divide the result of clause (1) by four.

(l) The deleted text beginhome delivereddeleted text end new text beginhome-delivered new text endmeals rate equals deleted text begin$9.30deleted text endnew text begin $8.17new text end. deleted text beginBeginning July
1, 2018,
deleted text end The commissioner shall increase the deleted text beginhome delivereddeleted text end new text beginhome-delivered new text endmeals rate
deleted text begin every July 1deleted text endnew text begin on January 1, 2020, and every two years thereafter,new text end by the percent increase in
the nursing facility dietary per diem using the two most recent and available nursing facility
cost reports.

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

new text begin (1) divide the adjusted base wage for adult day services by five to reflect an assumed
staffing ratio of one to five. Sum the result of this calculation and the registered nurse
management and supervision factor and multiply this result by the general and administrative
factor and by the applicable factors in subdivision 15, clauses (5) to (7); and
new text end

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

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

new text begin (1) sum the adjusted base wage for adult day services and the registered nurse
management and supervision factor and multiply the result by the general and administrative
factor and the applicable factors in subdivision 15, clauses (5) to (7); and
new text end

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 7. new text beginEVALUATION OF ELDERLY WAIVER RATE METHODOLOGY.
new text end

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

new text begin (1) the elderly waiver rate methodology base wage values compared to wages paid by
service providers;
new text end

new text begin (2) the elderly waiver rate methodology nonwage cost factor values compared to nonwage
costs of service providers; and
new text end

new text begin (3) the extent to which nonwage cost factors and factor values should vary by service.
new text end

new text begin (b) By January 1, 2021, the commissioner of human services shall submit a report to the
chairs and ranking minority members of the legislative committees with jurisdiction over
the elderly waiver program with recommended adjustments to the rate methodologies in
Minnesota Statutes, section 256B.0915, subdivisions 11 to 16, based on the results of the
evaluation in paragraph (a).
new text end

Sec. 8. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, section 256B.0915, subdivision 17, new text end new text begin is repealed effective January
1, 2020.
new text end

APPENDIX

Repealed Minnesota Statutes: 19-4269

256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.

Subd. 17.

Evaluation of rate methodology.

The commissioner, in consultation with stakeholders, shall conduct a study to evaluate the following:

(1) base wages in subdivision 14, to determine if the standard occupational classification codes for each rate and component rate are an appropriate representation of staff who deliver the services; and

(2) factors in subdivision 15, and adjusted base wage calculation in subdivision 16, to determine if the factors and calculations appropriately address nonwage provider costs.

By January 1, 2019, the commissioner shall submit a report to the legislature on the changes to the rate methodology in this statute, based on the results of the evaluation. Where feasible, the report shall address the impact of the new rates on the workforce situation and client access to services. The report should include any changes to the rate calculations methods that the commissioner recommends.