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Capital IconMinnesota Legislature
Office of the Revisor of Statutes

SF 2934

2nd Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/18/2023 06:18pm

KEY: stricken = removed, old language.
underscored = added, new language.
Version List Authors and Status
Pdf Rtf
Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 2.1 2.2 2.3
2.4 2.5
2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34
3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31
6.32
7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32
7.33
8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 11.34 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10
12.11
12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23
14.24
14.25 14.26 14.27 14.28 14.29 14.30 14.31 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23
15.24 15.25 15.26 15.27 15.28 15.29 15.30 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 17.1 17.2
17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22
20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22
21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19
23.20 23.21 23.22
23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18
24.19 24.20 24.21
24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13
26.14 26.15 26.16
26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24
27.25 27.26 27.27
27.28 27.29 27.30 27.31 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11
28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26
30.27 30.28 30.29
31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15
32.16
32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 33.1 33.2 33.3 33.4
33.5
33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23
33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20
34.21 34.22 34.23
34.24 34.25 34.26 34.27 34.28 34.29 34.30 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27
35.28 35.29 35.30 35.31 35.32
36.1 36.2 36.3 36.4 36.5 36.6 36.7
36.8 36.9 36.10
36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8
37.9 37.10 37.11
37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24
38.25 38.26 38.27
38.28 38.29 38.30 38.31 38.32 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11
39.12 39.13 39.14
39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21
41.22 41.23 41.24
41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 42.1 42.2 42.3 42.4 42.5
42.6 42.7 42.8
42.9 42.10 42.11 42.12 42.13
42.14 42.15 42.16
42.17 42.18 42.19 42.20 42.21
42.22 42.23 42.24
42.25 42.26 42.27 42.28 42.29 42.30 42.31 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26
43.27 43.28 43.29
44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13
44.14 44.15 44.16
44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13
46.14 46.15 46.16
46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 48.1 48.2 48.3 48.4 48.5 48.6 48.7
48.8 48.9 48.10
48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16
49.17 49.18 49.19
49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 51.1 51.2
51.3 51.4 51.5
51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24
51.25
51.26 51.27 51.28 51.29 51.30 51.31 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16
52.17 52.18 52.19
52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 53.33 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13
54.14 54.15 54.16
54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6
55.7 55.8 55.9 55.10 55.11 55.12 55.13
55.14 55.15 55.16
55.17 55.18 55.19 55.20 55.21 55.22 55.23
55.24 55.25 55.26
55.27 55.28 55.29 55.30 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26
56.27 56.28 56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29
57.30 57.31 57.32
58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20
58.21 58.22 58.23
58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 60.1 60.2 60.3 60.4
60.5 60.6 60.7 60.8 60.9 60.10
60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9
61.10 61.11 61.12
61.13 61.14 61.15 61.16 61.17 61.18
61.19 61.20 61.21
61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22
62.23
62.24 62.25 62.26 62.27
62.28 62.29 62.30 62.31
63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10
63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 63.33
64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19
65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2
66.3 66.4 66.5 66.6
66.7 66.8 66.9
66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18
66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 67.1 67.2 67.3 67.4 67.5 67.6 67.7
67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23
67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31
68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27
68.28 68.29 68.30 68.31 69.1 69.2 69.3 69.4 69.5
69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16
70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 71.1 71.2 71.3 71.4 71.5 71.6
71.7
71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6 72.7
72.8 72.9
72.10 72.11 72.12
72.13 72.14
72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 74.34 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2
77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19
77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 80.1 80.2
80.3
80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8
81.9
81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30
82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 83.1 83.2 83.3 83.4 83.5 83.6 83.7
83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20
83.21
83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9
85.10
85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22
85.23
85.24 85.25 85.26 85.27 85.28 85.29
86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10
87.11
87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28
88.29
89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26
89.27 89.28 89.29
89.30 89.31 89.32 89.33 90.1 90.2
90.3
90.4 90.5 90.6 90.7 90.8 90.9
90.10
90.11 90.12 90.13 90.14 90.15 90.16
90.17
90.18 90.19 90.20 90.21 90.22 90.23
90.24
90.25 90.26 90.27 90.28 90.29 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11
91.12
91.13 91.14 91.15 91.16 91.17 91.18
91.19 91.20 91.21
91.22 91.23 91.24 91.25 91.26 91.27
91.28 91.29 91.30
92.1 92.2 92.3 92.4 92.5 92.6 92.7
92.8 92.9 92.10
92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25
92.26 92.27 92.28
92.29 92.30 92.31 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30
93.31 93.32 93.33
94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21
95.22 95.23
95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 96.1 96.2 96.3 96.4 96.5
96.6 96.7 96.8 96.9
96.10
96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14
97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28
97.29
98.1 98.2 98.3 98.4 98.5 98.6
98.7
98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 99.33 99.34 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 100.34 101.1 101.2
101.3
101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 103.1 103.2
103.3
103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15
103.16
103.17 103.18 103.19 103.20 103.21 103.22 103.23
103.24 103.25 103.26 103.27 103.28 104.1 104.2
104.3
104.4 104.5 104.6 104.7 104.8 104.9 104.10
104.11
104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19
104.20
104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28
105.1
105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10
105.11
105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19
105.20
105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 106.1
106.2
106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12
106.13
106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23
106.24
106.25 106.26 106.27 107.1 107.2 107.3 107.4 107.5 107.6
107.7
107.8 107.9 107.10 107.11 107.12 107.13
107.14
107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29
107.30
108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13
108.14
108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23
108.24 108.25 108.26 108.27 108.28 108.29 108.30 109.1 109.2
109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 111.1 111.2 111.3 111.4
111.5 111.6 111.7
111.8 111.9 111.10 111.11 111.12
111.13 111.14 111.15 111.16
111.17 111.18 111.19 111.20
111.21 111.22
111.23 111.24
111.25 111.26 111.27 111.28 111.29 111.30 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 112.34 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23
114.24 114.25 114.26 114.27 114.28 114.29 114.30
115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 115.34 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17
116.18 116.19 116.20
116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5 119.6 119.7
119.8 119.9 119.10
119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30
124.1 124.2 124.3
124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27
124.28 124.29 124.30
125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21
125.22
125.23 125.24 125.25 125.26 125.27 125.28 125.29
125.30
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19
126.20
126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13
127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12
128.13
128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 129.1 129.2 129.3 129.4 129.5
129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 131.34 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18
132.19 132.20
132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33
133.1 133.2 133.3 133.4 133.5 133.6
133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24
133.25 133.26 133.27 133.28 133.29
133.30
134.1 134.2 134.3 134.4 134.5 134.6 134.7
134.8
134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21
134.22
134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 135.33 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 137.1 137.2
137.3
137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25
137.26
137.27 137.28 137.29 137.30 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17
138.18
138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8
139.9
139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28
139.29
140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26
140.27
140.28 140.29 140.30 140.31 140.32 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17
141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2 142.3 142.4 142.5 142.6 142.7
142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 143.1 143.2 143.3
143.4
143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23
145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31
146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13
146.14 146.15 146.16 146.17 146.18 146.19
146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28
147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 147.33 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27
150.28 150.29 150.30 150.31 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27
151.28 151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14
155.15 155.16 155.17 155.18 155.19
155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 156.34 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16
158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 159.1
159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18
159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14
160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28
161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11
161.12 161.13 161.14 161.15
161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29
162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 162.33 162.34 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13
163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22
163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31
164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10
164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21
164.22
164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 165.1 165.2 165.3 165.4 165.5 165.6 165.7
165.8
165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22
165.23
165.24 165.25 165.26 165.27 165.28 165.29
166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12
166.13 166.14 166.15
166.16 166.17 166.18 166.19
166.20 166.21 166.22 166.23
166.24 166.25
166.26 166.27
166.28 166.29 166.30 166.31 167.1 167.2 167.3 167.4 167.5 167.6
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A bill for an act
 relating to human services; establishing an office of addiction and recovery;
establishing the Minnesota board of recovery services; establishing title protection
for sober homes; modifying provisions governing disability services, aging services,
and behavioral health; modifying medical assistance eligibility requirements for
certain populations; making technical and conforming changes; establishing certain
grants; requiring reports; appropriating money; amending Minnesota Statutes 2022,
sections 4.046, subdivisions 6, 7, by adding a subdivision; 179A.54, by adding a
subdivision; 241.021, subdivision 1; 241.31, subdivision 5; 241.415; 245A.03,
subdivision 7; 245A.11, subdivisions 7, 7a; 245G.01, by adding subdivisions;
245G.02, subdivision 2; 245G.05, subdivision 1, by adding a subdivision; 245G.06,
subdivisions 1, 3, 4, by adding subdivisions; 245G.08, subdivision 3; 245G.09,
subdivision 3; 245G.22, subdivision 15; 245I.10, subdivision 6; 246.54,
subdivisions 1a, 1b; 252.27, subdivision 2a; 254B.01, subdivision 8, by adding
subdivisions; 254B.04, by adding a subdivision; 254B.05, subdivisions 1, 5;
256.043, subdivisions 3, 3a; 256.9754; 256B.04, by adding a subdivision; 256B.056,
subdivision 3; 256B.057, subdivision 9; 256B.0625, subdivisions 17, 17a, 18h,
22, by adding a subdivision; 256B.0638, subdivisions 2, 4, 5; 256B.0659,
subdivisions 1, 12, 19, 24; 256B.073, subdivision 3, by adding a subdivision;
256B.0759, subdivision 2; 256B.0911, subdivision 13; 256B.0913, subdivisions
4, 5; 256B.0917, subdivision 1b; 256B.0922, subdivision 1; 256B.0949, subdivision
15; 256B.14, subdivision 2; 256B.434, by adding a subdivision; 256B.49,
subdivisions 11, 28; 256B.4905, subdivision 5a; 256B.4911, by adding a
subdivision; 256B.4912, by adding subdivisions; 256B.4914, subdivisions 3, as
amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by adding a subdivision;
256B.492; 256B.5012, by adding subdivisions; 256B.766; 256B.85, subdivision
7, by adding a subdivision; 256B.851, subdivisions 5, 6; 256I.05, by adding
subdivisions; 256M.42; 256R.02, subdivision 19; 256R.17, subdivision 2; 256R.25;
256R.47; 256R.481; 256R.53, by adding subdivisions; 256S.15, subdivision 2;
256S.18, by adding a subdivision; 256S.19, subdivision 3; 256S.203, subdivisions
1, 2; 256S.205, subdivisions 3, 5; 256S.21; 256S.2101, subdivisions 1, 2, by adding
subdivisions; 256S.211, by adding subdivisions; 256S.212; 256S.213; 256S.214;
256S.215, subdivisions 2, 3, 4, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17; Laws 2019,
chapter 63, article 3, section 1, as amended; Laws 2021, First Special Session
chapter 7, article 16, section 28, as amended; article 17, sections 16; 20; proposing
coding for new law in Minnesota Statutes, chapters 121A; 245; 245D; 254B; 256;
256I; 256S; 325F; repealing Minnesota Statutes 2022, sections 245G.05, subdivision
2; 246.18, subdivisions 2, 2a; 256B.0638, subdivisions 1, 2, 3, 4, 5, 6; 256B.0759,
subdivision 6; 256B.0917, subdivisions 1a, 6, 7a, 13; 256B.4914, subdivision 9a;
256S.19, subdivision 4.

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

ARTICLE 1

DISABILITY SERVICES

Section 1.

Minnesota Statutes 2022, section 179A.54, is amended by adding a subdivision
to read:


new text begin Subd. 11. new text end

new text begin Home Care Orientation Trust. new text end

new text begin (a) The state and an exclusive representative
certified pursuant to this section may establish a joint labor and management trust, referred
to as the Home Care Orientation Trust, for the exclusive purpose of rendering voluntary
orientation training to individual providers of direct support services who are represented
by the exclusive representative.
 new text end

new text begin (b) Financial contributions by the state to the Home Care Orientation Trust shall be made
by the state pursuant to a collective bargaining agreement negotiated under this section. All
such financial contributions by the state shall be held in trust for the purpose of paying,
from principal, from income, or from both, the costs associated with developing, delivering,
and promoting voluntary orientation training for individual providers of direct support
services working under a collective bargaining agreement and providing services through
a covered program under section 256B.0711. The Home Care Orientation Trust shall be
administered, managed, and otherwise controlled jointly by a board of trustees composed
of an equal number of trustees appointed by the state and trustees appointed by the exclusive
representative under this section. The trust shall not be an agent of either the state or of the
exclusive representative.
 new text end

new text begin (c) Trust administrative, management, legal, and financial services may be provided to
the board of trustees by a third-party administrator, financial management institution, other
appropriate entity, or any combination thereof, as designated by the board of trustees from
time to time, and those services shall be paid from the money held in trust and created by
the state's financial contributions to the Home Care Orientation Trust.
 new text end

new text begin (d) The state is authorized to purchase liability insurance for members of the board of
trustees appointed by the state.
 new text end

new text begin (e) Financial contributions to, participation in, or both contributions to and participation
in the administration, management, or both the administration and management of the Home
Care Orientation Trust shall not be considered an unfair labor practice under section 179A.13
or in violation of Minnesota law.
 new text end

Sec. 2.

Minnesota Statutes 2022, section 245A.03, subdivision 7, is amended to read:


Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a family child foster care home or family adult foster care home
license is issued during this moratorium, and the license holder changes the license holder's
primary residence away from the physical location of the foster care license, the
commissioner shall revoke the license according to section 245A.07. The commissioner
shall not issue an initial license for a community residential setting licensed under chapter
245D. When approving an exception under this paragraph, the commissioner shall consider
the resource need determination process in paragraph (h), the availability of foster care
licensed beds in the geographic area in which the licensee seeks to operate, the results of a
person's choices during their annual assessment and service plan review, and the
recommendation of the local county board. The determination by the commissioner is final
and not subject to appeal. Exceptions to the moratorium include:

(1) foster care settings where at least 80 percent of the residents are 55 years of age or
older;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);

(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;

(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital-level care;
deleted text begin or
deleted text end

(5) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49new text begin or elderly waiver plan
under chapter 256Snew text end and residing in the customized living setting deleted text begin before July 1, 2022,deleted text end for
which a license is required. A customized living service provider subject to this exception
may rebut the presumption that a license is required by seeking a reconsideration of the
commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until deleted text begin June 30deleted text end new text begin December 31new text end , 2023. This exception is available when:

(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people deleted text begin under the brain injury or community access for disability
inclusion waiver plans under section 256B.49deleted text end in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;

(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and

(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agencynew text begin ; or
new text end

new text begin (6) new foster care licenses or community residential setting licenses for a customized
living setting that is a single-family home in which customized living or 24-hour customized
living services were authorized and delivered on June 30, 2021, under the brain injury or
community access for disability inclusion waiver plans under section 256B.49 or the elderly
waiver under chapter 256S and for which a license is required. A customized living service
provider subject to this exception may rebut the presumption that a license is required by
seeking a reconsideration of the commissioner's determination. The commissioner's
disposition of a request for reconsideration is final and not subject to appeal under chapter
14. The exception is available for any eligible setting licensed as an assisted living facility
under chapter 144G on or after August 1, 2021, if the assisted living licensee applies for a
license under chapter 245D before December 31, 2023. The initial licensed capacity of the
setting under this exception must be four. This exception is available when:
 new text end

new text begin (i) the case manager of each resident of the customized living setting provided the person
with information about the choice of service, service provider, and location of service,
including in the person's home, to help the person make an informed choice about remaining
in the newly licensed setting; and
 new text end

new text begin (ii) the estimated average cost of services provided in the licensed foster care or
community residential setting is less than or equal to the estimated average cost of services
delivered in the customized living setting as determined by the lead agencynew text end .

(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.

(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.

(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.

(e) A resource need determination process, managed at the state level, using the available
data required by section 144A.351, and other data and information shall be used to determine
where the reduced capacity determined under section 256B.493 will be implemented. The
commissioner shall consult with the stakeholders described in section 144A.351, and employ
a variety of methods to improve the state's capacity to meet the informed decisions of those
people who want to move out of corporate foster care or community residential settings,
long-term service needs within budgetary limits, including seeking proposals from service
providers or lead agencies to change service type, capacity, or location to improve services,
increase the independence of residents, and better meet needs identified by the long-term
services and supports reports and statewide data and information.

(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.

(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.

(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493.

(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.

(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from July 1, 2021.
 new text end

Sec. 3.

Minnesota Statutes 2022, section 245A.11, subdivision 7, is amended to read:


Subd. 7.

Adult foster care; variance for alternate overnight supervision.

(a) The
commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
requiring a caregiver to be present in an adult foster care home during normal sleeping hours
to allow for alternative methods of overnight supervision. The commissioner may grant the
variance if the local county licensing agency recommends the variance and the county
recommendation includes documentation verifying that:

(1) the county has approved the license holder's plan for alternative methods of providing
overnight supervision and determined the plan protects the residents' health, safety, and
rights;

(2) the license holder has obtained written and signed informed consent from each
resident or each resident's legal representative documenting the resident's or legal
representative's agreement with the alternative method of overnight supervision; and

(3) the alternative method of providing overnight supervision, which may include the
use of technology, is specified for each resident in the resident's: (i) individualized plan of
care; (ii) individual service plan under section 256B.092, subdivision 1b, if required; or (iii)
individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart
19, if required.

(b) To be eligible for a variance under paragraph (a), the adult foster care license holder
must not have had a conditional license issued under section 245A.06, or any other licensing
sanction issued under section 245A.07 during the prior 24 months based on failure to provide
adequate supervision, health care services, or resident safety in the adult foster care home.

(c) A license holder requesting a variance under this subdivision to utilize technology
as a component of a plan for alternative overnight supervision may request the commissioner's
review in the absence of a county recommendation. Upon receipt of such a request from a
license holder, the commissioner shall review the variance request with the county.

(d) deleted text begin A variance granted by the commissioner according to this subdivision before January
1, 2014, to a license holder for an adult foster care home must transfer with the license when
the license converts to a community residential setting license under chapter 245D. The
terms and conditions of the variance remain in effect as approved at the time the variance
was granteddeleted text end new text begin The variance requirements under this subdivision for alternative overnight
supervision do not apply to community residential settings licensed under chapter 245Dnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 4.

Minnesota Statutes 2022, section 245A.11, subdivision 7a, is amended to read:


Subd. 7a.

Alternate overnight supervision technology; adult foster care deleted text begin and
community residential settingdeleted text end licenses.

(a) The commissioner may grant an applicant or
license holder an adult foster care deleted text begin or community residential settingdeleted text end license for a residence
that does not have a caregiver in the residence during normal sleeping hours as required
under Minnesota Rules, part 9555.5105, subpart 37, item B, or section 245D.02, subdivision
33b, but uses monitoring technology to alert the license holder when an incident occurs that
may jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
to 9555.6265, or applicable requirements under chapter 245D, and the requirements under
this subdivision. The license printed by the commissioner must state in bold and large font:

(1) that the facility is under electronic monitoring; and

(2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.

(b) Applications for a license under this section must be submitted directly to the
Department of Human Services licensing division. The licensing division must immediately
notify the county licensing agency. The licensing division must collaborate with the county
licensing agency in the review of the application and the licensing of the program.

(c) Before a license is issued by the commissioner, and for the duration of the license,
the applicant or license holder must establish, maintain, and document the implementation
of written policies and procedures addressing the requirements in paragraphs (d) through
(f).

(d) The applicant or license holder must have policies and procedures that:

(1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;

(2) explain the discharge process when a resident served by the program requires
overnight supervision or other services that cannot be provided by the license holder due
to the limited hours that the license holder is on site;

(3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on site, and
how the license holder's response plan meets the requirements in paragraph (e), clause (1)
or (2);

(4) establish a process for documenting a review of the implementation and effectiveness
of the response protocol for the response required under paragraph (e), clause (1) or (2).
The documentation must include:

(i) a description of the triggering incident;

(ii) the date and time of the triggering incident;

(iii) the time of the response or responses under paragraph (e), clause (1) or (2);

(iv) whether the response met the resident's needs;

(v) whether the existing policies and response protocols were followed; and

(vi) whether the existing policies and protocols are adequate or need modification.

When no physical presence response is completed for a three-month period, the license
holder's written policies and procedures must require a physical presence response drill to
be conducted for which the effectiveness of the response protocol under paragraph (e),
clause (1) or (2), will be reviewed and documented as required under this clause; and

(5) establish that emergency and nonemergency phone numbers are posted in a prominent
location in a common area of the home where they can be easily observed by a person
responding to an incident who is not otherwise affiliated with the home.

(e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of residents served by the program:

(1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on site to respond to the situation; or

(2) response alternative (2) requires the electronic notification and alert system under
alternative (1), but more than ten minutes may pass before the license holder is present on
site to respond to the situation. Under alternative (2), all of the following conditions are
met:

(i) the license holder has a written description of the interactive technological applications
that will assist the license holder in communicating with and assessing the needs related to
the care, health, and safety of the foster care recipients. This interactive technology must
permit the license holder to remotely assess the well being of the resident served by the
program without requiring the initiation of the foster care recipient. Requiring the foster
care recipient to initiate a telephone call does not meet this requirement;

(ii) the license holder documents how the remote license holder is qualified and capable
of meeting the needs of the foster care recipients and assessing foster care recipients' needs
under item (i) during the absence of the license holder on site;

(iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and

(iv) each resident's individualized plan of care, support plan under sections 256B.0913,
subdivision 8; 256B.092, subdivision 1b; 256B.49, subdivision 15; and 256S.10, if required,
or individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart
19, if required, identifies the maximum response time, which may be greater than ten minutes,
for the license holder to be on site for that resident.

(f) Each resident's placement agreement, individual service agreement, and plan must
clearly state that the adult foster care deleted text begin or community residential settingdeleted text end license category is
a program without the presence of a caregiver in the residence during normal sleeping hours;
the protocols in place for responding to situations that present a serious risk to the health,
safety, or rights of residents served by the program under paragraph (e), clause (1) or (2);
and a signed informed consent from each resident served by the program or the person's
legal representative documenting the person's or legal representative's agreement with
placement in the program. If electronic monitoring technology is used in the home, the
informed consent form must also explain the following:

(1) how any electronic monitoring is incorporated into the alternative supervision system;

(2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;

(3) how the caregivers or direct support staff are trained on the use of the technology;

(4) the event types and license holder response times established under paragraph (e);

(5) how the license holder protects each resident's privacy related to electronic monitoring
and related to any electronically recorded data generated by the monitoring system. A
resident served by the program may not be removed from a program under this subdivision
for failure to consent to electronic monitoring. The consent form must explain where and
how the electronically recorded data is stored, with whom it will be shared, and how long
it is retained; and

(6) the risks and benefits of the alternative overnight supervision system.

The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the person
giving consent, and the person giving consent is offered a copy.

(g) Nothing in this section requires the applicant or license holder to develop or maintain
separate or duplicative policies, procedures, documentation, consent forms, or individual
plans that may be required for other licensing standards, if the requirements of this section
are incorporated into those documents.

(h) The commissioner may grant variances to the requirements of this section according
to section 245A.04, subdivision 9.

(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
under section 245A.02, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.

(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to remotely
determine what action the license holder needs to take to protect the well-being of the foster
care recipient.

(k) The commissioner shall evaluate license applications using the requirements in
paragraphs (d) to (f). The commissioner shall provide detailed application forms, including
a checklist of criteria needed for approval.

(l) To be eligible for a license under paragraph (a), the adult foster care deleted text begin or community
residential settingdeleted text end license holder must not have had a conditional license issued under section
245A.06 or any licensing sanction under section 245A.07 during the prior 24 months based
on failure to provide adequate supervision, health care services, or resident safety in the
adult foster care home deleted text begin or community residential settingdeleted text end .

(m) The commissioner shall review an application for an alternative overnight supervision
license within 60 days of receipt of the application. When the commissioner receives an
application that is incomplete because the applicant failed to submit required documents or
that is substantially deficient because the documents submitted do not meet licensing
requirements, the commissioner shall provide the applicant written notice that the application
is incomplete or substantially deficient. In the written notice to the applicant, the
commissioner shall identify documents that are missing or deficient and give the applicant
45 days to resubmit a second application that is substantially complete. An applicant's failure
to submit a substantially complete application after receiving notice from the commissioner
is a basis for license denial under section 245A.05. The commissioner shall complete
subsequent review within 30 days.

(n) Once the application is considered complete under paragraph (m), the commissioner
will approve or deny an application for an alternative overnight supervision license within
60 days.

(o) For the purposes of this subdivision, "supervision" means:

(1) oversight by a caregiver or direct support staff as specified in the individual resident's
place agreement or support plan and awareness of the resident's needs and activities; and

(2) the presence of a caregiver or direct support staff in a residence during normal sleeping
hours, unless a determination has been made and documented in the individual's support
plan that the individual does not require the presence of a caregiver or direct support staff
during normal sleeping hours.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 5.

new text begin [245D.261] COMMUNITY RESIDENTIAL SETTINGS; REMOTE
OVERNIGHT SUPERVISION.
 new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Resident" means an adult residing in a community residential setting.
 new text end

new text begin (c) "Technology" means:
 new text end

new text begin (1) enabling technology, which is a device capable of live two-way communication or
engagement between a resident and direct support staff at a remote location; or
 new text end

new text begin (2) monitoring technology, which is the use of equipment to oversee, monitor, and
supervise an individual who receives medical assistance waiver or alternative care services
under section 256B.0913 or 256B.092, or chapter 256S.
 new text end

new text begin Subd. 2. new text end

new text begin Documentation of permissible remote overnight supervision. new text end

new text begin A license
holder providing remote overnight supervision in a community residential setting in lieu of
on-site direct support staff must comply with the requirements of this chapter, including
the requirement under section 245D.02, subdivision 33b, paragraph (a), clause (3), that the
absence of direct support staff from the community residential setting while services are
being delivered must be documented in the resident's support plan or support plan addendum.
 new text end

new text begin Subd. 3. new text end

new text begin Provider requirements for remote overnight supervision; commissioner
notification. new text end

new text begin (a) A license holder providing remote overnight supervision in a community
residential setting must:
 new text end

new text begin (1) use technology;
 new text end

new text begin (2) notify the commissioner of the community residential setting's intent to use technology
in lieu of on-site staff. The notification must:
 new text end

new text begin (i) indicate a start date for the use of technology; and
 new text end

new text begin (ii) attest that all requirements under this section are met and policies required under
subdivision 4 are available upon request;
 new text end

new text begin (3) clearly state in each person's support plan addendum that the community residential
setting is a program without the in-person presence of overnight direct support;
 new text end

new text begin (4) include with each person's support plan addendum the license holder's protocols for
responding to situations that present a serious risk to the health, safety, or rights of residents
served by the program; and
 new text end

new text begin (5) include in each person's support plan addendum the person's maximum permissible
response time as determined by the person's support team.
 new text end

new text begin (b) Upon being notified via technology that an incident has occurred that may jeopardize
the health, safety, or rights of a resident, the license holder must conduct an evaluation of
the need for the physical presence of a staff member. If a physical presence is needed, a
staff person, volunteer, or contractor must be on site to respond to the situation within the
resident's maximum permissible response time.
 new text end

new text begin (c) A license holder must notify the commissioner if remote overnight supervision
technology will no longer be used by the license holder.
 new text end

new text begin (d) Upon receipt of notification of use of remote overnight supervision or discontinuation
of use of remote overnight supervision by a license holder, the commissioner shall notify
the county licensing agency and update the license.
 new text end

new text begin Subd. 4. new text end

new text begin Required policies and procedures for remote overnight supervision. new text end

new text begin (a) A
license holder providing remote overnight supervision must have policies and procedures
that:
 new text end

new text begin (1) protect the residents' health, safety, and rights;
 new text end

new text begin (2) explain the discharge process if a person served by the program requires in-person
supervision or other services that cannot be provided by the license holder due to the limited
hours that direct support staff are on site;
 new text end

new text begin (3) explain the backup system for technology in times of electrical outages or other
equipment malfunctions;
 new text end

new text begin (4) explain how the license holder trains the direct support staff on the use of the
technology; and
 new text end

new text begin (5) establish a plan for dispatching emergency response personnel to the site in the event
of an identified emergency.
 new text end

new text begin (b) Nothing in this section requires the license holder to develop or maintain separate
or duplicative policies, procedures, documentation, consent forms, or individual plans that
may be required for other licensing standards if the requirements of this section are
incorporated into those documents.
 new text end

new text begin (c) When no physical presence response is completed for a three-month period, the
license holder must conduct a physical presence response drill. The effectiveness of the
response protocol must be reviewed and documented.
 new text end

new text begin Subd. 5. new text end

new text begin Consent to use of monitoring technology. new text end

new text begin If a license holder uses monitoring
technology in a community residential setting, the license holder must obtain a signed
informed consent form from each resident served by the program or the resident's legal
representative documenting the resident's or legal representative's agreement to use of the
specific monitoring technology used in the setting. The informed consent form documenting
this agreement must also explain:
 new text end

new text begin (1) how the license holder uses monitoring technology to provide remote supervision;
 new text end

new text begin (2) the risks and benefits of using monitoring technology;
 new text end

new text begin (3) how the license holder protects each resident's privacy while monitoring technology
is being used in the setting; and
 new text end

new text begin (4) how the license holder protects each resident's privacy when the monitoring
technology system electronically records personally identifying data.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 6.

new text begin [256.4761] PROVIDER CAPACITY GRANTS FOR RURAL AND
UNDERSERVED COMMUNITIES.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment and authority. new text end

new text begin (a) The commissioner of human services
shall award grants to organizations that provide community-based services to rural or
underserved communities. The grants must be used to build organizational capacity to
provide home and community-based services in the state and to build new or expanded
infrastructure to access medical assistance reimbursement.
 new text end

new text begin (b) The commissioner shall conduct community engagement, provide technical assistance,
and establish a collaborative learning community related to the grants available under this
section and shall work with the commissioner of management and budget and the
commissioner of the Department of Administration to mitigate barriers in accessing grant
money.
 new text end

new text begin (c) The commissioner shall limit expenditures under this subdivision to the amount
appropriated for this purpose.
 new text end

new text begin (d) The commissioner shall give priority to organizations that provide culturally specific
and culturally responsive services or that serve historically underserved communities
throughout the state.
 new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin An eligible applicant for the capacity grants under subdivision 1 is
an organization or provider that serves, or will serve, rural or underserved communities
and:
 new text end

new text begin (1) provides, or will provide, home and community-based services in the state; or
 new text end

new text begin (2) serves, or will serve, as a connector for communities to available home and
community-based services.
 new text end

new text begin Subd. 3. new text end

new text begin Allowable grant activities. new text end

new text begin Grants under this section must be used by recipients
for the following activities:
 new text end

new text begin (1) expanding existing services;
 new text end

new text begin (2) increasing access in rural or underserved areas;
 new text end

new text begin (3) creating new home and community-based organizations;
 new text end

new text begin (4) connecting underserved communities to benefits and available services; or
 new text end

new text begin (5) building new or expanded infrastructure to access medical assistance reimbursement.
 new text end

Sec. 7.

new text begin [256.4762] LONG-TERM CARE WORKFORCE GRANTS FOR NEW
AMERICANS.
 new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For the purposes of this section, "new American" means an
individual born abroad and the individual's children, irrespective of immigration status.
 new text end

new text begin Subd. 2. new text end

new text begin Grant program established. new text end

new text begin The commissioner of human services shall
establish a grant program for organizations that support immigrants, refugees, and new
Americans interested in entering the long-term care workforce.
 new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) The commissioner shall select projects for funding under this
section. An eligible applicant for the grant program in subdivision 1 is an:
 new text end

new text begin (1) organization or provider that is experienced in working with immigrants, refugees,
and people born outside of the United States and that demonstrates cultural competency;
or
 new text end

new text begin (2) organization or provider with the expertise and capacity to provide training, peer
mentoring, supportive services, and workforce development or other services to develop
and implement strategies for recruiting and retaining qualified employees.
 new text end

new text begin (b) The commissioner shall prioritize applications from joint labor management programs.
 new text end

new text begin Subd. 4. new text end

new text begin Allowable grant activities. new text end

new text begin (a) Money allocated under this section must be
used to:
 new text end

new text begin (1) support immigrants, refugees, or new Americans to obtain or maintain employment
in the long-term care workforce;
 new text end

new text begin (2) develop connections to employment with long-term care employers and potential
employees;
 new text end

new text begin (3) provide recruitment, training, guidance, mentorship, and other support services
necessary to encourage employment, employee retention, and successful community
integration;
 new text end

new text begin (4) provide career education, wraparound support services, and job skills training in
high-demand health care and long-term care fields;
 new text end

new text begin (5) pay for program expenses, including but not limited to hiring instructors and
navigators, space rentals, and supportive services to help participants attend classes.
Allowable uses for supportive services include but are not limited to:
 new text end

new text begin (i) course fees;
 new text end

new text begin (ii) child care costs;
 new text end

new text begin (iii) transportation costs;
 new text end

new text begin (iv) tuition fees;
 new text end

new text begin (v) financial coaching fees;
 new text end

new text begin (vi) mental health supports; or
 new text end

new text begin (vii) uniforms costs incurred as a direct result of participating in classroom instruction
or training; or
 new text end

new text begin (6) repay student loan debt directly incurred as a result of pursuing a qualifying course
of study or training.
 new text end

Sec. 8.

new text begin [256.4764] HOME AND COMMUNITY-BASED WORKFORCE INCENTIVE
FUND GRANTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Grant program established. new text end

new text begin The commissioner of human services shall
establish grants for disability and home and community-based providers to assist with
recruiting and retaining direct support and frontline workers.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (b) "Commissioner" means the commissioner of human services.
 new text end

new text begin (c) "Eligible employer" means an organization enrolled in a Minnesota health care
program or providing housing services and that is:
 new text end

new text begin (1) a provider of home and community-based services under chapter 245D; or
 new text end

new text begin (2) a facility certified as an intermediate care facility for persons with developmental
disabilities.
 new text end

new text begin (d) "Eligible worker" means a worker who earns $30 per hour or less and is currently
employed or recruited to be employed by an eligible employer.
 new text end

new text begin Subd. 3. new text end

new text begin Allowable uses of grant money. new text end

new text begin (a) Grantees must use grant money to provide
payments to eligible workers for the following purposes:
 new text end

new text begin (1) retention, recruitment, and incentive payments;
 new text end

new text begin (2) postsecondary loan and tuition payments;
 new text end

new text begin (3) child care costs;
 new text end

new text begin (4) transportation-related costs; and
 new text end

new text begin (5) other costs associated with retaining and recruiting workers, as approved by the
commissioner.
 new text end

new text begin (b) Eligible workers may receive payments up to $1,000 per year from the home and
community-based workforce incentive fund.
 new text end

new text begin (c) The commissioner must develop a grant cycle distribution plan that allows for
equitable distribution of money among eligible employers. The commissioner's determination
of the grant awards and amounts is final and is not subject to appeal.
 new text end

new text begin Subd. 4. new text end

new text begin Attestation. new text end

new text begin As a condition of obtaining grant payments under this section, an
eligible employer must attest and agree to the following:
 new text end

new text begin (1) the employer is an eligible employer;
 new text end

new text begin (2) the total number of eligible employees;
 new text end

new text begin (3) the employer will distribute the entire value of the grant to eligible workers, as
allowed under this section;
 new text end

new text begin (4) the employer will create and maintain records under subdivision 6;
 new text end

new text begin (5) the employer will not use the money appropriated under this section for any purpose
other than the purposes permitted under this section; and
 new text end

new text begin (6) the entire value of any grant amounts will be distributed to eligible workers identified
by the employer.
 new text end

new text begin Subd. 5. new text end

new text begin Audits and recoupment. new text end

new text begin (a) The commissioner may perform an audit under
this section up to six years after a grant is awarded to ensure:
 new text end

new text begin (1) the grantee used the money solely for allowable purposes under subdivision 3;
 new text end

new text begin (2) the grantee was truthful when making attestations under subdivision 4; and
 new text end

new text begin (3) the grantee complied with the conditions of receiving a grant under this section.
 new text end

new text begin (b) If the commissioner determines that a grantee used grant money for purposes not
authorized under this section, the commissioner must treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner must recover any
overpayment.
 new text end

new text begin Subd. 6. new text end

new text begin Payments not to be considered income. new text end

new text begin (a) For the purposes of this subdivision,
"subtraction" has the meaning given in section 290.0132, subdivision 1, paragraph (a), and
the rules in that subdivision apply to this subdivision. The definitions in section 290.01
apply to this subdivision.
 new text end

new text begin (b) The amount of a payment received under this section is a subtraction.
 new text end

new text begin (c) Payments under this section are excluded from income, as defined in sections
290.0674, subdivision 2a, and 290A.03, subdivision 3.
 new text end

new text begin (d) Notwithstanding any law to the contrary, payments under this section must not be
considered income, assets, or personal property for purposes of determining eligibility or
recertifying eligibility for:
 new text end

new text begin (1) child care assistance programs under chapter 119B;
 new text end

new text begin (2) general assistance, Minnesota supplemental aid, and food support under chapter
256D;
 new text end

new text begin (3) housing support under chapter 256I;
 new text end

new text begin (4) the Minnesota family investment program and diversionary work program under
chapter 256J; and
 new text end

new text begin (5) economic assistance programs under chapter 256P.
 new text end

new text begin (e) The commissioner must not consider payments under this section as income or assets
under section 256B.056, subdivision 1a, paragraph (a), 3, or 3c, or for persons with eligibility
determined under section 256B.057, subdivision 3, 3a, or 3b.
 new text end

Sec. 9.

new text begin [256.4771] SUPPORTED-DECISION-MAKING PROGRAMS.
 new text end

new text begin Subdivision 1. new text end

new text begin Authorization. new text end

new text begin The commissioner of human services shall award general
operating grants to public and private nonprofit organizations, counties, and Tribes to provide
and promote supported decision making.
 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 terms in this section have
the meanings given.
 new text end

new text begin (b) "Supported decision making" has the meaning given in section 524.5-102, subdivision
16a.
 new text end

new text begin (c) "Supported-decision-making services" means services provided to help an individual
consider, access, or develop supported decision making, potentially as an alternative to
more restrictive forms of decision making, including guardianship and conservatorship.
The services may be provided to the individual, family members, or trusted support people.
The individual may currently be a person subject to guardianship or conservatorship, but
the services must not be used to help a person access a guardianship or conservatorship.
 new text end

new text begin Subd. 3. new text end

new text begin Grants. new text end

new text begin (a) The grants must be distributed as follows:
 new text end

new text begin (1) at least 75 percent of the grant money must be used to fund programs or organizations
that provide supported-decision-making services;
 new text end

new text begin (2) no more than 20 percent of the grant money may be used to fund county or Tribal
programs that provide supported-decision-making services; and
 new text end

new text begin (3) no more than five percent of the grant money may be used to fund programs or
organizations that do not provide supported-decision-making services but do promote the
use and advancement of supported decision making.
 new text end

new text begin (b) The grants must be distributed in a manner to promote racial and geographic diversity
in the populations receiving services as determined by the commissioner.
 new text end

new text begin Subd. 4. new text end

new text begin Evaluation and report. new text end

new text begin By December 1, 2024, the commissioner must submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services finance Next and policy an interim report on the impact and outcomes of
the grants, including the number of grants awarded and the organizations receiving the
grants. The interim report must include any available evidence of how grantees were able
to increase utilization of supported decision making and reduce or avoid more restrictive
forms of decision making such as guardianship and conservatorship. By December 1, 2025,
the commissioner must submit to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services Previous finance Next and policy a final report on the
impact and outcomes of the grants, including any updated information from the interim
report and the total number of people served by the grants. The final report must also detail
how the money was used to achieve the requirements in subdivision 3, paragraph (b).
 new text end

new text begin Subd. 5. new text end

new text begin Applications. new text end

new text begin Any public or private nonprofit agency may apply to the
commissioner for a grant under subdivision 3, paragraph (a), clause (1) or (3). Any county
or Tribal agency in Minnesota may apply to the commissioner for a grant under subdivision
3, paragraph (a), clause (2). The application must be submitted in a form approved by the
commissioner.
 new text end

new text begin Subd. 6. new text end

new text begin Duties of grantees. new text end

new text begin Every public or private nonprofit agency, county, or Tribal
agency that receives a grant to provide or promote supported decision making must comply
with rules related to the administration of the grants.
 new text end

Sec. 10.

new text begin [256.4773] TECHNOLOGY FOR HOME GRANT.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner must establish a technology for home
grant program that provides assistive technology consultations and resources for people
with disabilities who want to stay in their own home, move to their own home, or remain
in a less restrictive residential setting. The grant program may be administered using a team
approach that allows multiple professionals to assess and meet a person's assistive technology
needs. The team may include but is not limited to occupational therapists, physical therapists,
speech therapists, nurses, and engineers.
 new text end

new text begin Subd. 2. new text end

new text begin Eligible applicants. new text end

new text begin An eligible applicant is a person who uses or is eligible
for home care services under section 256B.0651, home and community-based services under
section 256B.092 or 256B.49, personal care assistance under section 256B.0659, or
community first services and supports under section 256B.85, and who meets one of the
following conditions:
 new text end

new text begin (1) lives in the applicant's own home and may benefit from assistive technology for
safety, communication, community engagement, or independence;
 new text end

new text begin (2) is currently seeking to live in the applicant's own home and needs assistive technology
to meet that goal; or
 new text end

new text begin (3) resides in a residential setting under section 256B.4914, subdivision 3, and is seeking
to reduce reliance on paid staff to live more independently in the setting.
 new text end

new text begin Subd. 3. new text end

new text begin Allowable grant activities. new text end

new text begin The technology for home grant program must
provide at-home, in-person assistive technology consultation and technical assistance to
help people with disabilities live more independently. Allowable activities include but are
not limited to:
 new text end

new text begin (1) consultations in people's homes, workplaces, or community locations;
 new text end

new text begin (2) connecting people to resources to help them live in their own homes, transition to
their own homes, or live more independently in residential settings;
 new text end

new text begin (3) conducting training for and set up and installation of assistive technology; and
 new text end

new text begin (4) participating on a person's care team to develop a plan to ensure assistive technology
goals are met.
 new text end

new text begin Subd. 4. new text end

new text begin Data collection and outcomes. new text end

new text begin Grantees must provide data summaries to the
commissioner for the purpose of evaluating the effectiveness of the grant program. The
commissioner must identify outcome measures to evaluate program activities to assess
whether the grant programs help people transition to or remain in the least restrictive setting.
 new text end

Sec. 11.

Minnesota Statutes 2022, 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 (r) 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 deleted text begin towardsdeleted text end new text begin towardnew text end 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.

(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

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

(g) "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 chapter 256S and sections 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.

(h) "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.

(i) "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.new text begin For purposes of this paragraph, traveling
includes driving and accompanying the recipient in the recipient's chosen mode of
transportation and according to the recipient's personal care assistance care plan.
new text end

(j) "Managing employee" has the same definition as Code of Federal Regulations, title
42, section 455.

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

(l) "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.

(m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

(n) "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.

(o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.

(p) "Self-administered medication" means medication taken orally, by injection, nebulizer,
or insertion, or applied topically without the need for assistance.

(q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.

(r) "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 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 12.

Minnesota Statutes 2022, section 256B.0659, subdivision 12, is amended to read:


Subd. 12.

Documentation of personal care assistance services provided.

(a) Personal
care assistance services for a recipient must be documented daily by each personal care
assistant, on a time sheet form approved by the commissioner. All documentation may be
web-based, electronic, or paper documentation. The completed form must be submitted on
a monthly basis to the provider and kept in the recipient's health record.

(b) The activity documentation must correspond to the personal care assistance care plan
and be reviewed by the qualified professional.

(c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:

(1) full name of personal care assistant and individual provider number;

(2) provider name and telephone numbers;

(3) full name of recipient and either the recipient's medical assistance identification
number or date of birth;

(4) consecutive dates, including month, day, and year, and arrival and departure times
with a.m. or p.m. notations;

(5) signatures of recipient or the responsible party;

(6) personal signature of the personal care assistant;

(7) any shared care provided, if applicable;

(8) a statement that it is a federal crime to provide false information on personal care
service billings for medical assistance payments; deleted text begin and
deleted text end

(9) dates and location of recipient stays in a hospital, care facility, or incarcerationnew text begin ; and
new text end

new text begin (10) any time spent traveling, as described in subdivision 1, paragraph (i), including
start and stop times with a.m. and p.m. designations, the origination site, and the destination
sitenew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 13.

Minnesota Statutes 2022, section 256B.0659, subdivision 19, is amended to read:


Subd. 19.

Personal care assistance choice option; qualifications; duties.

(a) Under
personal care assistance choice, the recipient or responsible party shall:

(1) recruit, hire, schedule, and terminate personal care assistants according to the terms
of the written agreement required under subdivision 20, paragraph (a);

(2) develop a personal care assistance care plan based on the assessed needs and
addressing the health and safety of the recipient with the assistance of a qualified professional
as needed;

(3) orient and train the personal care assistant with assistance as needed from the qualified
professional;

(4) supervise and evaluate the personal care assistant with the qualified professional,
who is required to visit the recipient at least every 180 days;

(5) monitor and verify in writing and report to the personal care assistance choice agency
the number of hours worked by the personal care assistant and the qualified professional;

(6) engage in an annual reassessment as required in subdivision 3a to determine
continuing eligibility and service authorization; deleted text begin and
deleted text end

(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being useddeleted text begin .deleted text end new text begin ; and
new text end

new text begin (8) ensure that a personal care assistant driving the recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota law.
 new text end

(b) The personal care assistance choice provider agency shall:

(1) meet all personal care assistance provider agency standards;

(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;

(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
care assistant; and

(4) ensure arm's-length transactions without undue influence or coercion with the recipient
and personal care assistant.

(c) The duties of the personal care assistance choice provider agency are to:

(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including but not limited to purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including but not
limited to workers' compensation, unemployment insurance, and labor market data required
under section 256B.4912, subdivision 1a;

(2) bill the medical assistance program for personal care assistance services and qualified
professional services;

(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;

(4) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(5) withhold and pay all applicable federal and state taxes;

(6) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;

(8) enroll in the medical assistance program as a personal care assistance choice agency;
and

(9) enter into a written agreement as specified in subdivision 20 before services are
provided.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 14.

Minnesota Statutes 2022, section 256B.0659, subdivision 24, is amended to read:


Subd. 24.

Personal care assistance provider agency; general duties.

A personal care
assistance provider agency shall:

(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;

(2) comply with general medical assistance coverage requirements;

(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;

(4) comply with background study requirements;

(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;

(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(8) withhold and pay all applicable federal and state taxes;

(9) document that the agency uses a minimum of 72.5 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits. The revenue generated by the qualified professional and
the reasonable costs associated with the qualified professional shall not be used in making
this calculation;

(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(11) enter into a written agreement under subdivision 20 before services are provided;

(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;

(13) provide the recipient with a copy of the home care bill of rights at start of service;

(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissioner;

(15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; deleted text begin and
deleted text end

(16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements
under subdivision 11, paragraph (d)new text begin ; and
new text end

new text begin (17) ensure that a personal care assistant driving a recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota lawnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 15.

Minnesota Statutes 2022, section 256B.0911, subdivision 13, is amended to read:


Subd. 13.

MnCHOICES assessor qualifications, training, and certification.

(a) The
commissioner shall develop and implement a curriculum and an assessor certification
process.

(b) MnCHOICES certified assessors must:

(1) either have a bachelor's degree in social work, nursing with a public health nursing
certificate, or other closely related field deleted text begin with at least one year of home and community-based
experiencedeleted text end or be a registered nurse with at least two years of home and community-based
experience; and

(2) have received training and certification specific to assessment and consultation for
long-term care services in the state.

(c) Certified assessors shall demonstrate best practices in assessment and support
planning, including person-centered planning principles, and have a common set of skills
that ensures consistency and equitable access to services statewide.

(d) Certified assessors must be recertified every three years.

Sec. 16.

Minnesota Statutes 2022, section 256B.0949, subdivision 15, is amended to read:


Subd. 15.

EIDBI provider qualifications.

(a) A QSP must be employed by an agency
and be:

(1) a licensed mental health professional who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child
development; or

(2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and
typical child development.

(b) A level I treatment provider must be employed by an agency and:

(1) have at least 2,000 hours of supervised clinical experience or training in examining
or treating people with ASD or a related condition or equivalent documented coursework
at the graduate level by an accredited university in ASD diagnostics, ASD developmental
and behavioral treatment strategies, and typical child development or an equivalent
combination of documented coursework or hours of experience; and

(2) have or be at least one of the following:

(i) a master's degree in behavioral health or child development or related fields including,
but not limited to, mental health, special education, social work, psychology, speech
pathology, or occupational therapy from an accredited college or university;

(ii) a bachelor's degree in a behavioral health, child development, or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy, from an accredited college or university, and
advanced certification in a treatment modality recognized by the department;

(iii) a board-certified behavior analyst; or

(iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical
experience that meets all registration, supervision, and continuing education requirements
of the certification.

(c) A level II treatment provider must be employed by an agency and must be:

(1) a person who has a bachelor's degree from an accredited college or university in a
behavioral or child development science or related field including, but not limited to, mental
health, special education, social work, psychology, speech pathology, or occupational
therapy; and meets at least one of the following:

(i) has at least 1,000 hours of supervised clinical experience or training in examining or
treating people with ASD or a related condition or equivalent documented coursework at
the graduate level by an accredited university in ASD diagnostics, ASD developmental and
behavioral treatment strategies, and typical child development or a combination of
coursework or hours of experience;

(ii) has certification as a board-certified assistant behavior analyst from the Behavior
Analyst Certification Board;

(iii) is a registered behavior technician as defined by the Behavior Analyst Certification
Board; or

(iv) is certified in one of the other treatment modalities recognized by the department;
or

(2) a person who has:

(i) an associate's degree in a behavioral or child development science or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy from an accredited college or university; and

(ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people
with ASD or a related condition. Hours worked as a mental health behavioral aide or level
III treatment provider may be included in the required hours of experience; or

(3) a person who has at least 4,000 hours of supervised clinical experience in delivering
treatment to people with ASD or a related condition. Hours worked as a mental health
behavioral aide or level III treatment provider may be included in the required hours of
experience; or

(4) a person who is a graduate student in a behavioral science, child development science,
or related field and is receiving clinical supervision by a QSP affiliated with an agency to
meet the clinical training requirements for experience and training with people with ASD
or a related condition; or

(5) a person who is at least 18 years of age and who:

(i) is fluent in a non-English languagenew text begin or is an individual certified by a Tribal Nationnew text end ;

(ii) completed the level III EIDBI training requirements; and

(iii) receives observation and direction from a QSP or level I treatment provider at least
once a week until the person meets 1,000 hours of supervised clinical experience.

(d) A level III treatment provider must be employed by an agency, have completed the
level III training requirement, be at least 18 years of age, and have at least one of the
following:

(1) a high school diploma or commissioner of education-selected high school equivalency
certification;

(2) fluency in a non-English languagenew text begin or Tribal Nation certificationnew text end ;

(3) one year of experience as a primary personal care assistant, community health worker,
waiver service provider, or special education assistant to a person with ASD or a related
condition within the previous five years; or

(4) completion of all required EIDBI training within six months of employment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 17.

Minnesota Statutes 2022, section 256B.49, subdivision 11, is amended to read:


Subd. 11.

Authority.

(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the federal Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:

(1) promote the support of persons with disabilities in the most integrated settings;

(2) expand the availability of services for persons who are eligible for medical assistance;

(3) promote cost-effective options to institutional care; and

(4) obtain federal financial participation.

(b) The provision of waiver services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individualnew text begin , except when
applying a size limitation to a setting, the commissioner must treat residents under 55 years
of age who are receiving services under the brain injury or the community access for
disability inclusion waiver as if the residents are 55 years of age or older if the residents
lived and received services in the setting on or before March 1, 2023new text end . For purposes of this
section, the approved home and community-based application is considered the necessary
federal requirement.

(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.

(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
federal Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.

(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.

(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
sectionnew text begin , except when applying a size limitation to a setting, the commissioner must treat
residents under 55 years of age who are receiving services under the brain injury or the
community access for disability inclusion waiver as if the residents are 55 years of age or
older if the residents lived and received services in the setting on or before March 1, 2023new text end .

(g) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.

(h) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 11, 2021.
 new text end

Sec. 18.

Minnesota Statutes 2022, section 256B.49, subdivision 28, is amended to read:


Subd. 28.

Customized living moratorium for brain injury and community access
for disability inclusion waivers.

(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), to prevent new development of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14,
the commissioner shall not enroll new customized living settings serving four or fewer
people in a single-family home to deliver customized living services as defined under the
brain injury or community access for disability inclusion waiver plans under this section.

(b) The commissioner may approve an exception to paragraph (a) when an existing
customized living setting changes ownership at the same addressnew text begin and must approve an
exception to paragraph (a) when the same owner relocates an existing customized living
setting to a new addressnew text end .

(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.

(d) For any new customized living settings serving four or fewer people in a single-family
home to deliver customized living services as defined in paragraph (a) and that was not
operational on or before June 30, 2021, the authorizing lead agency is financially responsible
for all home and community-based service payments in the setting.

(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person in the customized living setting.

new text begin EFFECTIVE DATE. new text end

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

Sec. 19.

Minnesota Statutes 2022, section 256B.4905, subdivision 5a, is amended to read:


Subd. 5a.

Employment first implementation for disability waiver services.

new text begin (a) new text end The
commissioner of human services shall ensure that:

(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption
that all working-age Minnesotans with disabilities can work and achieve competitive
integrated employment with appropriate services and supports, as needed; and

(2) each waiver recipient of working age be offered, after an informed decision-making
process and during a person-centered planning process, the opportunity to work and earn a
competitive wage before being offered exclusively day services as defined in section
245D.03, subdivision 1, paragraph (c), clause (4), or successor provisions.

new text begin (b) Nothing in this subdivision prohibits a waiver recipient of working age, after an
informed decision-making process and during a person-centered planning process, from
choosing employment at a special minimum wage under a 14(c) certificate as provided by
Code of Federal Regulations, title 29, sections 525.1 to 525.24. For any waiver recipient
who chooses employment at a special minimum wage, the commissioner must not impose
any limitations on the length of disability services provided to support the recipient's informed
choice or limitations on the reimbursement rates for the disability waiver services provided
to support the recipient's informed choice.
 new text end

Sec. 20.

Minnesota Statutes 2022, section 256B.4911, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Services provided by parents and spouses. new text end

new text begin (a) This subdivision limits medical
assistance payments under the consumer-directed community supports option for personal
assistance services provided by a parent to the parent's minor child or by a participant's
spouse. This subdivision applies to the consumer-directed community supports option
available under all of the following:
 new text end

new text begin (1) alternative care program;
 new text end

new text begin (2) brain injury waiver;
 new text end

new text begin (3) community alternative care waiver;
 new text end

new text begin (4) community access for disability inclusion waiver;
 new text end

new text begin (5) developmental disabilities waiver;
 new text end

new text begin (6) elderly waiver; and
 new text end

new text begin (7) Minnesota senior health option.
 new text end

new text begin (b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal
guardian of a minor.
 new text end

new text begin (c) If multiple parents are providing personal assistance services to their minor child or
children, each parent may provide up to 40 hours of personal assistance services in any
seven-day period regardless of the number of children served. The total number of hours
of personal assistance services provided by all of the parents must not exceed 80 hours in
a seven-day period regardless of the number of children served.
 new text end

new text begin (d) If only one parent is providing personal assistance services to a minor child or
children, the parent may provide up to 60 hours of personal assistance services in a seven-day
period regardless of the number of children served.
 new text end

new text begin (e) If a participant's spouse is providing personal assistance services, the spouse may
provide up to 60 hours of personal assistance services in a seven-day period.
 new text end

new text begin (f) This subdivision must not be construed to permit an increase in the total authorized
consumer-directed community supports budget for an individual.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 21.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 1b. new text end

new text begin Direct support professional annual labor market survey. new text end

new text begin (a) The
commissioner shall develop and administer a survey of direct care staff who work for
organizations that provide services under the following programs:
 new text end

new text begin (1) home and community-based services for seniors under chapter 256S and section
256B.0913, home and community-based services for people with developmental disabilities
under section 256B.092, and home and community-based services for people with disabilities
under section 256B.49;
 new text end

new text begin (2) personal care assistance services under section 256B.0625, subdivision 19a;
community first services and supports under section 256B.85; nursing services and home
health services under section 256B.0625, subdivision 6a; home care nursing services under
section 256B.0625, subdivision 7; and
 new text end

new text begin (3) financial management services for participants who directly employ direct-care staff
through consumer support grants under section 256.476; the personal care assistance choice
program under section 256B.0659, subdivisions 18 to 20; community first services and
supports under section 256B.85; and the consumer-directed community supports option
available under the alternative care program, the brain injury waiver, the community
alternative care waiver, the community access for disability inclusion waiver, the
developmental disabilities waiver, the elderly waiver, and the Minnesota senior health
option, except financial management services providers are not required to submit the data
listed in subdivision 1a, clauses (7) to (11).
 new text end

new text begin (b) The survey must collect information about the individual experience of the direct-care
staff and any other information necessary to assess the overall economic viability and
well-being of the workforce.
 new text end

new text begin (c) For purposes of this subdivision, "direct-care staff" means employees, including
self-employed individuals and individuals directly employed by a participant in a
consumer-directed service delivery option, providing direct service to participants under
this section. Direct-care staff does not include executive, managerial, or administrative staff.
 new text end

new text begin (d) Individually identifiable data submitted to the commissioner under this section are
considered private data on individuals as defined by section 13.02, subdivision 12.
 new text end

new text begin (e) The commissioner shall analyze data submitted under this section annually to assess
the overall economic viability and well-being of the workforce and the impact of the state
of workforce on access to services.
 new text end

Sec. 22.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 1c. new text end

new text begin Annual labor market report. new text end

new text begin The commissioner shall publish annual reports
on provider and state-level labor market data, including but not limited to the data outlined
in subdivisions 1a and 1b.
 new text end

Sec. 23.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 16. new text end

new text begin Rates established by the commissioner. new text end

new text begin For homemaker services eligible
for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
community alternative care waiver, and the community access for disability inclusion waiver,
the commissioner must establish rates equal to the rates established under sections 256S.21
to 256S.215 for the corresponding homemaker services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 24.

Minnesota Statutes 2022, 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;

(3) adult day services bath;

(4) community residential services;

(5) customized living;

(6) day support services;

(7) employment development services;

(8) employment exploration services;

(9) employment support services;

(10) family residential services;

(11) individualized home supports;

(12) individualized home supports with family training;

(13) individualized home supports with training;

(14) integrated community supports;

(15) night supervision;

(16) positive support services;

(17) prevocational services;

(18) residential support services;

(19) deleted text begin respite services;
deleted text end

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

deleted text begin (21)deleted text end new text begin (20)new text end other services as approved by the federal government in the state home and
community-based services waiver plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 25.

Minnesota Statutes 2022, section 256B.4914, subdivision 4, is amended to read:


Subd. 4.

Data collection for rate determination.

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

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

(c) Service providers, with information from the support plan and oversight by lead
agencies, shall provide values and information needed to calculate an individual's rate in
the rates management system. The determination of service levels must be part of a discussion
with members of the support team as defined in section 245D.02, subdivision 34. This
discussion must occur prior to the final establishment of each individual's rate. The values
and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

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

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

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

(9) service hours provided through monitoring technology.

(d) Updates to individual data must include:

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

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

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

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

(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and
(o); and meeting or exceeding the licensing standards for staffing required under section
245D.09, subdivision 1; and

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 26.

Minnesota Statutes 2022, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index; establishment and updates.

(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 calculating the 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 Occupational
Handbook must be used.

(b) The commissioner shall update the base wage index in subdivision 5a, publish these
updated values, and load them into the rate management system as follows:

(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2019;new text begin and
new text end

deleted text begin (2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2021; and
 deleted text end

deleted text begin (3)deleted text end new text begin (2) new text end on deleted text begin July 1, 2026deleted text end new text begin January 1, 2024new text end , and every two years thereafter, based on wage
data by SOC from the Bureau of Labor Statistics available deleted text begin 30deleted text end new text begin 24new text end months and one day prior
to the scheduled update.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 27.

Minnesota Statutes 2022, section 256B.4914, subdivision 5a, is amended to read:


Subd. 5a.

Base wage index; calculations.

The base wage index must be calculated as
follows:

(1) 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 specialist, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);

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

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

(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large
employers, with the exception of asleep-overnight staff for family residential services, which
is 36 percent of the minimum wage in Minnesota for large employers;

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

(i) 15 percent of the subtotal of 50 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant
(SOC code 31-1131); 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 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new 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);

(6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC
code 31-1131); and 30 percent of the median wage for home health and personal care aide
(SOC code 31-1120);

(7) for day support services staff and prevocational services staff, 20 percent of the
median wage for nursing assistant (SOC code 31-1131); 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 positive supports analyst staff, 100 percent of the median wage for deleted text begin substance
abuse, behavioral disorder, and mental health counselordeleted text end new text begin clinical, counseling, and school
psychologistsnew text end (SOC code deleted text begin 21-1018deleted text end new text begin 19-3031new text end );

(9) for positive supports professional staff, 100 percent of the median wage for deleted text begin clinical
counseling and schooldeleted text end psychologistnew text begin , all othernew text end (SOC code deleted text begin 19-3031deleted text end new text begin 19-3039new text end );

(10) for positive supports specialist staff, 100 percent of the median wage for deleted text begin psychiatric
techniciansdeleted text end new text begin occupational therapistnew text end (SOC code deleted text begin 29-2053deleted text end new text begin 29-1122new text end );

(11) for individualized home supports with family training staff, 20 percent of the median
wage for nursing aide (SOC code 31-1131); 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);

(12) 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);

(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
deleted text begin rehabilitation counselor (SOC code 21-1015)deleted text end new text begin education, guidance, school, and vocational
counselor (SOC code 21-1012)new text end ; 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 without training staff, 50 percent of the median
wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the
median wage for nursing assistant (SOC code 31-1131);new text begin and
new text end

(17) for night supervision staff, 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code 31-1131); 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 ; anddeleted text end new text begin .
new text end

deleted text begin (18) for respite staff, 50 percent of the median wage for home health and personal care
aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC
code 31-1014).
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 28.

Minnesota Statutes 2022, section 256B.4914, subdivision 5b, is amended to read:


Subd. 5b.

Standard component value adjustments.

The commissioner shall update
the client and programming support, transportation, and program facility cost component
values as required in subdivisions 6 to deleted text begin 9adeleted text end new text begin 9new text end for changes in the Consumer Price Index. The
commissioner shall adjust these values higher or lower, publish these updated values, and
load them into the rate management system as follows:

(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the
previous update to the data available on December 31, 2019;new text begin and
new text end

deleted text begin (2) on November 1, 2024, by the percentage change in the CPI-U from the date of the
previous update to the data available as of December 31, 2021; and
 deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end on deleted text begin Julydeleted text end new text begin Januarynew text end 1, deleted text begin 2026deleted text end new text begin 2024new text end , and every two years thereafter, by the percentage
change in the CPI-U from the date of the previous update to the data available deleted text begin 30deleted text end new text begin 12new text end months
and one day prior to the scheduled update.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 29.

Minnesota Statutes 2022, section 256B.4914, subdivision 5c, is amended to read:


Subd. 5c.

Removal of after-framework adjustments.

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 subdivisions 5 deleted text begin anddeleted text end new text begin ,new text end 5bnew text begin , and 5fnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 30.

Minnesota Statutes 2022, section 256B.4914, subdivision 5d, is amended to read:


Subd. 5d.

Unavailable data for updates and adjustments.

If Bureau of Labor Statistics
occupational codes or Consumer Price Index items specified in subdivision 5 deleted text begin ordeleted text end new text begin ,new text end 5bnew text begin , or 5fnew text end
are unavailable in the future, the commissioner shall recommend to the legislature codes or
items to update and replace.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 31.

Minnesota Statutes 2022, section 256B.4914, subdivision 5e, is amended to read:


Subd. 5e.

Inflationary update spending requirement.

(a) At least 80 percent of the
marginal increase in revenue from the rate deleted text begin adjustment applied to the service ratesdeleted text end new text begin adjustmentsnew text end
calculated under subdivisions 5 and deleted text begin 5b beginning on January 1, 2022,deleted text end new text begin 5fnew text end for services rendered
deleted text begin between January 1, 2022, and March 31, 2024,deleted text end new text begin on or after the day of implementation of the
adjustmentnew text end must be used to increase compensation-related costs for employees directly
employed by the program deleted text begin on or after January 1, 2022deleted text end .

(b) For the purposes of this subdivision, compensation-related costs include:

(1) wages and salaries;

(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;

(3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and

(4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to deleted text begin January 1, 2022deleted text end new text begin implementation of the applicable
rate adjustmentnew text end , including retention and recruitment bonuses and tuition reimbursement.

(c) Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider,
or for persons paid by the provider under a management contract, do not count toward the
80 percent requirement under this subdivision.

(d) A provider agency or individual provider that receives a rate subject to the
requirements of this subdivision shall prepare, and upon request submit to the commissioner,
a distribution plan that specifies the amount of money the provider expects to receive that
is subject to the requirements of this subdivision, including how that money was or will be
distributed to increase compensation-related costs for employees. Within 60 days of final
implementation of a rate adjustment subject to the requirements of this subdivision, the
provider must post the distribution plan and leave it posted for a period of at least six months
in an area of the provider's operation to which all direct support professionals have access.new text begin
The posted distribution plan must include instructions regarding how to contact the
commissioner or commissioner's representative if an employee believes the employee has
not received the compensation-related increase described in the plan.
new text end

deleted text begin (e) This subdivision expires June 30, 2024deleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 32.

Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision
to read:


new text begin Subd. 5f. new text end

new text begin Competitive workforce factor adjustments. new text end

new text begin (a) On January 1, 2024, and
every two years thereafter, the commissioner shall update the competitive workforce factor
to equal the differential between:
 new text end

new text begin (1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential support services and direct care staff for day programs;
and
 new text end

new text begin (2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations.
 new text end

new text begin (b) For each update of the competitive workforce factor, the update must not decrease
the competitive workforce factor by more than 2.0. If the competitive workforce factor is
less than or equal to zero, then the competitive workforce factor is zero.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 33.

Minnesota Statutes 2022, section 256B.4914, subdivision 8, is amended to read:


Subd. 8.

Unit-based services with programming; component values and calculation
of payment rates.

(a) For the purpose of this section, unit-based services with programming
include employment exploration services, employment development services, employment
support services, individualized home supports with family training, individualized home
supports with training, and positive support services provided to an individual outside of
any service plan for a day program or residential support service.

(b) 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 support ratio: 15.5 percent;

(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
5b;

(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.

(c) A unit of service for unit-based services with programming is 15 minutes.

(d) Payments for unit-based services with programming must be calculated as follows,
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:

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

(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;

(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;

(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 direct staffing hours by the appropriate staff wage;

(6) multiply the number of direct staffing hours by the product of the supervisory span
of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. 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;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;

(11) this is the subtotal rate;

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

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

(14) for services provided in a shared manner, divide the total payment in clause (13)
as follows:

(i) for employment exploration services, divide by the number of service recipients, not
to exceed five;

(ii) for employment support services, divide by the number of service recipients, not to
exceed six; and

(iii) for individualized home supports with training and individualized home supports
with family training, divide by the number of service recipients, not to exceed deleted text begin twodeleted text end new text begin threenew text end ;
and

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 34.

Minnesota Statutes 2022, section 256B.4914, subdivision 9, is amended to read:


Subd. 9.

Unit-based services without programming; component values and
calculation of payment rates.

(a) For the purposes of this section, unit-based services
without programming include individualized home supports without training and night
supervision provided to an individual outside of any service plan for a day program or
residential support service. Unit-based services without programming do not include respite.

(b) Component values for unit-based services without 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 support ratio: 7.0 percent;

(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision
5b;

(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.

(c) A unit of service for unit-based services without programming is 15 minutes.

(d) Payments for unit-based services without programming must be calculated as follows
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:

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

(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 to 5a;

(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;

(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 direct staffing hours by the appropriate staff wage;

(6) multiply the number of direct staffing hours by the product of the supervisory span
of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. 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;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;

(11) this is the subtotal rate;

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

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

(14) for individualized home supports without training provided in a shared manner,
divide the total payment amount in clause (13) by the number of service recipients, not to
exceed deleted text begin twodeleted text end new text begin threenew text end ; and

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 35.

Minnesota Statutes 2022, section 256B.4914, subdivision 10, is amended to read:


Subd. 10.

Evaluation of information and data.

(a) The commissioner shall, within
available resources, 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;

(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.

(b) The commissioner, in consultation with stakeholders, shall review and evaluate the
following values already in subdivisions 6 to deleted text begin 9adeleted text end new text begin 9new text end , or issues that impact all services, including,
but not limited to:

(1) values for transportation rates;

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

(3) values for indirect services;

(4) values for nursing;

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

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

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

(8) direct care workforce labor market measures;

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

(10) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section; and

(11) different competitive workforce factors by service, as determined under subdivision
10b.

(c) 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 Previous finance Next with the information and data gathered under paragraphs (a) and (b) on
January 15, 2021, with a full report, and a full report once every four years thereafter.

(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement
changes to the regional adjustment factors once every six years. Prior to implementation,
the commissioner shall consult with stakeholders on the methodology to calculate the
adjustment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 36.

Minnesota Statutes 2022, section 256B.4914, subdivision 10a, is amended to
read:


Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to deleted text begin 9adeleted text end new text begin 9new text end reflect the cost to provide
the service. As determined by the commissioner, in consultation with stakeholders identified
in subdivision 17, a provider enrolled to provide services with rates determined under this
section must submit requested cost data to the commissioner to support research on the cost
of providing services that have rates determined by the disability waiver rates system.
Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

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

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

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

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

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

(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy.

(d) The commissioner shall analyze cost data submitted under paragraph (a) and, in
consultation with stakeholders identified in subdivision 17, 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 once every
four years beginning January 1, 2021. The commissioner shall make recommendations in
conjunction with reports submitted to the legislature according to subdivision 10, paragraph
(c).

(e) The commissioner shall release cost data in an aggregate form, and cost data from
individual providers shall not be released except as provided for in current law.

(f) The commissioner, in consultation with stakeholders identified in subdivision 17,
shall develop and implement a process for providing training and technical assistance
necessary to support provider submission of cost documentation required under paragraph
(a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 37.

Minnesota Statutes 2022, section 256B.4914, subdivision 10c, is amended to
read:


Subd. 10c.

Reporting and analysis of competitive workforce factor.

(a) Beginning
February 1, deleted text begin 2021deleted text end new text begin 2025new text end , 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 Previous finance Next an analysis of the competitive
workforce factor.

(b) The report must include deleted text begin recommendations to update the competitive workforce factor
usingdeleted text end :

(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 10b.

(c) deleted text begin 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.deleted text end new text begin This
subdivision expires upon submission of the calendar year 2030 report.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 38.

Minnesota Statutes 2022, section 256B.4914, subdivision 12, is amended to read:


Subd. 12.

Customization of rates for individuals.

(a) For persons determined to have
higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
by an adjustment factor prior to calculating the rate under subdivisions 6 to deleted text begin 9adeleted text end new text begin 9new text end . The
customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour
for waiver recipients who meet the respective criteria as determined by the commissioner.

(b) For the purposes of this section, "deaf and hard-of-hearing" means:

(1) the person has a developmental disability and:

(i) an assessment score which indicates a hearing impairment that is severe or that the
person has no useful hearing;

(ii) an expressive communications score that indicates the person uses single signs or
gestures, uses an augmentative communication aid, or does not have functional
communication, or the person's expressive communications is unknown; and

(iii) a communication score which indicates the person comprehends signs, gestures,
and modeling prompts or does not comprehend verbal, visual, or gestural communication,
or that the person's receptive communication score is unknown; or

(2) the person receives long-term care services and has an assessment score that indicates
the person hears only very loud sounds, the person has no useful hearing, or a determination
cannot be made; and the person receives long-term care services and has an assessment that
indicates the person communicates needs with sign language, symbol board, written
messages, gestures, or an interpreter; communicates with inappropriate content, makes
garbled sounds or displays echolalia, or does not communicate needs.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 39.

Minnesota Statutes 2022, section 256B.4914, subdivision 14, is amended to read:


Subd. 14.

Exceptions.

(a) In a format prescribed by the commissioner, lead agencies
must identify individuals with exceptional needs that cannot be met under the disability
waiver rate system. The commissioner shall use that information to evaluate and, if necessary,
approve an alternative payment rate for those individuals. Whether granted, denied, or
modified, the commissioner shall respond to all exception requests in writing. The
commissioner shall include in the written response the basis for the action and provide
notification of the right to appeal under paragraph (h).

(b) Lead agencies must act on an exception request within 30 days and notify the initiator
of the request of their recommendation in writing. A lead agency shall submit all exception
requests along with its recommendation to the commissioner.

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

(1) an individual has service needs that cannot be met through additional units of service;

(2) an individual's rate determined under subdivisions 6 to deleted text begin 9adeleted text end new text begin 9new text end is so insufficient that it
has resulted in an individual receiving a notice of discharge from the individual's provider;
or

(3) an individual's service needs, including behavioral changes, require a level of service
which necessitates a change in provider or which requires the current provider to propose
service changes beyond those currently authorized.

(d) Exception requests must include the following information:

(1) the service needs required by each individual that are not accounted for in subdivisions
6 to deleted text begin 9adeleted text end new text begin 9new text end ;

(2) the service rate requested and the difference from the rate determined in subdivisions
6 to deleted text begin 9adeleted text end new text begin 9new text end ;

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

(4) any contingencies for approval.

(e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.

(f) Individual disability waiver recipients, an interested party, or the license holder that
would receive the rate exception increase may request that a lead agency submit an exception
request. A lead agency that denies such a request shall notify the individual waiver recipient,
interested party, or license holder of its decision and the reasons for denying the request in
writing no later than 30 days after the request has been made and shall submit its denial to
the commissioner in accordance with paragraph (b). The reasons for the denial must be
based on the failure to meet the criteria in paragraph (c).

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

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

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

(j) The starting date for the rate exception will be the later of the date of the recipient's
change in support or the date of the request to the lead agency for an exception.

(k) The commissioner shall track all exception requests received and their dispositions.
The commissioner shall issue quarterly public exceptions statistical reports, including the
number of exception requests received and the numbers granted, denied, withdrawn, and
pending. The report shall include the average amount of time required to process exceptions.

(l) Approved rate exceptions remain in effect in all cases until an individual's needs
change as defined in paragraph (c).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 40.

Minnesota Statutes 2022, section 256B.492, is amended to read:


256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE WITH
DISABILITIES.

(a) Individuals receiving services under a home and community-based waiver under
section 256B.092 or 256B.49 may receive services in the following settings:

(1) home and community-based settings that comply withnew text begin :
new text end

new text begin (i) new text end all requirements identified by the federal Centers for Medicare and Medicaid Services
in the Code of Federal Regulations, title 42, section 441.301(c)deleted text begin ,deleted text end new text begin ;new text end and

deleted text begin withdeleted text end new text begin (ii)new text end the requirements of the federally approved transition plan and waiver plans for
each home and community-based services waivernew text begin except when applying a size limitation
to a setting, the commissioner must treat residents under 55 years of age who are receiving
services under the brain injury or the community access for disability inclusion waiver as
if the residents are 55 years of age or older if the residents lived and received services in
the setting on or before March 1, 2023new text end ; and

(2) settings required by the Housing Opportunities for Persons with AIDS Program.

(b) The settings in paragraph (a) must not have the qualities of an institution which
include, but are not limited to: regimented meal and sleep times, limitations on visitors, and
lack of privacy. Restrictions agreed to and documented in the person's individual service
plan shall not result in a residence having the qualities of an institution as long as the
restrictions for the person are not imposed upon others in the same residence and are the
least restrictive alternative, imposed for the shortest possible time to meet the person's needs.

Sec. 41.

Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
to read:


new text begin Subd. 19. new text end

new text begin ICF/DD rate increase effective July 1, 2023. new text end

new text begin (a) Effective July 1, 2023, the
daily operating payment rate for a class A intermediate care facility for persons with
developmental disabilities is increased by $50.
 new text end

new text begin (b) Effective July 1, 2023, the daily operating payment rate for a class B intermediate
care facility for persons with developmental disabilities is increased by $50.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 42.

Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin ICF/DD minimum daily operating payment rates. new text end

new text begin (a) The minimum daily
operating payment rate for a class A intermediate care facility for persons with developmental
disabilities is $300.
 new text end

new text begin (b) The minimum daily operating payment rate for a class B intermediate care facility
for persons with developmental disabilities is $400.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 43.

Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
to read:


new text begin Subd. 21. new text end

new text begin Spending requirements. new text end

new text begin (a) At least 80 percent of the marginal increase in
revenue resulting from implementation of the rate increases under subdivisions 19 and 20
for services rendered on or after the day of implementation of the increases must be used
to increase compensation-related costs for employees directly employed by the facility.
 new text end

new text begin (b) For the purposes of this subdivision, compensation-related costs include:
 new text end

new text begin (1) wages and salaries;
 new text end

new text begin (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;
 new text end

new text begin (3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and
 new text end

new text begin (4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to implementation of the rate increases.
 new text end

new text begin (c) Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider,
or for persons paid by the provider under a management contract, do not count toward the
80 percent requirement under this subdivision.
 new text end

new text begin (d) A provider agency or individual provider that receives additional revenue subject to
the requirements of this subdivision shall prepare, and upon request submit to the
commissioner, a distribution plan that specifies the amount of money the provider expects
to receive that is subject to the requirements of this subdivision, including how that money
was or will be distributed to increase compensation-related costs for employees. Within 60
days of final implementation of the new rate methodology or any rate adjustment subject
to the requirements of this subdivision, the provider must post the distribution plan and
leave it posted for a period of at least six months in an area of the provider's operation to
which all direct support professionals have access. The posted distribution plan must include
instructions regarding how to contact the commissioner, or the commissioner's representative,
if an employee has not received the compensation-related increase described in the plan.
 new text end

Sec. 44.

Minnesota Statutes 2022, section 256B.85, subdivision 7, is amended to read:


Subd. 7.

Community first services and supports; covered services.

Services and
supports covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;

(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan; and

(ii) increase independence or substitute for human assistance, to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;

(4) observation and redirection for behavior or symptoms where there is a need for
assistance;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;

(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;

(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;

(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. deleted text begin These support
workers shall not:deleted text end new text begin Covered services under this clause are subject to the limitations described
in subdivision 7b; and
new text end

deleted text begin (i) provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and
 deleted text end

deleted text begin (ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and
 deleted text end

(9) worker training and development services as described in subdivision 18a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 45.

Minnesota Statutes 2022, section 256B.85, is amended by adding a subdivision
to read:


new text begin Subd. 7b. new text end

new text begin Services provided by parents and spouses. new text end

new text begin (a) This subdivision applies to
services and supports described in subdivision 7, clause (8).
 new text end

new text begin (b) If multiple parents are support workers providing CFSS services to their minor child
or children, each parent may provide up to 40 hours of medical assistance home and
community-based services in any seven-day period regardless of the number of children
served. The total number of hours of medical assistance home and community-based services
provided by all of the parents must not exceed 80 hours in a seven-day period regardless of
the number of children served.
 new text end

new text begin (c) If only one parent is a support worker providing CFSS services to the parent's minor
child or children, the parent may provide up to 60 hours of medical assistance home and
community-based services in a seven-day period regardless of the number of children served.
 new text end

new text begin (d) If a participant's spouse is a support worker providing CFSS services, the spouse
may provide up to 60 hours of medical assistance home and community-based services in
a seven-day period.
 new text end

new text begin (e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total
authorized service budget for an individual or the total number of authorized service units.
 new text end

new text begin (f) A parent or participant's spouse must not receive a wage that exceeds the current rate
for a CFSS support worker, including wages, benefits, and payroll taxes.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 46.

Minnesota Statutes 2022, section 256B.851, subdivision 5, is amended to read:


Subd. 5.

Payment rates; component values.

(a) The commissioner must use the
following component values:

(1) employee vacation, sick, and training factor, 8.71 percent;

(2) employer taxes and workers' compensation factor, 11.56 percent;

(3) employee benefits factor, 12.04 percent;

(4) client programming and supports factor, 2.30 percent;

(5) program plan support factor, 7.00 percent;

(6) general business and administrative expenses factor, 13.25 percent;

(7) program administration expenses factor, 2.90 percent; and

(8) absence and utilization factor, 3.90 percent.

(b) For purposes of implementation, the commissioner shall use the following
implementation components:

(1) personal care assistance services and CFSS: deleted text begin 75.45 percent;deleted text end new text begin 88.19 percent;
new text end

(2) enhanced rate personal care assistance services and enhanced rate CFSS: deleted text begin 75.45deleted text end new text begin 88.19
new text end percent; and

(3) qualified professional services and CFSS worker training and development: deleted text begin 75.45deleted text end
new text begin 88.19 new text end percent.

new text begin (c) Effective January 1, 2025, for purposes of implementation, the commissioner shall
use the following implementation components:
 new text end

new text begin (1) personal care assistance services and CFSS: 92.10 percent;
 new text end

new text begin (2) enhanced rate personal care assistance services and enhanced rate CFSS: 92.10
percent; and
 new text end

new text begin (3) qualified professional services and CFSS worker training and development: 92.10
percent.
 new text end

new text begin (d) Beginning January 1, 2025, the commissioner shall use the following worker retention
components:
 new text end

new text begin (1) for workers who have provided fewer than 1,001 cumulative hours in personal care
assistance services or CFSS, the worker retention component is zero percent;
 new text end

new text begin (2) for workers who have provided between 1,001 and 2,000 cumulative hours in personal
care assistance services or CFSS, the worker retention component is 2.17 percent;
 new text end

new text begin (3) for workers who have provided between 2,001 and 6,000 cumulative hours in personal
care assistance services or CFSS, the worker retention component is 4.36 percent;
 new text end

new text begin (4) for workers who have provided between 6,001 and 10,000 cumulative hours in
personal care assistance services or CFSS, the worker retention component is 7.35 percent;
and
 new text end

new text begin (5) for workers who have provided more than 10,000 hours in personal care assistance
services or CFSS, the worker retention component is 10.81 percent.
 new text end

new text begin (e) The commissioner shall define the appropriate worker retention component based
on the total number of units billed for services rendered by the individual provider since
July 1, 2017. The worker retention component must be determined by the commissioner
for each individual provider and is not subject to appeal.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to paragraph (b) are effective January 1, 2024,
or 90 days after federal approval, whichever is later. Paragraph (b) expires January 1, 2025,
or 90 days after federal approval of paragraph (c), whichever is later. Paragraphs (c), (d),
and (e) are effective January 1, 2025, or 90 days after federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 47.

Minnesota Statutes 2022, section 256B.851, subdivision 6, is amended to read:


Subd. 6.

Payment rates; rate determination.

(a) The commissioner must determine
the rate for personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, enhanced rate
CFSS, qualified professional services, and CFSS worker training and development as
follows:

(1) multiply the appropriate total wage component value calculated in subdivision 4 by
one plus the employee vacation, sick, and training factor in subdivision 5;

(2) for program plan support, multiply the result of clause (1) by one plus the program
plan support factor in subdivision 5;

(3) for employee-related expenses, add the employer taxes and workers' compensation
factor in subdivision 5 and the employee benefits factor in subdivision 5. The sum is
employee-related expenses. Multiply the product of clause (2) by one plus the value for
employee-related expenses;

(4) for client programming and supports, multiply the product of clause (3) by one plus
the client programming and supports factor in subdivision 5;

(5) for administrative expenses, add the general business and administrative expenses
factor in subdivision 5, the program administration expenses factor in subdivision 5, and
the absence and utilization factor in subdivision 5;

(6) divide the result of clause (4) by one minus the result of clause (5). The quotient is
the hourly rate;

(7) multiply the hourly rate by the appropriate implementation component under
subdivision 5. This is the adjusted hourly rate; and

(8) divide the adjusted hourly rate by four. The quotient is the total adjusted payment
rate.

new text begin (b) In processing claims, the commissioner shall incorporate a staff retention component
as specified under subdivision 5 by multiplying the total adjusted payment rate by one plus
the appropriate staff retention component under subdivision 5. This is the total payment
rate.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end The commissioner must publish the total deleted text begin adjusteddeleted text end new text begin finalnew text end payment rates.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or ninety days after
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
 new text end

Sec. 48.

Minnesota Statutes 2022, section 256S.2101, subdivision 1, is amended to read:


Subdivision 1.

Phase-in for disability waiver customized living rates.

All rates and
rate components for community access for disability inclusion customized living and brain
injury customized living under section 256B.4914 deleted text begin shalldeleted text end new text begin mustnew text end be the sum of deleted text begin tendeleted text end new text begin 21.6new text end percent
of the rates calculated under sections 256S.211 to 256S.215 and deleted text begin 90deleted text end new text begin 78.4new text end percent of the rates
calculated using the rate methodology in effect as of June 30, 2017.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 49.

Laws 2021, First Special Session chapter 7, article 17, section 20, is amended to
read:


Sec. 20. HCBS WORKFORCE DEVELOPMENT GRANT.

new text begin Subdivision 1. new text end

new text begin Appropriation. new text end

(a) This act includes $0 in fiscal year 2022 and $5,588,000
in fiscal year 2023 to address challenges related to attracting and maintaining direct care
workers who provide home and community-based services for people with disabilities and
older adults. The general fund base included in this act for this purpose is $5,588,000 in
fiscal year 2024 and $0 in fiscal year 2025.

(b) At least 90 percent of funding for this provision must be directed to workers who
earn deleted text begin 200deleted text end new text begin 300new text end percent or less of the most current federal poverty level issued by the United
States Department of Health and Human Services.

(c) The commissioner must consult with stakeholders to finalize a report detailing the
final plan for use of the funds. The commissioner must publish the report by March 1, 2022,
and notify the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and Previous finance Next .

new text begin Subd. 2. new text end

new text begin Public assistance eligibility. new text end

new text begin Notwithstanding any law to the contrary, workforce
development grant money received under this section is not income, assets, or personal
property for purposes of determining eligibility or recertifying eligibility for:
 new text end

new text begin (1) child care assistance programs under Minnesota Statutes, chapter 119B;
 new text end

new text begin (2) general assistance, Minnesota supplemental aid, and food support under Minnesota
Statutes, chapter 256D;
 new text end

new text begin (3) housing support under Minnesota Statutes, chapter 256I;
 new text end

new text begin (4) the Minnesota family investment program and diversionary work program under
Minnesota Statutes, chapter 256J; and
 new text end

new text begin (5) economic assistance programs under Minnesota Statutes, chapter 256P.
 new text end

new text begin Subd. 3. new text end

new text begin Medical assistance eligibility. new text end

new text begin Notwithstanding any law to the contrary,
workforce development grant money received under this section is not income or assets for
the purposes of determining eligibility for medical assistance under Minnesota Statutes,
section 256B.056, subdivision 1a, paragraph (a), 3, or 3c; or 256B.057, subdivision 3, 3a,
3b, 4, or 9.
 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. 50. new text begin MEMORANDUMS OF UNDERSTANDING.
new text end

new text begin The memorandums of understanding with Service Employees International Union
Healthcare Minnesota and Iowa, submitted by the commissioner of management and budget
on February 27, 2023, are ratified.
 new text end

Sec. 51. new text begin SELF-DIRECTED WORKER CONTRACT RATIFICATION.
new text end

new text begin The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota and Iowa, submitted to the Legislative
Coordinating Commissioner on February 27, 2023, is ratified.
 new text end

Sec. 52. new text begin BUDGET INCREASE FOR CONSUMER-DIRECTED COMMUNITY
SUPPORTS.
new text end

new text begin (a) Effective January 1, 2024, or upon federal approval, whichever is later,
consumer-directed community support budgets identified in the waiver plans under Minnesota
Statutes, sections 256B.092 and 256B.49, and chapter 256S; and the alternative care program
under Minnesota Statutes, section 256B.0913, must be increased by 8.49 percent.
 new text end

new text begin (b) Effective January 1, 2025, or upon federal approval, whichever is later,
consumer-directed community support budgets identified in the waiver plans under Minnesota
Statutes, sections 256B.092 and 256B.49, and chapter 256S; and the alternative care program
under Minnesota Statutes, section 256B.0913, must be increased by 4.53 percent.
 new text end

Sec. 53. new text begin DIRECT CARE SERVICE CORPS PILOT PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Metropolitan Center for Independent Living must
develop a pilot project establishing the Minnesota Direct Care Service Corps. The pilot
project must utilize financial incentives to attract postsecondary students to work as personal
care assistants or direct support professionals. The Metropolitan Center for Independent
Living must establish the financial incentives and minimum work requirements to be eligible
for incentive payments. The financial incentive must increase with each semester that the
student participates in the Minnesota Direct Care Service Corps.
 new text end

new text begin Subd. 2. new text end

new text begin Pilot sites. new text end

new text begin (a) Pilot sites must include one postsecondary institution in the
seven-county metropolitan area and at least one postsecondary institution outside of the
seven-county metropolitan area. If more than one postsecondary institution outside the
metropolitan area is selected, one must be located in northern Minnesota and the other must
be located in southern Minnesota.
 new text end

new text begin (b) After satisfactorily completing the work requirements for a semester, the pilot site
or its fiscal agent must pay students the financial incentive developed for the pilot project.
 new text end

new text begin Subd. 3. new text end

new text begin Evaluation and report. new text end

new text begin (a) The Metropolitan Center for Independent Living
must contract with a third party to evaluate the pilot project's impact on health care costs,
retention of personal care assistants, and patients' and providers' satisfaction of care. The
evaluation must include the number of participants, the hours of care provided by participants,
and the retention of participants from semester to semester.
 new text end

new text begin (b) By January 15, 2025, the Metropolitan Center for Independent Living must report
the findings under paragraph (a) to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services policy and Previous finance Next .
 new text end

Sec. 54. new text begin EMERGENCY GRANT PROGRAM FOR AUTISM SPECTRUM
DISORDER TREATMENT AGENCIES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Autism spectrum disorder" has the meaning given to "autism spectrum disorder or
a related condition" in Minnesota Statutes, section 256B.0949, subdivision 2, paragraph
(d).
 new text end

new text begin (c) "Autism spectrum disorder treatment services" means treatment delivered under
Minnesota Statutes, section 256B.0949.
 new text end

new text begin (d) "Qualified early intensive developmental and behavioral intervention agency" or
"qualified EIDBI agency" has the meaning given in Minnesota Statutes, section 256B.0949,
subdivision 2, paragraph (c).
 new text end

new text begin Subd. 2. new text end

new text begin Emergency grant program for autism spectrum disorder treatment
agencies. new text end

new text begin The commissioner of human services shall award emergency grant money to
eligible qualified EIDBI agencies to support the stability of the autism spectrum disorder
treatment provider sector.
 new text end

new text begin Subd. 3. new text end

new text begin Eligible agencies. new text end

new text begin Qualified EIDBI agencies that have been delivering autism
spectrum disorder treatment services for a minimum of six months are eligible to receive
emergency grants under this section.
 new text end

new text begin Subd. 4. new text end

new text begin Allocation of grants. new text end

new text begin (a) Eligible agencies must apply for a grant under this
section on an application in the form specified by the commissioner, which at a minimum
must contain:
 new text end

new text begin (1) a description of the purpose or project for which grant money will be used;
 new text end

new text begin (2) a description of the specific problem the grant money will address;
 new text end

new text begin (3) a description of achievable objectives, a work plan, and a timeline for implementation
and completion of processes or projects enabled by the grant; and
 new text end

new text begin (4) a process for documenting and evaluating results of the grant.
 new text end

new text begin (b) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications, the commissioner shall establish criteria, including but not limited to:
 new text end

new text begin (1) the eligibility of the project;
 new text end

new text begin (2) the applicant's thoroughness and clarity in describing the problem grant money is
intended to address;
 new text end

new text begin (3) a description of the applicant's proposed project;
 new text end

new text begin (4) a description of the population demographics and service area of the proposed project;
 new text end

new text begin (5) the manner in which the applicant will demonstrate the effectiveness of any projects
undertaken;
 new text end

new text begin (6) the proposed project's longevity and demonstrated financial sustainability after the
initial grant period; and
 new text end

new text begin (7) the evidence of efficiencies and effectiveness gained through collaborative efforts.
 new text end

new text begin (c) The commissioner may consider other relevant factors in addition to those listed in
paragraph (b).
 new text end

new text begin (d) In evaluating applications, the commissioner may request from the applicant additional
information regarding a proposed project, including information on project costs. An
applicant's failure to provide the information requested disqualifies an applicant.
 new text end

new text begin (e) The commissioner shall determine the number of grants awarded.
 new text end

new text begin (f) The commissioner shall award grants to eligible agencies through December 31,
2025.
 new text end

new text begin Subd. 5. new text end

new text begin Eligible uses of grant money. new text end

new text begin The commissioner shall develop a list of eligible
uses for grants awarded under this section.
 new text end

Sec. 55. new text begin RATE INCREASE FOR CERTAIN HOME CARE SERVICES.
new text end

new text begin (a) Effective January 1, 2024, or upon federal approval, whichever is later, the
commissioner of human services must increase payment rates for home health aide visits
by 14 percent from the rates in effect on December 31, 2023. The commissioner must apply
the annual rate increases under Minnesota Statutes, section 256B.0653, subdivision 8, to
the rates resulting from the application of the rate increases under this paragraph.
 new text end

new text begin (b) Effective January 1, 2024, or upon federal approval, whichever is later, the
commissioner must increase payment rates for respiratory therapy under Minnesota Rules,
part 9505.0295, subpart 2, item E, and for home health services and home care nursing
services, except home health aide visits, under Minnesota Statutes, section 256B.0651,
subdivision 2, clauses (1) to (3), by 55 percent from the rates in effect on December 31,
2023. The commissioner must apply the annual rate increases under Minnesota Statutes,
sections 256B.0653, subdivision 8, and 256B.0654, subdivision 5, to the rates resulting
from the application of the rate increase under this paragraph.
 new text end

Sec. 56. new text begin SPECIALIZED EQUIPMENT AND SUPPLIES LIMIT INCREASE.
new text end

new text begin Upon federal approval, the commissioner must increase the annual limit for specialized
equipment and supplies under Minnesota's federally approved home and community-based
service waiver plans, alternative care, and essential community supports to $10,000.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 57. new text begin STUDY TO EXPAND ACCESS TO SERVICES FOR PEOPLE WITH
CO-OCCURRING BEHAVIORAL HEALTH CONDITIONS AND DISABILITIES.
new text end

new text begin The commissioner, in consultation with stakeholders, must evaluate options to expand
services authorized under Minnesota's federally approved home and community-based
waivers, including positive support, crisis respite, respite, and specialist services. The
evaluation may include surveying community providers as to the barriers to meeting people's
needs and options to authorize services under Minnesota's medical assistance state plan and
strategies to decrease the number of people who remain in hospitals, jails, and other acute
or crisis settings when they no longer meet medical or other necessity criteria.
 new text end

Sec. 58. new text begin TEMPORARY GRANT FOR SMALL CUSTOMIZED LIVING
PROVIDERS.
new text end

new text begin (a) The commissioner must establish a temporary grant for:
 new text end

new text begin (1) customized living providers that serve six or fewer people in a single-family home
and that are transitioning to a community residential services licensure or integrated
community supports licensure; and
 new text end

new text begin (2) community residential service providers and integrated community supports providers
who transitioned from providing customized living or 24-hour customized living on or after
June 30, 2021.
 new text end

new text begin (b) Allowable uses of grant money include physical plant updates required for community
residential services or integrated community supports licensure, technical assistance to adapt
business models and meet policy and regulatory guidance, and other uses approved by the
commissioner. Allowable uses of grant money also include reimbursement for eligible costs
incurred by a community residential service provider or integrated community supports
provider directly related to the provider's transition from providing customized living or
24-hour customized living. License holders of eligible settings must apply for grant money
using an application process determined by the commissioner. Grant money approved by
the commissioner is a onetime award of up to $20,000 per eligible setting. To be considered
for grant money, eligible license holders must submit a grant application by June 30, 2024.
The commissioner may approve grant applications on a rolling basis.
 new text end

Sec. 59. new text begin DIRECTION TO COMMISSIONER; SUPPORTED-DECISION-MAKING
REIMBURSEMENT STUDY.
new text end

new text begin By December 15, 2024, the commissioner shall issue a report to the governor and the
chairs and ranking minority members of the legislative committees with jurisdiction over
human services detailing how medical assistance service providers could be reimbursed for
providing supported-decision-making services. The report must detail recommendations
for all medical assistance programs, including all home and community-based programs,
to provide for reimbursement for supported-decision-making services. The report must
develop detailed provider requirements for reimbursement, including the criteria necessary
to provide high-quality services. In developing provider requirements, the commissioner
shall consult with all relevant stakeholders, including organizations currently providing
supported-decision-making services. The report must also include strategies to promote
equitable access to supported-decision-making services to individuals who are Black,
Indigenous, or People of Color; people from culturally specific communities; people from
rural communities; and other people who may experience barriers to accessing medical
assistance home and community-based services.
 new text end

Sec. 60. new text begin DIRECTION TO COMMISSIONER; APPLICATION OF INTERMEDIATE
CARE FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
RATE INCREASES.
new text end

new text begin The commissioner of human services shall apply the rate increases under Minnesota
Statutes, section 256B.5012, subdivisions 19 and 20, as follows:
 new text end

new text begin (1) apply Minnesota Statutes, section 256B.5012, subdivision 19; and
 new text end

new text begin (2) apply any required rate increase as required under Minnesota Statutes, section
256B.5012, subdivision 20, to the results of clause (1).
 new text end

Sec. 61. new text begin DIRECTION TO COMMISSIONER; SHARED SERVICES.
new text end

new text begin (a) By December 1, 2023, the commissioner of human services shall seek any necessary
changes to home and community-based services waiver plans regarding sharing services in
order to:
 new text end

new text begin (1) permit shared services for additional services, including chore, homemaker, and
night supervision;
 new text end

new text begin (2) permit existing shared services at higher ratios, including individualized home
supports without training, individualized home supports with training, and individualized
home supports with family training at a ratio of one staff person to three recipients;
 new text end

new text begin (3) ensure that individuals who are seeking to share services permitted under the waiver
plans in an own-home setting are not required to live in a licensed setting in order to share
services so long as all other requirements are met; and
 new text end

new text begin (4) issue guidance for shared services, including:
 new text end

new text begin (i) informed choice for all individuals sharing the services;
 new text end

new text begin (ii) guidance for when multiple shared services by different providers occur in one home
and how lead agencies and individuals shall determine that shared service is appropriate to
meet the needs, health, and safety of each individual for whom the lead agency provides
case management or care coordination; and
 new text end

new text begin (iii) guidance clarifying that an individual's decision to share services does not reduce
any determination of the individual's overall or assessed needs for services.
 new text end

new text begin (b) The commissioner shall develop or provide guidance outlining:
 new text end

new text begin (1) instructions for shared services support planning;
 new text end

new text begin (2) person-centered approaches and informed choice in shared services support planning;
and
 new text end

new text begin (3) required contents of shared services agreements.
 new text end

new text begin (c) The commissioner shall seek and utilize stakeholder input for any proposed changes
to waiver plans and any shared services guidance.
 new text end

Sec. 62. new text begin DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
SERVICES RATES.
new text end

new text begin The commissioner of human services shall establish a rate system for shared homemaker
services and shared chore services provided under Minnesota Statutes, sections 256B.092
and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed
1-1/2 times the rate paid for serving a single individual, and for three persons sharing
services, the rate paid to a provider must not exceed two times the rate paid for serving a
single individual. These rates apply only when all of the criteria for the shared service have
been met.
 new text end

Sec. 63. new text begin DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Recommendations required. new text end

new text begin The commissioner of human services shall
develop recommendations for establishing life sharing as a covered medical assistance
waiver service.
 new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For the purposes of this section, "life sharing" means a
relationship-based living arrangement between an adult with a disability and an individual
or family in which they share their lives and experiences while the adult with a disability
receives support from the individual or family using person-centered practices.
 new text end

new text begin Subd. 3. new text end

new text begin Stakeholder engagement and consultation. new text end

new text begin (a) The commissioner must
proactively solicit participation in the development of the life-sharing medical assistance
service through a robust stakeholder engagement process that results in the inclusion of a
racially, culturally, and geographically diverse group of interested stakeholders from each
of the following groups:
 new text end

new text begin (1) providers currently providing or interested in providing life-sharing services;
 new text end

new text begin (2) people with disabilities accessing or interested in accessing life-sharing services;
 new text end

new text begin (3) disability advocacy organizations; and
 new text end

new text begin (4) lead agencies.
 new text end

new text begin (b) The commissioner must proactively seek input into and assistance with the
development of recommendations for establishing the life-sharing service from interested
stakeholders.
 new text end

new text begin (c) The first meeting must occur before July 31, 2023. The commissioner must meet
with stakeholders at least monthly through December 31, 2023. All meetings must be
accessible.
 new text end

new text begin Subd. 4. new text end

new text begin Required topics to be discussed during development of the
recommendations. new text end

new text begin The commissioner and the interested stakeholders must discuss the
following topics:
 new text end

new text begin (1) the distinction between life sharing, adult family foster care, family residential
services, and community residential services;
 new text end

new text begin (2) successful life-sharing models used in other states;
 new text end

new text begin (3) services and supports that could be included in a life-sharing service;
 new text end

new text begin (4) potential barriers to providing or accessing life-sharing services;
 new text end

new text begin (5) solutions to remove identified barriers to providing or accessing life-sharing services;
 new text end

new text begin (6) requirements of a life-sharing agency;
 new text end

new text begin (7) medical assistance payment methodologies for life-sharing providers and life-sharing
agencies;
 new text end

new text begin (8) expanding awareness of the life-sharing model; and
 new text end

new text begin (9) draft language for legislation necessary to further define and implement life-sharing
services.
 new text end

new text begin Subd. 5. new text end

new text begin Report to the legislature. new text end

new text begin By December 31, 2024, the commissioner must
provide to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over direct care services any draft legislation necessary to
implement the rates and requirements for life-sharing services.
 new text end

Sec. 64. new text begin DIRECTION TO COMMISSIONER; FOSTER CARE MORATORIUM
EXCEPTION APPLICATIONS.
new text end

new text begin (a) The commissioner must expedite the processing and review of all new and pending
applications for an initial foster care or community residential setting license under Minnesota
Statutes, section 245A.03, subdivision 7, paragraph (a), clauses (5) and (6).
 new text end

new text begin (b) The commissioner must include on the application materials for an initial foster care
or community residential setting license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clauses (5) and (6), an opportunity for applicants to signify
that they are seeking an initial foster care or community residential setting license in order
to transition an existing operational customized living setting to a foster care or community
residential setting. "Operational" has the meaning given in section 256B.49, subdivision
28, paragraph (e).
 new text end

new text begin (c) For any pending applications for a license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clause (5), the commissioner must determine if the applicant
is eligible for an exception under Minnesota Statutes, section 245A.03, subdivision 7,
paragraph (a), clause (6), and if so, act upon the application under clause (6) rather than
clause (5).
 new text end

new text begin (d) The commissioner must increase to four the licensed capacity of any setting for
which the commissioner issued a license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clause (5), before the final enactment of this act.
 new text end

new text begin (e) This section expires December 31, 2023.
 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. 65. new text begin AWARENESS-BUILDING CAMPAIGN FOR THE RECRUITMENT OF
DIRECT CARE PROFESSIONALS.
new text end

new text begin Subdivision 1. new text end

new text begin Grant program established. new text end

new text begin The commissioner of employment and
economic development shall develop and implement paid advertising as part of a
comprehensive awareness-building campaign aimed at recruiting direct care professionals
to provide long-term care services.
 new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "direct care professionals" means
long-term care services employees who provide direct support or care to people using aging,
disability, or behavioral health services.
 new text end

new text begin Subd. 3. new text end

new text begin Request for proposals; allowable uses of grant money. new text end

new text begin (a) The commissioner
shall publish a request for proposals to select an outside vendor or vendors to conduct the
awareness-building campaign for the recruitment of direct care professionals.
 new text end

new text begin (b) Grant money received under this section may be used:
 new text end

new text begin (1) for the development of recruitment materials for the direct care workforce to be
featured on:
 new text end

new text begin (i) television;
 new text end

new text begin (ii) streaming services;
 new text end

new text begin (iii) radio;
 new text end

new text begin (iv) social media;
 new text end

new text begin (v) billboards; and
 new text end

new text begin (vi) other print materials;
 new text end

new text begin (2) for the development of materials and strategies to highlight and promote the positive
aspects of the direct care workforce;
 new text end

new text begin (3) for the purchase of media time or space to feature recruitment materials for the direct
care workforce; and
 new text end

new text begin (4) for administrative costs necessary to implement this grant program.
 new text end

new text begin (c) The Department of Employment and Economic Development may collaborate with
relevant state agencies for the purposes of the development and implementation of this
campaign and is authorized to transfer administrative money to such agencies to cover any
associated administrative costs.
 new text end

Sec. 66. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2022, section 256B.4914, subdivision 9a, new text end new text begin is repealed.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

ARTICLE 2

AGING SERVICES

Section 1.

Minnesota Statutes 2022, section 256.9754, is amended to read:


256.9754 deleted text begin COMMUNITY SERVICES DEVELOPMENTdeleted text end new text begin LIVE WELL AT HOMEnew text end
GRANTS deleted text begin PROGRAMdeleted text end .

Subdivision 1.

Definitions.

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

(a) "Community" means a town, township, city, or targeted neighborhood within a city,
or a consortium of towns, townships, cities, or targeted neighborhoods within cities.

new text begin (b) "Core home and community-based services provider" means a Faith in Action, Living
at Home/Block Nurse, congregational nurse, or similar community-based program governed
by a board, the majority of whose members reside within the program's service area, that
organizes and uses volunteers and paid staff to deliver nonmedical services intended to
assist older adults to identify and manage risks and to maintain their community living and
integration in the community.
 new text end

new text begin (c) "Long-term services and supports" means any service available under the elderly
waiver program or alternative care grant programs, nursing facility services, transportation
services, caregiver support and respite care services, and other home and community-based
services identified as necessary either to maintain lifestyle choices for older adults or to
support them to remain in their own home.
 new text end

deleted text begin (b)deleted text end new text begin (d)new text end "Older adult services" means any services available under the elderly waiver
program or alternative care grant programs; nursing facility services; transportation services;
respite services; and other community-based services identified as necessary either to
maintain lifestyle choices for older Minnesotans, or to promote independence.

deleted text begin (c)deleted text end new text begin (e)new text end "Older adult" refers to individuals 65 years of age and older.

Subd. 2.

Creationnew text begin ; purposenew text end .

new text begin (a) new text end The deleted text begin community services developmentdeleted text end new text begin live well at homenew text end
grants deleted text begin program isdeleted text end new text begin arenew text end created under the administration of the commissioner of human
services.

new text begin (b) The purpose of projects selected by the commissioner of human services under this
section is to make strategic changes in the long-term services and supports system for older
adults and people with dementia, including statewide capacity for local service development
and technical assistance and statewide availability of home and community-based services
for older adult services, caregiver support and respite care services, and other supports in
Minnesota. These projects are intended to create incentives for new and expanded home
and community-based services in Minnesota in order to:
 new text end

new text begin (1) reach older adults early in the progression of their need for long-term services and
supports, providing them with low-cost, high-impact services that will prevent or delay the
use of more costly services;
 new text end

new text begin (2) support older adults to live in the most integrated, least restrictive community setting;
 new text end

new text begin (3) support the informal caregivers of older adults;
 new text end

new text begin (4) develop and implement strategies to integrate long-term services and supports with
health care services, in order to improve the quality of care and enhance the quality of life
of older adults and their informal caregivers;
 new text end

new text begin (5) ensure cost-effective use of financial and human resources;
 new text end

new text begin (6) build community-based approaches and community commitment to delivering
long-term services and supports for older adults in their own homes;
 new text end

new text begin (7) achieve a broad awareness and use of lower-cost in-home services as an alternative
to nursing homes and other residential services;
 new text end

new text begin (8) strengthen and develop additional home and community-based services and
alternatives to nursing homes and other residential services; and
 new text end

new text begin (9) strengthen programs that use volunteers.
 new text end

new text begin (c) The services provided by these projects are available to older adults who are eligible
for medical assistance and the elderly waiver under chapter 256S, the alternative care
program under section 256B.0913, or the essential community supports grant under section
256B.0922, and to persons who have their own money to pay for services.
 new text end

Subd. 3.

deleted text begin Provision ofdeleted text end new text begin Community services developmentnew text end grants.

The commissioner
shall makenew text begin community services developmentnew text end grants available to communities, providers of
older adult services deleted text begin identified in subdivision 1deleted text end , or deleted text begin todeleted text end a consortium of providers of older
adult servicesdeleted text begin ,deleted text end to establish older adult services. Grants may be provided for capital and other
costs including, but not limited to, start-up and training costs, equipment, and supplies
related to older adult services or other residential or service alternatives to nursing facility
care. Grants may also be made to renovate current buildings, provide transportation services,
fund programs that would allow older adults or individuals with a disability to stay in their
own homes by sharing a home, fund programs that coordinate and manage formal and
informal services to older adults in their homes to enable them to live as independently as
possible in their own homes as an alternative to nursing home care, or expand state-funded
programs in the area.

Subd. 3a.

Priority for other grants.

The commissioner of health shall give priority to
a grantee selected under subdivision 3 when awarding technology-related grants, if the
grantee is using technology as part of the proposal unless that priority conflicts with existing
state or federal guidance related to grant awards by the Department of Health. The
commissioner of transportation shall give priority to a grantee under subdivision 3 when
distributing transportation-related funds to create transportation options for older adults
unless that preference conflicts with existing state or federal guidance related to grant awards
by the Department of Transportation.

Subd. 3b.

State waivers.

The commissioner of health may waive applicable state laws
and rulesnew text begin for grantees under subdivision 3new text end on a time-limited basis if the commissioner of
health determines that a participating grantee requires a waiver in order to achieve
demonstration project goals.

new text begin Subd. 3c. new text end

new text begin Caregiver support and respite care projects. new text end

new text begin (a) The commissioner shall
establish projects to expand the availability of caregiver support and respite care services
for family and other caregivers. The commissioner shall use a request for proposals to select
nonprofit entities to administer the projects. Projects must:
 new text end

new text begin (1) establish a local coordinated network of volunteer and paid respite workers;
 new text end

new text begin (2) coordinate assignment of respite care services to caregivers of older adults;
 new text end

new text begin (3) assure the health and safety of the older adults;
 new text end

new text begin (4) identify at-risk caregivers;
 new text end

new text begin (5) provide information, education, and training for caregivers in the designated
community; and
 new text end

new text begin (6) demonstrate the need in the proposed service area, particularly where nursing facility
closures have occurred or are occurring or areas with service needs identified by section
144A.351. Preference must be given for projects that reach underserved populations.
 new text end

new text begin (b) Projects must clearly describe:
 new text end

new text begin (1) how they will achieve their purpose;
 new text end

new text begin (2) the process for recruiting, training, and retraining volunteers; and
 new text end

new text begin (3) a plan to promote the project in the designated community, including outreach to
persons needing the services.
 new text end

new text begin (c) Money for all projects under this subdivision may be used to:
 new text end

new text begin (1) hire a coordinator to develop a coordinated network of volunteer and paid respite
care services and assign workers to clients;
 new text end

new text begin (2) recruit and train volunteer providers;
 new text end

new text begin (3) provide information, training, and education to caregivers;
 new text end

new text begin (4) advertise the availability of the caregiver support and respite care project; and
 new text end

new text begin (5) purchase equipment to maintain a system of assigning workers to clients.
 new text end

new text begin (d) Volunteer and caregiver training must include resources on how to support an
individual with dementia.
 new text end

new text begin (e) Project money may not be used to supplant existing funding sources.
 new text end

new text begin Subd. 3d. new text end

new text begin Core home and community-based services projects. new text end

new text begin The commissioner
shall select and contract with core home and community-based services providers for projects
to provide services and supports to older adults both with and without family and other
informal caregivers using a request for proposals process. Projects must:
 new text end

new text begin (1) have a credible public or private nonprofit sponsor providing ongoing financial
support;
 new text end

new text begin (2) have a specific, clearly defined geographic service area;
 new text end

new text begin (3) use a practice framework designed to identify high-risk older adults and help them
take action to better manage their chronic conditions and maintain their community living;
 new text end

new text begin (4) have a team approach to coordination and care, ensuring that the older adult
participants, their families, and the formal and informal providers are all part of planning
and providing services;
 new text end

new text begin (5) provide information, support services, homemaking services, counseling, and training
for the older adults and family caregivers;
 new text end

new text begin (6) encourage service area or neighborhood residents and local organizations to
collaborate in meeting the needs of older adults in their geographic service areas;
 new text end

new text begin (7) recruit, train, and direct the use of volunteers to provide informal services and other
appropriate support to older adults and their caregivers; and
 new text end

new text begin (8) provide coordination and management of formal and informal services to older adults
and their families using less expensive alternatives.
 new text end

new text begin Subd. 3e. new text end

new text begin Community service grants. new text end

new text begin The commissioner shall award contracts for
grants to public and private nonprofit agencies to establish services that strengthen a
community's ability to provide a system of home and community-based services for elderly
persons. The commissioner shall use a request for proposals process.
 new text end

new text begin Subd. 3f. new text end

new text begin Live well at home grants extension. new text end

new text begin (a) A community or organization that
has previously received a grant under subdivision 3, except any grants or portion of a grant
for capital or other onetime costs, or subdivisions 3c to 3e, for a project that has proven to
be successful and that is no longer eligible for funding under subdivision 3, 3c, 3d, or 3e
may apply to the commissioner to receive ongoing funding to sustain the project.
 new text end

new text begin (b) The commissioner must use a request for proposals process and may use a two-year
grant cycle.
 new text end

Subd. 4.

Eligibility.

Grants may be awarded only to communities and providers or to a
consortium of providers that have a local match of 50 percent of the costs for the project in
the form of donations, local tax dollars, in-kind donations, fundraising, or other local matches.

Subd. 5.

Grant preference.

The commissioner of human services shall give preference
when awarding grants under this section to areas where nursing facility closures have
occurred or are occurring or areas with service needs identified by section 144A.351. The
commissioner may award grants to the extent grant funds are available and to the extent
applications are approved by the commissioner. Denial of approval of an application in one
year does not preclude submission of an application in a subsequent year. The maximum
grant amount is limited to $750,000.

Sec. 2.

new text begin [256.9756] CAREGIVER RESPITE SERVICES GRANTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Caregiver respite grant program established. new text end

new text begin The commissioner of
human services must establish a caregiver respite services grant program to increase the
availability of respite services for family caregivers of people with dementia and older adults
and to provide information, education, and training to respite caregivers and volunteers
regarding caring for people with dementia. From the money made available for this purpose,
the commissioner must award grants on a competitive basis to respite service providers,
giving priority to areas of the state where there is a high need of respite services.
 new text end

new text begin Subd. 2. new text end

new text begin Eligible uses. new text end

new text begin Grant recipients awarded grant money under this section must
use a portion of the grant award as determined by the commissioner to provide free or
subsidized respite services for family caregivers of people with dementia and older adults.
 new text end

new text begin Subd. 3. new text end

new text begin Report. new text end

new text begin By January 15, 2026, the commissioner shall submit a progress report
about the caregiver respite services grants in this section to the chairs and ranking minority
members of the legislative committees and divisions with jurisdiction over human services.
The progress report must include metrics of the use of grant program money. This subdivision
expires upon submission of the report. The commissioner shall inform the revisor of statutes
when the report is submitted.
 new text end

Sec. 3.

Minnesota Statutes 2022, section 256B.0913, subdivision 4, is amended to read:


Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a)
Funding for services under the alternative care program is available to persons who meet
the following criteria:

(1) the person is a citizen of the United States or a United States national;

(2) the person has been determined by a community assessment under section 256B.0911
to be a person who would require the level of care provided in a nursing facility, as
determined under section 256B.0911, subdivision 26, but for the provision of services under
the alternative care program;

(3) the person is age 65 or older;

(4) the person would be eligible for medical assistance within 135 days of admission to
a nursing facility;

(5) the person is not ineligible for the payment of long-term care services by the medical
assistance program due to an asset transfer penalty under section 256B.0595 or equity
interest in the home exceeding $500,000 as stated in section 256B.056;

(6) the person needs long-term care services that are not funded through other state or
federal funding, or other health insurance or other third-party insurance such as long-term
care insurance;

(7) except for individuals described in clause (8), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256S.18. This monthly limit does not prohibit the
alternative care client from payment for additional services, but in no case may the cost of
additional services purchased under this section exceed the difference between the client's
monthly service limit defined under section 256S.04, and the alternative care program
monthly service limit defined in this paragraph. If care-related supplies and equipment or
environmental modifications and adaptations are or will be purchased for an alternative
care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive
months beginning with the month of purchase. If the monthly cost of a recipient's other
alternative care services exceeds the monthly limit established in this paragraph, the annual
cost of the alternative care services shall be determined. In this event, the annual cost of
alternative care services shall not exceed 12 times the monthly limit described in this
paragraph;

(8) for individuals assigned a case mix classification A as described under section
256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies
in bathing, dressing, grooming, walking, and eating when the dependency score in eating
is three or greater as determined by an assessment performed under section 256B.0911, the
monthly cost of alternative care services funded by the program cannot exceed $593 per
month for all new participants enrolled in the program on or after July 1, 2011. This monthly
limit shall be applied to all other participants who meet this criteria at reassessment. This
monthly limit shall be increased annually as described in section 256S.18. This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (7) for
case mix classification A; deleted text begin and
deleted text end

(9) the person is making timely payments of the assessed monthly fee. A person is
ineligible if payment of the fee is over 60 days past due, unless the person agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee paymentsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (10) for a person participating in consumer-directed community supports, the person's
monthly service limit must be equal to the monthly service limits in clause (7), except that
a person assigned a case mix classification L must receive the monthly service limit for
case mix classification A.
 new text end

(b) The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(c) Alternative care funding under this subdivision is not available for a person who is
a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by medical
assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a
medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.

(d) Alternative care funding is not available for a person who resides in a licensed nursing
home, certified boarding care home, hospital, or intermediate care facility, except for case
management services which are provided in support of the discharge planning process for
a nursing home resident or certified boarding care home resident to assist with a relocation
process to a community-based setting.

(e) Alternative care funding is not available for a person whose income is greater than
the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent
of the federal poverty guideline effective July 1 in the fiscal year for which alternative care
eligibility is determined, who would be eligible for the elderly waiver with a waiver
obligation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 4.

Minnesota Statutes 2022, 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 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 deleted text begin 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 availabledeleted text end ;

(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, 2024.
 new text end

Sec. 5.

Minnesota Statutes 2022, section 256B.0917, subdivision 1b, is amended to read:


Subd. 1b.

Definitions.

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

(b) deleted text begin "Community" means a town; township; city; or targeted neighborhood within a city;
or a consortium of towns, townships, cities, or specific neighborhoods within a city.
deleted text end

deleted text begin (c) "Core home and community-based services provider" means a Faith in Action, Living
at Home Block Nurse, Congregational Nurse, or similar community-based program governed
by a board, the majority of whose members reside within the program's service area, that
organizes and uses volunteers and paid staff to deliver nonmedical services intended to
assist older adults to identify and manage risks and to maintain their community living and
integration in the community.
 deleted text end

deleted text begin (d)deleted text end "Eldercare development partnership" means a team of representatives of county
social service and public health agencies, the area agency on aging, local nursing home
providers, local home care providers, and other appropriate home and community-based
providers in the area agency's planning and service area.

deleted text begin (e)deleted text end new text begin (c)new text end "Long-term services and supports" means any service available under the elderly
waiver program or alternative care grant programs, nursing facility services, transportation
services, caregiver support and respite care services, and other home and community-based
services identified as necessary either to maintain lifestyle choices for older adults or to
support them to remain in their own home.

deleted text begin (f)deleted text end new text begin (d)new text end "Older adult" refers to an individual who is 65 years of age or older.

Sec. 6.

Minnesota Statutes 2022, 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 deleted text begin $400deleted text end new text begin $600new text end 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, subdivisions 17 to
21, 23, 24, or 27, 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 an assessment summary; and

(6) has been determined by a community assessment under section 256B.0911,
subdivisions 17 to 21, 23, 24, or 27, 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;

(ii) caregiver supportnew text begin , including respite carenew text end ;

(iii) homemaker support;

new text begin (iv) adult companion services;
 new text end

deleted text begin (iv)deleted text end new text begin (v)new text end chores;

deleted text begin (v)deleted text end new text begin (vi)new text end a personal emergency response device or system;

deleted text begin (vi)deleted text end new text begin (vii)new text end home-delivered meals; or

deleted text begin (vii)deleted text end new text begin (viii)new text end 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 assessment summary.

(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.

Sec. 7.

Minnesota Statutes 2022, section 256B.434, is amended by adding a subdivision
to read:


new text begin Subd. 4k. new text end

new text begin Property rate increase for certain nursing facilities. new text end

new text begin (a) A rate increase
under this subdivision ends upon the effective date of the transition of the facility's property
rate to a property payment rate under section 256R.26, subdivision 8.
 new text end

new text begin (b) The commissioner shall increase the property rate of a nursing facility located in the
city of Saint Paul at 1415 Almond Avenue in Ramsey County by $10.65 on September 1,
2023.
 new text end

new text begin (c) The commissioner shall increase the property rate of a nursing facility located in the
city of Duluth at 3111 Church Place in St. Louis County by $20.81 on September 1, 2023.
 new text end

new text begin (d) The commissioner shall increase the property rate of a nursing facility located in the
city of Chatfield at 1102 Liberty Street SE in Fillmore County by $21.35 on September 1,
2023.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2023.
 new text end

Sec. 8.

Minnesota Statutes 2022, section 256M.42, is amended to read:


256M.42 ADULT PROTECTION GRANT ALLOCATIONS.

Subdivision 1.

Formula.

(a) The commissioner shall allocate state money appropriated
under this section new text begin on an annual basis new text end to each county board deleted text begin and tribal government approved
by the commissioner to assume county agency dutiesdeleted text end for adult deleted text begin protective services or as a
lead investigative agencydeleted text end new text begin protectionnew text end under section 626.557 deleted text begin on an annual basis in an amount
determineddeleted text end new text begin and to Tribal Nations that have voluntarily chosen by resolution of Tribal
government to participate in vulnerable adult protection programsnew text end according to the following
formulanew text begin after the award of the amounts in paragraph (c)new text end :

(1) 25 percent must be allocated new text begin to the responsible agency new text end on the basis of the number
of reports of suspected vulnerable adult maltreatment under sections 626.557 and 626.5572,
deleted text begin when the county or tribe is responsibledeleted text end as determined by the most recent data of the
commissioner; and

(2) 75 percent must be allocated new text begin to the responsible agency new text end on the basis of the number
of screened-in reports for adult protective services or vulnerable adult maltreatment
investigations under sections 626.557 and 626.5572, deleted text begin when the county or tribe is responsibledeleted text end
as determined by the most recent data of the commissioner.

(b) deleted text begin The commissioner is precluded from changing the formula under this subdivision
or recommending a change to the legislature without public review and input.deleted text end new text begin
Notwithstanding paragraph (a), the commissioner must not award a county less than a
minimum allocation established by the commissioner.
new text end

new text begin (c) To receive money under this subdivision, a participating Tribal Nation must apply
to the commissioner. Of the amount appropriated for purposes of this section, the
commissioner must award $100,000 to each federally recognized Tribal Nation that has
applied to the commissioner and has a Tribal resolution establishing a vulnerable adult
protection program. Money received by a Tribal Nation under this section must be used for
its vulnerable adult protection program.
 new text end

Subd. 2.

Payment.

The commissioner shall make allocations for the state fiscal year
starting July 1, deleted text begin 2019deleted text end new text begin 2023new text end , and to each county board or tribal government on or before
October 10, deleted text begin 2019deleted text end new text begin 2023new text end . The commissioner shall make allocations under subdivision 1 to
each county board or tribal government each year thereafter on or before July 10.

Subd. 3.

deleted text begin Prohibition on supplanting existing moneydeleted text end new text begin Purpose of expendituresnew text end .

Money
received under this section must be used deleted text begin for staffing for protection of vulnerable adults or deleted text end
new text begin to meet the agency's duties under section 626.557 andnew text end to expand adult protective servicesnew text begin
to stop, prevent, and reduce risks of maltreatment for adults accepted for services under
section 626.557, or for multidisciplinary teams under section 626.5571new text end . deleted text begin Money must not
be used to supplant current county or tribe expenditures for these purposes.
deleted text end

new text begin Subd. 4. new text end

new text begin Required expenditures. new text end

new text begin State money must be used to expand, not supplant,
county or Tribal expenditures for the fiscal year 2023 base for adult protection programs,
service interventions, or multidisciplinary teams. This prohibition on county or Tribal
expenditures supplanting state money ends July 1, 2027.
 new text end

new text begin Subd. 5. new text end

new text begin County performance on adult protection measures. new text end

new text begin The commissioner must
set vulnerable adult protection measures and standards for money received under this section.
The commissioner must require an underperforming county to demonstrate that the county
designated money allocated under this section for the purpose required and implemented a
reasonable strategy to improve adult protection performance, including the provision of a
performance improvement plan and additional remedies identified by the commissioner.
The commissioner may redirect up to 20 percent of a county's money under this section
toward the performance improvement plan.
 new text end

new text begin Subd. 6. new text end

new text begin American Indian adult protection. new text end

new text begin Tribal Nations receiving money under
this section must establish vulnerable adult protection measures and standards and report
annually to the commissioner on these outcomes and the number of adults served.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 9.

Minnesota Statutes 2022, section 256R.02, subdivision 19, is amended to read:


Subd. 19.

External fixed costs.

"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; property taxes, special assessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; Public Employees
Retirement Association employer costs; and deleted text begin border citydeleted text end new text begin facility-specificnew text end rate deleted text begin adjustmentsdeleted text end new text begin
modificationsnew text end under section 256R.481.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 10.

Minnesota Statutes 2022, section 256R.17, subdivision 2, is amended to read:


Subd. 2.

Case mix indices.

(a) The commissioner shall assign a case mix index to each
case mix classification deleted text begin based on the Centers for Medicare and Medicaid Services staff time
measurement studydeleted text end new text begin as determined by the commissioner of health under section 144.0724new text end .

(b) An index maximization approach shall be used to classify residents. "Index
maximization" has the meaning given in section 144.0724, subdivision 2, paragraph (c).

Sec. 11.

Minnesota Statutes 2022, section 256R.25, is amended to read:


256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.

(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
(b) to (o).

(b) For a facility licensed as a nursing home, the portion related to the provider surcharge
under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
nursing home and a boarding care home, the portion related to the provider surcharge under
section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
of nursing home beds divided by its total number of licensed beds.

(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
amount of the fee divided by the sum of the facility's resident days.

(d) The portion related to development and education of resident and family advisory
councils under section 144A.33 is $5 per resident day divided by 365.

(e) The portion related to scholarships is determined under section 256R.37.

(f) The portion related to planned closure rate adjustments is as determined under section
256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.

(g) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.

(h) The portion related to single-bed room incentives is as determined under section
256R.41.

(i) The portions related to real estate taxes, special assessments, and payments made in
lieu of real estate taxes directly identified or allocated to the nursing facility are the allowable
amounts divided by the sum of the facility's resident days. Allowable costs under this
paragraph for payments made by a nonprofit nursing facility that are in lieu of real estate
taxes shall not exceed the amount which the nursing facility would have paid to a city or
township and county for fire, police, sanitation services, and road maintenance costs had
real estate taxes been levied on that property for those purposes.

(j) The portion related to employer health insurance costs is the allowable costs divided
by the sum of the facility's resident days.

(k) The portion related to the Public Employees Retirement Association is the allowable
costs divided by the sum of the facility's resident days.

(l) The portion related to quality improvement incentive payment rate adjustments is
the amount determined under section 256R.39.

(m) The portion related to performance-based incentive payments is the amount
determined under section 256R.38.

(n) The portion related to special dietary needs is the amount determined under section
256R.51.

(o) The portion related to the rate adjustments for deleted text begin border city facilitiesdeleted text end new text begin facility-specific
rate modificationsnew text end is the amount determined under section 256R.481.

new text begin (p) The portion related to the rate adjustment for critical access nursing facilities is the
amount determined under section 256R.47.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 12.

Minnesota Statutes 2022, section 256R.47, is amended to read:


256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.

(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.

(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.

(c) deleted text begin The commissioner shall allow the benefits in clauses (1) to (5)deleted text end For nursing facilities
designated as critical access nursing facilitiesdeleted text begin :deleted text end new text begin , the commissioner shall allow a supplemental
payment above a facility's operating payment rate as determined to be necessary by the
commissioner to maintain access to nursing facilities services in isolated areas identified
in paragraph (b). The commissioner must approve the amounts of supplemental payments
through a memorandum of understanding. Supplemental payments to facilities under this
section must be in the form of time-limited rate adjustments included in the external fixed
payment rate under section 256R.25.
new text end

deleted text begin (1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;
 deleted text end

deleted text begin (2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;
 deleted text end

deleted text begin (3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;
 deleted text end

deleted text begin (4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and
 deleted text end

deleted text begin (5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.
 deleted text end

(d) Designation of a critical access nursing facility is for a new text begin maximum new text end period of new text begin up to
new text end two years, after which the deleted text begin benefitsdeleted text end new text begin benefitnew text end allowed under paragraph (c) shall be removed.
Designated facilities may apply for continued designation.

deleted text begin (e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, to December 31, 2019.
 deleted text end

new text begin (e) The memorandum of understanding required by paragraph (c) must state that the
designation of a critical access nursing facility must be removed if the facility undergoes a
change of ownership as defined in section 144A.06, subdivision 2.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 13.

Minnesota Statutes 2022, section 256R.481, is amended to read:


256R.481 new text begin FACILITY-SPECIFIC new text end RATE deleted text begin ADJUSTMENTS FOR BORDER CITY
FACILITIESdeleted text end new text begin MODIFICATIONSnew text end .

new text begin Subdivision 1. new text end

new text begin Border city facilities. new text end

(a) The commissioner shall allow each nonprofit
nursing facility located within the boundaries of the city of Breckenridge or Moorhead prior
to January 1, 2015, to apply once annually for a rate add-on to the facility's external fixed
costs payment rate.

(b) A facility seeking an add-on to its external fixed costs payment rate under this section
must apply annually to the commissioner to receive the add-on. A facility must submit the
application within 60 calendar days of the effective date of any add-on under this section.
The commissioner may waive the deadlines required by this paragraph under extraordinary
circumstances.

(c) The commissioner shall provide the add-on to each eligible facility that applies by
the application deadline.

(d) The add-on to the external fixed costs payment rate is the difference on January 1
of the median total payment rate for case mix classification PA1 of the nonprofit facilities
located in an adjacent city in another state and in cities contiguous to the adjacent city minus
the eligible nursing facility's total payment rate for case mix classification PA1 as determined
under section 256R.22, subdivision 4.

new text begin Subd. 2. new text end

new text begin Nursing facility in Chisholm; temporary rate add-on. new text end

new text begin Effective July 1, 2023,
through December 31, 2027, the commissioner shall provide an external fixed rate add-on
for the nursing facility in the city of Chisholm in the amount of $11.81. If this nursing
facility completes a moratorium exception project that is approved after March 27, 2023,
this subdivision expires the day before the effective date of that moratorium rate adjustment
or December 31, 2027, whichever is earlier. The commissioner of human services shall
notify the revisor of statutes if this subdivision expires prior to December 31, 2027.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 14.

Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Nursing facility in Fergus Falls. new text end

new text begin Notwithstanding sections 256B.431, 256B.434,
and 256R.26, subdivision 9, a nursing facility located in the city of Fergus Falls licensed
for 105 beds on September 1, 2021, must have the property portion of its total payment rate
determined according to sections 256R.26 to 256R.267.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 15.

Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Nursing facility in Red Wing. new text end

new text begin The operating payment rate for a facility located
in the city of Red Wing at 1412 West 4th Street is the sum of its direct care costs per
standardized day, its other care-related costs per resident day, and its other operating costs
per day.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
 new text end

Sec. 16.

Minnesota Statutes 2022, section 256S.15, subdivision 2, is amended to read:


Subd. 2.

Foster care limit.

The elderly waiver payment for the foster care service in
combination with the payment for all other elderly waiver services, including case
management, must not exceed the monthly case mix budget cap for the participant as
specified in sections 256S.18, subdivision 3, and 256S.19, deleted text begin subdivisionsdeleted text end new text begin subdivisionnew text end 3 deleted text begin and
4deleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 17.

Minnesota Statutes 2022, section 256S.18, is amended by adding a subdivision
to read:


new text begin Subd. 3a. new text end

new text begin Monthly case mix budget caps for consumer-directed community
supports. new text end

new text begin The monthly case mix budget caps for each case mix classification for
consumer-directed community supports must be equal to the monthly case mix budget caps
in subdivision 3.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 18.

Minnesota Statutes 2022, section 256S.19, subdivision 3, is amended to read:


Subd. 3.

Calculation of monthly conversion budget deleted text begin cap without consumer-directed
community supportsdeleted text end new text begin capsnew text end .

(a) The elderly waiver monthly conversion budget cap for the
cost of elderly waiver services deleted text begin without consumer-directed community supportsdeleted text end must be
based on the nursing facility case mix adjusted total payment rate of the nursing facility
where the elderly waiver applicant currently resides for the applicant's case mix classification
as determined according to section 256R.17.

(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver
services deleted text begin without consumer-directed community supports shalldeleted text end new text begin mustnew text end be calculated by
multiplying the applicable nursing facility case mix adjusted total payment rate by 365,
dividing by 12, and subtracting the participant's maintenance needs allowance.

(c) A participant's initially approved monthly conversion budget cap for elderly waiver
services deleted text begin without consumer-directed community supports shalldeleted text end new text begin mustnew text end be adjusted at least
annually as described in section 256S.18, subdivision 5.

new text begin (d) Conversion budget caps for individuals participating in consumer-directed community
supports must be set as described in paragraphs (a) to (c).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 19.

Minnesota Statutes 2022, section 256S.203, subdivision 1, is amended to read:


Subdivision 1.

Capitation payments.

The commissioner must adjust the elderly waiver
capitation payment rates for managed care organizations paid to reflect the monthly service
rate limits for customized living services and 24-hour customized living services established
under section 256S.202 deleted text begin anddeleted text end new text begin ,new text end the rate adjustments for disproportionate share facilities under
section 256S.205new text begin , and the assisted living facility closure payments under section 256S.206new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 20.

Minnesota Statutes 2022, section 256S.203, subdivision 2, is amended to read:


Subd. 2.

Reimbursement rates.

Medical assistance rates paid to customized living
providers by managed care organizations under this chapter must not exceed the monthly
service rate limits and component rates as determined by the commissioner under sections
256S.15 and 256S.20 to 256S.202, plus any rate adjustment new text begin or special payment new text end under section
256S.205new text begin or 256S.206new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 21.

Minnesota Statutes 2022, section 256S.205, subdivision 3, is amended to read:


Subd. 3.

Rate adjustment eligibility criteria.

Only facilities satisfying all of the
following conditions on September 1 of the application year are eligible for designation as
a disproportionate share facility:

(1) at least deleted text begin 83.5deleted text end new text begin 80new text end percent of the residents of the facility are customized living residents;
and

(2) at least deleted text begin 70deleted text end new text begin 50new text end percent of the customized living residents are elderly waiver participants.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 22.

Minnesota Statutes 2022, section 256S.205, subdivision 5, is amended to read:


Subd. 5.

Rate adjustment; rate floor.

(a) Notwithstanding the 24-hour customized
living monthly service rate limits under section 256S.202, subdivision 2, and the component
service rates established under section 256S.201, subdivision 4, the commissioner must
establish a rate floor equal to deleted text begin $119deleted text end new text begin $139new text end per resident per day for 24-hour customized living
services provided to an elderly waiver participant in a designated disproportionate share
facility.

(b) The commissioner must apply the rate floor to the services described in paragraph
(a) provided during the rate year.

(c) The commissioner must adjust the rate floor by the same amount and at the same
time as any adjustment to the 24-hour customized living monthly service rate limits under
section 256S.202, subdivision 2.

(d) The commissioner shall not implement the rate floor under this section if the
customized living rates established under sections 256S.21 to 256S.215 will be implemented
at 100 percent on January 1 of the year following an application year.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 23.

new text begin [256S.206] ASSISTED LIVING FACILITY CLOSURE PAYMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Assisted living facility closure payments provided. new text end

new text begin The commissioner
of human services shall establish a special payment program to support licensed assisted
living facilities who serve waiver participants under section 256B.49 and chapter 256S
when the assisted living facility is acting to close the facility as outlined in section 144G.57.
The payments must support the facility to meet the health and safety needs of residents
during facility occupancy and revenue decline.
 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 terms in this subdivision
have the meanings given.
 new text end

new text begin (b) "Closure period" means the number of days in the approved closure plan for the
eligible facility as determined by the commissioner of health under section 144G.57, not to
exceed 60 calendar days.
 new text end

new text begin (c) "Eligible claim" means a claim for customized living services and 24-hour customized
living services provided to waiver participants under section 256B.49 and chapter 256S
during the eligible facility's closure period.
 new text end

new text begin (d) "Eligible facility" means a licensed assisted living facility that has an approved
closure plan, as determined by the commissioner of health under section 144G.57, that is
acting to close the facility and no longer serve residents in that setting. A facility where a
provider is relinquishing an assisted living facility license to transition to a different license
type is not an eligible facility.
 new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin (a) An eligible facility may apply to the commissioner of human
services for assisted living closure transition payments in the manner prescribed by the
commissioner.
 new text end

new text begin (b) The commissioner shall notify the facility within 14 calendars days of the facility's
application about the result of the application, including whether the facility meets the
definition of an eligible facility.
 new text end

new text begin Subd. 4. new text end

new text begin Issuing closure payments. new text end

new text begin (a) The commissioner must increase the payment
for eligible claims by 50 percent during the eligible facility's closure period.
 new text end

new text begin (b) The commissioner must direct managed care organizations to increase the payment
for eligible claims by 50 percent during the eligible facility's closure period for eligible
claims submitted to managed care organizations.
 new text end

new text begin Subd. 5. new text end

new text begin Interagency coordination. new text end

new text begin The commissioner of human services must
coordinate the activities under this section with any impacted state agencies and lead agencies.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
 new text end

Sec. 24.

Minnesota Statutes 2022, section 256S.21, is amended to read:


256S.21 RATE SETTING; APPLICATIONnew text begin ; EVALUATIONnew text end .

new text begin Subdivision 1. new text end

new text begin Application of rate setting. new text end

The deleted text begin paymentdeleted text end new text begin ratenew text end methodologies in sections
256S.2101 to 256S.215 apply tonew text begin :
new text end

new text begin (1)new text end elderly waiver, elderly waiver customized living, and elderly waiver foster care under
this chapter;

new text begin (2)new text end alternative care under section 256B.0913;

new text begin (3)new text end essential community supports under section 256B.0922; and

new text begin (4)new text end community access for disability inclusion customized living and brain injury
customized living under section 256B.49.

new text begin Subd. 2. new text end

new text begin Evaluation of rate setting. new text end

new text begin (a) Beginning January 1, 2024, and every two years
thereafter, the commissioner, in consultation with stakeholders, shall use all available data
and resources to evaluate the following rate setting elements:
 new text end

new text begin (1) the base wage index;
 new text end

new text begin (2) the factors and supervision wage components; and
 new text end

new text begin (3) the formulas to calculate adjusted base wages and rates.
 new text end

new text begin (b) Beginning January 15, 2026, 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 Previous finance Next and policy with a full report on
the information and data gathered under paragraph (a).
 new text end

new text begin Subd. 3. new text end

new text begin Cost reporting. new text end

new text begin (a) As determined by the commissioner, in consultation with
stakeholders, a provider enrolled to provide services with rates determined under this chapter
must submit requested cost data to the commissioner to support evaluation of the rate
methodologies in this chapter. Requested cost data may include but are 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 (b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to the provider's submission due date. If
by 30 days after the required submission date a provider fails to submit required reporting
data, the commissioner shall provide notice to the provider, and if by 60 days after the
required submission date a provider has not provided the required data, the commissioner
shall provide a second notice. The commissioner shall temporarily suspend payments to the
provider if cost data is not received 90 days after the required submission date. Withheld
payments must be made once data is received by the commissioner.
 new text end

new text begin (c) The commissioner shall coordinate the cost reporting activities required under this
section with the cost reporting activities directed under section 256B.4914, subdivision 10a.
 new text end

new text begin (d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders, may submit recommendations on rate methodologies in this
chapter, including ways to monitor and enforce the spending requirements directed in section
256S.2101, subdivision 3, through the reports directed by subdivision 2.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 and 2 are effective January 1, 2024. Subdivision
3 is effective January 1, 2025.
 new text end

Sec. 25.

Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:


Subd. 2.

Phase-in for elderly waiver rates.

Except for home-delivered meals deleted text begin as
described in section 256S.215, subdivision 15deleted text end new text begin and the services in subdivision 2anew text end , all rates
and rate components for elderly waiver, elderly waiver customized living, and elderly waiver
foster care under this chapter; alternative care under section 256B.0913; and essential
community supports under section 256B.0922 shall benew text begin :
new text end

new text begin (1) beginning January 1, 2024,new text end the sum of deleted text begin 18.8deleted text end new text begin 27.8new text end percent of the rates calculated under
sections 256S.211 to 256S.215, and deleted text begin 81.2deleted text end new text begin 72.2new text end percent of the rates calculated using the rate
methodology in effect as of June 30, 2017deleted text begin . The rate for home-delivered meals shall be the
sum of the service rate in effect as of January 1, 2019, and the increases described in section
256S.215, subdivision 15deleted text end new text begin ; and
new text end

new text begin (2) beginning January 1, 2026, the sum of 25 percent of the rates calculated under sections
256S.211 to 256S.215, and 75 percent of the rates calculated using the rate methodology
in effect as of June 30, 2017new text end .

Sec. 26.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:


new text begin Subd. 2a. new text end

new text begin Service rates exempt from phase-in. new text end

new text begin Subdivision 2 does not apply to rates
for homemaker services described in section 256S.215, subdivisions 9 to 11.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 27.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Spending requirements. new text end

new text begin (a) Except for community access for disability
inclusion customized living and brain injury customized living under section 256B.49, at
least 80 percent of the marginal increase in revenue from the implementation of any
adjustments to the phase-in in subdivision 2, or any updates to services rates directed under
section 256S.211, subdivision 3, must be used to increase compensation-related costs for
employees directly employed by the provider.
 new text end

new text begin (b) For the purposes of this subdivision, compensation-related costs include:
 new text end

new text begin (1) wages and salaries;
 new text end

new text begin (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;
 new text end

new text begin (3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and
 new text end

new text begin (4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to the implementation of the adjusted phase-in in
subdivision 2, including any concurrent or subsequent adjustments to the base wage indices.
 new text end

new text begin (c) Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider,
or for persons paid by the provider under a management contract, do not count toward the
80 percent requirement under this subdivision.
 new text end

new text begin (d) A provider agency or individual provider that receives additional revenue subject to
the requirements of this subdivision shall prepare, and upon request submit to the
commissioner, a distribution plan that specifies the amount of money the provider expects
to receive that is subject to the requirements of this subdivision, including how that money
was or will be distributed to increase compensation-related costs for employees. Within 60
days of final implementation of the new phase-in proportion or adjustment to the base wage
indices subject to the requirements of this subdivision, the provider must post the distribution
plan and leave it posted for a period of at least six months in an area of the provider's
operation to which all direct support professionals have access. The posted distribution plan
must include instructions regarding how to contact the commissioner, or the commissioner's
representative, if an employee has not received the compensation-related increase described
in the plan.
 new text end

Sec. 28.

Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Updating services rates. new text end

new text begin On January 1, 2024, and every two years thereafter,
the commissioner shall recalculate rates for services as directed in section 256S.215. Prior
to recalculating the rates, the commissioner shall:
 new text end

new text begin (1) update the base wage index for services in section 256S.212 based on the most
recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA data;
 new text end

new text begin (2) update the payroll taxes and benefits factor in section 256S.213, subdivision 1, based
on the most recently available nursing facility cost report data;
 new text end

new text begin (3) update the supervision wage components in section 256S.213, subdivisions 4 and 5,
based on the most recently available Bureau of Labor Statistics Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA data; and
 new text end

new text begin (4) update the adjusted base wage for services as directed in section 256S.214.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 29.

Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Updating home-delivered meals rate. new text end

new text begin On January 1 of each year, the
commissioner shall update the home-delivered meals rate in section 256S.215, subdivision
15, by the percent increase in the nursing facility dietary per diem using the two most recently
available nursing facility cost reports.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 30.

Minnesota Statutes 2022, section 256S.212, is amended to read:


256S.212 RATE SETTING; BASE WAGE INDEX.

Subdivision 1.

Updating SOC codes.

If any of the SOC codes and positions used in
this section are no longer available, the commissioner shall, in consultation with stakeholders,
select a new SOC code and position that is the closest match to the previously used SOC
position.

Subd. 2.

Home management and support services base wage.

For customized livingdeleted text begin ,deleted text end new text begin
andnew text end foster caredeleted text begin , and residential caredeleted text end component services, the home management and support
services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for new text begin home health and new text end personal deleted text begin and homedeleted text end care aide (SOC code deleted text begin 39-9021deleted text end new text begin
31-1120new text end ); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012).

Subd. 3.

Home care aide base wage.

For customized livingdeleted text begin ,deleted text end new text begin andnew text end foster caredeleted text begin , and
residential caredeleted text end component services, the home care aide base wage equals deleted text begin 50deleted text end new text begin 75new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home healthnew text begin
and personal carenew text end aides (SOC code deleted text begin 31-1011deleted text end new text begin 31-1120new text end ); and deleted text begin 50deleted text end new text begin 25new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end ).

Subd. 4.

Home health aide base wage.

For customized livingdeleted text begin ,deleted text end new text begin andnew text end foster caredeleted text begin , and
residential caredeleted text end component services, the home health aide base wage equals deleted text begin 20deleted text end new text begin 33.33new text end percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed
practical and licensed vocational nurses (SOC code 29-2061); deleted text begin and 80deleted text end new text begin 33.33new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end )new text begin ; and 33.34 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for home health and personal care aides (SOC code
31-1120)new text end .

Subd. 5.

Medication setups by licensed nurse base wage.

For customized livingdeleted text begin ,deleted text end new text begin andnew text end
foster caredeleted text begin , and residential caredeleted text end component services, the medication setups by licensed nurse
base wage equals deleted text begin tendeleted text end new text begin 25new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);
and deleted text begin 90deleted text end new text begin 75new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for registered nurses (SOC code 29-1141).

Subd. 6.

Chore services base wage.

The chore services base wage equals deleted text begin 100deleted text end new text begin 50new text end percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping
and groundskeeping workers (SOC code 37-3011)new text begin ; and 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners
(SOC code 37-2012)new text end .

Subd. 7.

Companion services base wage.

The companion services base wage equals
deleted text begin 50deleted text end new text begin 80new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
for new text begin home health and new text end personal deleted text begin and homedeleted text end care aides (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); and deleted text begin 50deleted text end new text begin
20new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
maids and housekeeping cleaners (SOC code 37-2012).

Subd. 8.

Homemaker deleted text begin services anddeleted text end assistance with personal care base wage.

The
homemaker deleted text begin services anddeleted text end assistance with personal care base wage equals deleted text begin 60deleted text end new text begin 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for new text begin home health
and new text end personal deleted text begin and homedeleted text end care deleted text begin aidedeleted text end new text begin aidesnew text end (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); deleted text begin 20deleted text end new text begin and 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end )deleted text begin ; and 20 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012)deleted text end .

Subd. 9.

Homemaker deleted text begin services anddeleted text end cleaning base wage.

The homemaker deleted text begin services anddeleted text end
cleaning base wage equals deleted text begin 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing
assistants (SOC code 31-1014); and 20deleted text end new text begin 100new text end percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).

Subd. 10.

Homemaker deleted text begin services anddeleted text end home management base wage.

The homemaker
deleted text begin services anddeleted text end home management base wage equals deleted text begin 60deleted text end new text begin 50new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for new text begin home health and new text end personal deleted text begin and homedeleted text end
care deleted text begin aidedeleted text end new text begin aidesnew text end (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); deleted text begin 20deleted text end new text begin and 50new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
deleted text begin 31-1014deleted text end new text begin 31-1131new text end )deleted text begin ; and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012)deleted text end .

Subd. 11.

In-home respite care services base wage.

The in-home respite care services
base wage equals deleted text begin fivedeleted text end new text begin 15new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin nursing assistantsdeleted text end new text begin home health and
personal care aidesnew text end (SOC code deleted text begin 31-1014deleted text end new text begin 31-1120new text end ); and deleted text begin 20deleted text end new text begin tennew text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061).

Subd. 12.

Out-of-home respite care services base wage.

The out-of-home respite care
services base wage equals deleted text begin fivedeleted text end new text begin 15new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin nursing assistantsdeleted text end new text begin
home health and personal care aidesnew text end (SOC code deleted text begin 31-1014deleted text end new text begin 31-1120new text end ); and deleted text begin 20deleted text end new text begin tennew text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061).

Subd. 13.

Individual community living support base wage.

The individual community
living support base wage equals deleted text begin 20deleted text end new text begin 60new text end percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for deleted text begin licensed practical and licensed vocational nursesdeleted text end new text begin social
and human services assistantsnew text end (SOC code deleted text begin 29-2061deleted text end new text begin 21-1093new text end ); and deleted text begin 80deleted text end new text begin 40new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end ).

Subd. 14.

Registered nurse base wage.

The registered nurse base wage equals 100
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
registered nurses (SOC code 29-1141).

Subd. 15.

deleted text begin Social workerdeleted text end new text begin Unlicensed supervisornew text end base wage.

The deleted text begin social workerdeleted text end new text begin
unlicensed supervisornew text end base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin medical and public health socialdeleted text end new text begin
first-line supervisors of personal servicenew text end workers (SOC code deleted text begin 21-1022deleted text end new text begin 39-1022new text end ).

new text begin Subd. 16. new text end

new text begin Adult day services base wage. new text end

new text begin The adult day services base wage equals 75
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home
health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1131).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 31.

Minnesota Statutes 2022, section 256S.213, is amended to read:


256S.213 RATE SETTING; FACTORS.

Subdivision 1.

Payroll taxes and benefits factor.

The payroll taxes and benefits factor
is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing
facilities on the most recent and available cost report.

Subd. 2.

General and administrative factor.

The general and administrative factor is
deleted text begin the difference of net general and administrative expenses and administrative salaries, divided
by total operating expenses for all nursing facilities on the most recent and available cost
reportdeleted text end new text begin 14.4 percentnew text end .

Subd. 3.

Program plan support factor.

new text begin (a) new text end The program plan support factor is deleted text begin 12.8deleted text end new text begin tennew text end
percent new text begin for the following services new text end to cover the cost of direct service staff needed to provide
support for deleted text begin home and community-baseddeleted text end new text begin thenew text end service when not engaged in direct contact with
participantsdeleted text begin .deleted text end new text begin :
new text end

new text begin (1) adult day services;
 new text end

new text begin (2) customized living; and
 new text end

new text begin (3) foster care.
 new text end

new text begin (b) The program plan support factor is 15.5 percent for the following services to cover
the cost of direct service staff needed to provide support for the service when not engaged
in direct contact with participants:
 new text end

new text begin (1) chore services;
 new text end

new text begin (2) companion services;
 new text end

new text begin (3) homemaker assistance with personal care;
 new text end

new text begin (4) homemaker cleaning;
 new text end

new text begin (5) homemaker home management;
 new text end

new text begin (6) in-home respite care;
 new text end

new text begin (7) individual community living support; and
 new text end

new text begin (8) out-of-home respite care.
 new text end

Subd. 4.

Registered nurse management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end .

The
registered nurse management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end equals 15 percent of
the registered nurse adjusted base wage as defined in section 256S.214.

Subd. 5.

deleted text begin Social workerdeleted text end new text begin Unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage
componentnew text end .

The deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end
equals 15 percent of the deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end adjusted base wage as defined
in section 256S.214.

new text begin Subd. 6. new text end

new text begin Facility and equipment factor. new text end

new text begin The facility and equipment factor for adult
day services is 16.2 percent.
 new text end

new text begin Subd. 7. new text end

new text begin Food, supplies, and transportation factor. new text end

new text begin The food, supplies, and
transportation factor for adult day services is 24 percent.
 new text end

new text begin Subd. 8. new text end

new text begin Supplies and transportation factor. new text end

new text begin The supplies and transportation factor
for the following services is 1.56 percent:
 new text end

new text begin (1) chore services;
 new text end

new text begin (2) companion services;
 new text end

new text begin (3) homemaker assistance with personal care;
 new text end

new text begin (4) homemaker cleaning;
 new text end

new text begin (5) homemaker home management;
 new text end

new text begin (6) in-home respite care;
 new text end

new text begin (7) individual community support services; and
 new text end

new text begin (8) out-of-home respite care.
 new text end

new text begin Subd. 9. new text end

new text begin Absence factor. new text end

new text begin The absence factor for the following services is 4.5 percent:
 new text end

new text begin (1) adult day services;
 new text end

new text begin (2) chore services;
 new text end

new text begin (3) companion services;
 new text end

new text begin (4) homemaker assistance with personal care;
 new text end

new text begin (5) homemaker cleaning;
 new text end

new text begin (6) homemaker home management;
 new text end

new text begin (7) in-home respite care;
 new text end

new text begin (8) individual community living support; and
 new text end

new text begin (9) out-of-home respite care.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 32.

Minnesota Statutes 2022, section 256S.214, is amended to read:


256S.214 RATE SETTING; ADJUSTED BASE WAGE.

For the purposes of section 256S.215, the adjusted base wage for each position equals
the position's base wage under section 256S.212 plus:

(1) the position's base wage multiplied by the payroll taxes and benefits factor under
section 256S.213, subdivision 1;

deleted text begin (2) the position's base wage multiplied by the general and administrative factor under
section 256S.213, subdivision 2; and
 deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end the position's base wage multiplied by the new text begin applicable new text end program plan support factor
under section 256S.213, subdivision 3deleted text begin .deleted text end new text begin ; and
new text end

new text begin (3) the position's base wage multiplied by the absence factor under section 256S.213,
subdivision 9, if applicable.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 33.

Minnesota Statutes 2022, section 256S.215, subdivision 2, is amended to read:


Subd. 2.

Home management and support services component rate.

The component
rate for home management and support services is new text begin calculated as follows:
new text end

new text begin (1) sum new text end the home management and support services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the
registered nurse management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end

new text begin (2) multiply the result of clause (1) by the general and administrative factor; and
 new text end

new text begin (3) sum the results of clauses (1) and (2).
 new text end

Sec. 34.

Minnesota Statutes 2022, section 256S.215, subdivision 3, is amended to read:


Subd. 3.

Home care aide services component rate.

The component rate for home care
aide services is new text begin calculated as follows:
new text end

new text begin (1) sum new text end the home health aide services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the registered nurse
management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end

new text begin (2) multiply the result of clause (1) by the general and administrative factor; and
 new text end

new text begin (3) sum the results of clauses (1) and (2).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 35.

Minnesota Statutes 2022, section 256S.215, subdivision 4, is amended to read:


Subd. 4.

Home health aide services component rate.

The component rate for home
health aide services is new text begin calculated as follows:
new text end

new text begin (1) sum new text end the home health aide services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the registered nurse
management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end

new text begin (2) multiply the result of clause (1) by the general and administrative factor; and
 new text end

new text begin (3) sum the results of clauses (1) and (2).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 36.

Minnesota Statutes 2022, section 256S.215, subdivision 7, is amended to read:


Subd. 7.

Chore services rate.

The 15-minute unit rate for chore services is calculated
as follows:

(1) sum the chore services adjusted base wage and the deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end
supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end

(2) new text begin multiply the result of clause (1) by the general and administrative factor;
new text end

new text begin (3) multiply the result of clause (1) by the supplies and transportation factor; and
 new text end

new text begin (4) sum the results of clauses (1) to (3) and new text end divide the result deleted text begin of clause (1)deleted text end by four.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 37.

Minnesota Statutes 2022, section 256S.215, subdivision 8, is amended to read:


Subd. 8.

Companion services rate.

The 15-minute unit rate for companion services is
calculated as follows:

(1) sum the companion services adjusted base wage and the deleted text begin social workerdeleted text end new text begin unlicensed
supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end

(2) new text begin multiply the result of clause (1) by the general and administrative factor;
new text end

new text begin (3) multiply the result of clause (1) by the supplies and transportation factor; and
 new text end

new text begin (4) sum the results of clauses (1) to (3) and new text end divide the result deleted text begin of clause (1)deleted text end by four.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 38.

Minnesota Statutes 2022, section 256S.215, subdivision 9, is amended to read:


Subd. 9.

Homemaker deleted text begin services anddeleted text end assistance with personal care rate.

The 15-minute
unit rate for homemaker deleted text begin services anddeleted text end assistance with personal care is calculated as follows:

(1) sum the homemaker deleted text begin services anddeleted text end assistance with personal care adjusted base wage
and the deleted text begin registered nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage
componentnew text end ; deleted text begin and
deleted text end

(2) new text begin multiply the result of clause (1) by the general and administrative factor;
new text end

new text begin (3) multiply the result of clause (1) by the supplies and transportation factor; and
 new text end

new text begin (4) sum the results of clauses (1) to (3) and new text end divide the result deleted text begin of clause (1)deleted text end by four.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 39.

Minnesota Statutes 2022, section 256S.215, subdivision 10, is amended to read:


Subd. 10.

Homemaker deleted text begin services anddeleted text end cleaning rate.

The 15-minute unit rate for
homemaker deleted text begin services anddeleted text end cleaning is calculated as follows:

(1) sum the homemaker deleted text begin services anddeleted text end cleaning adjusted base wage and the deleted text begin registered
nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end

(2) new text begin multiply the result of clause (1) by the general and administrative factor;
new text end

new text begin (3) multiply the result of clause (1) by the supplies and transportation factor; and
 new text end

new text begin (4) sum the results of clauses (1) to (3) and new text end divide the result deleted text begin of clause (1)deleted text end by four.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
 new text end

Sec. 40.

Minnesota Statutes 2022, section 256S.215, subdivision 11, is amended to read:


Subd. 11.

Homemaker deleted text begin services anddeleted text end home management rate.

The 15-minute unit rate
for homemaker deleted text begin services anddeleted text end home management is calculated as follows:

(1) sum the homemaker deleted text begin services anddeleted text end home management adjusted base wage and thedeleted text begin
registered nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ;
deleted text begin and
deleted text end

(2) new text begin multiply the result of clause (1) by the general and administrative factor;