SF 2158

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/19/2021 08:09am

A bill for an act
relating to human services; establish licensing standards for alternative adult day
services; establishing rates for alternative adult day services; extending the waiver
allowing remote delivery of adult day services; amending Minnesota Statutes 2020,
sections 245A.02, subdivisions 2a, 10; 256B.0913, subdivision 5; 256B.0922,
subdivision 1; 256B.4914, subdivisions 3, 5, 7; 256S.12, subdivision 1; 256S.215,
by adding subdivisions; Laws 2020, First Special Session chapter 7, section 1, as
amended; proposing coding for new law in Minnesota Statutes, chapter 245A.

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

Section 1.

Minnesota Statutes 2020, section 245A.02, subdivision 2a, is amended to read:

Subd. 2a.

Adult day care or family adult day services.

"Adult day care," "adult day
services," new text begin "alternative adult day services," new text end and "family adult day services" mean a program
operating less than 24 hours per day that provides functionally impaired adults with an
individualized and coordinated set of services including health services, social services, and
nutritional services that are directed at maintaining or improving the participants' capabilities
for self-care. Adult day care, adult day services, new text begin alternative adult day services, new text end and family
adult day services do not include programs where adults gather or congregate primarily for
purposes of socialization, education, supervision, caregiver respite, religious expression,
exercise, or nutritious meals.

Sec. 2.

Minnesota Statutes 2020, section 245A.02, subdivision 10, is amended to read:

Subd. 10.

Nonresidential program.

"Nonresidential program" means care, supervision,
rehabilitation, training or habilitation of a person provided outside the person's own home
and provided for fewer than 24 hours a day, including adult day care programs; and chemical
dependency or chemical abuse programs that are located in a nursing home or hospital and
receive public funds for providing chemical abuse or chemical dependency treatment services
under chapter 254B. Nonresidential programs include home and community-based services
for persons with disabilities or persons age 65 and older that are provided in or outside of
a person's own home under chapter 245D. new text begin Nonresidential programs include alternative adult
day services delivered remotely or in a person's home or residence under section 245A.1432.
new text end

Sec. 3.

new text begin [245A.1432] ALTERNATIVE ADULT DAY SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin A licensed adult day service provider may provide alternative
adult day services under the license holder's adult day services license if the license holder
meets the additional requirements of this section. Nothing in this section shall change
otherwise applicable adult day services licensing requirements under this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Alternative adult day services" means the following adult day services when delivered
remotely, via two-way interactive video or audio communication, or in person in the person's
home or residence:
new text end

new text begin (1) wellness checks and health-related services, including medication set-up and
administration overseen by a nurse;
new text end

new text begin (2) socialization and companionship;
new text end

new text begin (3) activities;
new text end

new text begin (4) meals delivered to the person's home;
new text end

new text begin (5) assistance with activities of daily living, including bathing; and
new text end

new text begin (6) individual support to family caregivers.
new text end

new text begin Subd. 3. new text end

new text begin Notice to commissioner required. new text end

new text begin Before delivering alternative adult day
services, a licensed adult day service provider must notify the commissioner of the license
holder's intention to provide alternative adult day services. The license holder must affirm
that the license holder will comply with the additional requirements of this section. The
commissioner shall determine the manner of notification and affirmation.
new text end

new text begin Subd. 4. new text end

new text begin Availability of facility director. new text end

new text begin The director of an adult day care facility
providing alternative adult day services must be available by telephone to all staff delivering
alternative adult day services at any time that staff are delivering alternative adult day
services.
new text end

new text begin Subd. 5. new text end

new text begin Service delivery records. new text end

new text begin A licensed adult day services program providing
alternative adult day services must maintain documentation of all alternative adult day
services delivered. The records must be accessible to the commissioner during the program's
hours of operation, must be completed on the actual day of service, and must include:
new text end

new text begin (1) the date of service;
new text end

new text begin (2) the first, middle, and last name of the person who receives services;
new text end

new text begin (3) the beginning and ending time of the service with a.m. and p.m. designations;
new text end

new text begin (4) the location of the service or method by which the service was delivered;
new text end

new text begin (5) a brief description of the service and the person's response to the service; and
new text end

new text begin (6) the full name of the staff person delivering the service.
new text end

new text begin Subd. 6. new text end

new text begin Service plans for alternative adult day services. new text end

new text begin Licensed adult day service
providers must review and revise, as needed, each person's service plan to reflect the delivery
of alternative adult day services.
new text end

new text begin Subd. 7. new text end

new text begin Training for alternative adult day services. new text end

new text begin Except as provided in subdivision
7a, in addition to meeting the training and orientation requirements for the provision of
adult day services, staff delivering alternative adult day services must receive:
new text end

new text begin (1) four hours of supervised orientation before working unsupervised with people who
receive alternative adult day services;
new text end

new text begin (2) orientation to the individual service plan for each person to whom the staff person
will deliver services;
new text end

new text begin (3) training related to the specific needs of each person to whom the staff person will
deliver services;
new text end

new text begin (4) training related to reporting and maintaining records of incidents; and
new text end

new text begin (5) written procedures governing medical emergencies, including identified sources of
emergency medical care and transportation.
new text end

new text begin A record of all training must be maintained at the adult day services facility.
new text end

new text begin Subd. 7a. new text end

new text begin First-aid and CPR training exemptions. new text end

new text begin Notwithstanding Minnesota Rules,
parts 9555.9650, item A, subitem (7), and 9555.9690, subpart 2, item C, the requirement
for basic first-aid and CPR training and documentation for staff providing alternative adult
day services is waived.
new text end

new text begin Subd. 8. new text end

new text begin Variances. new text end

new text begin The commissioner may grant a variance to any of the requirements
in this section if the conditions in section 245A.04, subdivision 9, are met.
new text end

Sec. 4.

Minnesota Statutes 2020, section 256B.0913, subdivision 5, is amended to read:

Subd. 5.

Services covered under alternative care.

Alternative care funding may be
used for payment of costs of:

(1) adult day services new text begin , alternative adult day services, new text end and adult day services bath;

(2) home care;

(3) homemaker services;

(4) personal care;

(5) case management and conversion case management;

(6) respite care;

(7) specialized supplies and equipment;

(8) home-delivered meals;

(9) nonmedical transportation;

(10) nursing services;

(11) chore services;

(12) companion services;

(13) nutrition services;

(14) family caregiver training and education;

(15) coaching and counseling;

(16) telehome care to provide services in their own homes in conjunction with in-home
visits;

(17) consumer-directed community supports under the alternative care programs which
are available statewide and limited to the average monthly expenditures representative of
all alternative care program participants for the same case mix resident class assigned in
the most recent fiscal year for which complete expenditure data is available;

(18) environmental accessibility and adaptations; and

(19) discretionary services, for which lead agencies may make payment from their
alternative care program allocation for services not otherwise defined in this section or
section 256B.0625, following approval by the commissioner.

Total annual payments for discretionary services for all clients served by a lead agency
must not exceed 25 percent of that lead agency's annual alternative care program base
allocation, except that when alternative care services receive federal financial participation
under the 1115 waiver demonstration, funding shall be allocated in accordance with
subdivision 17.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2020, section 256B.0922, subdivision 1, is amended to read:

Subdivision 1.

Essential community supports.

(a) The purpose of the essential
community supports program is to provide targeted services to persons age 65 and older
who need essential community support, but whose needs do not meet the level of care
required for nursing facility placement under section 144.0724, subdivision 11.

(b) Essential community supports are available not to exceed $400 per person per month.
Essential community supports may be used as authorized within an authorization period
not to exceed 12 months. Services must be available to a person who:

(1) is age 65 or older;

(2) is not eligible for medical assistance;

(3) has received a community assessment under section 256B.0911, subdivision 3a or
3b, and does not require the level of care provided in a nursing facility;

(4) meets the financial eligibility criteria for the alternative care program under section
256B.0913, subdivision 4;

(5) has a community support plan; and

(6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain their
community residence:

(i) adult day services new text begin and alternative adult day services new text end ;

(ii) caregiver support;

(iii) homemaker support;

(iv) chores;

(v) a personal emergency response device or system;

(vi) home-delivered meals; or

(vii) community living assistance as defined by the commissioner.

(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their community support plan.

(d) A person who has been determined to be eligible for essential community supports
must be reassessed at least annually and continue to meet the criteria in paragraph (b) to
remain eligible for essential community supports.

(e) The commissioner is authorized to use federal matching funds for essential community
supports as necessary and to meet demand for essential community supports as outlined in
subdivision 2, and that amount of federal funds is appropriated to the commissioner for this
purpose.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2020, 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 services new text begin , including alternative adult day services new text end ;

(3) adult day services bath;

(4) companion services;

(5) community residential services;

(6) customized living;

(7) day support services;

(8) day training and habilitation;

(9) employment development services;

(10) employment exploration services;

(11) employment support services;

(12) family residential services;

(13) housing access coordination;

(14) independent living skills;

(15) individualized home supports;

(16) individualized home supports with family training;

(17) individualized home supports with training;

(18) in-home family support;

(19) integrated community supports;

(20) night supervision;

(21) personal support;

(22) positive support services;

(23) prevocational services;

(24) residential support services;

(25) respite services;

(26) structured day services;

(27) supported living services;

(28) transportation services; and

(29) other services as approved by the federal government in the state home and
community-based services plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 7.

Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:

Subd. 5.

Base wage index and standard component values.

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

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

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);

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

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

(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

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

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

(10) for in-home family support and individualized home supports with family training
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);

(11) for individualized home supports with training 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);

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

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

(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);

(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);

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

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

(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

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

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

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

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

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

(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) general administrative support ratio: 13.25 percent;

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

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

(c) Component values for family foster care are:

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) general administrative support ratio: 3.3 percent;

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

(7) absence factor: 1.7 percent.

(d) Component values for day training and habilitation, day support services, and
prevocational services are:

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) program plan support ratio: 5.6 percent;

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

(7) general administrative support ratio: 13.25 percent;

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

(9) absence and utilization factor ratio: 9.4 percent.

(e) Component values for adult day services are:

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: 7.4 percent;

(7) general administrative support ratio: 13.25 percent;

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

(9) absence and utilization factor ratio: 9.4 percent.

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

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) program plan supports ratio: 15.5 percent;

(6) client programming and supports ratio: 4.7 percent;

(7) general administrative support ratio: 13.25 percent;

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

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

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

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) program plan support ratio: 7.0 percent;

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

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 2.9 percent; and

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

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

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) general administrative support ratio: 13.25 percent;

(6) program-related expense ratio: 2.9 percent; and

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

(i) On July 1, 2022, and every two years thereafter, the commissioner shall update the
base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.

(j) Beginning February 1, 2021, and every two years thereafter, the commissioner shall
report to the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over health and human services policy and finance an analysis of the
competitive workforce factor. The report must include recommendations to update the
competitive workforce factor using:

(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;

(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and

(3) workforce data as required under subdivision 10a, paragraph (g).

The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.

(k) On July 1, 2022, and every two years thereafter, the commissioner shall update the
framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); deleted text begin and deleted text end paragraph (g), clause (6); new text begin paragraph (o), clause (6); and paragraph (p),
clause (6); new text end subdivision 6, paragraphs (b), clauses (9) and (10), and (e), clause (10); and
subdivision 7, clauses (11), deleted text begin (17), and deleted text end new text begin (12), new text end (18), new text begin and (19), new text end 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 data available 30 months and one
day prior to the scheduled update. The commissioner shall publish these updated values
and load them into the rate management system.

(l) Upon the implementation of the updates under paragraphs (i) and (k), rate adjustments
authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108, article 7, section
60; and Laws 2014, chapter 312, article 27, section 75, shall be removed from service rates
calculated under this section.

(m) Any rate adjustments applied to the service rates calculated under this section outside
of the cost components and rate methodology specified in this section shall be removed
from rate calculations upon implementation of the updates under paragraphs (i) and (k).

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

new text begin (o) Component values for alternative adult day services delivered in person are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 7.4 percent;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

new text begin (p) Component values for alternative adult day services delivered remotely are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 7.4 percent;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:

Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day services, new text begin alternative adult day services delivered in person or remotely,
new text end day treatment and habilitation, day support services, 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) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);

(4) 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 (3);

(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;

(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21) deleted text begin ; deleted text end new text begin , except:
new text end

new text begin (i) for alternative adult day services delivered in person, multiply the number of day
direct staff hours by the product of the supervision span of control ratio in subdivision 5,
paragraph (o), clause (2), and the appropriate supervision wage in subdivision 5, paragraph
(a), clause (21); and
new text end

new text begin (ii) for alternative adult day services delivered remotely, multiply the number of day
direct staff hours by the product of the supervision span of control ratio in subdivision 5,
paragraph (p), clause (2), and the appropriate supervision wage in subdivision 5, paragraph
(a), clause (21);
new text end

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(3) deleted text begin . deleted text end new text begin , except:
new text end

new text begin (i) for alternative adult day services delivered in person, combine the results of clauses
(5) and (6), and multiply the result by one plus the employee vacation, sick, and training
allowance ratio in subdivision 5, paragraph (o), clause (3); and
new text end

new text begin (ii) for alternative adult day services delivered remotely, combine the results of clauses
(5) and (6), and multiply the result by one plus the employee vacation, sick, and training
allowance ratio in subdivision 5, paragraph (p), clause (3). new text end This is defined as the direct
staffing rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (5) deleted text begin ; deleted text end new text begin , except:
new text end

new text begin (i) for alternative adult day services delivered in person, for program plan support,
multiply the result of clause (7) by one plus the program plan support ratio in subdivision
5, paragraph (o), clause (5); and
new text end

new text begin (ii) for alternative adult day services delivered remotely, for program plan support,
multiply the result of clause (7) by one plus the program plan support ratio in subdivision
5, paragraph (p), clause (5);
new text end

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (4) deleted text begin ; deleted text end new text begin , except:
new text end

new text begin (i) for alternative adult day services delivered in person, for employee-related expenses,
multiply the result of clause (8) by one plus the employee-related cost ratio in subdivision
5, paragraph (o), clause (4); and
new text end

new text begin (ii) for alternative adult day services delivered remotely, for employee-related expenses,
multiply the result of clause (8) by one plus the employee-related cost ratio in subdivision
5, paragraph (p), clause (4);
new text end

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (6) deleted text begin ; deleted text end new text begin , except:
new text end

new text begin (i) for alternative adult day services delivered in person, for client programming and
supports, multiply the result of clause (9) by one plus the client programming and support
ratio in subdivision 5, paragraph (o), clause (6); and
new text end

new text begin (ii) for alternative adult day services delivered remotely, for client programming and
supports, multiply the result of clause (9) by one plus the client programming and support
ratio in subdivision 5, paragraph (p), clause (6);
new text end

(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs new text begin , including for alternative adult day services delivered in person new text end ;

(12) new text begin for fixed costs of delivering alternative adult day services remotely, add $19.30 per
week with consideration of staffing ratios to meet individual needs for services delivered
remotely only;
new text end

new text begin (13) new text end for adult day bath services, add $7.01 per 15 minute unit;

deleted text begin (13) deleted text end new text begin (14) new text end this is the subtotal rate;

deleted text begin (14) deleted text end new text begin (15) new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

deleted text begin (15) deleted text end new text begin (16) new text end divide the result of clause deleted text begin (13) deleted text end new text begin (14) new text end by one minus the result of clause deleted text begin (14) deleted text end new text begin (15) new text end .
This is the total payment amount;

deleted text begin (16) deleted text end new text begin (17) new text end adjust the result of clause deleted text begin (15) deleted text end new text begin (16) new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services;

deleted text begin (17) deleted text end new text begin (18) new text end for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

deleted text begin (18) deleted text end new text begin (19) new text end for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:

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

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

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 9.

Minnesota Statutes 2020, section 256S.12, subdivision 1, is amended to read:

Subdivision 1.

Adult day services authorization limits.

Adult day services new text begin , including
alternative adult day services, new text end may be authorized for up to 48 units, or 12 hours, per day
based on the needs of the participant and the participant's family caregivers.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 10.

Minnesota Statutes 2020, section 256S.215, is amended by adding a subdivision
to read:

new text begin Subd. 18. new text end

new text begin Alternative adult day services rate; delivered in person. new text end

new text begin The 15-minute
unit rate for alternative adult day services delivered in person, with an assumed staffing
ratio of one staff person to one participant, is the sum of:
new text end

new text begin (1) 1/16 of the home care aide services adjusted base wage, except that the general and
administrative factor used to determine the home care aide services adjusted base wage is
20 percent;
new text end

new text begin (2) one-fourth of the registered nurse management and supervision factor; and
new text end

new text begin (3) $0.63 to cover the cost of meals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 11.

Minnesota Statutes 2020, section 256S.215, is amended by adding a subdivision
to read:

new text begin Subd. 19. new text end

new text begin Alternative adult day services rate; delivered remotely. new text end

new text begin The 15-minute
unit rate for alternative adult day services delivered remotely, with an assumed staffing ratio
of one staff person to four participants, is the sum of:
new text end

new text begin (1) 1/16 of the home care aide services adjusted base wage, except that the general and
administrative factor used to determine the home care aide services adjusted base wage is
20 percent; and
new text end

new text begin (2) one-fourth of the registered nurse management and supervision factor.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 12.

Laws 2020, First Special Session chapter 7, section 1, subdivision 2, as amended
by Laws 2020, Third Special Session chapter 1, section 3, is amended to read:

Subd. 2.

Waivers and modifications; extension to June 30, 2021.

When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following waivers and modifications
to human services programs issued by the commissioner of human services pursuant to
Executive Orders 20-11 and 20-12, including any amendments to the waivers or modifications
issued before the peacetime emergency expires, shall remain in effect until June 30, 2021,
unless necessary federal approval is not received at any time for a waiver or modification:

(1) CV15: allowing phone or video visits for waiver programs;

(2) CV16: expanding access to telemedicine services for Children's Health Insurance
Program, Medical Assistance, and MinnesotaCare enrollees;

(3) CV21: allowing telemedicine alternative for school-linked mental health services
and intermediate school district mental health services;

(4) CV24: allowing phone or video use for targeted case management visits;

(5) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings;

(6) CV31: allowing partial waiver of county cost when COVID-19 delays discharges
from DHS-operated psychiatric hospitals;

(7) CV38: allowing flexibility in housing licensing requirements;

(8) CV43: expanding remote home and community-based services waiver services;

(9) deleted text begin CV44: allowing remote delivery of adult day services;
deleted text end

deleted text begin (10) deleted text end CV45: modifying certain licensing requirements for substance use disorder treatment,
except that the extension shall be limited to the portions of this modification requiring
programs to become and remain familiar with Minnesota Department of Health and Centers
for Disease Control and Prevention guidance on COVID-19; requiring programs to follow
Minnesota Department of Health and Centers for Disease Control and Prevention guidance
specific to the situation and program capabilities if a person receiving services or a staff
person tests positive for COVID-19; permitting programs to temporarily suspend group
counseling or limit attendance at sessions when unable to accommodate requirements for
social distancing and community mitigation; permitting comprehensive assessments to be
completed by telephone or video communication; permitting a counselor, recovery peer, or
treatment coordinator to provide treatment services from their home by telephone or video
communication to a client in their home; permitting programs to follow the Substance Abuse
and Mental Health Services Administration guidelines as directed by the State Opioid
Treatment Authority within the Department of Human Services Behavioral Health division
to allow for an increased number of take-home doses in accordance with an assessment
conducted under Minnesota Statutes, section 245G.22, subdivision 6; removing the
requirement for opioid treatment programs to conduct outreach activities in the community;
and permitting programs to document a client's verbal approval of a treatment plan instead
of requiring the client's signature;

deleted text begin (11) deleted text end new text begin (10) new text end CV49: modifying certain license requirements for adult day services;

deleted text begin (12) deleted text end new text begin (11) new text end CV50: modifying certain requirements for early intensive developmental and
behavioral intervention (EIDBI) services;

deleted text begin (13) deleted text end new text begin (12) new text end CV53: allowing flexibility for personal care assistance service oversight, except
that the portion of this modification permitting personal care assistance workers to bill 310
hours per month shall expire upon the expiration of the peacetime emergency;

deleted text begin (14) deleted text end new text begin (13) new text end CV64: modifying certain certification requirements for mental health centers,
except that the extension shall be limited to the portions of this modification requiring
programs to become and remain familiar with Minnesota Department of Health and Centers
for Disease Control and Prevention guidance on COVID-19; requiring programs to follow
Minnesota Department of Health and Centers for Disease Control and Prevention guidance
specific to the situation and program capabilities if a person receiving services or a staff
person tests positive for COVID-19; permitting alternative mental health professional
supervision of clinical services at satellite locations; permitting an alternative process for
case consultation meetings; and permitting mental health professionals to provide required
client-specific supervisory contact by telephone or video communication instead of
face-to-face supervision; and

deleted text begin (15) deleted text end new text begin (14) new text end CV03: suspending application requirements for economic assistance programs,
except that the extension shall be limited to the portions of this modification allowing remote
interviews for the Minnesota family investment program, and allowing the use of electronic
signatures for enrollment verification. Verbal signatures shall not be permitted for enrollment
verification.

new text begin EFFECTIVE DATE. new text end

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

Sec. 13.

Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Waivers and modifications; extension to June 30, 2022. new text end

new text begin When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the modification in CV44 allowing
remote delivery of adult day services issued by the commissioner of human services pursuant
to Executive Orders 20-11 and 20-12, including any amendments to the modification issued
before the peacetime emergency expires, shall remain in effect until June 30, 2022, unless
necessary federal approval is not received at any time.
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. 14. new text begin ESTABLISHMENT OF ALTERNATIVE ADULT DAY SERVICES RATES
AND RATE LIMITS.
new text end

new text begin The commissioner of human services shall establish under Minnesota Statutes, section
256S.15, subdivision 1, statewide service rates and service rate limits for alternative adult
day services provided under Minnesota Statutes, chapter 256S, and Minnesota Statutes,
sections 256B.0913 and 256B.0922. The commissioner shall set the rates and rate limits
for alternative adult day services, whether delivered remotely or in person, equal to the rates
and rate limits established under Minnesota Statutes, section 256S.15, for adult day services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end

Sec. 15. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the Senate Counsel, Research and Fiscal
Analysis Office, the House Research Department, and the commissioner of human services,
shall propose new legislation during the 2022 legislative session that recommends
renumbering the paragraphs of Minnesota Statutes, section 256B.4914, as subdivisions,
without changing the meaning or effect of these provisions, and minimizing the use of
internal cross-references, including by drafting new technical definitions as substitutes for
necessary cross-references or by other means acceptable to the commissioner of human
services.
new text end