HF 3191

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 05/01/2018 11:24pm

A bill for an act
relating to human services; modifying the disability waiver rate system; amending
Minnesota Statutes 2016, section 256B.4914, subdivision 4; Minnesota Statutes
2017 Supplement, section 256B.4914, subdivisions 2, 5, 6, 7, 8, 9, 10, 10a; Laws
2014, chapter 312, article 27, section 76.

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

Section 1.

Minnesota Statutes 2017 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) new text begin "Direct care staff" means employees providing direct service provision to people
receiving services under this section. Direct care staff does not include executive, managerial,
and administrative staff.
new text end

new text begin (f) new text end "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.

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

deleted text begin (g) deleted text end new text begin (h) 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 (h) deleted text end new text begin (i) 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.

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

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

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

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

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

(2) for day services under subdivision 7:

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

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

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

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

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

(iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
is six or more hours of time spent providing direct service;

(3) for unit-based services with programming under subdivision 8:

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

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

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

Sec. 2.

Minnesota Statutes 2016, 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 and information needed to calculate an individual's
rate into the rates management system. The determination of service levels must be part of
a discussion with members of the support team as defined in section 245D.02, subdivision
34. This discussion must occur prior to the final establishment of each individual's rate. The
values and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

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

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

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

(9) service hours provided through monitoring technology.

(e) Updates to individual data must include:

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

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

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

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

(2) meeting the requirements for staffing under subdivision 2, paragraphs deleted text begin (f) deleted text end new text begin (g) new text end , deleted text begin (i) deleted text end new text begin (m) new text end ,
and deleted text begin (m) deleted text end new text begin (n) new text end ; and meeting or exceeding the licensing standards for staffing required under
section 245D.09, subdivision 1; and

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

Sec. 3.

Minnesota Statutes 2017 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 must be used. The base wage index
must 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 assistant (SOC
code 31-1014); 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 assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(2) for day services, 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 60 percent of the median wage for social and human services aide (SOC code 21-1093);

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

(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 assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

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

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

(11) 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);

(12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);

(13) for supported employment staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

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

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

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

(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(18) 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 assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(19) 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 assistant (SOC code
31-1014);

(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

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

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

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

(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: 9.4 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: 15.5 percent;

(5) client programming and supports ratio: 4.7 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: 7.0 percent;

(5) client programming and support ratio: 2.3 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 2.9 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: 2.9 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
(a) 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. On deleted text begin July deleted text end new text begin January new text end 1, 2022, and every
deleted text begin five deleted text end new text begin two new text end years thereafter, the commissioner shall update the base wage index in paragraph
(a) based on the deleted text begin most recently available deleted text end wage data by SOC from the Bureau of Labor
Statistics new text begin available on December 31 of the year two years prior to the scheduled update new text end .
The commissioner shall publish these updated values and load them into the rate management
system.

(i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5); subdivision
6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), 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. On deleted text begin July deleted text end new text begin January new text end 1, 2022,
and every deleted text begin five deleted text end new text begin two new text end years thereafter, the commissioner shall update the framework components
in paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5);
subdivision 6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), for changes
in the Consumer Price Index. The commissioner shall adjust these values higher or lower
by the percentage change in the CPI-U from the date of the previous update to the deleted text begin date of
the deleted text end data deleted text begin most recently deleted text end available new text begin on December 31 of the year two years new text end prior to the scheduled
update. The commissioner shall publish these updated values and load them into the rate
management system.

(j) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

new text begin (k) The commissioner shall increase the updated base wage index in paragraph (h) with
a competitive workforce factor of 8.35 percent.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, except the amendment
to paragraph (k), which is effective July 1, 2018, or upon federal approval. The commissioner
shall inform the revisor of statutes when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2017 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 staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(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 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 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 (21);

(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 $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(b) The total rate must 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; new text begin and
new text end

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

deleted text begin (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.
deleted text end

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

(d) 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 due to conversion
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.

(e) 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end

Sec. 5.

Minnesota Statutes 2017 Supplement, section 256B.4914, subdivision 7, is amended
to read:

Subd. 7.

Payments for day programs.

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 and staffing ratio to meet a recipient's needs:

(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

(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;

(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 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 (21);

(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;

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

deleted text begin (16) deleted text end new text begin (15) new text end 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 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 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 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 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; new text begin and
new text end

deleted text begin (17) deleted text end new text begin (16) new text end for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:

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

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

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end

Sec. 6.

Minnesota Statutes 2017 Supplement, section 256B.4914, subdivision 8, is amended
to read:

Subd. 8.

Payments for unit-based services with programming.

Payments for unit-based
services with programming, including behavior programming, housing access coordination,
in-home family support, independent living skills training, independent living skills specialist
services, individualized home supports, hourly supported living services, employment
exploration services, employment development services, supported employment, and
employment support services 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 (21);

(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; new text begin and
new text end

(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
employment support services provided in a shared manner, divide the total payment amount
in clause (12) by the number of service recipients, not to exceed six. For independent living
skills training and individualized home supports provided in a shared manner, divide the
total payment amount in clause (12) by the number of service recipients, not to exceed two deleted text begin ;
and deleted text end new text begin .
new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end

Sec. 7.

Minnesota Statutes 2017 Supplement, section 256B.4914, subdivision 9, is amended
to read:

Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, 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 (21);

(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 day 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 (21);

(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; new text begin and
new text end

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

deleted text begin (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.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end

Sec. 8.

Minnesota Statutes 2017 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) No later than July 1, 2014, the commissioner shall, within available resources, begin
to conduct research and gather data and information from existing state systems or other
outside sources on the following items:

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

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

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

(c) Beginning January 1, 2014, through December 31, 2018, 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. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018.

(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
begin the review and evaluation of 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;

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

(3) values for indirect services;

(4) values for nursing;

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

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

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

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

(9) new text begin direct care staff labor market measures; and
new text end

new text begin (10) new text end outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.

(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, 2020, with another full report, and a full report once every four years
thereafter.

(f) The commissioner shall implement a regional adjustment factor to all rate calculations
in subdivisions 6 to 9, effective no later than January 1, 2015. Beginning July 1, 2017, the
commissioner shall renew analysis and implement changes to the regional adjustment factors
when adjustments required under subdivision 5, paragraph (h), occur. Prior to
implementation, the commissioner shall consult with stakeholders on the methodology to
calculate the adjustment.

(g) 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 must be effective January 1 of the following year.

(h) When the available shared staffing hours in a residential setting are insufficient to
meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.

(i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.

(j) Beginning July 1, 2017, the commissioner shall collect transportation and trip
information for all day services through the rates management system.

Sec. 9.

Minnesota Statutes 2017 Supplement, section 256B.4914, subdivision 10a, is
amended to read:

Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9 reflect the cost to provide the
service. As determined by the commissioner, in consultation with stakeholders identified
in section 256B.4913, subdivision 5, a provider enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner to support
research on the cost of providing services that have rates determined by the disability waiver
rates system. Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

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

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

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

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

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

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

(d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e). The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.

(e) The commissioner, in consultation with stakeholders identified in section 256B.4913,
subdivision 5, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (a).

new text begin (f) Beginning January 1, 2019, providers enrolled to provide services with rates
determined under this section shall submit labor market data to the commissioner annually.
new text end

new text begin (g) Beginning January 15, 2020, the commissioner shall publish annual reports on
provider and state-level labor market data, including, but not limited to:
new text end

new text begin (1) number of direct care staff;
new text end

new text begin (2) wages of direct care staff;
new text end

new text begin (3) benefits provided to direct care staff;
new text end

new text begin (4) direct care staff job vacancies; and
new text end

new text begin (5) direct care staff retention rates.
new text end

Sec. 10.

Laws 2014, chapter 312, article 27, section 76, is amended to read:

Sec. 76. DISABILITY WAIVER REIMBURSEMENT RATE ADJUSTMENTS.

deleted text begin Subdivision 1. deleted text end

deleted text begin Historical rate. deleted text end

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.

deleted text begin Subd. 2. deleted text end

deleted text begin Residential support services. deleted text end

deleted 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.
deleted text end

deleted text begin Subd. 3. deleted text end

deleted text begin Day programs. deleted text end

deleted 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.
deleted text end

deleted text begin Subd. 4. deleted text end

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

deleted 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.
deleted text end

deleted text begin Subd. 5. deleted text end

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

deleted 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.
deleted text end