SF 654

as introduced - 93rd Legislature (2023 - 2024) Posted on 01/31/2023 09:01am

A bill for an act
relating to human services; expanding access to shared services under the home
and community-based services waivers; amending Minnesota Statutes 2022,
sections 256B.4912, by adding a subdivision; 256B.4914, subdivisions 8, 9;
256S.16.

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

Section 1.

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 Shared services. new text end

new text begin (a) Medical assistance payments for shared services under
the home and community-based services waivers authorized under sections 256B.0913,
256B.092, and 256B.49 and chapter 256S are limited to this subdivision.
new text end

new text begin (b) For purposes of this subdivision, "shared services" means services provided at the
same time by the same direct care worker for individuals who have entered into an agreement
to share home and community-based services.
new text end

new text begin (c) Shared services include the following services as outlined in the coordinated service
and support plan and shared services agreement:
new text end

new text begin (1) chore services;
new text end

new text begin (2) extended home care services;
new text end

new text begin (3) homemaker services;
new text end

new text begin (4) individualized home supports;
new text end

new text begin (5) integrated community supports;
new text end

new text begin (6) night supervision services; and
new text end

new text begin (7) other supports as deemed appropriate based on the individuals' coordinated service
and support plans and shared services agreement.
new text end

new text begin (d) Shared services do not include:
new text end

new text begin (1) services for more than three individuals provided by one worker at one time;
new text end

new text begin (2) use of more than one worker for the shared services; or
new text end

new text begin (3) a child care program licensed under chapter 245A or operated by a local school
district or private school.
new text end

new text begin (e) The individuals, or the individuals' representatives as needed, must develop the plan
for shared services when developing or amending the coordinated service and support plan
and must follow the coordinated service and support plan process for approval of the plan
by the lead agency. The plan for shared services in a coordinated service and support plan
must include the intention to utilize shared services based on individuals' needs and
preferences.
new text end

new text begin (f) Individuals whose coordinated service and support plans include an intent to utilize
shared services must jointly develop, with the support of the individuals' representatives as
needed, a shared services agreement. This agreement must include:
new text end

new text begin (1) the names of the individuals receiving shared services;
new text end

new text begin (2) the names of the individuals' representatives, if identified in their coordinated service
and support plans, and their duties;
new text end

new text begin (3) the names of the case managers;
new text end

new text begin (4) the services provider;
new text end

new text begin (5) the shared services that must be provided;
new text end

new text begin (6) the schedule for shared services;
new text end

new text begin (7) the location where shared services must be provided;
new text end

new text begin (8) the training specific to each individual served;
new text end

new text begin (9) the training specific to providing shared services to the individuals identified in the
agreement;
new text end

new text begin (10) instructions to follow all required documentation for time and services provided;
new text end

new text begin (11) a contingency plan for each individual served that determines how services will be
provided and billed for when a person who shares services with the individual is absent due
to illness or other circumstances;
new text end

new text begin (12) the signatures of all parties involved in the shared services; and
new text end

new text begin (13) an agreement by each individual who is sharing services on the number of shared
hours for services provided.
new text end

new text begin (g) An individual or an individual's representative may withdraw from participating in
a shared services agreement at any time.
new text end

new text begin (h) The lead agency for each individual must authorize the use of the shared services
option if the shared service is appropriate to maintain the needs, health, and safety of each
individual for whom the lead agency provides case management or care coordination.
new text end

new text begin (i) This subdivision must not be construed to reduce the total authorized budget for an
individual.
new text end

new text begin (j) No later than September 30, 2023, the commissioner of human services must:
new text end

new text begin (1) submit an amendment to the Centers for Medicare and Medicaid Services for the
home and community-based services waivers authorized under sections 256B.0913,
256B.092, and 256B.49 and chapter 256S to allow for shared services under those waivers;
and
new text end

new text begin (2) develop guidance for shared services with stakeholder input. Guidance must include:
new text end

new text begin (i) recommendations for negotiating payment for one-to-two and one-to-three services;
and
new text end

new text begin (ii) a template of the shared services agreement.
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 occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 2.

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 new text begin , except
that for individualized home supports with training, a unit of service is one hour or 15
minutes new text end .

(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 deleted text begin , divide the total payment in clause (13)
as follows deleted text end :

(i) for employment exploration services, divide new text begin the total payment in clause (13) new text end by the
number of service recipients, not to exceed five;

(ii) for employment support services, divide new text begin the total payment in clause (13) new text end 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, deleted text begin divide by the number of service recipients, not to exceed two deleted text end new text begin multiply
the total payment in clause (13) when two persons are sharing services by no more than one
and one-half, and when three persons are sharing services by no more than two. These rates
apply only when all of the criteria for the shared service have been met new 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 occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 3.

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

(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 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (16) for individualized home supports without training for two persons sharing services,
the rate paid to a provider must not exceed one and one-half 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

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2022, section 256S.16, is amended to read:

256S.16 AUTHORIZATION OF ELDERLY WAIVER SERVICES AND SERVICE
RATES.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

A lead agency must use the service rates and service rate
limits published by the commissioner to authorize services.

new text begin Subd. 2. new text end

new text begin Shared services; rates. new text end

new text begin The commissioner shall provide a rate system for
shared chore services and shared homemaker services based on the chore services rate for
a single individual under section 256S.215, subdivision 7, and the homemaker services rates
for a single individual under section 256S.215, subdivisions 9 to 11. For two persons sharing
services, the rate paid to a provider must not exceed one and one-half 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

new text begin EFFECTIVE DATE. new text end

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

Sec. 5. new text begin DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
SERVICES RATES.
new text end

new text begin The commissioner of human services shall provide a rate system for shared chore services
and shared homemaker 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 one
and one-half 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. 6. new text begin DIRECTION TO COMMISSIONER; INDIRECT BILLING AUTHORIZED
FOR INDIVIDUALIZED HOME SUPPORTS WITH TRAINING.
new text end

new text begin By December 1, 2023, the commissioner of human services shall submit to the federal
Centers for Medicare and Medicaid Services any necessary changes to home and
community-based services waiver plans to allow for providers providing individualized
home supports with training to bill for services provided indirectly on behalf of the person.
Allowable tasks include:
new text end

new text begin (1) coordinating health providers and scheduling medical appointments; and
new text end

new text begin (2) general care coordination to support individuals living independently.
new text end

Sec. 7. new text begin DIRECTION TO COMMISSIONER; OUT-OF-STATE BILLING.
new text end

new text begin By December 1, 2023, the commissioner of human services shall submit to the federal
Centers for Medicare and Medicaid Services any necessary changes to home and
community-based services waiver plans to ensure that individualized home supports with
training and individualized home supports without training are included in the definition of
"direct care staff services" that may be authorized and provided to a waiver participant who
is either traveling temporarily out-of-state or attending an out-of-state postsecondary school.
new text end