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SF 3457

1st Engrossment - 91st Legislature (2019 - 2020) Posted on 03/05/2020 09:04am

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

Current Version - 1st Engrossment

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A bill for an act
relating to human services; establishing enrollment requirements for personal care
assistance agencies; establishing additional duties for personal care assistants and
qualified professionals; 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.0625, by adding a subdivision;
256B.0659, subdivision 14, by adding a subdivision; 256B.69, subdivision 5a;
Minnesota Statutes 2019 Supplement, sections 256B.0659, subdivisions 21, 24;
256B.85, subdivision 2; 256S.18, subdivision 7; proposing coding for new law in
Minnesota Statutes, chapter 256B.

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

ARTICLE 1

PERSONAL CARE ASSISTANCE SERVICES PROGRAM INTEGRITY

Section 1.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 11a. new text end

new text begin Personal care assistants; notice of change of employment required. new text end

new text begin Within
six months of ceasing employment as a personal care assistant with any personal care
assistance provider agency, the personal care assistant must notify the commissioner on a
form prescribed by the commissioner that the personal care assistant is no longer providing
personal care assistance services on behalf of a personal care assistance provider agency
with whom the personal care assistant was previously affiliated.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0659, subdivision 14, is amended to read:


Subd. 14.

Qualified professional; duties.

(a) deleted text beginEffective January 1, 2010,deleted text end All personal
care assistants must be supervised by a qualified professionalnew text begin who is enrolled as an individual
provider with the department as required under subdivision 13, paragraph (a)
new text end.

(b) Through direct training, observation, return demonstrations, and consultation with
the staff and the recipient, the qualified professional must ensure and document that the
personal care assistant is:

(1) capable of providing the required personal care assistance services;

(2) knowledgeable about the plan of personal care assistance services before services
are performed; and

(3) able to identify conditions that should be immediately brought to the attention of the
qualified professional.

(c) The qualified professional shall evaluate the personal care assistant within the first
14 days of starting to provide regularly scheduled services for a recipient, or sooner as
determined by the qualified professional, except for the personal care assistance choice
option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the qualified
professional shall evaluate the personal care assistance services for a recipient through direct
observation of a personal care assistant's work. The qualified professional may conduct
additional training and evaluation visits, based upon the needs of the recipient and the
personal care assistant's ability to meet those needs. Subsequent visits to evaluate the personal
care assistance services provided to a recipient do not require direct observation of each
personal care assistant's work and shall occur:

(1) at least every 90 days thereafter for the first year of a recipient's services;

(2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staff; and

(3) after the first 180 days of a recipient's service, supervisory visits may alternate
between unscheduled phone or Internet technology and in-person visits, unless the in-person
visits are needed according to the care plan.

(d) Communication with the recipient is a part of the evaluation process of the personal
care assistance staff.

(e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:

(1) satisfaction level of the recipient with personal care assistance services;

(2) review of the month-to-month plan for use of personal care assistance services;

(3) review of documentation of personal care assistance services provided;

(4) whether the personal care assistance services are meeting the goals of the service as
stated in the personal care assistance care plan and service plan;

(5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and

(6) revision of the personal care assistance care plan as necessary in consultation with
the recipient or responsible party, to meet the needs of the recipient.

(f) The qualified professional shall complete the required documentation in the agency
recipient and employee files and the recipient's home, including the following documentation:

(1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;

(2) a month-to-month plan for use of personal care assistance services;

(3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;

(4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;

(5) all communication with the recipient and personal care assistance staff; and

(6) hands-on training or individualized training for the care of the recipient.

(g) The documentation in paragraph (f) must be done on agency templates.

(h) The services that are not eligible for payment as qualified professional services
include:

(1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;

(2) agency administrative activities;

(3) training other than the individualized training required to provide care for a recipient;
and

(4) any other activity that is not described in this section.

new text begin (i) Within 30 days of ceasing employment as a qualified professional with any personal
care assistance provider agency, the qualified professional must notify the commissioner
on a form prescribed by the commissioner that the qualified professional is no longer
providing qualified professional services on behalf of a personal care assistance provider
agency with whom the qualified professional was previously affiliated.
new text end

Sec. 3.

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


new text begin Subd. 14a. new text end

new text begin Documentation of qualified professional services provided. new text end

new text begin Qualified
professional services for a recipient must be documented in a manner determined by the
commissioner and must include the qualified professional's full name and individual provider
number.
new text end

Sec. 4.

Minnesota Statutes 2019 Supplement, 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
enrollmentdeleted text begin, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner
deleted text endnew text begin as a personal care assistance provider agency,
including at reenrollment or revalidation
new text end, information and documentation deleted text beginthat includes,deleted text endnew text begin.
The information and documentation must be in a format determined by the commissioner
and include
new text end but deleted text beginisdeleted text end notnew text begin benew text end limited todeleted text begin,deleted text end 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 for each business location providing services. 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 for each business location
providing service;

(4) proof of workers' compensation insurance coverage identifying the business location
where personal care assistance services are provided;

(5) proof of liability insurance coverage identifying the business location where personal
care assistance services are provided and naming the department as a certificate holder;

(6) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
new text begin identification, prevention, detection, and reporting of fraud or any billing, record keeping,
or other administrative noncompliance;
new text endand employee and consumer safety including process
for notification and resolution of consumer grievances, identification and prevention of
communicable diseases, and employee misconduct;

(7) 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;

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

(9) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section, including the requirements
under subdivision 11, paragraph (d), if enhanced personal care assistance services are
provided and submitted for an enhanced rate under subdivision 17a;

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

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

(12) 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; deleted text beginand
deleted text end

(13) deleted text begineffective May 15, 2010,deleted text end 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
signeddeleted text begin.deleted text endnew text begin;
new text end

new text begin (14) a copy of the personal care assistance provider agency's self-auditing policy and
other materials demonstrating the personal care assistance provider agency's internal program
integrity procedures;
new text end

new text begin (15) a copy of the personal care assistance provider agency's policy for notifying its
qualified professionals of the qualified professional's obligation to notify the commissioner
within 30 days that a qualified professional is no longer employed by the agency; and
new text end

new text begin (16) a copy of the personal care assistance provider agency's policy for notifying the
commissioner within six months that a personal care assistant is no longer employed by the
agency.
new text end

new text begin (b) All personal care assistance provider agencies must provide annually to the
commissioner the information described in paragraph (a), clauses (2) to (5).
new text end

deleted text begin (b)deleted text endnew text begin (c)new text end 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. deleted text beginThe commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.
deleted text end

deleted text begin (c)deleted text endnew text begin (d)new text end 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 submitting an application for enrollment of the
agency as a provider. new text beginThe mandatory training, or any substantially similar refresher training
developed by the commissioner, must be completed every two years thereafter.
new text endAll personal
care assistance provider agencies shall also require qualified professionals to complete the
training required by subdivision 13 before submitting an application for 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 deleted text beginthreedeleted text endnew text begin twonew text end years. deleted text beginBy September 1, 2010,deleted text end 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. deleted text beginThis 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.
deleted text end 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.

deleted text begin (d)deleted text endnew text begin (e)new text end All surety bonds, fidelity bonds, workers' compensation insurance, and liability
insurance required by this subdivision must be maintained continuously. After initial
enrollment, a provider must submit proof of bonds and required coverages at any time at
the request of the commissioner. Services provided while there are lapses in coverage are
not eligible for payment. Lapses in coverage may result in sanctions, including termination.
The commissioner shall send instructions and a due date to submit the requested information
to the personal care assistance provider agency.

new text begin (f) Personal care assistance provider agencies enrolling for the first time must also
provide, at the time of enrollment as a personal care assistance provider agency in a format
determined by the commissioner, information and documentation. The information and
documentation must include proof of sufficient initial operating capital to support the
infrastructure necessary to allow for ongoing compliance with the requirements of this
section. Sufficient operating capital may be demonstrated as follows:
new text end

new text begin (1) copies of business bank account statements showing at least $5,000 in cash reserves;
new text end

new text begin (2) proof of a cash reserve or business line of credit sufficient to equal two payrolls of
the agency's current or projected business; or
new text end

new text begin (3) any other manner prescribed by the commissioner.
new text end

new text begin (g) At the time of revalidation as a personal care assistance provider agency, all personal
care assistance provider agencies must provide information and documentation in a format
determined by the commissioner that includes but is not limited to the following:
new text end

new text begin (1) documentation of the payroll paid for the preceding 12 months or other time period
as prescribed by the commissioner; and
new text end

new text begin (2) financial statements demonstrating compliance with the use of revenue requirements
of paragraph (a), clause (12).
new text end

Sec. 5.

Minnesota Statutes 2019 Supplement, section 256B.0659, subdivision 24, is
amended to read:


Subd. 24.

Personal care assistance provider agency; general duties.

A personal care
assistance provider agency shall:

(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;

(2) comply with general medical assistance coverage requirements;

(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;

(4) comply with background study requirements;

(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;

(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(8) withhold and pay all applicable federal and state taxes;

(9) document that the agency uses a minimum of 72.5 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits. The revenue generated by the qualified professional and
the reasonable costs associated with the qualified professional shall not be used in making
this calculation;

(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(11) enter into a written agreement under subdivision 20 before services are provided;

(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;

(13) provide the recipient with a copy of the home care bill of rights at start of service;

(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissioner;

(15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; deleted text beginand
deleted text end

(16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the deleted text beginPCAsdeleted text endnew text begin personal care assistantsnew text end whose
services meet the requirements under subdivision 11, paragraph (d)deleted text begin.deleted text endnew text begin;
new text end

new text begin (17) notify the commissioner on a form prescribed by the commissioner within 30 days
following the date upon which a qualified professional is no longer employed by or otherwise
affiliated with the personal care assistance provider agency for whom the qualified
professional previously provided qualified professional services; and
new text end

new text begin (18) notify the commissioner on a form prescribed by the commissioner within six
months following the date upon which a personal care assistant is no longer employed by
or otherwise affiliated with the personal care assistance provider agency for whom the
personal care assistant previously provided personal care assistance services.
new text end

ARTICLE 2

PERSONAL CARE ASSISTANT RATE REFORM

Section 1.

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 deleted text beginshalldeleted text endnew text begin mustnew text end require that managed care plansnew 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.0659deleted text begin.deleted text endnew text begin;
and
new text end

new text begin (2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider 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

Sec. 2.

Minnesota Statutes 2019 Supplement, section 256B.85, subdivision 2, is amended
to read:


Subd. 2.

Definitions.

(a) For the purposes of this sectionnew text begin and section 256B.851new text end, the terms
defined in this subdivision have the meanings given.

(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.

(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.

(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.

(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.

(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, and is specified in a community services and support plan,
including:

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

(ii) continuous tube feeding lasting longer than 12 hours per day;

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

(iii) requiring sterile or clean dressing changes or a wound vac; or

(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;

(3) parenteral therapy described as:

(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

(i) oxygen required more than eight hours per day;

(ii) respiratory vest more than one time per day;

(iii) bronchial drainage treatments more than two times per day;

(iv) sterile or clean suctioning more than six times per day;

(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and

(vi) ventilator dependence under section 256B.0651;

(5) insertion and maintenance of catheter, including:

(i) sterile catheter changes more than one time per month;

(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or

(iii) bladder irrigations;

(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;

(7) neurological intervention, including:

(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or

(ii) swallowing disorders diagnosed by a physician and requiring specialized assistance
from another on a daily basis; and

(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.

(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.

(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in section 256S.10.

(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.

(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.

(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
may not be found to be dependent in an activity of daily living if, because of the child's age,
an adult would either perform the activity for the child or assist the child with the activity
and the assistance needed is the assistance appropriate for a typical child of the same age.

(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5
, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.

(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).

(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.

(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.

(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).

(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.

(r) "Level I behavior" means physical aggression deleted text begintowardsdeleted text endnew text begin towardnew text end self or others or
destruction of property that requires the immediate response of another person.

(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker may not determine medication
dose or time for medication or inject medications into veins, muscles, or skin:

(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;

(2) organizing medications as directed by the participant or the participant's representative;
and

(3) providing verbal or visual reminders to perform regularly scheduled medications.

(t) "Participant" means a person who is eligible for CFSS.

(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected. If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:

(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;

(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and

(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.

(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.

(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.

(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into an agreement to receive
services at the same time and in the same setting by the same employer.

(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.

(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.

(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.

(bb) "Wages and benefits" means the hourly 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, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.

(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020, 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.

new text begin [256B.851] COMMUNITY FIRST SERVICES AND SUPPORTS; PAYMENT
RATES.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin (a) The payment methodologies in this section apply to:
new text end

new text begin (1) community first services and supports (CFSS), extended CFSS, and enhanced rate
CFSS under section 256B.85; and
new text end

new text begin (2) personal care assistance services under section 256B.0625, subdivisions 19a and
19c; extended personal care assistance service as defined in section 256B.0659, subdivision
1; and enhanced rate personal care assistance services under section 256B.0659, subdivision
17a.
new text end

new text begin (b) This section does not change existing personal care assistance program or community
first services and supports policies and procedures.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given in section 256B.85, subdivision 2, and as follows.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

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

new text begin (d) "Payment rate" or "rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.
new text end

new text begin Subd. 3. new text end

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

new text begin When initially establishing the base wage
component values, the commissioner must 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 must calculate
the base wage component values for staff providing personal care assistance services,
community first services and supports, extended personal care assistance services, extended
CFSS, enhanced rate personal care assistance services, and enhanced rate CFSS. The base
wage component value must be the median wage for personal care aide (SOC code 39-9021).
new text end

new text begin Subd. 4. new text end

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

new text begin (a) On July 1, 2022, and every
two years thereafter, the commissioner must update the base wage component values based
on the wage data by SOC codes from the Bureau of Labor Statistics available one year and
a day prior to the scheduled update.
new text end

new text begin (b) The commissioner must publish the updated base wage component values.
new text end

new text begin Subd. 5. new text end

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

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

new text begin (b) For personal care assistance services, community first services and supports, extended
personal care assistance services, extended CFSS, enhanced rate personal care assistance
services, and enhanced rate CFSS, the initial competitive workforce factor is 0.00.
new text end

new text begin Subd. 6. new text end

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

new text begin (a) On July 1, 2022, and every
two years thereafter, the commissioner must adjust the competitive workforce factor in
subdivision 5, paragraph (b), with an updated competitive workforce factor using the most
recently available data. The commissioner must calculate the biennial adjustment to the
competitive workforce factor as follows:
new text end

new text begin (1) subtract the weighted average for personal care aide (SOC code 39-9021) from the
weighted average wage for all other SOC codes with the same Bureau of Labor Statistics
classifications as personal care aide (SOC code 39-9021), for education, experience, and
training for job competency;
new text end

new text begin (2) determine the average of (i) the weighted average for personal care aide (SOC code
39-9021) and (ii) the weighted average wage for all other SOC codes with the same Bureau
of Labor Statistics classifications for education, experience, and training for job competency
as for personal care aide (SOC code 39-9021);
new text end

new text begin (3) divide the result of clause (1) by the result of clause (2);
new text end

new text begin (4) if the result of clause (3) is positive, increase the competitive workforce factor by
the lesser of the result of clause (3) and 0.01; and
new text end

new text begin (5) if the result of clause (3) is zero or negative, set the competitive workforce factor
equal to zero.
new text end

new text begin (b) The commissioner must publish the updated competitive workforce value.
new text end

new text begin Subd. 7. new text end

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

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

new text begin (1) for the employee vacation, sick, and training factor, 2.47 percent;
new text end

new text begin (2) for the employer taxes and workers' compensation factor, 11.56 percent;
new text end

new text begin (3) for the employee benefits factor, 4.56 percent;
new text end

new text begin (4) for the client programming and supports factor, 1.4 percent;
new text end

new text begin (5) for the program plan support factor, 4.29 percent;
new text end

new text begin (6) for the general business and administrative expenses factor, 13.5 percent;
new text end

new text begin (7) for the program administration expenses factor, 0 percent; and
new text end

new text begin (8) for the absence and utilization factor, 0 percent.
new text end

new text begin Subd. 8. new text end

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

new text begin (a) The commissioner must determine
the rate for each service under subdivision 1 as follows:
new text end

new text begin (1) multiply the appropriate total wage component value by one plus the employee
vacation, sick, and training factor;
new text end

new text begin (2) for program plan support, multiply the result of clause (1) by one plus the program
plan support factor;
new text end

new text begin (3) for employee-related expenses, add the employer taxes and workers' compensation
factor and the employee benefits factor. The sum is employee-related expenses. Multiply
the product of clause (2) by one plus the value for employee-related expenses;
new text end

new text begin (4) for client programming and supports, multiply the product of clause (3) by one plus
the client programming and supports factor;
new text end

new text begin (5) for administrative expenses, add the general business and administrative expenses
factor, the program administration expenses factor, and the absence and utilization factor;
new text end

new text begin (6) divide the result of clause (4) by one minus the result of clause (5). The quotient is
the hourly rate;
new text end

new text begin (7) divide the hourly rate by four. The quotient is the total payment rate; and
new text end

new text begin (8) for enhanced rate personal care assistance services and enhanced rate CFSS, multiply
the result of clause (7) by 1.075. The product is the enhanced total payment rate.
new text end

new text begin (b) The commissioner must publish the total payment rate and the enhanced total payment
rate.
new text end

new text begin Subd. 9. new text end

new text begin Payment rates; collective bargaining. new text end

new text begin The commissioner's authority to set
payment rates, including wages and benefits, for the services of individual providers as
defined in section 256B.0711, subdivision 1, paragraph (d), is subject to the state's obligations
to meet and negotiate under chapter 179A, as modified and made applicable to individual
providers under section 179A.54, and to agreements with any exclusive representative of
individual providers, as authorized by chapter 179A, as modified and made applicable to
individual providers under section 179A.54.
new text end

new text begin Subd. 10. new text end

new text begin Required reporting of cost data. new text end

new text begin (a) As determined by the commissioner
and in consultation with stakeholders, agencies enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner. The
commissioner may request cost data, including but 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) staff 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 the required cost data
for a fiscal year that ended not more than 18 months prior to the submission date. The
commissioner must provide each provider a 90-day notice prior to its submission due date.
If a provider fails to submit required cost data, the commissioner must provide notice to
providers that have not provided required cost data 30 days after the required submission
date and a second notice for providers who have not provided required cost data 60 days
after the required submission date. The commissioner must temporarily suspend payments
to a provider if the commissioner has not received required cost data 90 days after the
required submission date. The commissioner must make withheld payments when the
required cost data is received by the commissioner.
new text end

new text begin (c) The commissioner must conduct a random validation of data submitted under this
subdivision to ensure data accuracy.
new text end

new text begin (d) The commissioner, in consultation with stakeholders, must develop and implement
a process for providing training and technical assistance necessary to support provider
submission of cost data required under this subdivision.
new text end

new text begin Subd. 11. new text end

new text begin Required 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 standard component values in
this section appropriately address costs to provide the services covered under this section.
The commissioner must analyze cost data submitted under this section and may submit
recommendations to the chairs and ranking minority members of the legislative committees
with jurisdiction over human services on adjustments and updates to standard component
values, base wage component values, and competitive workforce factors.
new text end

new text begin (b) The commissioner must release cost data in an aggregate form. Cost data from
individual providers must not be released except as provided for in current law.
new text end

new text begin Subd. 12. new text end

new text begin Payment rates; reports required. new text end

new text begin (a) Notwithstanding subdivision 11,
paragraph (a), the commissioner must assess the standard component values and publish
evaluation findings and recommended changes to the rate methodology in a report to the
legislature by August 1, 2023.
new text end

new text begin (b) The commissioner must assess the long-term impacts of the rate methodology
implementation on staff providing services with rates determined under this section, including
but not limited to measuring changes in wages, benefits provided, hours worked, and
retention. Notwithstanding subdivision 11, paragraph (a), the commissioner must publish
evaluation findings in a report to the legislature by August 1, 2026.
new text end

new text begin (c) This subdivision expires on August 1, 2026, or upon the date the commissioner
submits to the legislature the report described in paragraph (b), whichever is later. The
commissioner must inform the revisor of statutes when the report is submitted.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020, 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. 4.

Minnesota Statutes 2019 Supplement, section 256S.18, subdivision 7, is amended
to read:


Subd. 7.

Monthly case mix budget cap exception.

The commissioner deleted text beginshalldeleted text endnew text begin mustnew text end approve
an exception to the monthly case mix budget cap in deleted text beginparagraph (a)deleted text endnew text begin subdivision 3new text end to account
for the additional cost of providing enhanced rate personal care assistance services under
section 256B.0659 or new text beginenhanced rate community first services and supports under section
new text end 256B.85. deleted text beginThe exception shall not exceed 107.5 percent of the budget otherwise available
to the individual.
deleted text end new text beginThe commissioner must calculate the difference between the rate for
personal care assistance services and enhanced rate personal care assistance services. The
additional budget amount approved under an exception must not exceed this difference.
new text end The exception must be reapproved on an annual basis at the time of a participant's annual
reassessment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020, 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