SF 679

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; providing long-term care provider rate increases;
requiring the use of new nursing facility case mix indices; providing an
exemption from the MinnesotaCare program prohibition on employer-subsidized
coverage; requiring workforce initiatives; requiring a study of nursing facility
rate rebasing; amending Minnesota Statutes 2006, sections 256B.434, by adding
subdivisions; 256B.438, by adding a subdivision; 256B.5012, by adding a
subdivision; 256L.07, subdivision 2; proposing coding for new law in Minnesota
Statutes, chapter 256.

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

Section 1.

new text begin [256.9755] LONG-TERM CARE WORKFORCE TRAINING AND
DEVELOPMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Access to standardized curriculum. new text end

new text begin The commissioner, in
cooperation with the Minnesota job skills partnership program established under chapter
116L, shall subsidize student access to the health care core curriculum developed by the
Health Education-Industry Partnership, using a sliding tuition scale tied to income.
new text end

new text begin Subd. 2. new text end

new text begin Additional workforce initiatives. new text end

new text begin The commissioner shall develop and
implement initiatives to train and increase the supply of long-term caregivers who provide
specialized nursing facility care and community-based care to elderly and disabled persons
with chronic care needs. The commissioner shall present to the legislature by January 15,
2008, a description of the initiatives to be implemented and draft legislation incorporating
any statutory changes necessary to implement the initiatives.
new text end

new text begin Subd. 3. new text end

new text begin Funding. new text end

new text begin The subsidies and initiatives required by this subdivision are
funded using savings to the general fund that result from nursing facility closures and
downsizing.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.434, is amended by adding a
subdivision to read:

new text begin Subd. 19. new text end

new text begin Rate increases for October 1, 2007, and October 1, 2008. new text end

new text begin (a) For the
rate years beginning October 1, 2007, and October 1, 2008, the commissioner shall make
available to each nursing facility reimbursed under this section an adjustment equal to five
percent of the total operating payment rate.
new text end

new text begin (b) Seventy-five percent of the money resulting from the rate adjustment under
paragraph (a) must be used to increase wages and benefits and pay associated costs
for all employees, except management fees, the administrator, and central office staff.
Seventy-five percent of the money received by a facility as a result of the rate adjustment
provided in paragraph (a) must be used only for wage and benefit increases and payment
of associated costs, implemented on or after the effective date of the rate increase each
year, and must not be used for increases implemented prior to that date.
new text end

new text begin (c) Nursing facilities may apply for the portion of the rate adjustment under
paragraph (a) for employee wages and benefits and associated costs. The application
must be made to the commissioner and contain a plan by which the nursing facility
will distribute the funds according to paragraph (b). For nursing facilities in which the
employees are represented by an exclusive bargaining representative, an agreement
negotiated and agreed to by the employer and the exclusive bargaining representative
constitutes the plan. The commissioner shall not review and shall not require changes
to the portion or portions of the plan covered by collective bargaining agreements. A
negotiated agreement may constitute the plan only if the agreement is finalized after the
date of enactment of all increases for the rate year and signed by both parties prior to
submission to the commissioner. The commissioner shall review the plan to ensure that
the rate adjustments are used as provided in paragraph (b). To be eligible, a facility must
submit its distribution plan by March 31, 2008, and March 31, 2009, respectively. The
commissioner may approve distribution plans on or before June 30, 2008, and June 30,
2009, respectively. If a facility's distribution plan is effective after the first day of the
applicable rate period that the funds are available, the rate adjustments are effective the
same date as the facility's plan.
new text end

new text begin (d) A copy of the approved distribution plan must be made available to all employees
by giving each employee a copy or by posting a copy in an area of the nursing facility
to which all employees have access. If an employee does not receive the wage and
benefit adjustment described in the facility's approved plan and is unable to resolve the
problem with the facility's management or through the employee's union representative,
the employee may contact the commissioner at an address or telephone number provided
by the commissioner and included in the approved plan.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256B.434, is amended by adding a
subdivision to read:

new text begin Subd. 20. new text end

new text begin Funding for staff increases. new text end

new text begin (a) For the rate year beginning October 1,
2007, the commissioner shall make available to nursing facilities reimbursed under this
section an adjustment equal to one percent of the total operating payment rate.
new text end

new text begin (b) The money resulting from the rate adjustment under paragraph (a) may be used by
a nursing facility only for wages, benefits, and associated costs for direct care employees
hired on or after the effective date of the rate increase. For purposes of this requirement, a
direct care employee means a registered nurse, licensed practical nurse, or certified nursing
assistant for whom at least 75 percent of work hours are spent on direct care to patients.
new text end

new text begin (c) Nursing facilities shall apply to the commissioner for a rate increase by
submitting an application form developed by the commissioner. In granting requests for
rate adjustments, the commissioner shall give preference to nursing facilities that have low
ratios of direct care staff to residents, or that demonstrate that an increase in direct care
staff will lead to a significant improvement in the quality of care provided.
new text end

new text begin (d) The commissioner shall require nursing facilities to report information on the use
of the rate adjustment, and shall monitor nursing facility compliance with the requirements
of paragraph (b). The commissioner may recover money that the commissioner determines
was spent inappropriately by reducing nursing facility operating payment rates in future
rate years.
new text end

Sec. 4.

Minnesota Statutes 2006, section 256B.438, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin New case mix indices. new text end

new text begin (a) Effective with rates for the rate year beginning
October 1, 2007, the commissioner shall implement the case mix indices recommended
by the time study conducted under Laws 2001, First Special Session chapter 9, article 5,
section 35, paragraph (e). The commissioner shall implement the new case mix indices
as follows:
new text end

new text begin (1) the September 30, 2006, case mix component of the nursing facility operating
payment rate is multiplied by the new case mix indices to create 36 case mix adjusted rates;
new text end

new text begin (2) the 36 case mix adjusted rates determined in clause (1), plus the noncase mix
component, shall be the 36 nursing facility operating payment rates; and
new text end

new text begin (3) any rate increases authorized by the legislature to take effect October 1, 2007,
shall be applied to the rates determined under clause (2).
new text end

new text begin (b) The commissioner shall adjust the October 1, 2007, operating rates in paragraph
(a) for nursing facilities estimated to receive a decrease in operating revenue. The rate
interim adjustment is established as follows:
new text end

new text begin (1) the commissioner shall use the minimum data set to classify private and medical
assistance patient days by resource utilization group (RUG) classification for the rate year
ending June 30, 2007, according to both the case mix indices and resident assessment
schedule to be used on September 30, 2007, and the case mix indices and resident
assessment schedule to be used on October 1, 2007;
new text end

new text begin (2) the commissioner shall use the resident days in clause (1) and the nursing
facility's October 1, 2007, unadjusted operating payment rate to estimate operating
revenue according to both the case mix indices and resident assessment schedule to be
used on September 30, 2007, and the case mix indices and resident assessment schedule
to be used on October 1, 2007;
new text end

new text begin (3) the estimated operating revenue determined with the case mix indices and
resident assessment schedule to be used on September 30, 2007, minus the operating
revenue determined with the case mix indices and resident assessment schedule to be used
on October 1, 2007, equals the decrease in medical assistance and private pay operating
revenue;
new text end

new text begin (4) facilities with an estimated decrease in clause (3) receive an interim rate
adjustment equal to the value determined in clause (3) divided by the medical assistance
and private pay resident days in clause (1);
new text end

new text begin (5) the interim rate adjustment is in effect from October 1, 2007, through June
30, 2008, and does not become part of a facility's operating payment rate after June 30,
2008. The interim rate adjustment shall be applied to the case mix portion of the facility
operating rate; and
new text end

new text begin (6) the commissioner, by August 15, 2007, shall provide nursing facilities which the
commissioner has estimated will experience a decrease in operating revenue, with written
notice that specifies the amount of the estimated decrease in operating revenue and the
amount of the interim rate adjustment. Nursing facilities have 30 days to decline the
interim rate adjustment.
new text end

new text begin (c) The commissioner shall adjust the July 1, 2008, operating rates of facilities
receiving the interim rate adjustments in paragraph (b) and facilities that demonstrate a
decrease in operating revenue from the implementation of the case mix indices and use of
all quarterly assessments. The adjustment is calculated as follows:
new text end

new text begin (1) facilities that received the interim rate adjustment in paragraph (b) shall report
to the commissioner the number of medical assistance and private pay resident days
by RUG classification for the six-month period October 1, 2007, through March 31,
2008, according to both the case mix indices and resident assessment schedule used on
September 30, 2007, and the case mix indices and resident assessment schedule used on
October 1, 2007. A facility not receiving the rate adjustment in paragraph (b) that had a
decrease in operating revenue resulting from implementation of the new case mix indices
and the use of quarterly assessments may report to the commissioner the number of
medical assistance and private pay resident days by RUG classification for the six-month
period October 1, 2007, through March 31, 2008, according to both the case mix indices
and resident assessment schedule used on September 30, 2007, and the case mix indices
and resident assessment schedule used on October 1, 2007. Nursing facilities shall submit
the required information to the commissioner by May 15, 2008, in the manner specified by
the commissioner;
new text end

new text begin (2) the commissioner shall use the resident days reported in clause (1) and the
nursing facility's October 1, 2007, unadjusted operating payment rate to determine
operating revenue under both the case mix indices and resident assessment schedule
used on September 30, 2007, and the case mix indices and resident assessment schedule
used on October 1, 2007;
new text end

new text begin (3) the operating revenue determined using the case mix indices and resident
assessment schedule used on September 30, 2007, minus the operating revenue determined
using the case mix indices and resident assessment schedule used on October 1, 2007,
must equal the decrease in operating revenue;
new text end

new text begin (4) the July 1, 2008, operating payment rate adjustment is the decrease in operating
revenue determined in clause (3) divided by the total medical assistance and private pay
days reported in clause (1) for the six-month period October 1, 2007, through March 31,
2008. The operating payment rate adjustment is applied to the case mix portion of the
facility operating rate; and
new text end

new text begin (5) if the amount determined in clause (4) is greater than the amount determined
under paragraph (b), clause (4), the commissioner shall retroactively pay to nursing
facilities the difference between the two amounts for all paid medical assistance days
between October 1, 2007, and June 30, 2008.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2007.
new text end

Sec. 5.

Minnesota Statutes 2006, section 256B.5012, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin ICF/MR rate increases October 1, 2007, and October 1, 2008. new text end

new text begin (a) For
the rate periods beginning October 1, 2007, and October 1, 2008, the commissioner shall
make available to each facility reimbursed under this section an adjustment to the total
operating payment rate of ....... percent.
new text end

new text begin (b) Seventy-five percent of the money resulting from the rate adjustment under
paragraph (a) must be used to increase wages and benefits and pay associated costs for
employees, except for administrative and central office employees. Seventy-five percent
of the money received by a facility as a result of the rate adjustment provided in paragraph
(a) must be used only for wage, benefit, and staff increases implemented on or after
the effective date of the rate increase each year, and must not be used for increases
implemented prior to that date. The wage adjustment eligible employees may receive may
vary based on merit, seniority, or other factors determined by the provider.
new text end

new text begin (c) For each facility, the commissioner shall make available an adjustment, based
on occupied beds, using the percentage specified in paragraph (a) multiplied by the total
payment rate, including variable rate but excluding the property-related payment rate, in
effect on the preceding day. The total payment rate must include the adjustment provided
in section new text begin 256B.501, subdivision 12 new text end .
new text end

new text begin (d) A facility whose payment rates are governed by closure agreements, receivership
agreements, or Minnesota Rules, part , is not eligible for an adjustment
otherwise granted under this subdivision.
new text end

new text begin (e) A facility may apply for the portion of the payment rate adjustment provided
under paragraph (a) for employee wages and benefits and associated costs. The application
must be made to the commissioner and contain a plan by which the facility will distribute
the funds according to paragraph (b). For facilities in which the employees are represented
by an exclusive bargaining representative, an agreement negotiated and agreed to by
the employer and the exclusive bargaining representative constitutes the plan. The
commissioner shall not review, and shall not require changes, to the portion or portions
of the plan covered by collective bargaining agreements. A negotiated agreement may
constitute the plan only if the agreement is finalized after the date of enactment of all rate
increases for the rate year. The commissioner shall review the plan to ensure that the
payment rate adjustment per diem is used as provided in this subdivision. To be eligible, a
facility must submit its plan by March 31, 2008, and December 31, 2008, respectively.
If a facility's plan is effective for its employees after the first day of the applicable rate
period that the funds are available, the payment rate adjustment per diem is effective
the same date as its plan.
new text end

new text begin (f) A copy of the approved distribution plan must be made available to all employees
by giving each employee a copy or by posting it in an area of the facility to which all
employees have access. If an employee does not receive the wage and benefit adjustment
described in the facility's approved plan and is unable to resolve the problem with the
facility's management or through the employee's union representative, the employee
may contact the commissioner at an address or telephone number provided by the
commissioner and included in the approved plan.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256L.07, subdivision 2, is amended to read:

Subd. 2.

deleted text begin Must not have access to deleted text end Employer-subsidized coverage.

(a) To be
eligible, a family or individual must not have access to subsidized health coverage through
an employer and must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or reapplication. A family or
individual whose employer-subsidized coverage is lost due to an employer terminating
health care coverage as an employee benefit during the previous 18 months is not eligible.

(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage
as an employee benefit.

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

new text begin (d) The commissioner, for the period July 1, 2007, through June 30, 2008, shall
exempt a family or individual from this subdivision if access to employer-subsidized
insurance is through employment at a nursing facility licensed under chapter 144A that
participates in the medical assistance program. The commissioner shall evaluate the extent
to which this exemption increases access to affordable health coverage, and shall present
recommendations to the legislature by February 1, 2008, as to whether this exemption
should be continued and whether the exemption should be extended to include families
and individuals with access to employer-subsidized insurance through other long-term
care providers.
new text end

Sec. 7. new text begin STUDY OF NURSING FACILITY RATE REBASING.
new text end

new text begin The commissioner of human services shall evaluate the extent to which medical
assistance reimbursement rates for nursing facilities reflect the cost of providing services,
both statewide and in different regions of the state. The commissioner shall present
recommendations to the legislature by January 15, 2008, on whether the rebasing of
rates on a statewide or regional basis is necessary to ensure that reimbursement rates are
sufficient to cover the cost of providing services.
new text end

Sec. 8. new text begin COMMUNITY SERVICES PROVIDER RATE INCREASES.
new text end

new text begin (a) The commissioner of human services shall increase reimbursement rates or rate
limits, as applicable, by ....... percent for the rate period beginning October 1, 2007, and
the rate period beginning October 1, 2008, effective for services rendered on or after
those dates.
new text end

new text begin (b) The ....... percent annual rate increase described in this section must be provided
to:
new text end

new text begin (1) home and community-based waivered services for persons with developmental
disabilities or related conditions under Minnesota Statutes, section 256B.501;
new text end

new text begin (2) home and community-based waivered services for the elderly under Minnesota
Statutes, section 256B.0915;
new text end

new text begin (3) waivered services under community alternatives for disabled individuals under
Minnesota Statutes, section 256B.49;
new text end

new text begin (4) community alternative care waivered services under Minnesota Statutes, section
256B.49;
new text end

new text begin (5) traumatic brain injury waivered services under Minnesota Statutes, section
256B.49;
new text end

new text begin (6) nursing services and home health services under Minnesota Statutes, section
256B.0625, subdivision 6a;
new text end

new text begin (7) personal care services and nursing supervision of personal care services under
Minnesota Statutes, section 256B.0625, subdivision 19a;
new text end

new text begin (8) private duty nursing services under Minnesota Statutes, section 256B.0625,
subdivision 7;
new text end

new text begin (9) day training and habilitation services for adults with developmental disabilities
or related conditions under Minnesota Statutes, sections 252.40 to 252.46;
new text end

new text begin (10) alternative care services under Minnesota Statutes, section 256B.0913;
new text end

new text begin (11) adult residential program grants under Minnesota Rules, parts 9535.2000 to
9535.3000;
new text end

new text begin (12) adult and family community support grants under Minnesota Rules, parts
9535.1700 to 9535.1760;
new text end

new text begin (13) the group residential housing supplementary service rate under Minnesota
Statutes, section 256I.05, subdivision 1a;
new text end

new text begin (14) adult mental health integrated fund grants under Minnesota Statutes, section
245.4661;
new text end

new text begin (15) semi-independent living services (SILS) under Minnesota Statutes, section
252.275, including SILS funding under county social services grants formerly funded
under Minnesota Statutes, chapter 256I;
new text end

new text begin (16) community support services for deaf and hard-of-hearing adults with mental
illness who use or wish to use sign language as their primary means of communication;
new text end

new text begin (17) living skills training programs for persons with intractable epilepsy who need
assistance in the transition to independent living;
new text end

new text begin (18) physical therapy services under sections 256B.0625, subdivision 8, and
256D.03, subdivision 4;
new text end

new text begin (19) occupational therapy services under sections 256B.0625, subdivision 8a, and
256D.03, subdivision 4;
new text end

new text begin (20) speech-language therapy services under section 256D.03, subdivision 4, and
Minnesota Rules, part 9505.0390; and
new text end

new text begin (21) respiratory therapy services under section 256D.03, subdivision 4, and
Minnesota Rules, part 9505.0295.
new text end

new text begin (c) Providers that receive a rate increase under this section shall use 75 percent of
the additional revenue to increase wages and benefits and pay associated costs for all
employees, except for management fees, the administrator, and central office staff.
new text end

new text begin (d) For public employees, the increase for wages and benefits for certain staff is
available and pay rates must be increased only to the extent that they comply with laws
governing public employees' collective bargaining. Money received by a provider for pay
increases under this section may be used only for increases implemented on or after the
first day of the rate period in which the increase is available and must not be used for
increases implemented prior to that date.
new text end

new text begin (e) A copy of the provider's plan for complying with paragraph (c) must be made
available to all employees by giving each employee a copy or by posting a copy in an area
of the provider's operation to which all employees have access. If an employee does not
receive the adjustment, if any, described in the plan and is unable to resolve the problem
with the provider, the employee may contact the employee's union representative. If the
employee is not covered by a collective bargaining agreement, the employee may contact
the commissioner at a telephone number provided by the commissioner and included in
the provider's plan.
new text end