HF 3616

as introduced - 89th Legislature (2015 - 2016) Posted on 03/24/2016 02:29pm

A bill for an act
relating to human services; modifying employment waiver services; adjusting the
disability waiver rate system budget neutrality adjustment for unit-based services
with programming; amending Minnesota Statutes 2014, sections 256B.4913, by
adding a subdivision; 256B.4914, subdivisions 3, 5, 16; Minnesota Statutes 2015
Supplement, sections 245D.03, subdivision 1; 256B.4914, subdivision 8.

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

Section 1.

Minnesota Statutes 2015 Supplement, section 245D.03, subdivision 1,
is amended to read:

Subdivision 1.

Applicability.

(a) The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of basic support services and intensive support services.

(b) Basic support services provide the level of assistance, supervision, and care that
is necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of
the person. Basic support services include:

(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and
8, or successor provisions; and section 245D.061 or successor provisions, which must
be stipulated in the statement of intended use required under Minnesota Rules, part
2960.3000, subpart 4;

(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;

(3) personal support as defined under the developmental disability waiver plan;

(4) 24-hour emergency assistance, personal emergency response as defined under
the community access for disability inclusion and developmental disability waiver plans;

(5) night supervision services as defined under the brain injury waiver plan; and

(6) homemaker services as defined under the community access for disability
inclusion, brain injury, community alternative care, developmental disability, and elderly
waiver plans, excluding providers licensed by the Department of Health under chapter
144A and those providers providing cleaning services only.

(c) Intensive support services provide assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and services specifically directed
toward the training, habilitation, or rehabilitation of the person. Intensive support services
include:

(1) intervention services, including:

(i) behavioral support services as defined under the brain injury and community
access for disability inclusion waiver plans;

(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and

(iii) specialist services as defined under the current developmental disability waiver
plan;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;

(ii) independent living services training as defined under the brain injury and
community access for disability inclusion waiver plans; and

(iii) semi-independent living services;

(3) residential supports and services, including:

(i) supported living services as defined under the developmental disability waiver
plan provided in a family or corporate child foster care residence, a family adult foster
care residence, a community residential setting, or a supervised living facility;

(ii) foster care services as defined in the brain injury, community alternative care,
and community access for disability inclusion waiver plans provided in a family or
corporate child foster care residence, a family adult foster care residence, or a community
residential setting; and

(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii) day training and habilitation services under sections 252.41 to 252.46, and as
defined under the developmental disability waiver plan; and

(iii) prevocational services as defined under the brain injury and community access
for disability inclusion waiver plans; and

(5) deleted text begin supported employment as defined under the brain injury, developmental
disability, and community access for disability inclusion waiver plans deleted text end new text begin employment
services, including:
new text end

new text begin (i) employment exploration services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans;
new text end

new text begin (ii) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waivers plans; and
new text end

new text begin (iii) employment support services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

Sec. 2.

Minnesota Statutes 2014, section 256B.4913, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin New services added after implementation. new text end

new text begin Services added to section
256B.4914 after January 1, 2014, are not subject to rate stabilization adjustment in this
section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 3.

Minnesota Statutes 2014, section 256B.4914, subdivision 3, is amended to read:

Subd. 3.

Applicable services.

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

(1) 24-hour customized living;

(2) adult day care;

(3) adult day care bath;

(4) behavioral programming;

(5) companion services;

(6) customized living;

(7) day training and habilitation;

(8) housing access coordination;

(9) independent living skills;

(10) in-home family support;

(11) night supervision;

(12) personal support;

(13) prevocational services;

(14) residential care services;

(15) residential support services;

(16) respite services;

(17) structured day services;

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

(19) supported living services;

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

(21) new text begin employment exploration services;
new text end

new text begin (22) employment development services; and
new text end

new text begin (23) new text end other services as approved by the federal government in the state home and
community-based services plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 4.

Minnesota Statutes 2014, 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 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 deleted text begin supported deleted text end employment new text begin support services new text end staff, deleted text begin 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) deleted text end new text begin 60 percent social and human services assistant (SOC
code 21-1093); 20 percent psychiatric technician (SOC code 29-2053); and 20 percent
nursing assistant (SOC code 31-1014) new text end ;

(12) new text begin for employment exploration services staff, 20 percent rehabilitation counselor
(SOC code 21-1015); 50 percent social and human services assistants (SOC code
21-1093); and 30 percent community and social services specialist (SOC code 21-1099);
new text end

new text begin (13) for employment development services staff, 50 percent education, guidance,
school, and vocational counselor (SOC code 21-1012); and 50 percent community and
social services specialist (SOC code 21-1099);
new text end

new text begin (14) new text end 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);

deleted text begin (13) deleted text end new text begin (15) new text end 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);

deleted text begin (14) deleted text end new text begin (16) new text end 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);

deleted text begin (15) deleted text end new text begin (17) new text end 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);

deleted text begin (16) deleted text end new text begin (18) new text end for supervisory staff, the basic wage is $17.43 per hour with exception of
the supervisor of behavior analyst and behavior specialists, which must be $30.75 per hour;

deleted text begin (17) deleted text end new text begin (19) new text end for registered nurse, the basic wage is $30.82 per hour; and

deleted text begin (18) deleted text end new text begin (20) new text end for licensed practical nurse, 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
(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. 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 paragraphs (b) to (g); subdivision 6, clauses (8) and (9); and subdivision 7, clauses
(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. 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 5.

Minnesota Statutes 2015 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, hourly supported
living services, new text begin employment exploration services, employment development services, new text end and
deleted text begin supported deleted text end employment new text begin support services new text end 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 EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 6.

Minnesota Statutes 2014, 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: deleted text begin 0.941 deleted text end new text begin 1.00 new text end ; and

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

(b) Within 12 months of January 1, 2014, 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.
The commissioner shall consult with the commissioner of management and budget 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 shall assure aggregate budget neutrality across all service areas
by adjusting the budget neutrality factor in paragraph (a) 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 (c) Services rates developed using values in subdivision 5, paragraph (a), clauses
(11), (12), and (13), are not subject to budget neutrality adjustments.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 7. new text begin DIRECTION TO THE COMMISSIONER.
new text end

new text begin The commissioner of human services shall submit necessary waiver amendments
to the Centers for Medicare and Medicaid Services to add employment exploration
services, employment development services, and employment support services to the
home and community-based services waiver authorized under Minnesota Statutes,
sections 256B.092 and 256B.49. The commissioner shall submit the necessary waiver
amendments by October 1, 2016.
new text end