Engrossments
Introduction		Posted on 02/08/2017
1st Engrossment		Posted on 03/28/2017
2nd Engrossment		Posted on 03/29/2017
3rd Engrossment		Posted on 04/04/2017
4th Engrossment		Posted on 05/10/2017

Unofficial Engrossments
1st Unofficial Engrossment		Posted on 04/05/2017
2nd Unofficial Engrossment		Posted on 04/10/2017

Conference Committee Reports
CCR-SF0800		Posted on 05/08/2017

Section 1.

Minnesota Statutes 2016, section 144A.351, subdivision 1, is amended to read:

Subdivision 1.

Report requirements.

The commissioners of health and human services,
with the cooperation of counties and in consultation with stakeholders, including persons
who need or are using long-term care services and supports, lead agencies, regional entities,
senior, disability, and mental health organization representatives, service providers, and
community members shall prepare a report to the legislature by August 15, 2013, and
biennially thereafter, regarding the status of the full range of long-term care services and
supports for the elderly and children and adults with disabilities and mental illnesses in
Minnesota.new text begin Any amounts appropriated for this report are available in either year of the
biennium.new text end The report shall address:

(1) demographics and need for long-term care services and supports in Minnesota;

(2) summary of county and regional reports on long-term care gaps, surpluses, imbalances,
and corrective action plans;

(3) status of long-term care services and related mental health services, housing options,
and supports by county and region including:

(i) changes in availability of the range of long-term care services and housing options;

(ii) access problems, including access to the least restrictive and most integrated services
and settings, regarding long-term care services; and

(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and

(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.

Sec. 2.

Minnesota Statutes 2016, 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; deleted text beginand
deleted text end

(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 onlynew text begin; and
new text end

new text begin (7) individual community living support under section 256B.0915, subdivision 3jnew text end.

(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; deleted text beginand
deleted text end

(iii) semi-independent living services;new text begin and
new text end

new text begin (iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;
new text end

(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 beginsupported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plansdeleted text endnew text begin 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 (6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; and
new text end

new text begin (7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plansnew text end.

new text begin EFFECTIVE DATE. new text end

new text begin (a) The amendment to paragraphs (b) and (c), clause (2), is
effective the day following final enactment.
new text end

new text begin (b) The amendments to paragraph (c), clauses (5) to (7), are 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 2016, section 252.41, subdivision 3, is amended to read:

Subd. 3.

Day training and habilitation services for adults with developmental
disabilities.

new text begin(a) new text end"Day training and habilitation services for adults with developmental
disabilities" means services that:

(1) include supervision, training, assistance, deleted text beginand supported employment,deleted text endnew text begin center-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the individual service and individual habilitation plans required under
Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
highest possible level of independence, productivity, and integration into the community;
and

(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
subdivision 2, to provide day training and habilitation services.

new text begin (b) new text endDay training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.

new text begin (c) Day training and habilitation services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.
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. 4.

new text begin [256.477] SELF-ADVOCACY GRANTS.
new text end

new text begin (a) The commissioner shall make available a grant for the purposes of establishing and
maintaining a statewide self-advocacy network for persons with intellectual and
developmental disabilities. The self-advocacy network shall:
new text end

new text begin (1) ensure that persons with intellectual and developmental disabilities are informed of
their rights in employment, housing, transportation, voting, government policy, and other
issues pertinent to the intellectual and developmental disability community;
new text end

new text begin (2) provide public education and awareness of the civil and human rights issues persons
with intellectual and developmental disabilities face;
new text end

new text begin (3) provide funds, technical assistance, and other resources for self-advocacy groups
across the state; and
new text end

new text begin (4) organize systems of communications to facilitate an exchange of information between
self-advocacy groups.
new text end

new text begin (b) An organization receiving a grant under paragraph (a) must be an organization
governed by people with intellectual and developmental disabilities that administers a
statewide network of disability groups in order to maintain and promote self-advocacy
services and supports for persons with intellectual and developmental disabilities throughout
the state.
new text end

Sec. 5.

Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:

Subd. 6a.

Home health services.

Home health services are those services specified in
Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical assistance
covers home health services at a recipient's home residencenew text begin or in the community where
normal life activities take the recipientnew text end. Medical assistance does not cover home health
services for residents of a hospital, nursing facility, or intermediate care facility, unless the
commissioner of human services has authorized skilled nurse visits for less than 90 days
for a resident at an intermediate care facility for persons with developmental disabilities,
to prevent an admission to a hospital or nursing facility or unless a resident who is otherwise
eligible is on leave from the facility and the facility either pays for the home health services
or forgoes the facility per diem for the leave days that home health services are used. Home
health services must be provided by a Medicare certified home health agency. All nursing
and home health aide services must be provided according to sections 256B.0651 to
256B.0653.

Sec. 6.

Minnesota Statutes 2016, section 256B.0625, subdivision 31, is amended to read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.

(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.

new text begin (g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 470.
new text end

Sec. 7.

Minnesota Statutes 2016, section 256B.0653, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For the purposes of this section, the following terms have the
meanings given.

(a) "Assessment" means an evaluation of the recipient's medical need for home health
agency services by a registered nurse or appropriate therapist that is conducted within 30
days of a request.

(b) "Home care therapies" means occupational, physical, and respiratory therapy and
speech-language pathology services provided in the home by a Medicare certified home
health agency.

(c) "Home health agency services" means services delivered deleted text beginin the recipient's home
residence, except as specified in section 256B.0625,deleted text end by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditionsnew text begin in settings permitted
under section 256B.0625, subdivision 6anew text end.

(d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.

(e) "Home health agency" means a home care provider agency that is Medicare-certified.

(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(h) "Respiratory therapy services" mean the services defined in chapter 147C.

(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
part 9505.0390.

(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.

(k) "Store-and-forward technology" means telehomecare services that do not occur in
real time via synchronous transmissions such as diabetic and vital sign monitoring.

(l) "Telehomecare" means the use of telecommunications technology via live, two-way
interactive audiovisual technology which may be augmented by store-and-forward
technology.

(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver
a skilled nurse visit to a recipient located at a site other than the site where the nurse is
located and is used in combination with face-to-face skilled nurse visits to adequately meet
the recipient's needs.

Sec. 8.

Minnesota Statutes 2016, section 256B.0653, subdivision 3, is amended to read:

Subd. 3.

Home health aide visits.

(a) Home health aide visits must be provided by a
certified home health aide using a written plan of care that is updated in compliance with
Medicare regulations. A home health aide shall provide hands-on personal care, perform
simple procedures as an extension of therapy or nursing services, and assist in instrumental
activities of daily living as defined in section 256B.0659, including assuring that the person
gets to medical appointments if identified in the written plan of care. Home health aide
visits deleted text beginmustdeleted text endnew text begin maynew text end be provided in the recipient's homenew text begin or in the community where normal life
activities take the recipientnew text end.

(b) All home health aide visits must have authorization under section 256B.0652. The
commissioner shall limit home health aide visits to no more than one visit per day per
recipient.

(c) Home health aides must be supervised by a registered nurse or an appropriate therapist
when providing services that are an extension of therapy.

Sec. 9.

Minnesota Statutes 2016, section 256B.0653, subdivision 4, is amended to read:

Subd. 4.

Skilled nurse visit services.

(a) Skilled nurse visit services must be provided
by a registered nurse or a licensed practical nurse under the supervision of a registered nurse,
according to the written plan of care and accepted standards of medical and nursing practice
according to chapter 148. Skilled nurse visit services must be ordered by a physician and
documented in a plan of care that is reviewed and approved by the ordering physician at
least once every 60 days. All skilled nurse visits must be medically necessary and provided
in the recipient's home residencenew text begin or in the community where normal life activities take the
recipient,new text end except as allowed under section 256B.0625, subdivision 6a.

(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up
to two visits per day per recipient. All visits must be based on assessed needs.

(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can
be accurately measured and assessed without a need for a face-to-face, hands-on encounter.
All telehomecare skilled nurse visits must have authorization and are paid at the same
allowable rates as face-to-face skilled nurse visits.

(d) The provision of telehomecare must be made via live, two-way interactive audiovisual
technology and may be augmented by utilizing store-and-forward technologies. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video is
used for research, training, or other purposes unrelated to the care of the patient, the identity
of the patient must be concealed.

(e) Authorization for skilled nurse visits must be completed under section 256B.0652.
A total of nine face-to-face skilled nurse visits per calendar year do not require authorization.
All telehomecare skilled nurse visits require authorization.

Sec. 10.

Minnesota Statutes 2016, section 256B.0653, subdivision 5, is amended to read:

Subd. 5.

Home care therapies.

(a) Home care therapies include the following: physical
therapy, occupational therapy, respiratory therapy, and speech and language pathology
therapy services.

(b) Home care therapies must be:

(1) provided in the recipient's residencenew text begin or in the community where normal life activities
take the recipientnew text end after it has been determined the recipient is unable to access outpatient
therapy;

(2) prescribed, ordered, or referred by a physician and documented in a plan of care and
reviewed, according to Minnesota Rules, part 9505.0390;

(3) assessed by an appropriate therapist; and

(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider
agency.

(c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be used
as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.

(d) For both physical and occupational therapies, the therapist and the therapist's assistant
may not both bill for services provided to a recipient on the same day.

Sec. 11.

Minnesota Statutes 2016, section 256B.0653, subdivision 6, is amended to read:

Subd. 6.

Noncovered home health agency services.

The following are not eligible for
payment under medical assistance as a home health agency service:

(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;

(2) the following skilled nurse visits:

(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;

(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;

(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;

(iv) services done for the sole purpose to train other home health agency workers;

(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and

(vi) Medicare evaluation or administrative nursing visits required by Medicare;

(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education; deleted text beginand
deleted text end

(4) home care therapies provided in other settings such as a clinicdeleted text begin, day program,deleted text end or as
an inpatient or when the recipient can access therapy outside of the recipient's residencenew text begin;
and
new text end

new text begin (5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7new text end.

Sec. 12.

Minnesota Statutes 2016, section 256B.0653, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Face-to-face encounter. new text end

new text begin (a) A face-to-face encounter by a qualifying provider
must be completed for all home health services regardless of the need for prior authorization,
except when providing a onetime perinatal visit by skilled nursing. The face-to-face encounter
may occur through telemedicine as defined in section 256B.0625, subdivision 3b. The
encounter must be related to the primary reason the recipient requires home health services
and must occur within the 90 days before or the 30 days after the start of services. The
face-to-face encounter may be conducted by one of the following practitioners, licensed in
Minnesota:
new text end

new text begin (1) a physician;
new text end

new text begin (2) a nurse practitioner or clinical nurse specialist;
new text end

new text begin (3) a certified nurse midwife; or
new text end

new text begin (4) a physician assistant.
new text end

new text begin (b) The allowed nonphysician practitioner, as described in this subdivision, performing
the face-to-face encounter must communicate the clinical findings of that face-to-face
encounter to the ordering physician. Those clinical findings must be incorporated into a
written or electronic document included in the recipient's medical record. To assure clinical
correlation between the face-to-face encounter and the associated home health services, the
physician responsible for ordering the services must:
new text end

new text begin (1) document that the face-to-face encounter, which is related to the primary reason the
recipient requires home health services, occurred within the required time period; and
new text end

new text begin (2) indicate the practitioner who conducted the encounter and the date of the encounter.
new text end

new text begin (c) For home health services requiring authorization, including prior authorization, home
health agencies must retain the qualifying documentation of a face-to-face encounter as part
of the recipient health service record, and submit the qualifying documentation to the
commissioner or the commissioner's designee upon request.
new text end

Sec. 13.

Minnesota Statutes 2016, section 256B.0659, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms defined in
paragraphs (b) to deleted text begin(r)deleted text endnew text begin (s)new text end have the meanings given unless otherwise provided in text.

(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.

(c) "Behavior," effective January 1, 2010, means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression towards self, others, or destruction of property that requires the immediate
response of another person.

(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.

new text begin (e) "Complex personal care assistance services" means personal care assistance services:
new text end

new text begin (1) for a person who qualifies for ten hours or more of personal care assistance services
per day; and
new text end

new text begin (2) provided by a personal care assistant who is qualified to provide complex personal
assistance services under subdivision 11, paragraph (d).
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

deleted text begin (f)deleted text endnew text begin (g)new text end "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.

deleted text begin (g)deleted text endnew text begin (h)new text end "Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, which
exceed the amount, duration, and frequency of the state plan personal care assistance services
for participants who:

(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or

(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.

deleted text begin (h)deleted text endnew text begin (i)new text end "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.

deleted text begin (i)deleted text endnew text begin (j)new text end "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community.

deleted text begin (j)deleted text endnew text begin (k)new text end "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.

deleted text begin (k)deleted text endnew text begin (l)new text end "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.

deleted text begin (l)deleted text endnew text begin (m)new text end "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.

deleted text begin (m)deleted text endnew text begin (n)new text end "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

deleted text begin (n)deleted text endnew text begin (o)new text end "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.

deleted text begin (o)deleted text endnew text begin (p)new text end "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.

deleted text begin (p)deleted text endnew text begin (q)new text end "Self-administered medication" means medication taken orally, by injection,
nebulizer, or insertion, or applied topically without the need for assistance.

deleted text begin (q)deleted text endnew text begin (r)new text end "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.

deleted text begin (r)deleted text endnew text begin (s)new text end "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2018.
new text end

Sec. 14.

Minnesota Statutes 2016, section 256B.0659, subdivision 2, is amended to read:

Subd. 2.

Personal care assistance services; covered services.

(a) The personal care
assistance services eligible for payment include services and supports furnished to an
individual, as needed, to assist in:

(1) activities of daily living;

(2) health-related procedures and tasks;

(3) observation and redirection of behaviors; and

(4) instrumental activities of daily living.

(b) Activities of daily living include the following covered services:

(1) dressing, including assistance with choosing, application, and changing of clothing
and application of special appliances, wraps, or clothing;

(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;

(3) bathing, including assistance with basic personal hygiene and skin care;

(4) eating, including assistance with hand washing and application of orthotics required
for eating, transfers, and feeding;

(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;

(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;

(7) positioning, including assistance with positioning or turning a recipient for necessary
care and comfort; and

(8) toileting, including assistance with helping recipient with bowel or bladder elimination
and care including transfers, mobility, positioning, feminine hygiene, use of toileting
equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting
clothing.

(c) Health-related procedures and tasks include the following covered services:

(1) range of motion and passive exercise to maintain a recipient's strength and muscle
functioning;

(2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party, including
medications given through a nebulizer;

(3) interventions for seizure disorders, including monitoring and observation; and

(4) other activities considered within the scope of the personal care service and meeting
the definition of health-related procedures and tasks under this section.

(d) A personal care assistant may provide health-related procedures and tasks associated
with the complex health-related needs of a recipient if the procedures and tasks meet the
definition of health-related procedures and tasks under this section and the personal care
assistant is trained by a qualified professional and demonstrates competency to safely
complete the procedures and tasks. Delegation of health-related procedures and tasks and
all training must be documented in the personal care assistance care plan and the recipient's
and personal care assistant's files. A personal care assistant must not determine the medication
dose or time for medication.

(e) Effective January 1, 2010, for a personal care assistant to provide the health-related
procedures and tasks of tracheostomy suctioning and services to recipients on ventilator
support there must be:

(1) delegation and training by a registered nurse, certified or licensed respiratory therapist,
or a physician;

(2) utilization of clean rather than sterile procedure;

(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;

(4) individualized training regarding the needs of the recipient; and

(5) supervision by a qualified professional who is a registered nurse.

(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal care
assistance care plan, and any other support services provided.

(g) Instrumental activities of daily living under subdivision 1, paragraph deleted text begin(i)deleted text endnew text begin (j)new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2018.
new text end

Sec. 15.

Minnesota Statutes 2016, section 256B.0659, subdivision 11, is amended to read:

Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant must
meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;

(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;

(9) complete training and orientation on the needs of the recipient; and

(10) be limited to providing and being paid for up to 275 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.

new text begin (d) A personal care assistant is qualified to provide complex personal care assistance
services as defined in subdivision 1, paragraph (e), if the personal care assistant:
new text end

new text begin (1) provides services according to the care plan in subdivision 7 to an individual described
in subdivision 1, paragraph (e), clause (1); and
new text end

new text begin (2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided by Code of
Federal Regulations, title 42, section 483.151 or 484.36, or alternative, comparable,
state-approved training and competency requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2018.
new text end

Sec. 16.

Minnesota Statutes 2016, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 17a. new text end

new text begin Rate for complex personal care assistance services. new text end

new text begin The rate paid to a
provider for complex personal care assistance services shall be 110 percent of the rate paid
for personal care assistance services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2018.
new text end

Sec. 17.

Minnesota Statutes 2016, section 256B.0659, subdivision 21, is amended to read:

Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:

(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;

(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;

(7) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;

(8) copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this sectionnew text begin, including the requirements
under subdivision 11, paragraph (d), if complex personal care assistance services are provided
and submitted for paymentnew text end;

(11) documentation of the agency's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;

(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program financial
management. This training is effective July 1, 2009. Any personal care assistance provider
agency enrolled before that date shall, if it has not already, complete the provider training
within 18 months of July 1, 2009. Any new owners or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.

Sec. 18.

Minnesota Statutes 2016, section 256B.0911, subdivision 1a, is amended to read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) Until additional requirements apply under paragraph (b), "long-term care consultation
services" means:

(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;

(2) providing recommendations for and referrals to cost-effective community services
that are available to the individual;

(3) development of an individual's person-centered community support plan;

(4) providing information regarding eligibility for Minnesota health care programs;

(5) face-to-face long-term care consultation assessments, which may be completed in a
hospital, nursing facility, intermediate care facility for persons with developmental disabilities
(ICF/DDs), regional treatment centers, or the person's current or planned residence;

(6) determination of home and community-based waiver and other service eligibility as
required under sections 256B.0913, 256B.0915, and 256B.49, including level of care
determination for individuals who need an institutional level of care as determined under
subdivision 4e, based on assessment and community support plan development, appropriate
referrals to obtain necessary diagnostic information, and including an eligibility determination
for consumer-directed community supports;

(7) providing recommendations for institutional placement when there are no
cost-effective community services available;

(8) providing access to assistance to transition people back to community settings after
institutional admission; and

(9) providing information about competitive employment, with or without supports, for
school-age youth and working-age adults and referrals to the Disability Linkage Line and
Disability Benefits 101 to ensure that an informed choice about competitive employment
can be made. For the purposes of this subdivision, "competitive employment" means work
in the competitive labor market that is performed on a full-time or part-time basis in an
integrated setting, and for which an individual is compensated at or above the minimum
wage, but not less than the customary wage and level of benefits paid by the employer for
the same or similar work performed by individuals without disabilities.

(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
and 3a, "long-term care consultation services" also means:

(1) service eligibility determination for state plan home care services identified in:

(i) section 256B.0625, subdivisions 7, 19a, and 19c;

(ii) consumer support grants under section 256.476; or

(iii) section 256B.85;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections 256B.0621,
subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part 9525.0016;

(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination of
eligibility for family support grants under section 252.32, semi-independent living services
under section 252.275, and day training and habilitation services under section 256B.092;
and

(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
and (3).

(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and also
includes telephone assistance and follow up once a long-term care consultation assessment
has been completed.

(d) "Minnesota health care programs" means the medical assistance program under this
chapter and the alternative care program under section 256B.0913.

(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.

new text begin (f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives. For the purposes of this section,
"informed choice" means a voluntary choice of services by a person from all available
service options based on accurate and complete information concerning all available service
options and concerning the person's own preferences, abilities, goals, and objectives. In
order for a person to make an informed choice, all available options must be developed and
presented to the person to empower the person to make decisions.
new text end

Sec. 19.

Minnesota Statutes 2016, section 256B.0911, subdivision 2b, is amended to read:

Subd. 2b.

MnCHOICES certified assessors.

(a) Each lead agency shall use certified
assessors who have completed MnCHOICES training and the certification processes
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
deleted text begin principalsdeleted text endnew text begin principlesnew text end and have a common set of skills that must ensure consistency and
equitable access to services statewide. deleted text beginA lead agency may choose, according to departmental
policies, to contract with a qualified, certified assessor to conduct assessments and
reassessments on behalf of the lead agency.deleted text endnew text begin Certified assessors must use person-centered
planning principles to conduct an interview that identifies what is important to the person,
the person's needs for supports, health and safety concerns, and the person's abilities, interests,
and goals.
new text end

new text begin Certified assessors are responsible for:
new text end

new text begin (1) ensuring persons are offered objective, unbiased access to resources;
new text end

new text begin (2) ensuring persons have the needed information to support informed choice, including
where and how they choose to live and the opportunity to pursue desired employment;
new text end

new text begin (3) determining level of care and eligibility for long-term services and supports;
new text end

new text begin (4) using the information gathered from the interview to develop a person-centered
community support plan that reflects identified needs and support options within the context
of values, interests, and goals important to the person; and
new text end

new text begin (5) providing the person with a community support plan that summarizes the person's
assessment findings, support options, and agreed-upon next steps.
new text end

(b) MnCHOICES certified assessors are persons with a minimum of a bachelor's degree
in social work, nursing with a public health nursing certificate, or other closely related field
with at least one year of home and community-based experience, or a registered nurse with
at least two years of home and community-based experience who has received training and
certification specific to assessment and consultation for long-term care services in the state.

Sec. 20.

Minnesota Statutes 2016, section 256B.0911, is amended by adding a subdivision
to read:

new text begin Subd. 3f. new text end

new text begin Long-term care reassessments and community support plan updates.
new text end

new text begin Face-to-face reassessments must be conducted annually or as required by federal and state
laws and rules. Reassessments build upon all previous assessments conducted and include
a review of needs and services to identify any changes. Reassessments provide information
to support the person's informed choice and opportunities to express choice regarding
activities that contribute to quality of life, as well as information and opportunity to identify
goals related to desired employment, community activities, and preferred living environment.
Reassessments allow for a review of the current support plan's effectiveness, monitoring of
services, and the development of an updated person-centered community support plan.
Reassessments verify continued eligibility or offer alternatives as warranted and provide
an opportunity for quality assurance of service delivery.
new text end

Sec. 21.

Minnesota Statutes 2016, section 256B.0911, subdivision 4d, is amended to read:

Subd. 4d.

Preadmission screening of individuals under 65 years of age.

(a) It is the
policy of the state of Minnesota to ensure that individuals with disabilities or chronic illness
are served in the most integrated setting appropriate to their needs and have the necessary
information to make informed choices about home and community-based service options.

(b) Individuals under 65 years of age who are admitted to a Medicaid-certified nursing
facility must be screened prior to admission according to the requirements outlined in section
256.975, subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as
required under section 256.975, subdivision 7.

(c) Individuals under 65 years of age who are admitted to nursing facilities with only a
telephone screening must receive a face-to-face assessment from the long-term care
consultation team member of the county in which the facility is located or from the recipient's
county case manager within deleted text begin40 calendar days of admissiondeleted text endnew text begin the timeline established by the
commissioner, based on review of datanew text end.

(d) At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.

(e) For individuals under 21 years of age, a screening interview which recommends
nursing facility admission must be face-to-face and approved by the commissioner before
the individual is admitted to the nursing facility.

(f) In the event that an individual under 65 years of age is admitted to a nursing facility
on an emergency basis, the Senior LinkAge Line must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within deleted text begin40 calendar days of admissiondeleted text endnew text begin the timeline established by the commissioner,
based on review of datanew text end.

(g) At the face-to-face assessment, the long-term care consultation team member or the
case manager must present information about home and community-based options, including
consumer-directed options, so the individual can make informed choices. If the individual
chooses home and community-based services, the long-term care consultation team member
or case manager must complete a written relocation plan within 20 working days of the
visit. The plan shall describe the services needed to move out of the facility and a time line
for the move which is designed to ensure a smooth transition to the individual's home and
community.

(h) An individual under 65 years of age residing in a nursing facility shall receive a
face-to-face assessment at least every 12 months to review the person's service choices and
available alternatives unless the individual indicates, in writing, that annual visits are not
desired. In this case, the individual must receive a face-to-face assessment at least once
every 36 months for the same purposes.

(i) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
agencies directly for face-to-face assessments for individuals under 65 years of age who
are being considered for placement or residing in a nursing facility.

(j) Funding for preadmission screening follow-up shall be provided to the Disability
Linkage Line for the under-60 population by the Department of Human Services to cover
options counseling salaries and expenses to provide the services described in subdivisions
7a to 7c. The Disability Linkage Line shall employ, or contract with other agencies to
employ, within the limits of available funding, sufficient personnel to provide preadmission
screening follow-up services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (dd).

Sec. 22.

Minnesota Statutes 2016, section 256B.0911, subdivision 5, is amended to read:

Subd. 5.

Administrative activity.

new text begin(a) new text endThe commissioner shall streamline the processes,
including timelines for when assessments need to be completed, required to provide the
services in this section and shall implement integrated solutions to automate the business
processes to the extent necessary for community support plan approval, reimbursement,
program planning, evaluation, and policy development.

new text begin (b) The commissioner of human services shall work with lead agencies responsible for
conducting long-term consultation services to modify the MnCHOICES application and
assessment policies to create efficiencies while ensuring federal compliance with medical
assistance and long-term services and supports eligibility criteria.
new text end

Sec. 23.

Minnesota Statutes 2016, section 256B.0921, is amended to read:

256B.0921 HOME AND COMMUNITY-BASED SERVICES INCENTIVE POOL.

The commissioner of human services shall develop an initiative to provide incentives
for innovation innew text begin: (1)new text end achieving integrated competitive employmentdeleted text begin,deleted text endnew text begin; (2) achieving integrated
competitive employment for youth under age 25 upon their graduation from school; (3)new text end
living in the most integrated settingdeleted text begin,deleted text endnew text begin;new text end and new text begin(4) new text endother outcomes determined by the commissioner.
The commissioner shall seek requests for proposals and shall contract with one or more
entities to provide incentive payments for meeting identified outcomes. deleted text beginThe initial requests
for proposals must be issued by October 1, 2016.
deleted text end

Sec. 24.

Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:

Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" means 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 waiver services 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).

(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:

(1) for a day service recipient who 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, the historical rate must be the new text beginweighted
average new text endauthorized rate for the provider new text beginnumber new text endin the county of service, effective December
1, 2013; or

(2) for a unit-based service with programming or a unit-based service without
programming recipient who 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, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or

(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must 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 historical rate 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) 0.5 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);

(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); deleted text beginand
deleted text end

(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. The commissioner shall, upon enactment, seek federal approval for the
addition of this banding periodnew text begin; and
new text end

new text begin (7) one percent from the rate in effect in clause (6) for the 12-month period immediately
following the time period of clause (6)new text end.

(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.

(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.

(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:

(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;

(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

(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).

(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. 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 begin EFFECTIVE DATE. new text end

new text begin (a) The amendment to paragraph (b) is effective the day following
final enactment.
new text end

new text begin (b) The amendment to paragraph (c) 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. 25.

Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin New services. new text end

new text begin (a) A service added to section 256B.4914 after January 1, 2014,
is not subject to rate stabilization adjustment in this section.
new text end

new text begin (b) Employment support services authorized after January 1, 2018, under the new
employment support services definition according to the home and community-based services
waivers for people with disabilities under sections 256B.092 and 256B.49 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 the day following final enactment.
new text end

Sec. 26.

Minnesota Statutes 2016, 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) "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.

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

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

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

(j) "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.

(k) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.

(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
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.

(m) "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.

(n) "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 9deleted text begin:
deleted text end

deleted text begin (i) for respite servicesdeleted text end, a unit of service is deleted text begina day ordeleted text end 15 minutes. deleted text beginWhen a day rate is
authorized, any portion of a calendar day when an individual receives services is billable
as a day; and
deleted text end

deleted text begin (ii) for all other services, a unit of service is 15 minutes.
deleted 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. 27.

Minnesota Statutes 2016, 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;

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

deleted text begin (19)deleted text endnew text begin (18)new text end supported living services;

deleted text begin (20)deleted text endnew text begin (19)new text end transportation services; deleted text beginand
deleted text end

new text begin (20) individualized home supports;
new text end

new text begin (21) independent living skills specialist services;
new text end

new text begin (22) employment exploration services;
new text end

new text begin (23) employment development services;
new text end

new text begin (24) employment support services; and
new text end

deleted text begin (21)deleted text endnew text begin (25)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 (a) Clause (20) is effective the day following final enactment.
new text end

new text begin (b) Clauses (21) to (24) are effective upon federal approval. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 28.

Minnesota Statutes 2016, 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 deleted text beginaidedeleted text endnew text begin assistantnew text end
(SOC code deleted text begin31-1012deleted text endnew text begin 31-1014new text end); 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 deleted text beginaidedeleted text endnew text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text endnew text begin 31-1014new text end); 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 deleted text beginaidedeleted text endnew text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text endnew text begin 31-1014new text end); 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 deleted text beginwill be $7.66 per hourdeleted text endnew text begin is the minimum
wage in Minnesota for large employersnew text end, except in a family foster care setting, the wage is
deleted text begin $2.80 per hourdeleted text endnew text begin 36 percent of the minimum wage in Minnesota for large employersnew text end;

(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 deleted text beginaidedeleted text endnew text begin
assistantnew text end (SOC code deleted text begin31-1012deleted text endnew text begin 31-1014new text end); 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, deleted text begin50deleted text endnew text begin 100new text end percent of the median wage for
community and social services specialist (SOC code 21-1099);deleted text begin and 50 percent of the median
wage for social and human services aide (SOC code 21-1093);
deleted text end

(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) new text beginfor 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);
new text end

new text begin (11) new text endfor 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);

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

deleted text begin (11)deleted text endnew text begin (13) new text end for deleted text beginsupporteddeleted text end employment new text beginsupport services new text endstaff, deleted text begin20deleted text endnew text begin 50new text end percent of the median
wage for deleted text beginnursing aidedeleted text endnew text begin rehabilitation counselornew text end (SOC code deleted text begin31-1012deleted text endnew text begin 21-1015new text end); deleted text begin20 percent of
the median wage for psychiatric technician (SOC code 29-2053);deleted text end and deleted text begin60deleted text endnew text begin 50new text end percent of the
median wage for new text begincommunity and new text endsocial deleted text beginand humandeleted text end services deleted text beginaidedeleted text endnew text begin specialistnew text end (SOC code
deleted text begin 21-1093deleted text endnew text begin 21-1099new text end);

new text begin (14) 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);
new text end

new text begin (15) 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);
new text end

deleted text begin (12)deleted text endnew text begin (16)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 deleted text beginaides,
orderlies, and attendantsdeleted text endnew text begin assistantnew text end (SOC code deleted text begin31-1012deleted text endnew text begin 31-1014new text end);

deleted text begin (13)deleted text endnew text begin (17)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 deleted text beginaidedeleted text endnew text begin assistantnew text end (SOC
code deleted text begin31-1012deleted text endnew text begin 31-1014new text end); 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 endnew text begin (18)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 deleted text beginaides, orderlies,
and attendantsdeleted text endnew text begin assistantnew text end (SOC code deleted text begin31-1012deleted text endnew text begin 31-1014new text end);

deleted text begin (15)deleted text endnew text begin (19)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 deleted text beginaides,
orderlies, and attendantsdeleted text endnew text begin assistantnew text end (SOC code deleted text begin31-1012deleted text endnew text begin 31-1014new text end);

deleted text begin (16)deleted text endnew text begin (20)new text end for supervisory staff, deleted text beginthe basic wage is $17.43 per hourdeleted text endnew text begin, 100 percent of the
median wage for community and social services specialist (SOC code 21-1099),new text end with new text beginthe
new text end exception of the supervisor of behavior new text beginprofessional, behavior new text endanalystnew text begin,new text end and behavior
specialists, which deleted text beginmust be $30.75 per hourdeleted text endnew text begin is 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031)new text end;

deleted text begin (17)deleted text endnew text begin (21)new text end for registered nursenew text begin staffnew text end, deleted text beginthe basic wage is $30.82 per hourdeleted text endnew text begin, 100 percent of
the median wage for registered nurses (SOC code 29-1141)new text end; and

deleted text begin (18)deleted text endnew text begin (22)new text end for licensed practical nursenew text begin staffnew text end, deleted text beginthe basic wage is $18.64 per hourdeleted text endnew text begin 100 percent
of the median wage for licensed practical nurses (SOC code 29-2061)new text end.

(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: deleted text begin3.9deleted text end new text begin9.4new text end 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: deleted text begin3.1deleted text endnew text begin 15.5new text end percent;

(5) client programming and supports ratio: deleted text begin8.6deleted text endnew text begin 4.7new text end 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: deleted text begin3.1deleted text endnew text begin 7.0new text end percent;

(5) client programming and support ratio: deleted text begin8.6deleted text endnew text begin 2.3new text end percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: deleted text begin6.1deleted text endnew text begin 2.9new text end 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: deleted text begin6.1deleted text endnew text begin 2.9new text end 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. deleted text beginThis 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.deleted text end new text beginOn January 1, 2022, and every two
years thereafter, the commissioner shall update the base wage index in paragraph (a) based
on the most recently available wage data by SOC from the Bureau of Labor Statistics. The
commissioner shall publish these updated values and load them into the rate management
system.
new text end

(i) On July 1, 2017, the commissioner shall update the framework components in
deleted text begin paragraphs (b) to (g)deleted text endnew text begin paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f),
clause (5)new text end; subdivision 6, clauses (8) and (9); and subdivision 7, clauses new text begin(10), new text end(16)new text begin,new text end 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. deleted text beginThis 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.deleted text endnew text begin On January 1, 2022, and every two 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 date of the data most recently available prior to the
scheduled update. The commissioner shall publish these updated values and load them into
the rate management system.
new text end

new text begin (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 end

new text begin (k) 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:
new text end

new text begin (1) worker wage costs;
new text end

new text begin (2) benefits paid;
new text end

new text begin (3) supervisor wage costs;
new text end

new text begin (4) executive wage costs;
new text end

new text begin (5) vacation, sick, and training time paid;
new text end

new text begin (6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end

new text begin (7) administrative costs paid;
new text end

new text begin (8) program costs paid;
new text end

new text begin (9) transportation costs paid;
new text end

new text begin (10) vacancy rates; and
new text end

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

new text begin (l) 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.
new text end

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

new text begin (n) The commissioner shall analyze cost documentation in paragraph (k) 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 business cost data in an
aggregate form, and business cost data from individual providers shall not be released except
as provided for in current law.
new text end

new text begin (o) 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 (k).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin (a) The amendments to paragraphs (a) to (g) are effective January
1, 2018, except the amendment to paragraph (d), clause (8), which is effective January 1,
2019, and the amendment to paragraph (a), clause (10), which is effective the day following
final enactment.
new text end

new text begin (b) The amendments to paragraphs (h) to (o) are effective the day following final
enactment.
new text end

Sec. 29.

Minnesota Statutes 2016, 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 deleted text begin(16)deleted text endnew text begin (20)new text end;

(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;

(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 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.

Sec. 30.

Minnesota Statutes 2016, 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 deleted text begin(16)deleted text endnew text begin (20)new text end;

(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 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;

(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 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.

Sec. 31.

Minnesota Statutes 2016, 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, new text beginindependent living skills specialist
services, individualized home supports, new text endhourly supported living services, new text beginemployment
exploration services, employment development services, new text endand deleted text beginsupporteddeleted text end employment new text beginsupport
services new text endprovided 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 deleted text begin(16)deleted text endnew text begin (20)new text end;

(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 deleted text beginsupporteddeleted text end employmentnew text begin support servicesnew text end provided in a shared manner, divide
the total payment amount in clause (12) by the number of service recipients, not to exceed
deleted text begin threedeleted text endnew text begin sixnew text end. For independent living skills training new text beginand individualized home supports new text endprovided
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 the day following final enactment.
new text end

Sec. 32.

Minnesota Statutes 2016, 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 deleted text begin(16)deleted text endnew text begin (20)new text end;

(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 deleted text begin(16)deleted text endnew text begin (20)new text end;

(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.

Sec. 33.

Minnesota Statutes 2016, 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) new text beginBeginning January 1, 2014, through December 31, 2018, new text endusing 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, 2014new text begin, and the final report
shall be issued by December 31, 2018new text end.

(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 deleted text beginfor day servicesdeleted text end;

deleted text begin (2) values for transportation rates in residential services;
deleted text end

deleted text begin (3)deleted text endnew text begin (2)new text end values for services where monitoring technology replaces staff time;

deleted text begin (4)deleted text endnew text begin (3)new text end values for indirect services;

deleted text begin (5)deleted text endnew text begin (4)new text end values for nursing;

deleted text begin (6) component values for independent living skills;
deleted text end

deleted text begin (7) component values for family foster care that reflect licensing requirements;
deleted text end

deleted text begin (8) adjustments to other components to replace the budget neutrality factor;
deleted text end

deleted text begin (9) remote monitoring technology for nonresidential services;
deleted text end

deleted text begin (10) values for basic and intensive services in residential services;
deleted text end

deleted text begin (11)deleted text endnew text begin (5)new text end values for the facility use rate in day services, and the weightings used in the
day service ratios and adjustments to those weightings;

deleted text begin (12)deleted text endnew text begin (6)new text end values for workers' compensation as part of employee-related expenses;

deleted text begin (13)deleted text endnew text begin (7)new text end values for unemployment insurance as part of employee-related expenses;

deleted text begin (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
deleted text end

deleted text begin (15)deleted text endnew text begin (8)new text end any changes in state or federal law with deleted text beginandeleted text endnew text begin a directnew text end impact on the underlying
cost of providing home and community-based servicesdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (9) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.
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, deleted text begin2019deleted text endnew text begin 2020new text end, with another full report, and a full report once every four
years thereafter.

deleted text begin (f) Based on the commissioner's evaluation of the information and data collected in
paragraphs (b) to (d), the commissioner shall make recommendations to the legislature 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.
deleted text end

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

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

deleted text begin (i) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a methodology sufficient to determine the shared staffing
levels necessary to meet, at a minimum, health and welfare needs of individuals who will
be living together in shared residential settings, and the required shared staffing activities
described in subdivision 2, paragraph (l). This determination methodology must ensure
staffing levels are adaptable to meet the needs and desired outcomes for current and
prospective residents in shared residential settings.
deleted text end

deleted text begin (j)deleted text endnew text begin (h)new text end 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.

new text begin (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.
new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 34.

Minnesota Statutes 2016, 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) 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) A service rate developed using values in subdivision 5, paragraph (a), clause (10),
is not subject to budget neutrality adjustments.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 35.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Culturally affirmative. new text end

new text begin "Culturally affirmative" describes services that are
designed and delivered within the context of the culture, language, and life experiences of
a person who is deaf, a person who is deafblind, and a person who is hard-of-hearing.
new text end

Sec. 36.

Minnesota Statutes 2016, section 256C.23, subdivision 2, is amended to read:

Subd. 2.

Deaf.

"Deaf" means a hearing loss of such severity that the individual must
depend primarily on visual communication such asnew text begin American Sign Language or other signed
language, visual and manual means of communication such as signing systems in English
or Cued Speech,new text end writing, deleted text beginlipdeleted text endnew text begin speechnew text end reading, deleted text beginmanual communication,deleted text end and gestures.

Sec. 37.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:

new text begin Subd. 2c. new text end

new text begin Interpreting services. new text end

new text begin "Interpreting services" means services that include:
new text end

new text begin (1) interpreting between a spoken language, such as English, and a visual language, such
as American Sign Language;
new text end

new text begin (2) interpreting between a spoken language and a visual representation of a spoken
language, such as Cued Speech and signing systems in English;
new text end

new text begin (3) interpreting within one language where the interpreter uses natural gestures and
silently repeats the spoken message, replacing some words or phrases to give higher visibility
on the lips;
new text end

new text begin (4) interpreting using low vision or tactile methods for persons who have a combined
hearing and vision loss or are deafblind; and
new text end

new text begin (5) interpreting from one communication mode or language into another communication
mode or language that is linguistically and culturally appropriate for the participants in the
communication exchange.
new text end

Sec. 38.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Real-time captioning. new text end

new text begin "Real-time captioning" means a method of captioning
in which a caption is simultaneously prepared and displayed or transmitted at the time of
origination by specially trained real-time captioners.
new text end

Sec. 39.

Minnesota Statutes 2016, section 256C.233, subdivision 1, is amended to read:

Subdivision 1.

Deaf and Hard-of-Hearing Services Division.

The commissioners of
deleted text begin human services,deleted text end education, employment and economic development, and health shall deleted text begincreate
a distinct and separate organizational unit to be known asdeleted text endnew text begin advise the commissioner of human
services on the activities ofnew text end the Deaf and Hard-of-Hearing Services Division deleted text beginto addressdeleted text endnew text begin.
This division addressesnew text end the developmentaldeleted text begin, social, educational, and occupationaldeleted text end new text beginand
social-emotionalnew text end needs ofnew text begin persons who arenew text end deaf,new text begin persons who arenew text end deafblind, andnew text begin persons
who arenew text end hard-of-hearing deleted text beginpersonsdeleted text end through a statewide network of deleted text begincollaborativedeleted text end services and
deleted text begin by coordinating the promulgation of public policies, regulations, legislation, and programs
affectingdeleted text endnew text begin advocates on behalf of and provides information and training about how to best
serve persons who arenew text end deaf,new text begin persons who arenew text end deafblind, andnew text begin persons who arenew text end hard-of-hearing
deleted text begin personsdeleted text end. deleted text beginAn interdepartmental management team shall advise the activities of the Deaf and
Hard-of-Hearing Services Division.deleted text end The commissioner of human services shall coordinate
the work of the interagency deleted text beginmanagement teamdeleted text endnew text begin advisersnew text end and receive legislative appropriations
for the division.

Sec. 40.

Minnesota Statutes 2016, section 256C.233, subdivision 2, is amended to read:

Subd. 2.

Responsibilities.

The Deaf and Hard-of-Hearing Services Division shall:

(1) establish and maintain a statewide network of regional deleted text beginservice centersdeleted text end new text beginculturally
affirmative servicesnew text end for new text beginMinnesotans who are new text enddeaf,new text begin Minnesotans who arenew text end deafblind, andnew text begin
Minnesotans who arenew text end hard-of-hearing deleted text beginMinnesotansdeleted text end;

(2) deleted text beginassistdeleted text endnew text begin work across divisions withinnew text end the deleted text beginDepartmentsdeleted text endnew text begin Departmentnew text end of Human Services,
deleted text begin Education, and Employment and Economic Development to coordinate the promulgation
and implementation of public policies, regulations, legislation, programs, and services
affectingdeleted text endnew text begin as well as with other agencies and counties, to ensure that there is an understanding
of:
new text end

new text begin (i) the communication challenges faced by persons who arenew text end deaf,new text begin persons who arenew text end
deafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text beginpersonsdeleted text endnew text begin;
new text end

new text begin (ii) the best practices for accommodating and mitigating communication challenges;
and
new text end

new text begin (iii) the legal requirements for providing access to and effective communication with
persons who are deaf, persons who are deafblind, and persons who are hard-of-hearingnew text end; deleted text beginand
deleted text end

(3) deleted text beginprovide a coordinated system ofdeleted text endnew text begin assess the supply and demandnew text end statewide deleted text begininterpreting
ordeleted text endnew text begin fornew text end interpreter deleted text beginreferraldeleted text end servicesdeleted text begin.deleted text endnew text begin and real-time captioning services, implement strategies
to provide greater access to these services in areas without sufficient supply, and build the
base of service providers across the state;
new text end

new text begin (4) maintain a statewide information resource that includes contact information and
professional certification credentials of interpreting service providers and real-time captioning
service providers;
new text end

new text begin (5) provide culturally affirmative mental health services to persons who are deaf, persons
who are deafblind, and persons who are hard-of-hearing who:
new text end

new text begin (i) use a visual language such as American Sign Language or a tactile form of a language;
or
new text end

new text begin (ii) otherwise need culturally affirmative therapeutic services;
new text end

new text begin (6) research and develop best practices and recommendations for emerging issues;
new text end

new text begin (7) provide as much information as practicable on the division's stand-alone Web site
in American Sign Language; and
new text end

new text begin (8) report to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services biennially, beginning on January 1, 2019, on the following:
new text end

new text begin (i) the number of regional service center staff, the location of the office of each staff
person, other service providers with which they are colocated, the number of people served
by each staff person and a breakdown of whether each person was served on-site or off-site,
and for those served off-site, a list of locations where services were delivered and the number
who were served in-person and the number who were served via technology;
new text end

new text begin (ii) the amount and percentage of the division budget spent on reasonable
accommodations for staff;
new text end

new text begin (iii) the number of people who use demonstration equipment and consumer evaluations
of the experience;
new text end

new text begin (iv) the number of training sessions provided by division staff, the topics covered, the
number of participants, and consumer evaluations, including a breakdown by delivery
method such as in-person or via technology;
new text end

new text begin (v) the number of training sessions hosted at a division location provided by another
service provider, the topics covered, the number of participants, and consumer evaluations,
including a breakdown by delivery method such as in-person or via technology;
new text end

new text begin (vi) for each grant awarded, the amount awarded to the grantee and a summary of the
grantee's results, including consumer evaluations of the services or products provided;
new text end

new text begin (vii) the number of people on waiting lists for any services provided by division staff
or for services or equipment funded through grants awarded by the division;
new text end

new text begin (viii) the amount of time staff spent driving to appointments to deliver direct one-to-one
client services in locations outside of the regional service centers;
new text end

new text begin (ix) the amount spent on mileage reimbursement and the number of clients who received
mileage reimbursement for traveling to the regional service centers for services; and
new text end

new text begin (x) the regional needs and feedback on addressing service gaps identified by the advisory
committees.
new text end

Sec. 41.

Minnesota Statutes 2016, section 256C.24, subdivision 1, is amended to read:

Subdivision 1.

Location.

The Deaf and Hard-of-Hearing Services Division shall establish
deleted text begin up to eightdeleted text endnew text begin at least sixnew text end regional service centers fornew text begin persons who arenew text end deaf andnew text begin persons who
arenew text end hard-of-hearing deleted text beginpersonsdeleted text end. The centers shall be distributed regionally to provide access
fornew text begin persons who arenew text end deaf,new text begin persons who arenew text end deafblind, andnew text begin persons who arenew text end hard-of-hearing
deleted text begin personsdeleted text end in all parts of the state.

Sec. 42.

Minnesota Statutes 2016, section 256C.24, subdivision 2, is amended to read:

Subd. 2.

Responsibilities.

Each regional service center shall:

(1) deleted text beginserve as a central entry point fordeleted text endnew text begin establish connections and collaborations and explore
co-locating with other public and private entities providing services to persons who arenew text end
deaf,new text begin persons who arenew text end deafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text beginpersons in need of
services and make referrals to the services neededdeleted text endnew text begin in the regionnew text end;

new text begin (2) for those in need of services, assist in coordinating services between service providers
and persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing,
and the persons' families, and make referrals to the services needed;
new text end

deleted text begin (2)deleted text endnew text begin (3)new text end employ staff trained to work withnew text begin persons who arenew text end deaf,new text begin persons who arenew text end deafblind,
andnew text begin persons who arenew text end hard-of-hearing deleted text beginpersonsdeleted text end;

deleted text begin (3)deleted text endnew text begin (4) if adequate services are not available from another public or private service
provider in the region,new text end provide deleted text beginto alldeleted text endnew text begin individual assistance to persons who arenew text end deaf, new text beginpersons
who are new text enddeafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text beginpersons access to interpreter services
which are necessary to help them obtain servicesdeleted text endnew text begin, and the persons' familiesnew text endnew text begin. Individual
culturally affirmative assistance may be provided using technology only in areas of the state
where a person has access to sufficient quality telecommunications or broadband services
to allow effective communication. When a person who is deaf, a person who is deafblind,
or a person who is hard-of-hearing does not have access to sufficient telecommunications
or broadband service, individual assistance shall be available in personnew text end;

new text begin (5) identify regional training needs, work with deaf and hard-of-hearing services training
staff, and collaborate with others to deliver training for persons who are deaf, persons who
are deafblind, and persons who are hard-of-hearing, and the persons' families, and other
service providers about subjects including the persons' rights under the law, American Sign
Language, and the impact of hearing loss and options for accommodating it;
new text end

deleted text begin (4) implement a plan to provide loaned equipment and resource materials to deaf,
deafblind, and hard-of-hearingdeleted text end new text begin(6) have a mobile or permanent lab where new text endpersonsnew text begin who are
deaf, persons who are deafblind, and persons who are hard-of-hearing can try a selection
of modern assistive technology and equipment to determine what would best meet the
persons' needsnew text end;

deleted text begin (5) cooperate with responsible departments and administrative authorities to provide
access for deaf, deafblind, and hard-of-hearing persons to services provided by state, county,
and regional agencies;
deleted text end

deleted text begin (6)deleted text endnew text begin (7)new text end collaborate with the Resource Center for the Deaf and Hard-of-Hearing Persons,
other divisions of the Department of Educationdeleted text begin,deleted text end and local school districts to develop and
deliver programs and services for families with new text beginchildren who are new text enddeaf, new text beginchildren who are
new text end deafblind, or new text beginchildren who are new text endhard-of-hearing deleted text beginchildrendeleted text end and to support school personnel
serving these children;

deleted text begin (7) when possible,deleted text endnew text begin (8)new text end provide training to the social service or income maintenance staff
employed by counties or by organizations with whom counties contract for services to
ensure that communication barriers which preventnew text begin persons who arenew text end deaf, new text beginpersons who are
new text end deafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text beginpersonsdeleted text end from using services are removed;

deleted text begin (8) when possible,deleted text endnew text begin (9)new text end provide training to deleted text beginstate and regionaldeleted text end human service agenciesnew text begin in
the regionnew text end regarding program access for new text beginpersons who are new text enddeaf, new text beginpersons who are new text enddeafblind,
and new text beginpersons who are new text endhard-of-hearing deleted text beginpersonsdeleted text end; deleted text beginand
deleted text end

deleted text begin (9)deleted text endnew text begin (10)new text end assess the ongoing need and supply of services for new text beginpersons who are new text enddeaf, new text beginpersons
who are new text enddeafblind, and new text beginpersons who are new text endhard-of-hearing deleted text beginpersonsdeleted text end in all parts of the statenew text begin,
annually consult with the division's advisory committees to identify regional needs and
solicit feedback on addressing service gaps,new text end and cooperate with public and private service
providers to develop these servicesdeleted text begin.deleted text endnew text begin;
new text end

new text begin (11) provide culturally affirmative mental health services to persons who are deaf,
persons who are deafblind, and persons who are hard-of-hearing who:
new text end

new text begin (i) use a visual language such as American Sign Language or a tactile form of a language;
or
new text end

new text begin (ii) otherwise need culturally affirmative therapeutic services; and
new text end

new text begin (12) establish partnerships with state and regional entities statewide that have the
technological capacity to provide Minnesotans with virtual access to the division's services
and division-sponsored training via technology.
new text end

Sec. 43.

Minnesota Statutes 2016, section 256C.261, is amended to read:

256C.261 SERVICES FOR new text beginPERSONS WHO ARE new text endDEAFBLIND deleted text beginPERSONSdeleted text end.

(a) The commissioner of human services shall deleted text begincombine the existing biennial base level
funding for deafblind services into a single grant program. At least 35 percent of the total
funding is awarded for services and other supports to deafblind children and their families
and at least 25 percent is awarded for services and other supports to deafblind adults.deleted text endnew text begin use
at least 35 percent of the deafblind services biennial base level grant funding for services
and other supports for a child who is deafblind and the child's family. The commissioner
shall use at least 25 percent of the deafblind services biennial base level grant funding for
services and other supports for an adult who is deafblind.
new text end

The commissioner shall award grants for the purposes of:

(1) providing services and supports to deleted text beginindividualsdeleted text endnew text begin personsnew text end who are deafblind; and

(2) developing and providing training to counties and the network of senior citizen
service providers. The purpose of the training grants is to teach counties how to use existing
programs that capture federal financial participation to meet the needs of eligible new text beginpersons
who are new text enddeafblind deleted text beginpersonsdeleted text end and to build capacity of senior service programs to meet the
needs of seniors with a dual sensory hearing and vision loss.

(b) The commissioner may make grants:

(1) for services and training provided by organizations; and

(2) to develop and administer consumer-directed services.

new text begin (c) Consumer-directed services shall be provided in whole by grant-funded providers.
The deaf and hard-of-hearing regional service centers shall not provide any aspect of a
grant-funded consumer-directed services program.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end Any entity that is able to satisfy the grant criteria is eligible to receive a grant
under paragraph (a).

deleted text begin (d)deleted text endnew text begin (e)new text end Deafblind service providers may, but are not required to, provide intervenor
services as part of the service package provided with grant funds under this section.

Sec. 44. new text beginEXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
BUDGET METHODOLOGY EXCEPTION.
new text end

new text begin (a) No later than September 30, 2017, if necessary, the commissioner of human services
shall submit an amendment to the Centers for Medicare and Medicaid Services for the home
and community-based services waivers authorized under Minnesota Statutes, sections
256B.092 and 256B.49, to expand the exception to the consumer-directed community
supports budget methodology under Laws 2015, chapter 71, article 7, section 54, to provide
up to 30 percent more funds for either:
new text end

new text begin (1) consumer-directed community supports participants who have a coordinated service
and support plan which identifies the need for an increased amount of services or supports
under consumer-directed community supports than the amount they are currently receiving
under the consumer-directed community supports budget methodology:
new text end

new text begin (i) to increase the amount of time a person works or otherwise improves employment
opportunities;
new text end

new text begin (ii) to plan a transition to, move to, or live in a setting described in Minnesota Statutes,
section 256D.44, subdivision 5, paragraph (f), clause (1), item (ii), or paragraph (g); or
new text end

new text begin (iii) to develop and implement a positive behavior support plan; or
new text end

new text begin (2) home and community-based waiver participants who are currently using licensed
providers for (i) employment supports or services during the day; or (ii) residential services,
either of which cost more annually than the person would spend under a consumer-directed
community supports plan for any or all of the supports needed to meet the goals identified
in paragraph (a), clause (1), items (i), (ii), and (iii).
new text end

new text begin (b) The exception under paragraph (a), clause (1), is limited to those persons who can
demonstrate that they will have to discontinue using consumer-directed community supports
and accept other non-self-directed waiver services because their supports needed for the
goals described in paragraph (a), clause (1), items (i), (ii), and (iii), cannot be met within
the consumer-directed community supports budget limits.
new text end

new text begin (c) The exception under paragraph (a), clause (2), is limited to those persons who can
demonstrate that, upon choosing to become a consumer-directed community supports
participant, the total cost of services, including the exception, will be less than the cost of
current waiver services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The exception under this section is effective October 1, 2017, or
upon federal approval, whichever is later. Notwithstanding any other law to the contrary,
the exception in Laws 2016, chapter 144, section 1, remains in effect until the exception
under Laws 2015, chapter 71, article 7, section 54, or under this section becomes effective,
whichever occurs first. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 45.

new text begin CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
METHODOLOGY EXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
CRISIS RESIDENTIAL SETTINGS.
new text end

new text begin (a) By September 30, 2017, the commissioner shall establish an institutional and crisis
bed consumer-directed community supports budget exception process in the home and
community-based services waivers under Minnesota Statutes, sections 256B.092 and
256B.49. This budget exception process shall be available for any individual who:
new text end

new text begin (1) is not offered available and appropriate services within 60 days since approval for
discharge from the individual's current institutional setting; and
new text end

new text begin (2) requires services that are more expensive than appropriate services provided in a
noninstitutional setting using the consumer-directed community supports option.
new text end

new text begin (b) Institutional settings for purposes of this exception include intermediate care facilities
for persons with developmental disabilities; nursing facilities; acute care hospitals; Anoka
Metro Regional Treatment Center; Minnesota Security Hospital; and crisis beds. The budget
exception shall be limited to no more than the amount of appropriate services provided in
a noninstitutional setting as determined by the lead agency managing the individual's home
and community-based services waiver. The lead agency shall notify the Department of
Human Services of the budget exception.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 46. new text beginCONSUMER-DIRECTED COMMUNITY SUPPORTS REVISED BUDGET
METHODOLOGY REPORT.
new text end

new text begin (a) The commissioner of human services, in consultation with stakeholders and others
including representatives of lead agencies, home and community-based services waiver
participants using consumer-directed community supports, advocacy groups, state agencies,
the Institute on Community Integration at the University of Minnesota, and service and
financial management providers, shall develop a revised consumer-directed community
supports budget methodology. The new methodology shall be based on (1) the costs of
providing services as reflected by the wage and other relevant components incorporated in
the disability waiver rate formulas under Minnesota Statutes, chapter 256B, and (2)
state-to-county waiver-funding methodologies. The new methodology should develop
individual consumer-directed community supports budgets comparable to those provided
for similar needs individuals if paying for non-consumer-directed community supports
waiver services.
new text end

new text begin (b) By December 15, 2018, the commissioner shall report a revised consumer-directed
community supports budget methodology, including proposed legislation and funding
necessary to implement the new methodology, to the chairs and ranking minority members
of the house of representatives and senate committees with jurisdiction over health and
human services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 47. new text beginFEDERAL WAIVER AMENDMENTS.
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 waivers authorized under Minnesota Statutes, sections 256B.092
and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
community-based employment services from day training and habilitation and prevocational
services. The commissioner shall submit all necessary waiver amendments by October 1,
2017.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 48. new text beginTRANSPORTATION STUDY.
new text end

new text begin The commissioner of human services, with cooperation from lead agencies and in
consultation with stakeholders, shall conduct a study to identify opportunities to increase
access to transportation services for an individual who receives home and community-based
services. The commissioner shall submit a report with recommendations to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services by January 15, 2019. The report shall:
new text end

new text begin (1) study all aspects of the current transportation service network, including the fleet
available, the different rate-setting methods currently used, methods that an individual uses
to access transportation, and the diversity of available provider agencies;
new text end

new text begin (2) identify current barriers for an individual accessing transportation and for a provider
providing waiver services transportation in the marketplace;
new text end

new text begin (3) identify efficiencies and collaboration opportunities to increase available
transportation, including transportation funded by medical assistance, and available regional
transportation and transit options;
new text end

new text begin (4) study transportation solutions in other states for delivering home and community-based
services;
new text end

new text begin (5) study provider costs required to administer transportation services;
new text end

new text begin (6) make recommendations for coordinating and increasing transportation accessibility
across the state; and
new text end

new text begin (7) make recommendations for the rate setting of waivered transportation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 49. new text beginDIRECTION TO COMMISSIONER; TELECOMMUNICATION
EQUIPMENT PROGRAM.
new text end

new text begin The commissioner of human services shall work in consultation with the Commission
of Deaf, Deafblind, and Hard-of-Hearing Minnesotans to provide recommendations by
January 15, 2018, to the chairs and ranking minority members of the house of representatives
and senate committees with jurisdiction over human services to modernize the
telecommunication equipment program. The recommendations must address:
new text end

new text begin (1) types of equipment and supports the program should provide to ensure people with
communication difficulties have equitable access to telecommunications services;
new text end

new text begin (2) additional services the program should provide, such as education about technology
options that can improve a person's access to telecommunications services; and
new text end

new text begin (3) how the current program's service delivery structure might be improved to better
meet the needs of people with communication disabilities.
new text end

new text begin The commissioner shall also provide draft legislative language to accomplish the
recommendations. Final recommendations, the final report, and draft legislative language
must be approved by both the commissioner and the chair of the Commission of Deaf,
Deafblind, and Hard-of-Hearing Minnesotans.
new text end

Sec. 50. new text beginDIRECTION TO COMMISSIONER; BILLING FOR MENTAL HEALTH
SERVICES.
new text end

new text begin By January 1, 2018, the commissioner of human services shall report to the chairs and
ranking minority members of the house of representatives and senate committees with
jurisdiction over deaf and hard-of-hearing services on the potential costs and benefits of the
Deaf and Hard-of-Hearing Services Division billing for the cost of providing mental health
services.
new text end

Sec. 51. new text beginDIRECTION TO COMMISSIONER; MnCHOICES ASSESSMENT TOOL.
new text end

new text begin The commissioner of human services shall work with lead agencies responsible for
conducting long-term consultation services under Minnesota Statutes, section 256B.0911,
to modify the MnCHOICES assessment tool and related policies to:
new text end

new text begin (1) reduce assessment times;
new text end

new text begin (2) create efficiencies within the tool and within practice and policy for conducting
assessments and support planning;
new text end

new text begin (3) implement policy changes reducing the frequency and depth of assessment and
reassessment, while ensuring federal compliance with medical assistance and disability
waiver eligibility requirements; and
new text end

new text begin (4) evaluate alternative payment methods.
new text end

Sec. 52. new text beginRANDOM MOMENT TIME STUDY EVALUATION REQUIRED.
new text end

new text begin The commissioner of human services shall evaluate the random moment time study
methodology for reimbursement of costs associated with county duties required under
Minnesota Statutes, section 256B.0911. The study must determine whether random moment
is efficient and effective in supporting functions of assessment and support planning and
the purpose under Minnesota Statutes, section 256B.0911, subdivision 1. The commissioner
shall submit a report to the chairs and ranking minority members of the house of
representatives and senate committees with jurisdiction over health and human services by
January 15, 2019. The report must provide recommendations for changes to payment
methodologies and functions related to assessment, eligibility determination, and support
planning.
new text end

Sec. 53. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2016, sections 144A.351, subdivision 2; 256C.23, subdivision
3; 256C.233, subdivision 4; and 256C.25, subdivisions 1 and 2, new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2016, section 256B.4914, subdivision 16, new text end new text begin is repealed effective
January 1, 2018.
new text end

new text begin (c) new text end new text begin Laws 2012, chapter 247, article 4, section 47, as amended by Laws 2014, chapter
312, article 27, section 72, Laws 2015, chapter 71, article 7, section 58, Laws 2016, chapter
144, section 1; and Laws 2015, chapter 71, article 7, section 54, new text end new text begin are repealed upon the
effective date of section 44.
new text end

SF 800

Bill Text Versions

Current Version - 4th Engrossment

ARTICLE 1

COMMUNITY SUPPORTS

Section 1.

Subdivision 1.

Report requirements.

Sec. 2.

Subdivision 1.

Applicability.

new text begin EFFECTIVE DATE. new text end

Sec. 3.

Subd. 3.

Day training and habilitation services for adults with developmental disabilities.

new text begin EFFECTIVE DATE. new text end

Sec. 4.

new text begin [256.477] SELF-ADVOCACY GRANTS. new text end

Sec. 5.

Subd. 6a.

Home health services.

Sec. 6.

Subd. 31.

Medical supplies and equipment.

Sec. 7.

Subd. 2.

Definitions.

Sec. 8.

Subd. 3.

Home health aide visits.

Sec. 9.

Subd. 4.

Skilled nurse visit services.

Sec. 10.

Subd. 5.

Home care therapies.

Sec. 11.

Subd. 6.

Noncovered home health agency services.

Sec. 12.

new text begin Subd. 7. new text end

new text begin Face-to-face encounter. new text end

Sec. 13.

Subdivision 1.

Definitions.

new text begin EFFECTIVE DATE. new text end

Sec. 14.

Subd. 2.

Personal care assistance services; covered services.

new text begin EFFECTIVE DATE. new text end

Sec. 15.

Subd. 11.

Personal care assistant; requirements.

new text begin EFFECTIVE DATE. new text end

Sec. 16.

new text begin Subd. 17a. new text end

new text begin Rate for complex personal care assistance services. new text end

new text begin EFFECTIVE DATE. new text end

Sec. 17.

Subd. 21.

Requirements for provider enrollment of personal care assistance provider agencies.

Sec. 18.

Subd. 1a.

Definitions.

Sec. 19.

Subd. 2b.

MnCHOICES certified assessors.

Sec. 20.

new text begin Subd. 3f. new text end

new text begin Long-term care reassessments and community support plan updates. new text end

Sec. 21.

Subd. 4d.

Preadmission screening of individuals under 65 years of age.

Sec. 22.

Subd. 5.

Administrative activity.

Sec. 23.

256B.0921 HOME AND COMMUNITY-BASED SERVICES INCENTIVE POOL.

Sec. 24.

Subd. 4a.

Day training and habilitation services for adults with developmental
disabilities.

new text begin [256.477] SELF-ADVOCACY GRANTS.
new text end

Requirements for provider enrollment of personal care assistance provider
agencies.

new text begin Long-term care reassessments and community support plan updates.
new text end

Sec. 44. new text beginEXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
BUDGET METHODOLOGY EXCEPTION.
new text end

new text begin CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
METHODOLOGY EXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
CRISIS RESIDENTIAL SETTINGS.
new text end