SF 3082

as introduced - 89th Legislature (2015 - 2016) Posted on 03/22/2016 09:49am

A bill for an act
relating to human services; modifying the budget neutrality adjustments for
the disability waivers rate system; amending Minnesota Statutes 2014, section
256B.4914, subdivision 16; Minnesota Statutes 2015 Supplement, section
256B.4913, subdivision 4a.

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

Section 1.

Minnesota Statutes 2015 Supplement, section 256B.4913, subdivision 4a,
is amended to read:

Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on
the last day of the month in which the rate management system is populated with the
data necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding
period" means the time period beginning on January 1, 2014, and ending upon the
expiration of the 12-month period defined in paragraph (c), clause deleted text begin (5) deleted text end new text begin (6) new text end .

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

(1) for a day service recipient who was not authorized to receive these waiver
services prior to January 1, 2014; added a new service or services on or after January 1,
2014; or changed providers on or after January 1, 2014, the historical rate must be the
authorized rate for the provider in the county of service, effective December 1, 2013; or

(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or

(3) for residential service recipients who change providers on or after January 1,
2014, the historical rate must be set by each lead agency within their county aggregate
budget using their respective methodology for residential services effective December 1,
2013, for determining the provider rate for a similarly situated recipient being served by
that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under
this section so that the unit rate is deleted text begin no higher or lower than deleted text end :

(1) new text begin no higher or lower than new text end 0.5 percent from the historical rate for the implementation
period;

(2) new text begin no higher or lower than new text end 0.5 percent from the rate in effect in clause (1), for the
12-month period immediately following the time period of clause (1);

(3) new text begin no higher or lower than new text end 0.5 percent from the rate in effect in clause (2), for the
12-month period immediately following the time period of clause (2);

(4) new text begin no higher or lower than new text end 1.0 percent from the rate in effect in clause (3), for the
12-month period immediately following the time period of clause (3);

(5) new text begin no higher or lower than new text end 1.0 percent from the rate in effect in clause (4), for the
12-month period immediately following the time period of clause (4); deleted text begin and
deleted text end

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

new text begin (7) no lower than 10.0 percent from the historical rate as defined in paragraph (b), for
the 12-month period immediately following the time period in clause (6) and thereafter new text end .

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

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

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

(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for
the individual with variables reflecting the level of service in effect on December 1, 2013;

(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or
9, for the individual with variables reflecting the updated level of service at the time
of application; and

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

(g) This subdivision must not apply to rates for recipients served by providers new
to a given county after January 1, 2014. Providers of personal supports services who also
acted as fiscal support entities must be treated as new providers as of January 1, 2014.

Sec. 2.

Minnesota Statutes 2014, section 256B.4914, subdivision 16, is amended to read:

Subd. 16.

Budget neutrality adjustments.

deleted text begin (a) deleted text end The commissioner shall use the
following adjustments to the rate generated by the framework to assure budget neutrality
deleted text begin until the rate information is available to implement paragraph (b) deleted text end . The rate generated by
the framework shall be multiplied by the appropriate factor, as designated below:

(1) for residential services: 1.003;

(2) for day services: deleted text begin 1.000 deleted text end new text begin 1.051 new text end ;

(3) for unit-based services with programming: deleted text begin 0.941 deleted text end new text begin 1.017 new text end ; and

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

deleted text begin (b) Within 12 months of January 1, 2014, the commissioner shall compare estimated
spending for all home and community-based waiver services under the new payment rates
defined in subdivisions 6 to 9 with estimated spending for the same recipients and services
under the rates in effect on July 1, 2013. This comparison must distinguish spending under
each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients
and services for one or more service months after the new rates have gone into effect.
The commissioner shall consult with the commissioner of management and budget on
this analysis to ensure budget neutrality. If estimated spending under the new rates for
services under one or more subdivisions differs in this comparison by 0.3 percent or
more, the commissioner shall assure aggregate budget neutrality across all service areas
by adjusting the budget neutrality factor in paragraph (a) in each subdivision so that total
estimated spending for each subdivision under the new rates matches estimated spending
under the rates in effect on July 1, 2013.
deleted text end