HF 3076

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 02:54pm

A bill for an act
relating to human services; creating a monitoring technology review panel;
modifying payment methodologies for home and community-based services
waivers; amending Minnesota Statutes 2013 Supplement, sections 256B.4913,
subdivision 4a; 256B.4914, subdivisions 2, 4, 5, 6, 7, 8, 9, 10, 14, 15, 16, by
adding subdivisions.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.4913, subdivision 4a,
is amended to read:

Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" deleted text begin shall mean deleted text end new text begin means new text end the period beginning January 1, 2014, and
ending on the last day of the month in which the rate management system is populated
with the data necessary to calculate rates for substantially all individuals receiving home
and community-based new text begin waiver new text end services new text begin under sections 256B.092 and 256B.49. "Banding
period" means the time period beginning on January 1, 2014, and ending upon the
expiration of the 12-month period defined in paragraph (c), clause (5) new text end .

(b) For purposes of this subdivision, the deleted text begin banding value deleted text end new text begin historical rate new text end for all service
recipients deleted text begin shall mean deleted text end new text begin means new text end the individual reimbursement rate new text begin and units of service new text end for a
recipient in effect on December 1, 2013, except that:

(1) deleted text begin (i) for day training and habilitation pilot program service recipients, the banding
value shall be the authorized rate for the provider in the county of service effective
December 1, 2013, if the deleted text end new text begin for a day service new text end recipient deleted text begin : deleted text end new text begin who new text end was not authorized to receive
these waiver services prior to January 1, 2014; added a new service or services on or after
January 1, 2014; or changed providers on or after January 1, 2014 new text begin , the historical rate
must be the authorized rate and units of service for the provider in the county of service,
effective December 1, 2013 new text end ; deleted text begin and deleted text end new text begin or
new text end

deleted text begin (ii) for all other unit or day service recipients, the banding value shall be the
weighted average authorized rate for each provider number in the county of service
effective December 1, 2013, if the deleted text end new text begin (2) for a unit-based service with programming or
a unit-based service without programming new text end recipient deleted text begin : deleted text end new text begin who new text end was not authorized to receive
these waiver services prior to January 1, 2014; added a new service or services on or after
January 1, 2014; or changed providers on or after January 1, 2014 new text begin , the historical rate must
be the weighted average authorized rate and units of service for each provider number in
the county of service, effective December 1, 2013 new text end ; deleted text begin and deleted text end new text begin or
new text end

deleted text begin (2) deleted text end new text begin (3) new text end for residential service recipients who change providers on or after January
1, 2014, the deleted text begin banding value shall deleted text end new text begin historical rate must new text end be set by each lead agency within
their county aggregate budget using their respective methodology for residential services
effective December 1, 2013, for determining the provider rate for a similarly situated
recipient being served by that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under
this section so that the unit rate is no higher or lower than:

(1) 0.5 percent from the deleted text begin banding value deleted text end new text begin historical rate new text end for the implementation period;

(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period
immediately following the time period of clause (1);

(3) 1.0 percent from the rate in effect in clause (2), for the 12-month period
immediately following the time period of clause (2);

(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period
immediately following the time period of clause (3); and

(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period
immediately following the time period of clause (4).

(d) new text begin The commissioner shall review all changes to units and rates that were in effect
on December 1, 2013, to verify that:
new text end

new text begin (1) counties reviewed the units included in service agreements and verified they met
the definition in Minnesota Rules, part 9525.1860, subpart 3;
new text end

new text begin (2) the rates and units in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013; and
new text end

new text begin (3) changes in the types of services authorized as a result of conversion produce the
equivalent level of spending and service unit utilization on an annual basis as those in
effect on October 31, 2013.
new text end

new text begin (e) By August 1, 2014, the commissioner shall complete the review in paragraph
(d), adjust units of service or rates to provide equivalent annual spending or service
authorization, and provide a lump-sum payment to all applicable service providers
equivalent to the adjustment under this paragraph if the adjusted units of service or rates
would have resulted in a greater payment to the provider if the adjusted units of service or
rates were in effect on November 1, 2013.
new text end

new text begin (f) During the banding period, the historical rate must be adjusted to account for
change in an individual's need. The commissioner shall adjust the historical rate by:
new text end

new text begin (1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for
the individual with variables reflecting the level of service in effect on December 1, 2013;
new text end

new text begin (2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or
9, for the individual with variables reflecting the updated level of service at the time
of application; and
new text end

new text begin (3) adding to or subtracting from the historical rate, the difference between the
values in clauses (1) and (2).
new text end

new text begin (g) Lead agencies are prohibited from recalculating historical rates and service units
if an individual relocates to another county or terminates services.
new text end

new text begin (h) new text end This subdivision deleted text begin shall deleted text end new text begin must new text end not apply to rates for recipients served by providers
new to a given county after January 1, 2014. new text begin Providers of personal supports services who
also acted as fiscal support entities must be treated as new providers as of January 1, 2014.
new text end

Sec. 2.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 2,
is amended to read:

Subd. 2.

Definitions.

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

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

(c) "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.

(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.

(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.

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

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

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

new text begin (i) "Nursing hours" means the time spent by a registered nurse or licensed practical
nurse providing assessment, treatment, medication and other monitoring, and other duties
that are required to be performed by a nurse by rule, regulation, or physician's order to meet
the health and safety needs for each recipient, and is based on the requirements in each
individual's coordinated service and support plan under section 245D.02, subdivision 4b;
any coordinated service and support plan addendum under section 245D.02, subdivision
4c; a uniform assessment tool; provider observation; or the individual's case history.
new text end

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

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

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

new text begin (m) "Shared staffing" means time spent by employees not defined under paragraph
(f) or (i) providing or available to provide direct support and assistance with activities
of daily living as defined under section 256B.0659, subdivision 1, paragraph (b);
instrumental activities of daily living as defined under section 256B.0659, subdivision 1,
paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; a uniform assessment tool; the
program site staffing pattern; provider observation; or the individual's case history. The
value must be equivalent for all recipients by service site.
new text end

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

new text begin (o) "Unit of service" means the following:
new text end

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

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

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

new text begin (A) a day unit of service, defined as six or more hours of time spent providing direct
services and transportation. Every unit of service provided in a calendar day is billable; or
new text end

new text begin (B) a partial day unit of service, defined as fewer than six hours of time spent
providing direct services and transportation. Every unit of service provided in a calendar
day is billable;
new text end

new text begin (ii) for adult day and structured day services, a unit of service is a day or 15 minutes.
A day unit of service is five or more hours of time spent providing direct services. Every
unit of service provided in a calendar day is billable;
new text end

new text begin (iii) for prevocational services, a unit of service is a day or an hour. A day unit of
service is five or more hours of time spent providing direct service. Every unit of service
provided in a calendar day is billable; and
new text end

new text begin (iv) for all other day services, a unit of service is 15 minutes. Every unit of service
provided in a calendar day is billable;
new text end

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

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

new text begin (ii) for all other services, a unit of service is 15 minutes. Every unit of service
provided in a calendar day is billable; and
new text end

new text begin (4) for unit-based services without programming under subdivision 9:
new text end

new text begin (i) for respite services, a unit of service is a day or 15 minutes. Every unit of service
provided in a calendar day is billable. When a day rate is authorized, any portion of a
calendar day when an individual receives services is billable as a day; and
new text end

new text begin (ii) for all other services, a unit of service is 15 minutes. Every unit of service
provided in a calendar day is billable.
new text end

Sec. 3.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 4,
is amended to read:

Subd. 4.

Data collection for rate determination.

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

(b) Data for services under section 256B.4913, subdivision 4a, shall be collected in a
manner prescribed by the commissioner.

(c) Data and information in the rates management system may be used to calculate
an individual's rate.

(d) Service providers, with information from the community support plan and
oversight by lead agencies, shall provide values new text begin , with amounts up to two decimal places,
new text end and information needed to calculate an individual's rate into the rates management system.
deleted text begin These deleted text end new text begin The determination of values must be part of a meeting of the interdisciplinary team,
assembled in accordance with Code of Federal Regulations, title 42, section 483.440,
and in accordance with the service planning and delivery standards under sections
245D.07 and 245D.071. This meeting must occur prior to the final establishment of each
individual's rate. The new text end values and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) deleted text begin direct RN deleted text end new text begin registered nurse new text end hours;

(4) deleted text begin direct LPN deleted text end new text begin licensed practical nurse new text end hours;

(5) staffing ratios;

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

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

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

(9) service hours provided through monitoring technology.

(e) Updates to individual data deleted text begin shall deleted text end new text begin must new text end include:

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

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

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

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

new text begin (2) meet the requirements for staffing under subdivision 2, paragraphs (f), (i), and
(m); and exceed the licensing standards for staffing required under section 245D.09,
subdivision 1; and
new text end

new text begin (3) meet the staffing ratio requirements under subdivision 2, paragraph (n), and
exceed the licensing standards for staffing required under section 245D.31.
new text end

new text begin (g) The commissioner shall issue a single complete system manual that contains text
from all referenced documents for all users of the rates management system, with definitions
and processes to ensure consistent application of terms in subdivision 2 and processes in
this subdivision by lead agencies. The commissioner shall periodically verify that lead
agency implementation practices are producing consistent, statewide implementation.
The rates management system manual must include the necessary references to the
state's community-based services manual for service definition and authorization. The
commissioner shall provide a public notice at least 30 days before substantive changes to
the manual are effective via LISTSERV and the department's Web site. The commissioner
shall allow public input on the proposed changes during this 30-day period.
new text end

Sec. 4.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 5,
is amended to read:

Subd. 5.

Base wage index and standard component values.

(a) The base wage
index is established to determine staffing costs associated with providing services to
individuals receiving home and community-based services. For purposes of developing
and calculating the proposed base wage, Minnesota-specific wages taken from job
descriptions and standard occupational classification (SOC) codes from the Bureau of
Labor Statistics as defined in the most recent edition of the Occupational Handbook deleted text begin shall
deleted text end new text begin must new text end be used. The base wage index deleted text begin shall deleted text end new text begin must new text end be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and
home health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide
(SOC code 31-1012); and 20 percent of the median wage for social and human services
aide (SOC code 21-1093); and

(ii) 85 percent of the subtotal of 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);

(2) for day services, 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);

(3) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in
a family foster care setting, the wage is $2.80 per hour;

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

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

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

(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);

(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);

(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);

(10) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social
and human services aide (SOC code 21-1093); and ten percent of the median wage for
psychiatric technician (SOC code 29-2053);

(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);

(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);

(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);

(14) for respite 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);

(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);

(16) for supervisory staff, the basic wage is $17.43 per hour with exception of
the supervisor of behavior analyst and behavior specialists, which deleted text begin shall deleted text end new text begin must new text end be $30.75
per hour;

(17) for deleted text begin RN deleted text end new text begin registered nurse new text end , the basic wage is $30.82 per hour; and

(18) for deleted text begin LPN deleted text end new text begin licensed practical nurse new text end , the basic wage is $18.64 per hour.

(b) Component values for residential support services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 3.3 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence factor: 1.7 percent.

(d) Component values for day services for all services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 5.6 percent;

(5) client programming and support ratio: ten percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 1.8 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(e) Component values for unit-based services with programming are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan supports ratio: 3.1 percent;

(5) client programming and supports ratio: 8.6 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(f) Component values for unit-based services without programming except respite
are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 3.1 percent;

(5) client programming and support ratio: 8.6 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(g) Component values for unit-based services without programming for respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 6.1 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
deleted text begin (b) deleted text end new text begin (a) new text end based on the wage data by standard occupational code (SOC) from the Bureau of
Labor Statistics available on December 31, 2016. The commissioner shall publish these
updated values and load them into the rate management system. This adjustment occurs
every five years. For adjustments in 2021 and beyond, the commissioner shall use the data
available on December 31 of the calendar year five years prior.

(i) On July 1, 2017, the commissioner shall update the framework components in
deleted text begin paragraph (c) deleted text end new text begin paragraphs (b) to (g); subdivision 6, clauses (8) and (9); and subdivision
7, clauses (16) and (17), new text end for changes in the Consumer Price Index. The commissioner
will adjust these values higher or lower by the percentage change in the Consumer Price
Index-All Items, United States city average (CPI-U) from January 1, 2014, to January 1,
2017. The commissioner shall publish these updated values and load them into the rate
management system. This adjustment occurs every five years. For adjustments in 2021
and beyond, the commissioner shall use the data available on January 1 of the calendar
year four years prior and January 1 of the current calendar year.

Sec. 5.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 6,
is amended to read:

Subd. 6.

Payments for residential support services.

(a) Payments for residential
support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
subdivision 22, must be calculated as follows:

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

new text begin (i) shared staffing hours are established for each program site based on the needs of
individuals receiving services, and allocated equally by the number of individuals being
served in each program site; and
new text end

new text begin (ii) the type of overnight staffing hours for all recipients in each program site is
based on the highest assessed need for any individual by program site new text end ;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of shared and individual direct staff hours provided on-site
or through monitoring technology and deleted text begin direct deleted text end nursing hours by the appropriate staff wages
in subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of shared and individual direct staff hours provided
on-site or through monitoring technology and deleted text begin direct deleted text end nursing hours by the product of
the supervision span of control ratio in subdivision 5, paragraph (b), clause (1), and the
appropriate supervision wage in subdivision 5, paragraph (a), clause (16);

(6) combine the results of clauses (4) and (5), excluding any shared and individual
direct staff hours provided through monitoring technology, and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(b), clause (2). This is defined as the direct staffing cost;

(7) for employee-related expenses, multiply the direct staffing cost, excluding any
shared and individual direct staff hours provided through monitoring technology, by one
plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (3);

(8) for client programming and supports, the commissioner shall add $2,179; and

(9) for transportation, if provided, the commissioner shall add deleted text begin $1,680 deleted text end new text begin $7,500 per
year per program site new text end , or deleted text begin $3,000 deleted text end new text begin $12,000 per year per program site new text end if customized for
adapted transport, deleted text begin per year deleted text end new text begin based on the resident with the highest assessed need new text end .

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

(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any
shared and individual direct staff hours provided through monitoring technology that
was excluded in clause (7);

(2) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is
the total payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

(c) The payment methodology for customized living, 24-hour customized living,
and residential care services deleted text begin shall deleted text end new text begin must new text end be the customized living tool. Revisions to the
customized living tool deleted text begin shall deleted text end new text begin must new text end be made to reflect the services and activities unique to
disability-related recipient needs.

(d) The commissioner shall establish a Monitoring Technology Review Panel to
deleted text begin annually deleted text end review deleted text begin and approve deleted text end the plans, safeguards, and rates that include residential
direct care provided remotely through monitoring technology. Lead agencies shall submit
individual service plans that include supervision using monitoring technology to the
Monitoring Technology Review Panel for approval. Individual service plans that include
supervision using monitoring technology as of December 31, 2013, shall be submitted to
the Monitoring Technology Review Panel, but the plans are not subject to approval.

new text begin (e) For individuals enrolled prior to January 1, 2014, the days of service authorized
must meet or exceed the days of service used to convert service agreements in effect on
December 1, 2013, and must not result in a reduction in spending or service utilization
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required
under section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
new text end

new text begin (f) The number of days authorized for all individuals enrolling after January 1, 2014,
in residential services must include every day that services start and end. The standard for
service authorization is 365 days.
new text end

new text begin (g) For the purposes of review under Minnesota Rules, parts 9505.2160 to
9505.2245, the values used to set an individual's rate must be compared using averages, on
an annual basis. The commissioner shall not evaluate rates by extrapolating results for
any period less than 12 months.
new text end

Sec. 6.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 7,
is amended to read:

Subd. 7.

Payments for day programs.

new text begin (a) new text end 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:

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

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

new text begin (ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision new text end ;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of day program direct staff hours and deleted text begin direct deleted text end nursing hours
by the appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care
rate;

(5) multiply the number of day direct staff hours by the product of the supervision
span of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (16);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
clause (2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (d), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);

(10) for program facility costs, add $19.30 per week with consideration of staffing
ratios to meet individual needs;

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

(12) this is the subtotal rate;

(13) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

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

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

(16) for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:

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

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

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

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

(17) for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:

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

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

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

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

new text begin (b) For the purposes of review under Minnesota Rules, parts 9505.2160 to
9505.2245, the values used to set an individual's rate must be compared using averages, on
an annual basis. The commissioner shall not evaluate rates by extrapolating results for
any period less than 12 months.
new text end

Sec. 7.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 8,
is amended to read:

Subd. 8.

Payments for unit-based services with programming.

new text begin (a) new text end Payments
for unit-based with program services, including 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 must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:

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

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
clause (2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the
program plan supports ratio in subdivision 5, paragraph (e), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount;

(13) for supported employment provided in a shared manner, divide the total
payment amount in clause (12) by the number of service recipients, not to exceed three.
For independent living skills training provided in a shared manner, divide the total
payment amount in clause (12) by the number of service recipients, not to exceed two; and

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

new text begin (b) For the purposes of review under Minnesota Rules, parts 9505.2160 to
9505.2245, the values used to set an individual's rate must be compared using averages, on
an annual basis. The commissioner shall not evaluate rates by extrapolating results for
any period less than 12 months.
new text end

Sec. 8.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 9,
is amended to read:

Subd. 9.

Payments for unit-based services without programming.

new text begin (a) new text end Payments
for unit-based without program services, including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:

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

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5 or the customized direct care rate;

(5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f),
clause (2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (f), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount;

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

(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(15) for a recipient requiring deaf and hard-of-hearing customization under
subdivision 12, add the customization rate provided in subdivision 12 to the result of
clause (14). This is defined as the customized direct care rate;

(16) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a);

(17) multiply the number of direct staff hours by the product of the supervisory span
of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16);

(18) combine the results of clauses (16) and (17), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;

(19) for employee-related expenses, multiply the result of clause (18) by one plus
the employee-related cost ratio in subdivision 5, paragraph (g), clause (3);

(20) this is the subtotal rate;

(21) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

(22) divide the result of clause (20) by one minus the result of clause (21). This is
the total payment amount; and

(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

new text begin (b) For the purposes of authorizing personal support services, including support by a
fiscal support entity, lead agencies shall authorize units:
new text end

new text begin (1) for individuals receiving services prior to January 1, 2014, equivalent to or in
excess of the units specified in the service agreements in effect on October 31, 2013.
Fewer units may be authorized if an individual's service needs decrease; and
new text end

new text begin (2) for individuals beginning services on or after January 1, 2014, that exceed the
average number of units for recipients in each county on October 31, 2013. Fewer units
may be authorized if an individual's service needs decrease.
new text end

new text begin (c) For the purposes of review under Minnesota Rules, parts 9505.2160 to
9505.2245, the values used to set an individual's rate must be compared using averages, on
an annual basis. The commissioner must not evaluate rates by extrapolating results for
any period less than 12 months.
new text end

Sec. 9.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 10,
is amended to read:

Subd. 10.

Updating payment values and additional information.

(a) From
January 1, 2014, through December 31, 2017, the commissioner shall develop and
implement uniform procedures to refine terms and adjust values used to calculate payment
rates in this section.

(b) new text begin No later than July 1, 2014, new text end the commissioner shall deleted text begin , within available resources,
deleted text end new text begin begin to new text end conduct research and gather data and information from existing state systems or
other outside sources on the following items:

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

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

new text begin (3) the underlying cost to provide services and care to recipients with a primary
diagnosis of mental illness new text end .

(c) Using a statistically valid set of rates management system data, the commissioner,
in consultation with stakeholders, shall analyze for each service the average difference in
the rate on December 31, 2013, and the framework rate at the individual, provider, lead
agency, and state levels. new text begin The commissioner shall issue monthly reports to the stakeholders
on the difference in rates for individuals after removing any identifying information,
by service and by county, during the implementation period under section 256B.4913,
subdivision 4a. The first report shall encompass data from January 1, 2014, to June 30,
2014, and must be issued at the July 2014 stakeholder meeting.
new text end

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

(1) values for transportation rates for day services;

(2) values for transportation rates in residential services;

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

(4) values for indirect services;

(5) values for nursing;

(6) component values for independent living skills;

(7) component values for family foster care that reflect licensing requirements;

(8) adjustments to other components to replace the budget neutrality factor;

(9) remote monitoring technology for nonresidential services;

(10) values for basic and intensive services in residential services;

(11) values for the facility use rate in day services;

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

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

(14) a component value to reflect costs for individuals with rates previously adjusted
for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
as of December 31, 2013; and

(15) any changes in state or federal law with an impact on the underlying cost of
providing home and community-based services new text begin , including, but not limited to, employer
requirements to provide health insurance and provider requirements to implement
electronic medical records new text end .

(e) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (b) to (d)
on the following dates:

(1) January 15, 2015, with preliminary results and data;

(2) January 15, 2016, with a status implementation update, and additional data
and summary information;

(3) January 15, 2017, with the full report; and

(4) January 15, 2019, with another full report, and a full report once every four
years thereafter.

(f) Based on the commissioner's evaluation of the information and data collected
in paragraphs (b) to (d), the commissioner deleted text begin may deleted text end new text begin shall new text end make recommendations to
the legislature deleted text begin to address any potential issues deleted text end new text begin by January 15, 2015, to address any
issues identified during the first year of implementation. After January 15, 2015, the
commissioner may make recommendations to the legislature to address potential issues new text end .

(g) The commissioner shall implement a regional adjustment factor to all rate
calculations in subdivisions 6 to 9, effective no later than January 1, 2015. Prior to
implementation, the commissioner shall consult with stakeholders on the methodology to
calculate the adjustment.

(h) The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively
approved changes in:

(1) calculation values including derived wage rates and related employee and
administrative factors;

(2) service utilization;

(3) county and tribal allocation changes; and

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

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

Sec. 10.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 14,
is amended to read:

Subd. 14.

Exceptions.

(a) In a format prescribed by the commissioner, lead
agencies must identify individuals with exceptional needs that cannot be met under the
disability waiver rate system. The commissioner shall use that information to evaluate
and, if necessary, approve an alternative payment rate for those individuals.

(b) Lead agencies must submit exception requests to the state.

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

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

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

new text begin (3) a value used to calculate a rate in subdivision 6, 7, 8, or 9 does not reflect the
underlying cost of providing the service new text end .

(d) Exception requests must include the following information:

(1) the service needs required by each individual that are not accounted for in
subdivisions 6, 7, 8, and 9;

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

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

(4) the duration of the rate exception; and

(5) any contingencies for approval.

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

(f) Individual disability waiver recipients may request that a lead agency submit an
exception request. A lead agency that denies such a request shall notify the individual
waiver recipient of its decision and the reasons for denying the request in writing no later
than 30 days after the individual's request has been made.

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

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

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

Sec. 11.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 15,
is amended to read:

Subd. 15.

County or tribal allocations.

(a) Upon implementation of the disability
waiver rates management system on January 1, 2014, the commissioner shall establish
a method of tracking and reporting the fiscal impact of the disability waiver rates
management system on individual lead agencies.

(b) Beginning January 1, 2014, the commissioner shall make annual adjustments to
lead agencies' home and community-based waivered service budget allocations to adjust
for rate differences and the resulting impact on county allocations upon implementation of
the disability waiver rates system.

new text begin (c) During the first two years of implementation under section 256B.4913, lead
agencies exceeding their allocations under sections 256B.092 and 256B.49 shall only be
held liable for spending in excess of their allocations after a reallocation of resources by
the commissioner under paragraph (b). The commissioner shall reallocate resources under
sections 256B.092, subdivision 12, and 256B.49, subdivision 11a. The commissioner
shall notify lead agencies of this process by July 1, 2014.
new text end

Sec. 12.

Minnesota Statutes 2013 Supplement, section 256B.4914, subdivision 16,
is amended to read:

Subd. 16.

Budget neutrality adjustments.

(a) The commissioner shall use the
following adjustments to the rate generated by the framework to assure budget neutrality
until the rate information is available to implement paragraph (b). The rate generated by
the framework shall be multiplied by the appropriate factor, as designated below:

(1) for residential services: 1.003;

(2) for day services: 1.000;

(3) for unit-based services with programming: 0.941; and

(4) for unit-based services without programming: 0.796.

(b) deleted text begin Within 12 months of January 1, 2014 deleted text end new text begin In conjunction with the November 2014
revenue and spending forecast new text end , the commissioner shall compare estimated spending for
all home and community-based waiver services under the new payment rates defined in
subdivisions 6 to 9 with estimated spending for the same recipients and services under the
rates in effect on July 1, 2013. This comparison must distinguish spending under each
of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients and
services for one or more service months after the new rates have gone into effect.

new text begin (c) new text end The commissioner shall deleted text begin consult with deleted text end new text begin provide the total level of spending for
services under subdivisions 6, 7, 8, and 9 to new text end the commissioner of management and budget
deleted text begin on this analysis to ensure budget neutrality. If estimated spending under the new rates for
services under one or more subdivisions differs in this comparison by 0.3 percent or more,
the commissioner deleted text end new text begin . The commissioner of management and budget shall preserve the total
amount of spending prior to the implementation of rates in this section if projections using
rates in subdivisions 6, 7, 8, and 9 in aggregate are lower. new text end

new text begin (d) If the total spending projections prior to implementation of rates are used, the
commissioner of human services new text end shall assure aggregate deleted text begin budget neutrality across all
deleted text end new text begin spending for each new text end service deleted text begin areas deleted text end new text begin area meets the total included in the forecast new text end by adjusting
deleted text begin the budget neutrality factor in paragraph (a) deleted text end new text begin any values new text end in each subdivision so that total
estimated spending for each subdivision under the new rates matches estimated spending
under the rates in effect on July 1, 2013. new text begin Adjustments must be made to individual rates
with sufficient time so that aggregate spending with the rates in subdivisions 6, 7, 8, and 9
equals the aggregate spending prior to implementation for the current state fiscal year.
new text end

Sec. 13.

Minnesota Statutes 2013 Supplement, section 256B.4914, is amended by
adding a subdivision to read:

new text begin Subd. 17. new text end

new text begin Provider appeal procedures. new text end

new text begin (a) The following actions by a lead agency
may be appealed by the provider or provider group if the following conditions are met:
new text end

new text begin (1) if conversion of units and rates to establish the units and rates in effect on
December 1, 2013, results in reduced spending or service unit utilization compared to
units and rates in effect on October 31, 2013;
new text end

new text begin (2) if the variables used to set a final rate are insufficient to meet the licensing
standards for staffing required under section 245D.09;
new text end

new text begin (3) if the variables used to set a final rate are insufficient to meet the requirements
for staffing under subdivision 2, paragraph (n), and do not exceed the licensing standards
for staffing required under section 245D.31; and
new text end

new text begin (4) if the variables used to set the final rate are insufficient to meet the health and
safety needs of the individual receiving services identified in the individual's coordinated
service and support plan under section 245D.02, subdivision 4b, and any coordinated
service and support plan addendum under section 245D.02, subdivision 4c.
new text end

new text begin (b) An appeal must meet the following criteria:
new text end

new text begin (1) the provider or provider group must notify the commissioner in writing of its
intent to appeal within 30 days of receiving the total payment rate determination or decision
that is being appealed. Written appeal must be filed with the commissioner within 60 days
after receiving the total payment rate determination or decision that is being appealed; and
new text end

new text begin (2) the appeal must specify:
new text end

new text begin (i) each disputed item and the reason for the dispute;
new text end

new text begin (ii) the date the dispute began, the computation, and the amount that the provider
believes to be correct;
new text end

new text begin (iii) documentation and a narrative explanation demonstrating how rates determined
by the lead agency do not satisfy the conditions in paragraph (a); and
new text end

new text begin (iv) contact information for the provider filing the appeal.
new text end

new text begin (c) The appeal must be heard under the contested case provisions in sections 14.57
to 14.62, and Minnesota Rules, parts 1400.5010 to 1400.8400. Upon agreement of both
parties, the dispute may be resolved informally through any informal dispute resolution
method, such as settlement, mediation, or modified appeal procedures established by
agreement between the commissioner and the chief administrative law judge.
new text end

new text begin (d) Upon resolution of the appeal, any reimbursement must be paid via a lump sum
directly to the provider.
new text end

Sec. 14.

Minnesota Statutes 2013 Supplement, section 256B.4914, is amended by
adding a subdivision to read:

new text begin Subd. 18. new text end

new text begin Individual appeal procedures. new text end

new text begin The individual disability waiver recipient
may appeal variable values used to set a rate under subdivision 6, 7, 8, or 9, as provided in
sections 256.045 and 256.0451.
new text end

Sec. 15. new text begin DISABILITY WAIVER REIMBURSEMENT RATE ADJUSTMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Historical rate. new text end

new text begin The commissioner of human services shall adjust
the historical rates calculated in Minnesota Statutes, section 256B.4913, subdivision 4a,
paragraph (b), in effect during the banding period under Minnesota Statutes, section
256B.4913, subdivision 4a, paragraph (a), for the reimbursement rate increases effective
April 1, 2014, and any rate modification enacted during the 2014 legislative session.
new text end

new text begin Subd. 2. new text end

new text begin Residential support services. new text end

new text begin The commissioner of human services
shall adjust the rates calculated in Minnesota Statutes, section 256B.4914, subdivision 6,
paragraphs (b), clause (4), and (c), for the reimbursement rate increases effective April 1,
2014, and any rate modification enacted during the 2014 legislative session.
new text end

new text begin Subd. 3. new text end

new text begin Day programs. new text end

new text begin The commissioner of human services shall adjust the rates
calculated in Minnesota Statutes, section 256B.4914, subdivision 7, paragraph (a), clauses
(15) to (17), for the reimbursement rate increases effective April 1, 2014, and any rate
modification enacted during the 2014 legislative session.
new text end

new text begin Subd. 4. new text end

new text begin Unit-based services with programming. new text end

new text begin The commissioner of human
services shall adjust the rate calculated in Minnesota Statutes, section 256B.4914,
subdivision 8, paragraph (a), clause (14), for the reimbursement rate increases effective
April 1, 2014, and any rate modification enacted during the 2014 legislative session.
new text end

new text begin Subd. 5. new text end

new text begin Unit-based services without programming. new text end

new text begin The commissioner of
human services shall adjust the rate calculated in Minnesota Statutes, section 256B.4914,
subdivision 9, paragraph (a), clause (23), for the reimbursement rate increases effective
April 1, 2014, and any rate modification enacted during the 2014 legislative session.
new text end