SF 968

as introduced - 91st Legislature (2019 - 2020) Posted on 02/07/2019 02:58pm

A bill for an act
relating to human services; establishing a payment rate methodology for personal
care assistance services; requiring commissioner of human services to study
methodology; requiring providers to submit workforce data; requiring reports;
amending Minnesota Statutes 2018, sections 256B.0659, subdivisions 1, 11, 21,
24, 28, by adding subdivisions; 256B.0915, subdivision 3a; 256B.69, subdivision
5a; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2018, 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 towards 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) new text begin "Commissioner" means the commissioner of human services.
new text end

new text begin (f) "Component value" means underlying factors that are built into the rate methodology
to calculate service rates and that are part of the cost of providing services.
new text end

new text begin (g) new text end "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

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

new text begin (i) "Enhanced care personal care assistance services" means personal care assistance
services included in a care plan developed according to subdivision 7 provided to a recipient
who qualifies for ten or more hours per day of personal care assistance services by a personal
care assistant who satisfies the requirements of subdivision 11, paragraph (d).
new text end

deleted text begin (g) deleted text end new text begin (j) new text end "Extended personal care assistance service" means personal care assistance services
new text begin or enhanced care personal care assistance services new text end included in a service plan under one of
the home and community-based services waivers authorized under sections 256B.0915,
256B.092, subdivision 5, and 256B.49, which exceed the amount, duration, and frequency
of the state plan personal care assistance services new text begin or enhanced care personal care assistance
services new text end 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 new text begin or enhanced
care personal care assistance services new text end are to be reduced; or

(2) need additional personal care assistance services new text begin or enhanced care personal care
assistance services new text end 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.

deleted text begin (h) deleted text end new text begin (k) new text end "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.

deleted text begin (i) deleted text end new text begin (l) new text end "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.

deleted text begin (j) deleted text end new text begin (m) new text end "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.

new text begin (n) "Median" means the amount that divides distribution between two equal groups,
one-half above the median and one-half below the median.
new text end

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

new text begin (p) "Qualified professional service" means supervision of personal care assistance services
and personal care assistants provided by a qualified professional under section 256B.0625,
subdivision 19c.
new text end

deleted text begin (l) deleted text end new text begin (q) new text end "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.

deleted text begin (m) deleted text end new text begin (r) new text end "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

deleted text begin (n) deleted text end new text begin (s) new text end "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.

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

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

deleted text begin (q) deleted text end new text begin (v) new text end "Service plan" means a written summary of the assessment and description of
the services needed by the recipient.

deleted text begin (r) deleted text end new text begin (w) new text end "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0659, subdivision 11, is amended to read:

Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant must
meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;

(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;

(9) complete training and orientation on the needs of the recipient; and

(10) be limited to providing and being paid for up to 275 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.

new text begin (d) Personal care assistants providing enhanced care personal care services must satisfy
the current requirements of Medicare for training and competency or competency evaluation
of home health aides or nursing assistants, as provided in Code of Federal Regulations, title
42, section 483.141 or 484.36, or alternative state-approved training or competency
requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:

Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:

(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;

(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;

(7) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;

(8) copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section new text begin , including the requirements
under subdivision 11, paragraph (d), if enhanced care personal care services are provided
and submitted for reimbursement under this section new text end ;

(11) documentation of the agency's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;

(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program financial
management. This training is effective July 1, 2009. Any personal care assistance provider
agency enrolled before that date shall, if it has not already, complete the provider training
within 18 months of July 1, 2009. Any new owners or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2018, 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) effective January 1, 2010, 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;
deleted text begin and
deleted text end

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

new text begin (15) document that for personal care assistants who are providing enhanced care personal
care assistance services, the additional revenue the agency receives from medical assistance
as a result of the differential between the rate for enhanced care personal care assistance
services and personal care assistance services is passed through to the personal care assistant
in the form of wages and benefits.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.0659, subdivision 28, is amended to read:

Subd. 28.

Personal care assistance provider agency; required documentation.

(a)
Required documentation must be completed and kept in the personal care assistance provider
agency file or the recipient's home residence. The required documentation consists of:

(1) employee files, including:

(i) applications for employment;

(ii) background study requests and results;

(iii) orientation records about the agency policies;

(iv) trainings completed with demonstration of competence new text begin , including verification of
the completion of training required under subdivision 11, paragraph (d), if enhanced care
personal care assistance services are provided and submitted for reimbursement under this
section new text end ;

(v) supervisory visits;

(vi) evaluations of employment; and

(vii) signature on fraud statement;

(2) recipient files, including:

(i) demographics;

(ii) emergency contact information and emergency backup plan;

(iii) personal care assistance service plan;

(iv) personal care assistance care plan;

(v) month-to-month service use plan;

(vi) all communication records;

(vii) start of service information, including the written agreement with recipient; and

(viii) date the home care bill of rights was given to the recipient;

(3) agency policy manual, including:

(i) policies for employment and termination;

(ii) grievance policies with resolution of consumer grievances;

(iii) staff and consumer safety;

(iv) staff misconduct; and

(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
resolution of consumer grievances;

(4) time sheets for each personal care assistant along with completed activity sheets for
each recipient served; and

(5) agency marketing and advertising materials and documentation of marketing activities
and costs.

(b) The commissioner may assess a fine of up to $500 on provider agencies that do not
consistently comply with the requirements of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 32. new text end

new text begin Payment rates; application generally. new text end

new text begin The payment methodologies in
subdivisions 32 to 36 apply to personal care assistance services, enhanced care personal
care assistance services, qualified professional services, and community first services and
supports under section 256B.85, subdivisions 8 and 18a.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 33. new text end

new text begin Payment rates; base wage index. new text end

new text begin (a) When initially establishing the base
wage component values, the commissioner shall use the Minnesota-specific median wage
for the standard occupational classification (SOC) codes published by the Bureau of Labor
Statistics in the most recent edition of the Occupational Handbook. The commissioner shall
calculate the wage component values as follows:
new text end

new text begin (1) for personal care assistance services, the base wage component value shall be the
median wage for personal care aide (SOC code 39-9021);
new text end

new text begin (2) for enhanced care personal care assistance services, the base wage component value
shall be the sum of 50 percent of the median wage for personal care aide (SOC code 39-9021)
and 50 percent of the median wage for home health aide (SOC code 31-1011); and
new text end

new text begin (3) for qualified professional services, the base wage component value shall be the sum
of 70 percent of the median wage for registered nurse (SOC code 29-1141), 15 percent of
the median wage for health care social worker (SOC code 21-1022), and 15 percent of the
median wage for social and human service assistant (SOC code 21-1093).
new text end

new text begin (b) On January 1, 2022, and every two years thereafter, the commissioner shall update
the base wage component values in paragraph (a) based on the wage data by SOC from the
Bureau of Labor Statistics available one year and a day prior to the scheduled update. The
commissioner shall publish the updated base wage component values.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 34. new text end

new text begin Payment rates; total wage index. new text end

new text begin (a) The commissioner shall multiply the
base wage component values in subdivision 33 by one plus the competitive workforce factor.
The product is the total wage component value.
new text end

new text begin (b) For personal care assistance services and for enhanced care personal care assistance
services, the initial competitive workforce factor is eight percent.
new text end

new text begin (c) For qualified professional services, the competitive workforce factor is zero.
new text end

new text begin (d) On January 1, 2022, and every two years thereafter, the commissioner shall adjust
the competitive workforce factor in paragraph (b) with an updated competitive workforce
factor using the data available one year and a day prior to the scheduled adjustment. The
commissioner must calculate the biennial adjustments to the competitive workforce factor
after determining the base wage index updates required in subdivision 33, paragraph (d).
The commissioner shall adjust the competitive workforce factor toward the percent difference
between: (1) the weighted average wage for personal care aide (SOC code 39-9021); and
(2) the weighted average wage for all other SOC codes with the same Bureau of Labor
Statistics classifications for education, experience, and training required for job competency.
For each biennial adjustment of the competitive workforce factor, the commissioner shall
not increase or decrease the competitive workforce factor from its previous value by no
more than three percentage points. If, after a biennial adjustment, the competitive workforce
factor is less than or equal to zero, the competitive workforce factor shall be zero. The
commissioner shall publish the updated competitive workforce value.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 9.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 35. new text end

new text begin Payment rates; standard component values. new text end

new text begin The commissioner shall use
the following component values:
new text end

new text begin (1) employee vacation, sick, and training factor, ... percent;
new text end

new text begin (2) employer taxes and workers' compensation, ... percent;
new text end

new text begin (3) employee benefits, ... percent;
new text end

new text begin (4) client programming and supports, ... percent;
new text end

new text begin (5) program plan support factor, ... percent; and
new text end

new text begin (6) general business and administrative expenses, ... percent.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 10.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 36. new text end

new text begin Payment rates; rate determination. new text end

new text begin (a) The commissioner shall determine
the rates for personal care assistance services, enhanced care personal care assistance services,
and qualified professional services as follows:
new text end

new text begin (1) multiply the total wage component value determined in subdivision 34 by one plus
the employee vacation, sick, and training factor. The product is the direct staffing rate;
new text end

new text begin (2) for employee-related expenses, add the factor for employer taxes and workers'
compensation and the factor for employee benefits. The sum is employee-related expenses.
Multiply the total wage component value determined in subdivision 34 by one plus the value
for employee-related expenses;
new text end

new text begin (3) for program expenses, add the client programming and supports factor and the factor
for program plan support. The sum is program expenses. Multiply the base wage component
value for personal care services in subdivision 33, paragraph (a), clause (1), by one plus the
program expenses;
new text end

new text begin (4) for administrative expenses, multiply the base wage component value for personal
care services in subdivision 33, paragraph (a), clause (1), by one plus the factor for general
business and administrative expenses; and
new text end

new text begin (5) add the results of clauses (1) to (4) to the total wage component value determined
in subdivision 34. The sum is the total payment rate.
new text end

new text begin (b) The commissioner shall publish the total payment rates.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 11.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 37. new text end

new text begin Personal care assistance provider agency; required reporting and analysis
of cost data. new text end

new text begin (a) The commissioner must evaluate on an ongoing basis whether the base
wage component values and component values in subdivisions 33 and 34 appropriately
address the cost to provide the service. The commissioner must make recommendations to
adjust the rate methodology as indicated by the evaluation. As determined by the
commissioner, in consultation with stakeholders, personal care assistance agencies enrolled
to provide services with rates determined under this section must submit requested cost data
to the commissioner. Requested cost data may include, but is not limited to:
new text end

new text begin (1) worker wage costs;
new text end

new text begin (2) benefits paid;
new text end

new text begin (3) supervisor wage costs;
new text end

new text begin (4) executive wage costs;
new text end

new text begin (5) vacation, sick, and training time paid;
new text end

new text begin (6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end

new text begin (7) administrative costs paid;
new text end

new text begin (8) program costs paid;
new text end

new text begin (9) transportation costs paid;
new text end

new text begin (10) vacancy rates; and
new text end

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

new text begin (b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to 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.
new text end

new text begin (c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.
new text end

new text begin (d) The commissioner shall analyze cost documentation in paragraph (a), and may submit
recommendations on component values and updated base wage component factors and
competitive workforce factors to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services in conjunction with reports submitted to
the legislature according to section 256B.4914, subdivision 10a. 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.
new text end

new text begin (e) The commissioner, in consultation with stakeholders, 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 end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 12.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:

new text begin Subd. 38. new text end

new text begin Payment rates evaluation. new text end

new text begin (a) Notwithstanding subdivision 37, paragraph
(d), the commissioner shall assess the component values used in the rate methodology in
subdivision 35. The commissioner shall publish evaluation findings and recommended
changes to the rate methodology in a report to the legislature on August 1, 2022.
new text end

new text begin (b) The commissioner shall assess the long-term impacts of the rate methodology
implementation on personal care assistants and qualified professionals, including but not
limited to measuring changes in wages, benefits provided, hours worked, and retention.
Notwithstanding subdivision 37, paragraph (d), the commissioner shall publish evaluation
findings in a report to the legislature on August 1, 2025.
new text end

new text begin (c) This subdivision expires on August 1, 2025, or upon the date the commissioner
submits to the legislature the report described in paragraph (b), whichever is later. The
commissioner shall inform the revisor of statutes when the report in submitted.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when approval is obtained.
new text end

Sec. 13.

new text begin [256B.0715] DIRECT CARE WORKFORCE REPORT.
new text end

new text begin The commissioner of human services shall annually assess the direct care workforce
and publish findings in a direct care workforce report each August beginning August 1,
2020. This report shall consider the number of workers employed, the number of regular
hours worked, the number of overtime hours worked, the regular wages and benefits paid,
the overtime wages paid, retention rates, and job vacancies across providers of home and
community-based services disability waiver services, state plan home care services, and
state plan personal care assistance services.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:

Subd. 3a.

Elderly waiver cost limits.

(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256R.17 for nursing
home rate determination is implemented and the first day of each subsequent state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.

(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:

(1) no dependencies in activities of daily living; or

(2) 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 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).

(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).

(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph (g), shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).

(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for
elderly waiver services in effect on the previous December 31 shall be increased by the
difference between any legislatively adopted home and community-based provider rate
increases effective on January 1 or since the previous January 1 and the average statewide
percentage increase in nursing facility operating payment rates under chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on January 1, or occurring
since the previous January 1.

new text begin (f) The commissioner shall approve an exception to the monthly case mix budget cap
in paragraph (a) to account for the additional cost of providing enhanced care personal care
assistance services under section 256B.0659. The commissioner shall calculate the difference
between the rate for personal care services and enhanced care personal care services. The
additional budget amount approved under an exception shall not exceed this difference.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (f) is effective July 1, 2020, 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. 15.

Minnesota Statutes 2018, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.

(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.

(d) The commissioner shall require that managed care plans new text begin :
new text end

new text begin (1) new text end use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659 deleted text begin . deleted text end new text begin ;
and
new text end

new text begin (2) by January 30 of each year in which a rate increase occurs for any aspect of personal
care assistance services, enhanced care personal care assistance services, and qualified
professional services under section 256B.0659, inform the commissioner and the chairs and
ranking minority members of the legislative committees with jurisdiction over personal care
assistance service rates of the amount of the rate increase that is paid to each personal care
assistance agency with which the plan has a contract.
new text end

(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.

The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.

(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.

The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.

(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.

(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.

(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.

(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.

(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.

(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).

(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.

new text begin EFFECTIVE DATE. new text end

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