Engrossments
Introduction		Posted on 01/03/2023

A bill for an act
relating to human services; modifying rates for certain disability waiver services;
modifying rates for certain elderly waiver services; modifying rate floors for certain
customized living services; modifying rates for nursing facilities; establishing rate
floors for intermediate care facilities for persons with developmental disabilities;
modifying rates for intermediate care facilities for persons with developmental
disabilities; modifying rates for community first services and supports; modifying
rates for personal care assistance services; modifying rates for certain home care
services; modifying rates for nonemergency medical transportation services;
establishing a fuel cost rate adjustment for medical transportation services;
modifying provisions related to home and community-based services; modifying
provisions related to the emergency staffing pool; establishing a residential settings
closure prevention grant program; appropriating money; amending Minnesota
Statutes 2022, sections 256B.0625, subdivisions 17, 17a; 256B.0659, subdivisions
1, 12, 17a, 19, 24; 256B.0913, subdivisions 4, 5; 256B.4911, by adding a
subdivision; 256B.4912, by adding a subdivision; 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.5012, by adding subdivisions; 256B.85, subdivisions 7, 7a, by adding a
subdivision; 256B.851, subdivision 5; 256E.35, subdivisions 1, 2, 4a, 6, 7; 256P.02,
by adding a subdivision; 256R.02, subdivisions 16, 24, 26, 29, 34, by adding
subdivisions; 256R.23, subdivisions 2, 3; 256R.24, subdivision 1; 256R.25;
256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision
3; 256S.205, subdivisions 3, 5; 256S.2101, subdivisions 1, 2, by adding
subdivisions; 256S.212; 256S.213; 256S.214; 256S.215; Laws 2022, chapter 40,
section 6; proposing coding for new law in Minnesota Statutes, chapter 256;
repealing Minnesota Statutes 2022, sections 256B.4914, subdivision 9a; 256S.19,
subdivision 4.

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

ARTICLE 1

CAREGIVERS STABILIZATION ACT

Section 1. new text begin TITLE.
new text end

new text begin This act may be cited as the "Caregivers Stabilization Act of 2023."
new text end

ARTICLE 2

DISABILITY WAIVERS

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 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. 2.

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

Sec. 3.

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

Sec. 4.

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

Sec. 5.

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 substance
abuse, behavioral disorder, and mental health counselor (SOC code 21-1018);

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

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

(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

Sec. 6.

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

Sec. 7.

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

Sec. 8.

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

Sec. 9.

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 deleted text begin anddeleted text end new text begin ,new text end 5b deleted text begin beginning on January 1, 2022deleted text end ,new text begin and 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

Sec. 10.

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

Sec. 11.

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.

(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

Sec. 12.

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.

(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;

(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

Sec. 13.

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 finance 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

Sec. 14.

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.

(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

Sec. 15.

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 finance 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. 16.

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

Sec. 17.

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.

(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

Sec. 18.

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

Sec. 19. 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. 20. 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. 21. 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 commissioner must provide a method for the commissioner and interested
stakeholders to cofacilitate public meetings. The first meeting must occur before January
31, 2023. The commissioner must host the cofacilitated meetings at least monthly through
December 31, 2023. All meetings must be accessible to all interested stakeholders, recorded,
and posted online within one week of the meeting date.
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 and adult family foster care;
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) potential medical assistance payment methodologies for life-sharing services;
new text end

new text begin (7) expanding awareness of the life-sharing model; and
new text end

new text begin (8) draft language for legislation necessary to 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 house of representatives and
senate committees and divisions with jurisdiction over direct care services a report
summarizing the discussions between the commissioner and the interested stakeholders and
the commissioner's recommendations. The report must also include any draft legislation
necessary to define and implement life-sharing services.
new text end

Sec. 22. 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

ARTICLE 3

ELDERLY WAIVER

Section 1.

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 deleted text begin shalldeleted text end new text begin mustnew text end be determined. In this event, the annual cost
of alternative care services deleted text begin shalldeleted text end new text begin mustnew text end 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 deleted text begin shalldeleted text end new text begin mustnew text end 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 feenew 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 Anew text end .

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 payments.

(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 deleted text begin shalldeleted text end new text begin mustnew text end 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

Sec. 2.

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

Sec. 3.

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

Sec. 4.

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. 5.

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 also 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. 6.

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. 7.

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

Sec. 8.

Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:

Subd. 2.

Phase-in for elderly waiver rates.

Except for deleted text begin home-delivered meals as
described in section 256S.215, subdivision 15deleted text end new text begin the services in subdivisions 4 and 5new 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 deleted text begin shalldeleted text end new text begin mustnew text end be the sum of deleted text begin 18.8deleted 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 81.2deleted 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. deleted 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 15.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 9.

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) At least 80 percent of the marginal increase in
revenue from the implementation of any adjustments to a phase-in proportion under this
section, or any adjustments to the base wage indices under section 256S.212, for services
rendered on or after the day of implementation of the modified phase-in proportion or
applicable adjustment to the base wage indices 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 adjusted phase-in proportions
under this section, 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

new text begin EFFECTIVE DATE. new text end

Sec. 10.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Phase-in for home-delivered meals rate. new text end

new text begin The home-delivered meals rate for
the elderly waiver under this chapter; alternative care under section 256B.0913; and essential
community supports under section 256B.0922 must be the sum of 65 percent of the rate in
section 256S.215, subdivision 15, and 35 percent of the rate calculated using the rate
methodology in effect as of June 30, 2017.
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. 11.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

new text begin Subd. 5. 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. 12.

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.

new text begin Subd. 1a. new text end

new text begin Updating base wages. new text end

new text begin (a) On January 1, 2024, and every two years thereafter,
the commissioner must update the base wages for the services listed in paragraph (b) based
on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA data. Any marginal increase in revenue from implementation of any
adjustment to base wages under this section, including any modifications to SOC codes or
positions, is subject to the spending requirements under section 256S.2101, subdivision 3.
new text end

new text begin (b) This subdivision applies to:
new text end

new text begin (1) the homemaker services and assistance with personal care base wage under subdivision
8;
new text end

new text begin (2) the homemaker services and cleaning base wage under subdivision 9;
new text end

new text begin (3) the homemaker services and home management base wage under subdivision 10;
and
new text end

new text begin (4) for the purposes of calculating the unlicensed supervisor supervision wage component
used to calculate the homemaker services rates under section 256S.215, subdivisions 9 to
11, the unlicensed supervisor base wage under subdivision 15.
new text end

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 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 ); 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 health
new text begin and personal care new 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 services and assistance with personal care base wage.

The
homemaker services and 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 services and cleaning base wage.

The homemaker services and
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 services and home management base wage.

The homemaker
services and 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 aidesnew 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 39-1098new 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. 13.

Minnesota Statutes 2022, section 256S.213, is amended to read:

256S.213 RATE SETTING; FACTORSnew text begin AND SUPERVISION WAGE
COMPONENTSnew text end .

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
percentnew text begin for the following servicesnew 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 services and assistance with personal care;
new text end

new text begin (4) homemaker services and cleaning;
new text end

new text begin (5) homemaker services and 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 services and assistance with personal care;
new text end

new text begin (4) homemaker services and cleaning;
new text end

new text begin (5) homemaker services and 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

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 services and assistance with personal care;
new text end

new text begin (5) homemaker services and cleaning;
new text end

new text begin (6) homemaker services and 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. 14.

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. 15.

Minnesota Statutes 2022, section 256S.215, is amended to read:

256S.215 RATE SETTING; COMPONENT RATES.

Subdivision 1.

Medication setups by licensed nurse component rate.

The component
rate for medication setups by a licensed nurse equals the medication setups by licensed
nurse adjusted base wage.

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

Subd. 3.

Home care aide services component rate.

The component rate for home care
aide services isnew text begin calculated as follows:
new text end

new text begin (1) sumnew 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 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

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

Subd. 5.

Socialization component rate.

The component rate under elderly waiver
customized living for one-to-one socialization equals the home management and support
services component rate.

Subd. 6.

Transportation component rate.

The component rate under elderly waiver
customized living for one-to-one transportation equals the home management and support
services component rate.

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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

Subd. 9.

Homemaker services and assistance with personal care rate.

The 15-minute
unit rate for homemaker services and assistance with personal care is calculated as follows:

(1) sum the homemaker services and 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

Subd. 10.

Homemaker services and cleaning rate.

The 15-minute unit rate for
homemaker services and cleaning is calculated as follows:

(1) sum the homemaker services and 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 base wagenew 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

Subd. 11.

Homemaker services and home management rate.

The 15-minute unit rate
for homemaker services and home management is calculated as follows:

(1) sum the homemaker services and home management 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

Subd. 12.

In-home respite care services rates.

(a) The 15-minute unit rate for in-home
respite care services is calculated as follows:

(1) sum the in-home respite care services adjusted base wage and the registered nurse
management and 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

(b) The in-home respite care services daily rate equals the in-home respite care services
15-minute unit rate multiplied by 18.

Subd. 13.

Out-of-home respite care services rates.

(a) The 15-minute unit rate for
out-of-home respite care is calculated as follows:

(1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

(b) The out-of-home respite care services daily rate equals the 15-minute unit rate for
out-of-home respite care services multiplied by 18.

Subd. 14.

Individual community living support rate.

The individual community living
support rate is calculated as follows:

(1) sum the deleted text begin home care aidedeleted text end new text begin individual community living supportnew text end adjusted base wage
and the deleted text begin social workerdeleted text end new text begin registered nurse management andnew 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) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.

Subd. 15.

Home-delivered meals rate.

The home-delivered meals rate equals deleted text begin $9.30deleted text end new text begin
$8.17new text end .new text begin On July 1 of each year,new text end the commissioner shall deleted text begin increasedeleted text end new text begin updatenew text end the home delivered
meals rate deleted text begin every July 1deleted text end by the percent increase in the nursing facility dietary per diem using
the two most recent and available nursing facility cost reports.

Subd. 16.

Adult day services rate.

The 15-minute unit rate for adult day servicesdeleted text begin , with
an assumed staffing ratio of one staff person to four participants, is the sum ofdeleted text end new text begin is calculated
as followsnew text end :

(1) deleted text begin one-sixteenth of the home care aidedeleted text end new text begin divide the adult daynew text end services adjusted base wagedeleted text begin ,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percentdeleted text end new text begin by five to reflect an assumed staffing ratio of one
to fivenew text end ;

(2) deleted text begin one-fourth of the registered nurse management and supervision factordeleted text end new text begin sum the result
of clause (1) and the registered nurse management and supervision wage componentnew text end ; deleted text begin and
deleted text end

(3) deleted text begin $0.63 to cover the cost of meals.deleted text end new text begin multiply the result of clause (2) by the general and
administrative factor;
new text end

new text begin (4) multiply the result of clause (2) by the facility and equipment factor;
new text end

new text begin (5) multiply the result of clause (2) by the food, supplies, and transportation factor; and
new text end

new text begin (6) sum the results of clauses (2) to (5) and divide the result by four.
new text end

Subd. 17.

Adult day services bath rate.

The 15-minute unit rate for adult day services
bath is deleted text begin the sum ofdeleted text end new text begin calculated as followsnew text end :

(1) deleted text begin one-fourth of the home care aidedeleted text end new text begin sum the adult daynew text end services adjusted base wagedeleted text begin ,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percentdeleted text end new text begin and the registered nurse management and
supervision wage componentnew text end ;

(2) deleted text begin one-fourth of the registered nurse management and supervision factordeleted text end new text begin multiply the
result of clause (1) by the general and administrative factornew text end ; deleted text begin and
deleted text end

(3) deleted text begin $0.63 to cover the cost of meals.deleted text end new text begin multiply the result of clause (1) by the facility and
equipment factor;
new text end

new text begin (4) multiply the result of clause (1) by the food, supplies, and transportation factor; and
new text end

new text begin (5) sum the results of clauses (1) to (4) and divide the result by four.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 16. new text begin DIRECTION TO COMMISSIONER; ESTABLISHING SHARED SERVICE
RATES.
new text end

new text begin The commissioner shall establish a rate system for shared homemaker services and
shared chore services based on homemaker rates for a single individual under section
256S.215, subdivisions 9 to 11, and the chore rate for a single individual under section
256S.215, subdivision 7. 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. 17. new text begin REVISOR INSTRUCTION.
new text end

new text begin (a) In Minnesota Statutes, chapter 256S, the revisor of statutes shall change the following
terms wherever the terms appear:
new text end

new text begin (1) "homemaker services and assistance with personal care" to "homemaker assistance
with personal care services";
new text end

new text begin (2) "homemaker services and cleaning" to "homemaker cleaning services"; and
new text end

new text begin (3) "homemaker services and home management" to "homemaker home management
services."
new text end

new text begin (b) The revisor shall make any necessary grammatical changes related to the changes
in terms under paragraph (a).
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. 18. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2022, section 256S.19, subdivision 4, 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.
new text end

ARTICLE 4

HOME CARE

Section 1.

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

Sec. 2.

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

Sec. 3.

Minnesota Statutes 2022, section 256B.0659, subdivision 17a, is amended to read:

Subd. 17a.

Enhanced rate.

An enhanced rate of deleted text begin 107.5deleted text end new text begin 143new text end percent of the rate paid for
personal care assistance services shall be paid for services provided to persons who qualify
for ten or more hours of personal care assistance services per day when provided by a
personal care assistant who meets the requirements of subdivision 11, paragraph (d). Any
change in the eligibility criteria for the enhanced rate for personal care assistance services
as described in this subdivision and referenced in subdivision 11, paragraph (d), does not
constitute a change in a term or condition for individual providers as defined in section
256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter
179A.

new text begin EFFECTIVE DATE. new text end

Sec. 4.

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 usednew 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 lawnew 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.

(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

Sec. 5.

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

Sec. 6.

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

Sec. 7.

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

Sec. 8.

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

Subd. 7a.

Enhanced rate.

An enhanced rate of deleted text begin 107.5deleted text end new text begin 143new text end percent of the rate paid for
CFSS must be paid for services provided to persons who qualify for ten or more hours of
CFSS per day when provided by a support worker who meets the requirements of subdivision
16, paragraph (e). Any change in the eligibility criteria for the enhanced rate for CFSS as
described in this subdivision and referenced in subdivision 16, paragraph (e), does not
constitute a change in a term or condition for individual providers as defined in section
256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter
179A.

new text begin EFFECTIVE DATE. new text end

Sec. 9.

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

Sec. 10.

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 75.45deleted text end new text begin ...new text end percent;

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

new text begin EFFECTIVE DATE. new text end

Sec. 11. new text begin PERSONAL CARE ASSISTANCE ENHANCED RATE FOR PERSONS
USING CONSUMER-DIRECTED COMMUNITY SUPPORTS.
new text end

new text begin The commissioner of human services shall increase the annual budgets for participants
who use consumer-directed community supports under Minnesota Statutes, sections
256B.0913, subdivision 5, clause (17); 256B.092, subdivision 1b, paragraph (a), clause (4);
and 256B.49, subdivision 16, paragraph (c); and chapter 256S, by 43 percent for participants
who: (1) are determined by assessment to be eligible for ten or more hours of personal care
assistance services or community first services and supports per day; and (2) use direct
support services provided by a worker employed by the participant who has completed
training identified in Minnesota Statutes, section 256B.0659, subdivision 11, paragraph (d),
or 256B.85, subdivision 16, paragraph (e).
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 12. new text begin RATE INCREASE FOR CERTAIN HOME CARE SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Rate increases. new text end

new text begin (a) Effective January 1, 2024, or upon federal approval,
whichever is later, the commissioner of human services shall 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 shall 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 38.8 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

new text begin Subd. 2. 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 for home care services resulting from implementation of the rate increases under
this section for services rendered on or after the day of implementation of the increase must
be used to increase compensation-related costs for employees directly employed by the
provider to provide the services.
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 (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 (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

ARTICLE 5

NURSING FACILITIES

Section 1.

Minnesota Statutes 2022, section 256R.02, subdivision 16, is amended to read:

Subd. 16.

Dietary costs.

"Dietary costs" means the costs for deleted text begin the salaries and wages of
the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other employees assigned
to the kitchen and dining room, and associated fringe benefits and payroll taxes. Dietary
costs also includesdeleted text end the salaries or fees of dietary consultants, dietary supplies, and food
preparation and serving.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for the rate year beginning January 1,
2025, 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. 2.

Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
read:

new text begin Subd. 16a. new text end

new text begin Dietary labor costs. new text end

new text begin "Dietary labor costs" means the costs for the salaries
and wages of the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other
employees assigned to the kitchen and dining room, and associated fringe benefits and
payroll taxes.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 3.

Minnesota Statutes 2022, section 256R.02, subdivision 24, is amended to read:

Subd. 24.

Housekeeping costs.

"Housekeeping costs" means deleted text begin the costs for the salaries
and wages of the housekeeping supervisor, housekeepers, and other cleaning employees
and associated fringe benefits and payroll taxes. It also includesdeleted text end the cost of housekeeping
supplies, includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end cleaning and lavatory supplies and contract services.

new text begin EFFECTIVE DATE. new text end

Sec. 4.

Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
read:

new text begin Subd. 24a. new text end

new text begin Housekeeping labor costs. new text end

new text begin "Housekeeping labor costs" means the costs for
the salaries and wages of the housekeeping supervisor, housekeepers, and other cleaning
employees, and associated fringe benefits and payroll taxes.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 5.

Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
read:

new text begin Subd. 25b. new text end

new text begin Known cost change factor. new text end

new text begin "Known cost change factor" means 1.00 plus
the forecasted percentage change in the CPI-U index from July 1 of the reporting period to
July 1 of the rate year as determined by the national economic consultant used by the
commissioner of management and budget.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 6.

Minnesota Statutes 2022, section 256R.02, subdivision 26, is amended to read:

Subd. 26.

Laundry costs.

"Laundry costs" means the costs deleted text begin for the salaries and wages
of the laundry supervisor and other laundry employees, associated fringe benefits, and
payroll taxes. It also includes the costsdeleted text end of linen and bedding, the laundering of resident
clothing, laundry supplies, and contract services.

new text begin EFFECTIVE DATE. new text end

Sec. 7.

Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
read:

new text begin Subd. 26a. new text end

new text begin Laundry labor costs. new text end

new text begin "Laundry labor costs" means the costs for the salaries
and wages of the laundry supervisor and other laundry employees, and associated fringe
benefits and payroll taxes.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 8.

Minnesota Statutes 2022, section 256R.02, subdivision 29, is amended to read:

Subd. 29.

Maintenance and plant operations costs.

"Maintenance and plant operations
costs" means deleted text begin the costs for the salaries and wages of the maintenance supervisor, engineers,
heating-plant employees, and other maintenance employees and associated fringe benefits
and payroll taxes. It also includesdeleted text end identifiable costs for maintenance and operation of the
building and grounds, includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end fuel, electricity, plastic waste bags,
medical waste and garbage removal, water, sewer, supplies, tools, repairs, and minor
equipment not requiring capitalization under Medicare guidelines.

new text begin EFFECTIVE DATE. new text end

Sec. 9.

Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
read:

new text begin Subd. 29a. new text end

new text begin Maintenance and plant operations labor costs. new text end

new text begin "Maintenance and plant
operations labor costs" means the costs for the salaries and wages of the maintenance
supervisor, engineers, heating-plant employees, and other maintenance employees, and
associated fringe benefits and payroll taxes.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 10.

Minnesota Statutes 2022, section 256R.02, subdivision 34, is amended to read:

Subd. 34.

Other care-related costs.

"Other care-related costs" means the sum of activities
costs, other direct care costs, raw food costs,new text begin dietary labor costs, housekeeping labor costs,
laundry labor costs, maintenance and plant operations labor costs,new text end therapy costs, and social
services costs.

new text begin EFFECTIVE DATE. new text end

Sec. 11.

Minnesota Statutes 2022, section 256R.23, subdivision 2, is amended to read:

Subd. 2.

Calculation of direct care cost per standardized day.

Each facility's direct
care cost per standardized day isnew text begin (1) the product ofnew text end the facility's direct care costsnew text begin and the
known cost change factor, (2)new text end divided by the sum of the facility's standardized days. A
facility's direct care cost per standardized day is the facility's cost per day for direct care
services associated with a case mix index of 1.00.

new text begin EFFECTIVE DATE. new text end

Sec. 12.

Minnesota Statutes 2022, section 256R.23, subdivision 3, is amended to read:

Subd. 3.

Calculation of other care-related cost per resident day.

Each facility's other
care-related cost per resident day isnew text begin (1) the product ofnew text end its other care-related costsnew text begin and the
known cost change factornew text end ,new text begin (2)new text end divided by the sum of the facility's resident days.

new text begin EFFECTIVE DATE. new text end

Sec. 13.

Minnesota Statutes 2022, section 256R.24, subdivision 1, is amended to read:

Subdivision 1.

Determination of other operating cost per day.

Each facility's other
operating cost per day isnew text begin (1) the product ofnew text end its other operating costsnew text begin and the known cost
change factor, (2)new text end divided by the sum of the facility's resident days.

new text begin EFFECTIVE DATE. new text end

Sec. 14.

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 isnew text begin (1) the product ofnew text end the
allowable costsnew text begin and the known cost change factor, (2)new text end 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 border city facilities is the amount
determined under section 256R.481.

new text begin EFFECTIVE DATE. new text end

Sec. 15. new text begin NURSING FACILITY FUNDING.
new text end

new text begin (a) Effective July 1, 2023, through December 31, 2025, the total payment rate for all
facilities reimbursed under Minnesota Statutes, chapter 256R, must be increased by $28.65
per resident day.
new text end

new text begin (b) To be eligible to receive a payment under this section, a nursing facility must attest
to the commissioner of human services that the additional revenue will be used exclusively
to increase compensation-related costs for employees directly employed by the facility on
or after July 1, 2023, excluding:
new text end

new text begin (1) owners of the building and operation;
new text end

new text begin (2) persons employed in the central office of an entity that has any ownership interest
in the nursing facility or exercises control over the nursing facility;
new text end

new text begin (3) persons paid by the nursing facility under a management contract; and
new text end

new text begin (4) persons providing separately billable services.
new text end

new text begin (c) Contracted housekeeping, dietary, and laundry employees providing services on site
at the nursing facility are eligible for compensation-related cost increases under this section,
provided the agency that employs them submits to the nursing facility proof of the costs of
the increases provided to those employees.
new text end

new text begin (d) For purposes of this section, compensation-related costs include:
new text end

new text begin (1) permanent new increases to wages and salaries implemented on or after July 1, 2023,
and before September 1, 2023, for nursing facility employees;
new text end

new text begin (2) permanent new increases to wages and salaries implemented on or after July 1, 2023,
and before September 1, 2023, for employees in the organization's shared services
departments of hospital-attached nursing facilities for the nursing facility allocated share
of wages; and
new text end

new text begin (3) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, PERA, workers' compensation, and pension and employee retirement accounts directly
associated with the wage and salary increases in clauses (1) and (2) incurred no later than
December 31, 2025, and paid for no later than June 30, 2026.
new text end

new text begin (e) A facility that receives a rate increase under this section must complete a distribution
plan in the form and manner determined by the commissioner. This plan must specify the
total amount of money the facility is estimated to receive from this rate increase and how
that money will be distributed to increase the allowable compensation-related costs described
in paragraph (d) for employees described in paragraphs (b) and (c). This estimate must be
computed by multiplying $28.65 by the sum of the medical assistance and private pay
resident days as defined in Minnesota Statutes, section 256R.02, subdivision 45, for the
period beginning October 1, 2021, through September 30, 2022, dividing this sum by 365
and multiplying the result by 915. A facility must submit its distribution plan to the
commissioner by October 1, 2023. The commissioner may review the distribution plan to
ensure that the payment rate adjustment per resident day is used in accordance with this
section. The commissioner may allow for a distribution plan amendment under exceptional
circumstances to be determined at the sole discretion of the commissioner.
new text end

new text begin (f) By September 1, 2023, a facility must post the distribution plan summary and leave
it posted for a period of at least six months in an area of the facility to which all employees
have access. The posted distribution plan summary must be in the form and manner
determined by the commissioner. The distribution plan summary must include instructions
regarding how to contact the commissioner, or the commissioner's representative, if an
employee believes the employee is covered by paragraph (b) or (c) and has not received the
compensation-related increases described in paragraph (d). The instruction to such employees
must include the e-mail address and telephone number that may be used by the employee
to contact the commissioner's representative. The posted distribution plan summary must
demonstrate how the increase in paragraph (a) received by the nursing facility from July 1,
2023, through December 1, 2025, will be used in full to pay the compensation-related costs
in paragraph (d) for employees described in paragraphs (b) and (c).
new text end

new text begin (g) If the nursing facility expends less on new compensation-related costs than the amount
that was made available by the rate increase in this section for that purpose, the amount of
this rate adjustment must be reduced to equal the amount utilized by the facility for purposes
authorized under this section. If the facility fails to post the distribution plan summary in
its facility as required, fails to submit its distribution plan to the commissioner by the due
date, or uses these funds for unauthorized purposes, these rate increases must be treated as
an overpayment and subsequently recovered.
new text end

new text begin (h) The commissioner shall not treat payments received under this section as an applicable
credit for purposes of setting total payment rates under Minnesota Statutes, chapter 256R.
new text end

new text begin EFFECTIVE DATE. new text end

ARTICLE 6

INTERMEDIATE CARE FACILITIES

Section 1.

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

Sec. 2.

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

Sec. 3.

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 (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 (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. 4. 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

ARTICLE 7

EMERGENCY AND NONEMERGENCY MEDICAL TRANSPORTATION

Section 1.

Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to
read:

Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (h).

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, physician assistant, or a medical or mental health professional to
certify that the recipient requires nonemergency medical transportation services.
Nonemergency medical transportation providers shall perform driver-assisted services for
eligible individuals, when appropriate. Driver-assisted service includes passenger pickup
at and return to the individual's residence or place of business, assistance with admittance
of the individual to the medical facility, and assistance in passenger securement or in securing
of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner to determine the client's most appropriate mode of transportation. If public
transit or a certified transportation provider is not available to provide the appropriate service
mode for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.

(k) The commissioner shall:

(1) verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and deleted text begin $11deleted text end new text begin $12.93new text end for the base rate and deleted text begin $1.30deleted text end new text begin $1.53new text end per mile when provided by a
nonemergency medical transportation provider;

(4) deleted text begin $13deleted text end new text begin $15.28new text end for the base rate and deleted text begin $1.30deleted text end new text begin $1.53new text end per mile for assisted transport;

(5) deleted text begin $18deleted text end new text begin $21.15new text end for the base rate and deleted text begin $1.55deleted text end new text begin $1.82new text end per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

new text begin (r) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent
up or down for every increase or decrease of ten cents for the price of gasoline. The increase
or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
or decrease must be calculated using the average of the most recently available price of all
grades of gasoline for Minnesota as posted publicly by the United States Energy Information
Administration.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read:

Subd. 17a.

Payment for ambulance services.

(a) Medical assistance covers ambulance
services. Providers shall bill ambulance services according to Medicare criteria.
Nonemergency ambulance services shall not be paid as emergencies. Effective for services
rendered on or after July 1, 2001, medical assistance payments for ambulance services shall
be paid at the Medicare reimbursement rate or at the medical assistance payment rate in
effect on July 1, 2000, whichever is greater.

(b) Effective for services provided on or after July 1, 2016, medical assistance payment
rates for ambulance services identified in this paragraph are increased by five percent.
Capitation payments made to managed care plans and county-based purchasing plans for
ambulance services provided on or after January 1, 2017, shall be increased to reflect this
rate increase. The increased rate described in this paragraph applies to ambulance service
providers whose base of operations as defined in section 144E.10 is located:

(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or

(2) within a municipality with a population of less than 1,000.

new text begin (c) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one
percent up or down for every increase or decrease of ten cents for the price of gasoline. The
increase or decrease must be calculated using a base gasoline price of $3.00. The percentage
increase or decrease must be calculated using the average of the most recently available
price of all grades of gasoline for Minnesota as posted publicly by the United States Energy
Information Administration.
new text end

new text begin EFFECTIVE DATE. new text end

Sec. 3. new text begin NONEMERGENCY MEDICAL TRANSPORTATION SPENDING
REQUIREMENTS.
new text end

new text begin (a) At least 80 percent of the marginal increase in revenue from the implementation of
rate increases in this act under Minnesota Statutes, section 256B.0625, subdivision 17,
paragraph (m), clauses (3) to (5), for services rendered on or after the day of implementation
of the rate increases must be used to increase compensation-related costs for drivers.
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 (4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to the implementation of the rate increases.
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 section, including how that money was
or will be distributed to increase compensation-related costs for drivers. 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 drivers have access. The posted distribution plan must include instructions
regarding how to contact the commissioner, or the commissioner's representative, if a driver
has not received the compensation-related increase described in the plan.
new text end

ARTICLE 8

RESIDENTIAL SETTING CLOSURE PREVENTION GRANTS

Section 1.

new text begin [256.4795] RESIDENTIAL SETTING CLOSURE PREVENTION
GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Residential setting closure prevention grants established. new text end

new text begin The
commissioner of human services shall establish a grant program to reduce the risk of
residential settings in financial distress from closing. The commissioner shall limit
expenditures under this subdivision to the amount appropriated for this purpose.
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 them.
new text end

new text begin (b) "At risk of closure" or "at risk of closing" means a residential setting is in significant
financial distress, and, in the judgment of the commissioner, the setting will close without
additional funding from the commissioner.
new text end

new text begin (c) "Residential setting" means any of the following: (1) a nursing facility; (2) an assisted
living facility with a majority of residents receiving services funded by medical assistance;
(3) a setting exempt from assisted living facility licensure under section 144G.08, subdivision
7, clauses (10) to (13), with a majority of residents receiving services funded by medical
assistance; (4) an intermediate care facility for persons with developmental disabilities; or
(5) an adult foster care setting, a community residential setting, or an integrated community
supports setting.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) A license holder operating a residential setting in significant
financial distress may apply to the commissioner for a grant under this section to relieve its
immediate financial distress.
new text end

new text begin (b) Lead agencies that suspect a residential setting is in significant financial distress may
refer the license holder to the commissioner for consideration by the commissioner for grant
funding under this section. Upon a referral from a lead agency under this section, the
commissioner shall immediately solicit an application from the license holder, providing
individualized technical assistance to the license holder regarding the application process.
new text end

new text begin (c) The commissioner must give priority for closure prevention grants to residential
settings that are the most significantly at risk of closing in violation of the applicable notice
requirements prior to the termination of services.
new text end

new text begin Subd. 4. new text end

new text begin Criteria and limitations. new text end

new text begin (a) Within available appropriations for this purpose,
the commissioner must award sufficient funding to a residential setting at risk of closure to
ensure that the residential setting remains open long enough to comply with the applicable
termination of services notification requirements.
new text end

new text begin (b) The commissioner may award additional funding to a residential setting at risk of
closure if, in the judgment of the commissioner, the residential setting is likely to remain
open and financially viable after receiving time-limited additional funding from the
commissioner.
new text end

new text begin (c) Before receiving any additional funding under paragraph (b), grantees must work
with the commissioner to develop a business plan and corrective action plan to reduce the
risk of future financial distress. No residential setting may receive additional funding under
paragraph (b) more than once.
new text end

new text begin Subd. 5. new text end

new text begin Interagency coordination. new text end

new text begin The commissioner must coordinate the grant
activities under this section with any other impacted state agencies and lead agencies.
new text end

new text begin Subd. 6. new text end

new text begin Administrative funding. new text end

new text begin The commissioner may use up to 6.5 percent of the
grant money appropriated for the commissioner's costs related to administration of this
program.
new text end

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 9

EXPANSION OF EMERGENCY STAFFING POOL

Section 1.

Laws 2022, chapter 40, section 6, is amended to read:

Sec. 6. COMMISSIONER OF HUMAN SERVICES; TEMPORARY STAFFING
POOLdeleted text begin ; APPROPRIATIONdeleted text end .

(a) The commissioner of human services shall establish a temporary emergency staffing
pool for congregate settingsnew text begin and for providers or recipients of home- and community-based
servicesnew text end experiencing staffing crises. Vendor contracts may include retention bonuses,
sign-on bonuses, and payment for hours on call. The commissioner may pay for necessary
training, travel, and lodging expenses of the temporary staff. Contracts for temporary staffing
executed under this section: (1) should minimize the recruitment away from providers'
current workforces; and (2) may not be executed with an individual until at least 30 days
since the individual was last employed in Minnesota by one of the types of facilitiesnew text begin ,
providers, or individualsnew text end listed in paragraph (g).

(b) Temporary staff, at the request of the commissioner, may be deployed tonew text begin providers
of home- and community-based services, individual recipients of home- and
community-based services, andnew text end long-term care facilities and other congregate care residential
facilities and programs experiencing an emergency staffing crisis on or after the effective
date of this section. Temporary staff must be provided at no cost to thenew text begin provider, individual
recipient,new text end facilitynew text begin ,new text end or program receiving the temporary staff.

(d) The commissioner must coordinate the activities under this section with any other
impacted state agencies, to appropriately prioritize locations to deploy contracted temporary
staff.

(e) The commissioner must give priority for deploying staff tonew text begin providers, individual
recipients,new text end facilitiesnew text begin ,new text end and programs with the most significant staffing crises and where, but
for this assistance, residentsnew text begin or service recipientsnew text end would be at significant risk of injury due
to the need to transfer to deleted text begin anotherdeleted text end new text begin anew text end facility or a hospital for adequately staffed care.

(f) Anew text begin provider, individual recipient,new text end facilitynew text begin ,new text end or program may seek onetime assistance
per settingnew text begin or individual service recipientnew text end from the temporary staffing pool only after thenew text begin
provider, individual recipient,new text end facilitynew text begin ,new text end or program has used all resources available to obtain
temporary staff but is unable to meet thenew text begin provider's, individual's,new text end facility'snew text begin ,new text end or program's
temporary staffing needs. Anew text begin provider, individual,new text end facilitynew text begin ,new text end or program may apply for
temporary staff for up to 21 days. Applicants must submit a proposed plan for ensuring
resident safety at the end of that time period.

(g)new text begin Providers, individuals,new text end facilitiesnew text begin ,new text end and programs eligible to obtain temporary staff
from the temporary staffing pool include:

(1) nursing facilities;

(2) assisted living facilities;

(3) intermediate care facilities for persons with developmental disabilities;

(4) adult foster care deleted text begin ordeleted text end new text begin ,new text end community residential settingsnew text begin , or integrated community supports
settingsnew text end ;

(5) licensed substance use disorder treatment facilities;

(6) unlicensed county-based substance use disorder treatment facilities;

(7) licensed facilities for adults with mental illness;

(8) licensed detoxification programs;

(9) licensed withdrawal management programs;

(10) licensed children's residential facilities;

(11) licensed child foster residence settings;

(12) unlicensed, Tribal-certified facilities that perform functions similar to the licensed
facilities listed in this paragraph;

(13) boarding care homes;

(14) board and lodging establishments serving people with disabilities or disabling
conditions;

(15) board and lodging establishments with special services;

(16) supervised living facilities;

(17) supportive housing;

(18) sober homes;

(19) community-based halfway houses for people exiting the correctional system;

(20) shelters serving people experiencing homelessness;

(21) drop-in centers for people experiencing homelessness;

(22) homeless outreach services for unsheltered individuals;

(23) shelters for people experiencing domestic violence; deleted text begin and
deleted text end

(24) temporary isolation spaces for people who test positive for COVID-19new text begin ;
new text end

new text begin (25) individuals who use consumer-directed community supports;
new text end

new text begin (26) individuals who use the personal care assistance choice program;
new text end

new text begin (27) personal care assistance provider agencies;
new text end

new text begin (28) individuals who use the community first services and supports budget model;
new text end

new text begin (29) agency-providers of community first services and supports; and
new text end

new text begin (30) providers of individualized home supportsnew text end .

(h) Notwithstanding Minnesota Statutes, chapter 16C, the commissioner may maintain,
extend, or renew contracts for temporary staffing entered into on or after September 1, 2020.
The commissioner may also enter into new contracts with eligible entities for temporary
staff deployed in the temporary staffing pool. The commissioner may use up to 6.5 percent
of this funding for the commissioner's costs related to administration of this program.

(i) The commissioner shall seek all allowable FEMA reimbursement for the costs of this
activity.

ARTICLE 10

FAMILY ASSETS FOR INDEPENDENCE

Section 1.

Minnesota Statutes 2022, section 256E.35, subdivision 1, is amended to read:

Subdivision 1.

Establishment.

The Minnesota family assets for independence initiative
is established to provide incentives for low-income families to accrue assets for education,
housing, vehicles,new text begin emergencies,new text end and economic development purposes.

Sec. 2.

Minnesota Statutes 2022, section 256E.35, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Eligible educational institution" means the following:

(1) an institution of higher education described in section 101 or 102 of the Higher
Education Act of 1965; or

(2) an area vocational education school, as defined in subparagraph (C) or (D) of United
States Code, title 20, chapter 44, section 2302 (3) (the Carl D. Perkins Vocational and
Applied Technology Education Act), which is located within any state, as defined in United
States Code, title 20, chapter 44, section 2302 (30). This clause is applicable only to the
extent section 2302 is in effect on August 1, 2008.

(c) "Family asset account" means a savings account opened by a household participating
in the Minnesota family assets for independence initiative.

(d) "Fiduciary organization" means:

(1) a community action agency that has obtained recognition under section 256E.31;

(2) a federal community development credit union deleted text begin serving the seven-county metropolitan
areadeleted text end ; deleted text begin or
deleted text end

(3) a women-oriented economic development agency deleted text begin serving the seven-county
metropolitan area.deleted text end new text begin ;
new text end

new text begin (4) a federally recognized Tribal nation; or
new text end

new text begin (5) a nonprofit organization, as defined under section 501(c)(3) of the Internal Revenue
Code.
new text end

(e) "Financial coach" means a person who:

(1) has completed an intensive financial literacy training workshop that includes
curriculum on budgeting to increase savings, debt reduction and asset building, building a
good credit rating, and consumer protection;

(2) participates in ongoing statewide family assets for independence in Minnesota (FAIM)
network training meetings under FAIM program supervision; and

(3) provides financial coaching to program participants under subdivision 4a.

(f) "Financial institution" means a bank, bank and trust, savings bank, savings association,
or credit union, the deposits of which are insured by the Federal Deposit Insurance
Corporation or the National Credit Union Administration.

(g) "Household" means all individuals who share use of a dwelling unit as primary
quarters for living and eating separate from other individuals.

(h) "Permissible use" means:

(1) postsecondary educational expenses at an eligible educational institution as defined
in paragraph (b), including books, supplies, and equipment required for courses of instruction;

(2) acquisition costs of acquiring, constructing, or reconstructing a residence, including
any usual or reasonable settlement, financing, or other closing costs;

(3) business capitalization expenses for expenditures on capital, plant, equipment, working
capital, and inventory expenses of a legitimate business pursuant to a business plan approved
by the fiduciary organization;

(4) acquisition costs of a principal residence within the meaning of section 1034 of the
Internal Revenue Code of 1986 which do not exceed 100 percent of the average area purchase
price applicable to the residence determined according to section 143(e)(2) and (3) of the
Internal Revenue Code of 1986; deleted text begin and
deleted text end

(5) acquisition costs of a personal vehicle only if approved by the fiduciary organizationdeleted text begin .deleted text end new text begin ;
new text end

new text begin (6) contribution to an emergency savings account; and
new text end

new text begin (7) contribution to a Minnesota 529 savings plan.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256E.35, subdivision 4a, is amended to read:

Subd. 4a.

Financial coaching.

A financial coach shall provide the following to program
participants:

(1) financial education relating to budgeting, debt reduction, asset-specific training,
new text begin credit building, new text end and financial stability activities;

(2) asset-specific training related to buying a home or vehicle, acquiring postsecondary
education, deleted text begin ordeleted text end starting or expanding a small businessnew text begin , saving for emergencies, or saving for
a child's educationnew text end ; and

(3) financial stability education and training to improve and sustain financial security.

Sec. 4.

Minnesota Statutes 2022, section 256E.35, subdivision 6, is amended to read:

Subd. 6.

Withdrawal; matching; permissible uses.

(a) To receive a match, a
participating household must transfer funds withdrawn from a family asset account to its
matching fund custodial account held by the fiscal agent, according to the family asset
agreement. The fiscal agent must determine if the match request is for a permissible use
consistent with the household's family asset agreement.

(b) The fiscal agent must ensure the household's custodial account contains the applicable
matching funds to match the balance in the household's account, including interest, on at
least a quarterly basis and at the time of an approved withdrawal. Matches must be a
contribution of $3 from state grant or TANF funds for every $1 of funds withdrawn from
the family asset account not to exceed a deleted text begin $6,000deleted text end new text begin $9,000new text end lifetime limit.

(c) Notwithstanding paragraph (b), if funds are appropriated for the Federal Assets for
Independence Act of 1998, and a participating fiduciary organization is awarded a grant
under that act, participating households with that fiduciary organization must be provided
matches as follows:

(1) from state grant and TANF funds, a matching contribution of $1.50 for every $1 of
funds withdrawn from the family asset account not to exceed a deleted text begin $3,000deleted text end new text begin $4,500new text end lifetime limit;
and

(2) from nonstate funds, a matching contribution of not less than $1.50 for every $1 of
funds withdrawn from the family asset account not to exceed a deleted text begin $3,000deleted text end new text begin $4,500new text end lifetime limit.

(d) Upon receipt of transferred custodial account funds, the fiscal agent must make a
direct payment to the vendor of the goods or services for the permissible use.

Sec. 5.

Minnesota Statutes 2022, section 256E.35, subdivision 7, is amended to read:

Subd. 7.

Program reporting.

The fiscal agent on behalf of each fiduciary organization
participating in a family assets for independence initiative must report quarterly to the
commissioner of human services identifying the participants with accounts, the number of
accounts, the amount of savings and matches for each participant's account, the uses of the
account, deleted text begin anddeleted text end the number of businesses, homes, vehicles, and educational services paid for
with money from the account,new text begin and the amount of contributions to Minnesota 529 savings
plans and emergency savings accounts,new text end as well as other information that may be required
for the commissioner to administer the program and meet federal TANF reporting
requirements.

Sec. 6.

Minnesota Statutes 2022, section 256P.02, is amended by adding a subdivision to
read:

new text begin Subd. 4. new text end

new text begin Account exception. new text end

new text begin Family asset accounts under section 256E.35 and individual
development accounts authorized under the Assets for Independence Act, Title IV of the
Community Opportunities, Accountability, and Training and Educational Services Human
Services Reauthorization Act of 1998, Public Law 105-285, must be excluded when
determining the equity value of personal property.
new text end

ARTICLE 11

APPROPRIATIONS

Section 1. new text begin APPROPRIATION; FAMILY ASSETS FOR INDEPENDENCE.
new text end

new text begin $100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of human services for the purposes of the family assets
for independence program in Minnesota Statutes, section 256E.35.
new text end

Sec. 2. new text begin APPROPRIATION; LIFESHARING SERVICE DEVELOPMENT.
new text end

new text begin $184,000 in fiscal year 2024 is appropriated from the general fund to the commissioner
of human services for engaging stakeholders and developing a lifesharing service under the
state's medical assistance disability waivers and elderly waiver. This is a onetime
appropriation and is available until June 30, 2025.
new text end

Sec. 3. new text begin APPROPRIATION; RESIDENTIAL SETTING CLOSURE PREVENTION
GRANTS.
new text end

new text begin $6,671,000 in fiscal year 2024 and $6,671,000 in fiscal year 2025 are appropriated from
the general fund to the commissioner of human services for residential setting closure
prevention grants under Minnesota Statutes, section 256.4795.
new text end

Sec. 4. new text begin APPROPRIATION; WELLNESS IN THE WOODS.
new text end

new text begin $100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of human services for a grant to Wellness in the Woods
for daily peer support and special sessions for individuals who are in substance use disorder
recovery, are transitioning out of incarceration, or have experienced trauma.
new text end

APPENDIX

Repealed Minnesota Statutes: 23-01278

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.

Subd. 9a.

Respite services; component values and calculation of payment rates.

(a) For the purposes of this section, respite services include respite services provided to an individual outside of any service plan for a day program or residential support service.

(b) Component values for respite services are:

(1) competitive workforce factor: 4.7 percent;

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

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

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

(5) general administrative support ratio: 13.25 percent;

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

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

(d) Payments for respite services must be calculated as follows unless the service is reimbursed separately as part of a residential support services or day program payment rate:

(1) determine the number of units of service to meet an individual'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 deaf and hard-of-hearing customization 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 employee-related expenses, multiply the result of clause (7) by one plus the employee-related cost ratio;

(9) this is the subtotal rate;

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

(11) divide the result of clause (9) by one minus the result of clause (10). This is the total payment amount;

(12) for respite services provided in a shared manner, divide the total payment amount in clause (11) by the number of service recipients, not to exceed three; and

(13) adjust the result of clause (12) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services.

256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS.

Subd. 4.

Calculation of monthly conversion budget cap with consumer-directed community supports.

For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent.

SF 7

Bill Text Versions

Current Version - as introduced

ARTICLE 1

CAREGIVERS STABILIZATION ACT

Section 1. new text begin TITLE.new text end

ARTICLE 2

DISABILITY WAIVERS

Section 1.

new text begin Subd. 16. new text end

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

new text begin EFFECTIVE DATE. new text end

Sec. 2.

Subd. 3.

Applicable services.

new text begin EFFECTIVE DATE. new text end

Sec. 3.

Subd. 4.

Data collection for rate determination.

new text begin EFFECTIVE DATE. new text end

Sec. 4.

Subd. 5.

Base wage index; establishment and updates.

new text begin EFFECTIVE DATE. new text end

Sec. 5.

Subd. 5a.

Base wage index; calculations.

new text begin EFFECTIVE DATE. new text end

Sec. 6.

Subd. 5b.

Standard component value adjustments.

new text begin EFFECTIVE DATE. new text end

Sec. 7.

Subd. 5c.

Removal of after-framework adjustments.

new text begin EFFECTIVE DATE. new text end

Sec. 8.

Subd. 5d.

Unavailable data for updates and adjustments.

new text begin EFFECTIVE DATE. new text end

Sec. 9.

Subd. 5e.

Inflationary update spending requirement.

new text begin EFFECTIVE DATE. new text end

Sec. 10.

new text begin Subd. 5f. new text end

new text begin Competitive workforce factor adjustments. new text end

new text begin EFFECTIVE DATE. new text end

Sec. 11.

Subd. 8.

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

new text begin EFFECTIVE DATE. new text end

Sec. 12.

Subd. 9.

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

new text begin EFFECTIVE DATE. new text end

Sec. 13.

Subd. 10.

Evaluation of information and data.

new text begin EFFECTIVE DATE. new text end

Sec. 14.

Subd. 10a.

Reporting and analysis of cost data.

new text begin EFFECTIVE DATE. new text end

Sec. 15.

Subd. 10c.

Reporting and analysis of competitive workforce factor.

new text begin EFFECTIVE DATE. new text end

Sec. 16.

Subd. 12.

Customization of rates for individuals.

new text begin EFFECTIVE DATE. new text end

Sec. 17.

Subd. 14.

Exceptions.

new text begin EFFECTIVE DATE. new text end

Sec. 18.

Subdivision 1.

Phase-in for disability waiver customized living rates.

new text begin EFFECTIVE DATE. new text end

Section 1. new text begin TITLE.
new text end

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

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

Sec. 19. new text begin DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
SERVICES RATES.
new text end

Sec. 20. new text begin DIRECTION TO COMMISSIONER; SHARED SERVICES.
new text end

Sec. 21. new text begin DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.
new text end

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

Sec. 22. new text begin REPEALER.
new text end

new text begin Monthly case mix budget caps for consumer-directed community
supports. new text end

Calculation of monthly conversion budget deleted text begin cap without consumer-directed
community supportsdeleted text end new text begin capsnew text end .