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SF 3118

as introduced - 91st Legislature (2019 - 2020) Posted on 02/13/2020 03:50pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to human services; modifying disability waiver payment rates for respite
care and individualized home supports with training; amending Minnesota Statutes
2019 Supplement, section 256B.4914, subdivisions 3, 5, 6, 7, 8, 9.

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

Section 1.

Minnesota Statutes 2019 Supplement, 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) companion services;

(5) community residential services;

(6) customized living;

(7) day support services;

(8) day training and habilitation;

(9) employment development services;

(10) employment exploration services;

(11) employment support services;

(12) family residential services;

(13) housing access coordination;

(14) independent living skills;

(15) individualized home supports;

(16) individualized home supports with family training;

(17) individualized home supports with training;

(18) in-home family support;

(19) integrated community supports;

(20) night supervision;

(21) personal support;

(22) positive support services;

(23) prevocational services;

(24) residential support services;

deleted text begin (25) respite services;
deleted text end

deleted text begin (26)deleted text end new text begin(25) new text endstructured day services;

deleted text begin (27)deleted text endnew text begin (26)new text end supported living services;

deleted text begin (28)deleted text endnew text begin (27)new text end transportation services; and

deleted text begin (29)deleted text endnew text begin (28)new text end other services as approved by the federal government in the state home and
community-based services plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2019 Supplement, section 256B.4914, subdivision 5, is amended
to read:


Subd. 5.

Base wage index and standard component values.

(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 developing and calculating
the proposed 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 most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); 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 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 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);

(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);

(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 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);

(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;

(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

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

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

(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 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);

(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);

(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 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);

(11) 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);

(12) for independent living skills 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
rehabilitation counselor (SOC code 21-1015); 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 staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);

(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 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 (19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
deleted text end

deleted text begin (20)deleted text end new text begin(19) new text endfor personal support staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

deleted text begin (21)deleted text endnew text begin (20)new text end 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 specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);

deleted text begin (22)deleted text endnew text begin (21)new text end for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and

deleted text begin (23)deleted text endnew text begin (22)new text end for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).

(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support 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: 1.3 percent; and

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

(c) Component values for family foster care 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: 3.3 percent;

(6) program-related expense ratio: 1.3 percent; and

(7) absence factor: 1.7 percent.

(d) Component values for day training and habilitation, day support services, and
prevocational 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) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: ten percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

(e) Component values for adult day 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) program plan support ratio: 5.6 percent;

(6) client programming and support ratio: 7.4 percent;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 1.8 percent; and

(9) absence and utilization factor ratio: 9.4 percent.

(f) Component values for unit-based services with programming new text beginexcept individualized
home supports with training
new text endare:

(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 supports ratio: 15.5 percent;

(6) client programming and supports ratio: 4.7 percent;

(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.

new text begin (g) Component values for unit-based services with programming for individualized
home supports with training are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan supports ratio: 15.5 percent;
new text end

new text begin (6) client programming and supports ratio: 4.7 percent;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 6.1 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 7.5 percent.
new text end

deleted text begin (g)deleted text end new text begin(h) new text endComponent values for unit-based services without programming deleted text beginexcept respitedeleted text end
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;

(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.

deleted text begin (h) Component values for unit-based services without programming for respite are:
deleted text end

deleted text begin (1) competitive workforce factor: 4.7 percent;
deleted text end

deleted text begin (2) supervisory span of control ratio: 11 percent;
deleted text end

deleted text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
deleted text end

deleted text begin (4) employee-related cost ratio: 23.6 percent;
deleted text end

deleted text begin (5) general administrative support ratio: 13.25 percent;
deleted text end

deleted text begin (6) program-related expense ratio: 2.9 percent; and
deleted text end

deleted text begin (7) absence and utilization factor ratio: 3.9 percent.
deleted text end

(i) On July 1, 2022, and every two years thereafter, the commissioner shall update the
base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.

(j) Beginning February 1, 2021, 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. The report must include recommendations to update the
competitive workforce factor using:

(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 10a, paragraph (g).

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.

(k) On July 1, 2022, and every two years thereafter, the commissioner shall update the
framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); deleted text beginanddeleted text end paragraph (g), clause (6)new text begin; and paragraph (h), clause (6)new text end; subdivision 6,
paragraphs (b), clauses (9) and (10), and (e), clause (10); and subdivision 7, clauses (11),
(17), and (18), for changes in the Consumer Price Index. The commissioner shall adjust
these values higher or lower by the percentage change in the CPI-U from the date of the
previous update to the data available 30 months and one day prior to the scheduled update.
The commissioner shall publish these updated values and load them into the rate management
system.

(l) Upon the implementation of the updates under paragraphs (i) and (k), rate adjustments
authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108, article 7, section
60; and Laws 2014, chapter 312, article 27, section 75, shall be removed from service rates
calculated under this section.

(m) 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 paragraphs (i) and (k).

(n) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2019 Supplement, section 256B.4914, subdivision 6, is amended
to read:


Subd. 6.

Payments for residential support services.

(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, family residential services, foster care
services, integrated community supports, and supportive living services daily.

(b) Payments for community residential services, corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services
must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and deleted text begin(21) to (23)deleted text endnew text begin (20) to (22)new text end,
multiply the result of clause (2) by the product of one plus the competitive workforce factor
in subdivision 5, paragraph (b), clause (1);

(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 shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;

(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin(21)deleted text endnew text begin (20)new text end;

(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;

(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);

(9) for client programming and supports, the commissioner shall add $2,179; and

(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(c) The total rate must be calculated using the following steps:

(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(d) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.

(e) Payments for integrated community support services must be calculated as follows:

(1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;

(2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;

(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;

(4) except for subdivision 5, paragraph (a), clauses (4) and deleted text begin(21) to (23)deleted text endnew text begin (20) to (22)new text end,
multiply the result of clause (3) by the product of one plus the competitive workforce factor
in subdivision 5, paragraph (b), clause (1);

(5) 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 (4);

(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;

(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause deleted text begin(21)deleted text endnew text begin
(20)
new text end;

(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;

(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and

(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.

(f) The total rate must be calculated as follows:

(1) add the results of paragraph (e), clauses (9) and (10);

(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.

(h) The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.

Sec. 4.

Minnesota Statutes 2019 Supplement, section 256B.4914, subdivision 7, is amended
to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day services must be calculated as follows:

(1) determine the number of units of service and staffing ratio to meet a recipient's needs:

(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and

(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and deleted text begin(21) to (23)deleted text endnew text begin (20) to (22)new text end,
multiply the result of clause (2) by the product of one plus the competitive workforce factor
in subdivision 5, paragraph (d), clause (1);

(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 day program direct staff hours and nursing hours by the
appropriate staff wage;

(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin(21)deleted text endnew text begin (20)new text end;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(3). 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 in subdivision 5, paragraph (d), clause (5);

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (4);

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (6);

(11) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs;

(12) for adult day bath services, add $7.01 per 15 minute unit;

(13) this is the subtotal rate;

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

(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;

(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;

(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:

(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;

(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;

(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or

(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.

Sec. 5.

Minnesota Statutes 2019 Supplement, section 256B.4914, subdivision 8, is amended
to read:


Subd. 8.

Payments for unit-based services with programming.

new text begin (a) For purposes of
this subdivision, unit-based services with programming includes employment exploration
services, employment development services, housing access coordination, individualized
home supports with family training, individualized home supports with training, in-home
family support, independent living skills training, and hourly supported living services
provided to an individual outside of any day or residential service plan, unless the services
are authorized separately under subdivision 6 or 7.
new text end

new text begin (b) new text endPayments for unit-based services with programming, including employment
exploration services, employment development services, housing access coordination,
individualized home supports with family training, individualized home supports with
training, in-home family support, independent living skills training, and hourly supported
living services provided to an individual outside of any day or residential service plan must
be calculated as followsdeleted text begin, unless the services are authorized separately under subdivision 6
or 7
deleted text end:

(1) determine the number of units of service to meet a recipient's needs;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) except for subdivision 5, paragraph (a), clauses (4) and deleted text begin(21) to (23)deleted text endnew text begin (20) to (22)new text end,
multiply the result of clause (2) by the product of one plus the competitive workforce factor
in subdivision 5, paragraph (f), clause (1);

(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 staff hours by the appropriate staff wage;

(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin(21)deleted text endnew text begin (20)new text end;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(3). 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 supports ratio in subdivision 5, paragraph (f), clause (5);

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (4);

(10) for client programming and supports, multiply the result of clause (9) by one plus
the new text beginservice-appropriate new text endclient programming and supports ratio deleted text beginin subdivision 5, paragraph
(f), clause (6)
deleted text end;

(11) this is the subtotal rate;

(12) sum the standard general and administrative rate, 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 employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills training, individualized home supports with training, and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed two; and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 6.

Minnesota Statutes 2019 Supplement, section 256B.4914, subdivision 9, is amended
to read:


Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, deleted text beginrespite,deleted text end and companion care provided to an individual outside
of any day or residential service plan must be calculated as follows unless the services are
authorized separately under subdivision 6 or 7:

(1) deleted text beginfor all services except respite,deleted text end determine the number of units of service to meet a
recipient's needs;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(3) except for subdivision 5, paragraph (a), clauses (4) and deleted text begin(21) to (23)deleted text endnew text begin (20) to (22)new text end,
multiply the result of clause (2) by the product of one plus the competitive workforce factor
in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause (1);

(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 staff hours by the appropriate staff wage;

(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin(21)deleted text endnew text begin (20)new text end;

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end,
clause (3). 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 in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause (5);

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause (4);

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause (6);

(11) this is the subtotal rate;

(12) sum the standard general and administrative rate, 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;new text begin and
new text end

deleted text begin (14) for respite services, determine the number of day units of service to meet an
individual's needs;
deleted text end

deleted text begin (15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
deleted text end

deleted text begin (16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph (h), clause (1);
deleted text end

deleted text begin (17) 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 (16);
deleted text end

deleted text begin (18) multiply the number of direct staff hours by the appropriate staff wage;
deleted text end

deleted text begin (19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph (h), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
deleted text end

deleted text begin (20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (h),
clause (3). This is defined as the direct staffing rate;
deleted text end

deleted text begin (21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph (h), clause (4);
deleted text end

deleted text begin (22) this is the subtotal rate;
deleted text end

deleted text begin (23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
deleted text end

deleted text begin (24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;
deleted text end

deleted text begin (25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
deleted text end

deleted text begin (26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
deleted text end

deleted text begin (27)deleted text end new text begin(14) new text endadjust the result of deleted text beginclausesdeleted text endnew text begin clausenew text end (13)deleted text begin, (25), and (26)deleted text end by a factor to be
determined by the commissioner to adjust for regional differences in the cost of providing
services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
new text end