1.1 	A bill for an act
1.2 	relating to human services; establishing a payment rate methodology for personal 
1.3 	care assistance services; requiring commissioner of human services to study 
1.4 	methodology; requiring providers to submit workforce data; requiring reports; 
1.5 	amending Minnesota Statutes 2018, sections 256B.0659, subdivisions 1, 11, 21, 
1.6 	24, 28, by adding subdivisions; 256B.0915, subdivision 3a; 256B.69, subdivision 
1.7 	5a; proposing coding for new law in Minnesota Statutes, chapter 256B.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2018, section 256B.0659, subdivision 1, is amended to read:
1.10 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
1.11 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
1.12 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility, 
1.13 	positioning, eating, and toileting.
1.14 	(c) "Behavior," effective January 1, 2010, means a category to determine the home care 
1.15 	rating and is based on the criteria found in this section. "Level I behavior" means physical 
1.16 	aggression towards self, others, or destruction of property that requires the immediate 
1.17 	response of another person.
1.18 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
1.19 	determine the home care rating and is based on the criteria found in this section.
1.20 	(e) "Commissioner" means the commissioner of human services.
1.21 	(f) "Component value" means underlying factors that are built into the rate methodology 
1.22 	to calculate service rates and that are part of the cost of providing services.
2.1 	(g) "Critical activities of daily living," effective January 1, 2010, means transferring, 
2.2 	mobility, eating, and toileting.
2.3 	(f) (h) "Dependency in activities of daily living" means a person requires assistance to 
2.4 	begin and complete one or more of the activities of daily living.
2.5 	(i) "Enhanced care personal care assistance services" means personal care assistance 
2.6 	services included in a care plan developed according to subdivision 7 provided to a recipient 
2.7 	who qualifies for ten or more hours per day of personal care assistance services by a personal 
2.8 	care assistant who satisfies the requirements of subdivision 11, paragraph (d).
2.9 	(g) (j) "Extended personal care assistance service" means personal care assistance services 
2.10 	or enhanced care personal care assistance services included in a service plan under one of 
2.11 	the home and community-based services waivers authorized under sections 256B.0915, 
2.12 	256B.092, subdivision 5, and 256B.49, which exceed the amount, duration, and frequency 
2.13 	of the state plan personal care assistance services or enhanced care personal care assistance 
2.14 	services for participants who:
2.15 	(1) need assistance provided periodically during a week, but less than daily will not be 
2.16 	able to remain in their homes without the assistance, and other replacement services are 
2.17 	more expensive or are not available when personal care assistance services or enhanced 
2.18 	care personal care assistance services are to be reduced; or
2.19 	(2) need additional personal care assistance services or enhanced care personal care 
2.20 	assistance services beyond the amount authorized by the state plan personal care assistance 
2.21 	assessment in order to ensure that their safety, health, and welfare are provided for in their 
2.22 	homes.
2.23 	(h) (k) "Health-related procedures and tasks" means procedures and tasks that can be 
2.24 	delegated or assigned by a licensed health care professional under state law to be performed 
2.25 	by a personal care assistant.
2.26 	(i) (l) "Instrumental activities of daily living" means activities to include meal planning 
2.27 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
2.28 	essential items; performing household tasks integral to the personal care assistance services; 
2.29 	communication by telephone and other media; and traveling, including to medical 
2.30 	appointments and to participate in the community.
2.31 	(j) (m) "Managing employee" has the same definition as Code of Federal Regulations, 
2.32 	title 42, section 455.
3.1 	(n) "Median" means the amount that divides distribution between two equal groups, 
3.2 	one-half above the median and one-half below the median.
3.3 	(k) (o) "Qualified professional" means a professional providing supervision of personal 
3.4 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
3.5 	(p) "Qualified professional service" means supervision of personal care assistance services 
3.6 	and personal care assistants provided by a qualified professional under section 256B.0625, 
3.7 	subdivision 19c.
3.8 	(l) (q) "Personal care assistance provider agency" means a medical assistance enrolled 
3.9 	provider that provides or assists with providing personal care assistance services and includes 
3.10 	a personal care assistance provider organization, personal care assistance choice agency, 
3.11 	class A licensed nursing agency, and Medicare-certified home health agency.
3.12 	(m) (r) "Personal care assistant" or "PCA" means an individual employed by a personal 
3.13 	care assistance agency who provides personal care assistance services.
3.14 	(n) (s) "Personal care assistance care plan" means a written description of personal care 
3.15 	assistance services developed by the personal care assistance provider according to the 
3.16 	service plan.
3.17 	(o) (t) "Responsible party" means an individual who is capable of providing the support 
3.18 	necessary to assist the recipient to live in the community.
3.19 	(p) (u) "Self-administered medication" means medication taken orally, by injection, 
3.20 	nebulizer, or insertion, or applied topically without the need for assistance.
3.21 	(q) (v) "Service plan" means a written summary of the assessment and description of 
3.22 	the services needed by the recipient.
3.23 	(r) (w) "Wages and benefits" means wages and salaries, the employer's share of FICA 
3.24 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage 
3.25 	reimbursement, health and dental insurance, life insurance, disability insurance, long-term 
3.26 	care insurance, uniform allowance, and contributions to employee retirement accounts.

3.27 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
3.28 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
3.29 	when approval is obtained.

3.30 	Sec. 2. Minnesota Statutes 2018, section 256B.0659, subdivision 11, is amended to read:
3.31 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant must 
3.32 	meet the following requirements:
4.1 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of 
4.2 	age with these additional requirements:
4.3 	(i) supervision by a qualified professional every 60 days; and
4.4 	(ii) employment by only one personal care assistance provider agency responsible for 
4.5 	compliance with current labor laws;
4.6 	(2) be employed by a personal care assistance provider agency;
4.7 	(3) enroll with the department as a personal care assistant after clearing a background 
4.8 	study. Except as provided in subdivision 11a, before a personal care assistant provides 
4.9 	services, the personal care assistance provider agency must initiate a background study on 
4.10 	the personal care assistant under chapter 245C, and the personal care assistance provider 
4.11 	agency must have received a notice from the commissioner that the personal care assistant 
4.12 	is:
4.13 	(i) not disqualified under section 245C.14; or
4.14 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
4.15 	disqualification under section 245C.22;
4.16 	(4) be able to effectively communicate with the recipient and personal care assistance 
4.17 	provider agency;
4.18 	(5) be able to provide covered personal care assistance services according to the recipient's 
4.19 	personal care assistance care plan, respond appropriately to recipient needs, and report 
4.20 	changes in the recipient's condition to the supervising qualified professional or physician;
4.21 	(6) not be a consumer of personal care assistance services;
4.22 	(7) maintain daily written records including, but not limited to, time sheets under 
4.23 	subdivision 12;
4.24 	(8) effective January 1, 2010, complete standardized training as determined by the 
4.25 	commissioner before completing enrollment. The training must be available in languages 
4.26 	other than English and to those who need accommodations due to disabilities. Personal care 
4.27 	assistant training must include successful completion of the following training components: 
4.28 	basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic 
4.29 	roles and responsibilities of personal care assistants including information about assistance 
4.30 	with lifting and transfers for recipients, emergency preparedness, orientation to positive 
4.31 	behavioral practices, fraud issues, and completion of time sheets. Upon completion of the 
5.1 	training components, the personal care assistant must demonstrate the competency to provide 
5.2 	assistance to recipients;
5.3 	(9) complete training and orientation on the needs of the recipient; and
5.4 	(10) be limited to providing and being paid for up to 275 hours per month of personal 
5.5 	care assistance services regardless of the number of recipients being served or the number 
5.6 	of personal care assistance provider agencies enrolled with. The number of hours worked 
5.7 	per day shall not be disallowed by the department unless in violation of the law.
5.8 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
5.9 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
5.10 	(c) Persons who do not qualify as a personal care assistant include parents, stepparents, 
5.11 	and legal guardians of minors; spouses; paid legal guardians of adults; family foster care 
5.12 	providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of 
5.13 	a residential setting.
5.14 	(d) Personal care assistants providing enhanced care personal care services must satisfy 
5.15 	the current requirements of Medicare for training and competency or competency evaluation 
5.16 	of home health aides or nursing assistants, as provided in Code of Federal Regulations, title 
5.17 	42, section 483.141 or 484.36, or alternative state-approved training or competency 
5.18 	requirements.

5.19 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
5.20 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
5.21 	when approval is obtained.

5.22 	Sec. 3. Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:
5.23 		Subd. 21.Requirements for provider enrollment of personal care assistance provider 
5.24 	agencies. (a) All personal care assistance provider agencies must provide, at the time of 
5.25 	enrollment, reenrollment, and revalidation as a personal care assistance provider agency in 
5.26 	a format determined by the commissioner, information and documentation that includes, 
5.27 	but is not limited to, the following:
5.28 	(1) the personal care assistance provider agency's current contact information including 
5.29 	address, telephone number, and e-mail address;
5.30 	(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid 
5.31 	revenue in the previous calendar year is up to and including $300,000, the provider agency 
5.32 	must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is 
6.1 	over $300,000, the provider agency must purchase a surety bond of $100,000. The surety 
6.2 	bond must be in a form approved by the commissioner, must be renewed annually, and must 
6.3 	allow for recovery of costs and fees in pursuing a claim on the bond;
6.4 	(3) proof of fidelity bond coverage in the amount of $20,000;
6.5 	(4) proof of workers' compensation insurance coverage;
6.6 	(5) proof of liability insurance;
6.7 	(6) a description of the personal care assistance provider agency's organization identifying 
6.8 	the names of all owners, managing employees, staff, board of directors, and the affiliations 
6.9 	of the directors, owners, or staff to other service providers;
6.10 	(7) a copy of the personal care assistance provider agency's written policies and 
6.11 	procedures including: hiring of employees; training requirements; service delivery; and 
6.12 	employee and consumer safety including process for notification and resolution of consumer 
6.13 	grievances, identification and prevention of communicable diseases, and employee 
6.14 	misconduct;
6.15 	(8) copies of all other forms the personal care assistance provider agency uses in the 
6.16 	course of daily business including, but not limited to:
6.17 	(i) a copy of the personal care assistance provider agency's time sheet if the time sheet 
6.18 	varies from the standard time sheet for personal care assistance services approved by the 
6.19 	commissioner, and a letter requesting approval of the personal care assistance provider 
6.20 	agency's nonstandard time sheet;
6.21 	(ii) the personal care assistance provider agency's template for the personal care assistance 
6.22 	care plan; and
6.23 	(iii) the personal care assistance provider agency's template for the written agreement 
6.24 	in subdivision 20 for recipients using the personal care assistance choice option, if applicable;
6.25 	(9) a list of all training and classes that the personal care assistance provider agency 
6.26 	requires of its staff providing personal care assistance services;
6.27 	(10) documentation that the personal care assistance provider agency and staff have 
6.28 	successfully completed all the training required by this section, including the requirements 
6.29 	under subdivision 11, paragraph (d), if enhanced care personal care services are provided 
6.30 	and submitted for reimbursement under this section;
6.31 	(11) documentation of the agency's marketing practices;
7.1 	(12) disclosure of ownership, leasing, or management of all residential properties that 
7.2 	is used or could be used for providing home care services;
7.3 	(13) documentation that the agency will use the following percentages of revenue 
7.4 	generated from the medical assistance rate paid for personal care assistance services for 
7.5 	employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal 
7.6 	care assistance choice option and 72.5 percent of revenue from other personal care assistance 
7.7 	providers. The revenue generated by the qualified professional and the reasonable costs 
7.8 	associated with the qualified professional shall not be used in making this calculation; and
7.9 	(14) effective May 15, 2010, documentation that the agency does not burden recipients' 
7.10 	free exercise of their right to choose service providers by requiring personal care assistants 
7.11 	to sign an agreement not to work with any particular personal care assistance recipient or 
7.12 	for another personal care assistance provider agency after leaving the agency and that the 
7.13 	agency is not taking action on any such agreements or requirements regardless of the date 
7.14 	signed.
7.15 	(b) Personal care assistance provider agencies shall provide the information specified 
7.16 	in paragraph (a) to the commissioner at the time the personal care assistance provider agency 
7.17 	enrolls as a vendor or upon request from the commissioner. The commissioner shall collect 
7.18 	the information specified in paragraph (a) from all personal care assistance providers 
7.19 	beginning July 1, 2009.
7.20 	(c) All personal care assistance provider agencies shall require all employees in 
7.21 	management and supervisory positions and owners of the agency who are active in the 
7.22 	day-to-day management and operations of the agency to complete mandatory training as 
7.23 	determined by the commissioner before enrollment of the agency as a provider. Employees 
7.24 	in management and supervisory positions and owners who are active in the day-to-day 
7.25 	operations of an agency who have completed the required training as an employee with a 
7.26 	personal care assistance provider agency do not need to repeat the required training if they 
7.27 	are hired by another agency, if they have completed the training within the past three years. 
7.28 	By September 1, 2010, the required training must be available with meaningful access 
7.29 	according to title VI of the Civil Rights Act and federal regulations adopted under that law 
7.30 	or any guidance from the United States Health and Human Services Department. The 
7.31 	required training must be available online or by electronic remote connection. The required 
7.32 	training must provide for competency testing. Personal care assistance provider agency 
7.33 	billing staff shall complete training about personal care assistance program financial 
7.34 	management. This training is effective July 1, 2009. Any personal care assistance provider 
7.35 	agency enrolled before that date shall, if it has not already, complete the provider training 
8.1 	within 18 months of July 1, 2009. Any new owners or employees in management and 
8.2 	supervisory positions involved in the day-to-day operations are required to complete 
8.3 	mandatory training as a requisite of working for the agency. Personal care assistance provider 
8.4 	agencies certified for participation in Medicare as home health agencies are exempt from 
8.5 	the training required in this subdivision. When available, Medicare-certified home health 
8.6 	agency owners, supervisors, or managers must successfully complete the competency test.

8.7 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
8.8 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
8.9 	when approval is obtained.

8.10 	Sec. 4. Minnesota Statutes 2018, section 256B.0659, subdivision 24, is amended to read:
8.11 		Subd. 24.Personal care assistance provider agency; general duties. A personal care 
8.12 	assistance provider agency shall:
8.13 	(1) enroll as a Medicaid provider meeting all provider standards, including completion 
8.14 	of the required provider training;
8.15 	(2) comply with general medical assistance coverage requirements;
8.16 	(3) demonstrate compliance with law and policies of the personal care assistance program 
8.17 	to be determined by the commissioner;
8.18 	(4) comply with background study requirements;
8.19 	(5) verify and keep records of hours worked by the personal care assistant and qualified 
8.20 	professional;
8.21 	(6) not engage in any agency-initiated direct contact or marketing in person, by phone, 
8.22 	or other electronic means to potential recipients, guardians, or family members;
8.23 	(7) pay the personal care assistant and qualified professional based on actual hours of 
8.24 	services provided;
8.25 	(8) withhold and pay all applicable federal and state taxes;
8.26 	(9) effective January 1, 2010, document that the agency uses a minimum of 72.5 percent 
8.27 	of the revenue generated by the medical assistance rate for personal care assistance services 
8.28 	for employee personal care assistant wages and benefits. The revenue generated by the 
8.29 	qualified professional and the reasonable costs associated with the qualified professional 
8.30 	shall not be used in making this calculation;
9.1 	(10) make the arrangements and pay unemployment insurance, taxes, workers' 
9.2 	compensation, liability insurance, and other benefits, if any;
9.3 	(11) enter into a written agreement under subdivision 20 before services are provided;
9.4 	(12) report suspected neglect and abuse to the common entry point according to section 
9.5 	256B.0651;
9.6 	(13) provide the recipient with a copy of the home care bill of rights at start of service; 
9.7 	and
9.8 	(14) request reassessments at least 60 days prior to the end of the current authorization 
9.9 	for personal care assistance services, on forms provided by the commissioner.; and
9.10 	(15) document that for personal care assistants who are providing enhanced care personal 
9.11 	care assistance services, the additional revenue the agency receives from medical assistance 
9.12 	as a result of the differential between the rate for enhanced care personal care assistance 
9.13 	services and personal care assistance services is passed through to the personal care assistant 
9.14 	in the form of wages and benefits.

9.15 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
9.16 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
9.17 	when approval is obtained.

9.18 	Sec. 5. Minnesota Statutes 2018, section 256B.0659, subdivision 28, is amended to read:
9.19 		Subd. 28.Personal care assistance provider agency; required documentation. (a) 
9.20 	Required documentation must be completed and kept in the personal care assistance provider 
9.21 	agency file or the recipient's home residence. The required documentation consists of:
9.22 	(1) employee files, including:
9.23 	(i) applications for employment;
9.24 	(ii) background study requests and results;
9.25 	(iii) orientation records about the agency policies;
9.26 	(iv) trainings completed with demonstration of competence, including verification of 
9.27 	the completion of training required under subdivision 11, paragraph (d), if enhanced care 
9.28 	personal care assistance services are provided and submitted for reimbursement under this 
9.29 	section;
9.30 	(v) supervisory visits;
9.31 	(vi) evaluations of employment; and
10.1 	(vii) signature on fraud statement;
10.2 	(2) recipient files, including:
10.3 	(i) demographics;
10.4 	(ii) emergency contact information and emergency backup plan;
10.5 	(iii) personal care assistance service plan;
10.6 	(iv) personal care assistance care plan;
10.7 	(v) month-to-month service use plan;
10.8 	(vi) all communication records;
10.9 	(vii) start of service information, including the written agreement with recipient; and
10.10 	(viii) date the home care bill of rights was given to the recipient;
10.11 	(3) agency policy manual, including:
10.12 	(i) policies for employment and termination;
10.13 	(ii) grievance policies with resolution of consumer grievances;
10.14 	(iii) staff and consumer safety;
10.15 	(iv) staff misconduct; and
10.16 	(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and 
10.17 	resolution of consumer grievances;
10.18 	(4) time sheets for each personal care assistant along with completed activity sheets for 
10.19 	each recipient served; and
10.20 	(5) agency marketing and advertising materials and documentation of marketing activities 
10.21 	and costs.
10.22 	(b) The commissioner may assess a fine of up to $500 on provider agencies that do not 
10.23 	consistently comply with the requirements of this subdivision.

10.24 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
10.25 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
10.26 	when approval is obtained.

11.1 	Sec. 6. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
11.2 	to read:
11.3 		Subd. 32.Payment rates; application generally. The payment methodologies in 
11.4 	subdivisions 32 to 36 apply to personal care assistance services, enhanced care personal 
11.5 	care assistance services, qualified professional services, and community first services and 
11.6 	supports under section 256B.85, subdivisions 8 and 18a.

11.7 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
11.8 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
11.9 	when approval is obtained.

11.10 	Sec. 7. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
11.11 	to read:
11.12 		Subd. 33.Payment rates; base wage index. (a) When initially establishing the base 
11.13 	wage component values, the commissioner shall use the Minnesota-specific median wage 
11.14 	for the standard occupational classification (SOC) codes published by the Bureau of Labor 
11.15 	Statistics in the most recent edition of the Occupational Handbook. The commissioner shall 
11.16 	calculate the wage component values as follows:
11.17 	(1) for personal care assistance services, the base wage component value shall be the 
11.18 	median wage for personal care aide (SOC code 39-9021);
11.19 	(2) for enhanced care personal care assistance services, the base wage component value 
11.20 	shall be the sum of 50 percent of the median wage for personal care aide (SOC code 39-9021) 
11.21 	and 50 percent of the median wage for home health aide (SOC code 31-1011); and
11.22 	(3) for qualified professional services, the base wage component value shall be the sum 
11.23 	of 70 percent of the median wage for registered nurse (SOC code 29-1141), 15 percent of 
11.24 	the  median wage for health care social worker (SOC code 21-1022), and 15 percent of the 
11.25 	median wage for social and human service assistant (SOC code 21-1093).
11.26 	(b) On January 1, 2022, and every two years thereafter, the commissioner shall update 
11.27 	the base wage component values in paragraph (a) based on the wage data by SOC from the 
11.28 	Bureau of Labor Statistics available one year and a day prior to the scheduled update. The 
11.29 	commissioner shall publish the updated base wage component values.

11.30 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
11.31 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
11.32 	when approval is obtained.

12.1 	Sec. 8. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
12.2 	to read:
12.3 		Subd. 34.Payment rates; total wage index. (a) The commissioner shall multiply the 
12.4 	base wage component values in subdivision 33 by one plus the competitive workforce factor. 
12.5 	The product is the total wage component value.
12.6 	(b) For personal care assistance services and for enhanced care personal care assistance 
12.7 	services,  the initial competitive workforce factor is eight percent.
12.8 	(c) For qualified professional services, the competitive workforce factor is zero.
12.9 	(d) On January 1, 2022, and every two years thereafter, the commissioner shall adjust 
12.10 	the competitive workforce factor in paragraph (b) with an updated competitive workforce 
12.11 	factor using the data available one year and a day prior to the scheduled adjustment. The 
12.12 	commissioner must calculate the biennial adjustments to the competitive workforce factor 
12.13 	after determining the base wage index updates required in subdivision 33, paragraph (d). 
12.14 	The commissioner shall adjust the competitive workforce factor toward the percent difference 
12.15 	between: (1) the weighted average wage for personal care aide (SOC code 39-9021); and 
12.16 	(2) the weighted average wage for all other SOC codes with the same Bureau of Labor 
12.17 	Statistics classifications for education, experience, and training required for job competency. 
12.18 	For each biennial adjustment of the competitive workforce factor, the commissioner shall 
12.19 	not increase or decrease the competitive workforce factor from its previous value by no 
12.20 	more than three percentage points. If, after a biennial adjustment, the competitive workforce 
12.21 	factor is less than or equal to zero, the competitive workforce factor shall be zero. The 
12.22 	commissioner shall publish the updated competitive workforce value.

12.23 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
12.24 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
12.25 	when approval is obtained.

12.26 	Sec. 9. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
12.27 	to read:
12.28 		Subd. 35.Payment rates; standard component values. The commissioner shall use 
12.29 	the following component values:
12.30 	(1) employee vacation, sick, and training factor, ... percent;
12.31 	(2) employer taxes and workers' compensation, ... percent;
12.32 	(3) employee benefits, ... percent;
13.1 	(4) client programming and supports, ... percent;
13.2 	(5) program plan support factor, ... percent; and
13.3 	(6) general business and administrative expenses, ... percent.

13.4 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
13.5 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
13.6 	when approval is obtained.

13.7 	Sec. 10. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
13.8 	to read:
13.9 		Subd. 36.Payment rates; rate determination. (a) The commissioner shall determine 
13.10 	the rates for personal care assistance services, enhanced care personal care assistance services, 
13.11 	and qualified professional services as follows:
13.12 	(1) multiply the total wage component value determined in subdivision 34 by one plus 
13.13 	the employee vacation, sick, and training factor. The product is the direct staffing rate;
13.14 	(2) for employee-related expenses, add the factor for employer taxes and workers' 
13.15 	compensation and the factor for employee benefits. The sum is employee-related expenses. 
13.16 	Multiply the total wage component value determined in subdivision 34 by one plus the value 
13.17 	for employee-related expenses;
13.18 	(3) for program expenses, add the client programming and supports factor and the factor 
13.19 	for program plan support.  The sum is program expenses. Multiply the base wage component 
13.20 	value for personal care services in subdivision 33, paragraph (a), clause (1), by one plus the 
13.21 	program expenses;
13.22 	(4) for administrative expenses, multiply the base wage component value for personal 
13.23 	care services in subdivision 33, paragraph (a), clause (1), by one plus the factor for general 
13.24 	business and administrative expenses; and
13.25 	(5) add the results of clauses (1) to (4) to the total wage component value determined 
13.26 	in subdivision 34.  The sum is the total payment rate.
13.27 	(b) The commissioner shall publish the total payment rates.

13.28 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
13.29 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
13.30 	when approval is obtained.

14.1 	Sec. 11. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
14.2 	to read:
14.3 		Subd. 37.Personal care assistance provider agency; required reporting and analysis 
14.4 	of cost data. (a) The commissioner must evaluate on an ongoing basis whether the base 
14.5 	wage component values and component values in subdivisions 33 and 34 appropriately 
14.6 	address the cost to provide the service. The commissioner must make recommendations to 
14.7 	adjust the rate methodology as indicated by the evaluation. As determined by the 
14.8 	commissioner, in consultation with stakeholders, personal care assistance agencies enrolled 
14.9 	to provide services with rates determined under this section must submit requested cost data 
14.10 	to the commissioner. Requested cost data may include, but is not limited to:
14.11 	(1) worker wage costs;
14.12 	(2) benefits paid;
14.13 	(3) supervisor wage costs;
14.14 	(4) executive wage costs;
14.15 	(5) vacation, sick, and training time paid;
14.16 	(6) taxes, workers' compensation, and unemployment insurance costs paid;
14.17 	(7) administrative costs paid;
14.18 	(8) program costs paid;
14.19 	(9) transportation costs paid;
14.20 	(10) vacancy rates; and
14.21 	(11) other data relating to costs required to provide services requested by the 
14.22 	commissioner.
14.23 	(b) At least once in any five-year period, a provider must submit cost data for a fiscal 
14.24 	year that ended not more than 18 months prior to the submission date. The commissioner 
14.25 	shall provide each provider a 90-day notice prior to its submission due date. If a provider 
14.26 	fails to submit required reporting data, the commissioner shall provide notice to providers 
14.27 	that have not provided required data 30 days after the required submission date, and a second 
14.28 	notice for providers who have not provided required data 60 days after the required 
14.29 	submission date. The commissioner shall temporarily suspend payments to the provider if 
14.30 	cost data is not received 90 days after the required submission date. Withheld payments 
14.31 	shall be made once data is received by the commissioner.
15.1 	(c) The commissioner shall conduct a random validation of data submitted under 
15.2 	paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation 
15.3 	in paragraph (a) and provide recommendations for adjustments to cost components.
15.4 	(d) The commissioner shall analyze cost documentation in paragraph (a), and may submit 
15.5 	recommendations on component values and updated base wage component factors and 
15.6 	competitive workforce factors to the chairs and ranking minority members of the legislative 
15.7 	committees with jurisdiction over human services in conjunction with reports submitted to 
15.8 	the legislature according to section 256B.4914, subdivision 10a. The commissioner shall 
15.9 	release cost data in an aggregate form, and cost data from individual providers shall not be 
15.10 	released except as provided for in current law.
15.11 	(e) The commissioner, in consultation with stakeholders, shall develop and implement 
15.12 	a process for providing training and technical assistance necessary to support provider 
15.13 	submission of cost documentation required under paragraph (a).

15.14 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
15.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
15.16 	when approval is obtained.

15.17 	Sec. 12. Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision 
15.18 	to read:
15.19 		Subd. 38.Payment rates evaluation. (a) Notwithstanding subdivision 37, paragraph 
15.20 	(d), the commissioner shall assess the component values used in the rate methodology in 
15.21 	subdivision 35. The commissioner shall publish evaluation findings and recommended 
15.22 	changes to the rate methodology in a report to the legislature on August 1, 2022.
15.23 	(b) The commissioner shall assess the long-term impacts of the rate methodology 
15.24 	implementation on personal care assistants and qualified professionals, including but not 
15.25 	limited to measuring changes in wages, benefits provided, hours worked, and retention. 
15.26 	Notwithstanding subdivision 37, paragraph (d), the commissioner shall publish evaluation 
15.27 	findings in a report to the legislature on August 1, 2025.
15.28 	(c) This subdivision expires on August 1, 2025, or upon the date the commissioner 
15.29 	submits to the legislature the  report described in paragraph (b), whichever is later.  The 
15.30 	commissioner shall inform the revisor of statutes when the report in submitted.

15.31 	EFFECTIVE DATE. This section is effective January 1, 2020, or upon federal approval, 
15.32 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
15.33 	when approval is obtained.

16.1 	Sec. 13. [256B.0715] DIRECT CARE WORKFORCE REPORT.
16.2 	The commissioner of human services shall annually assess the direct care workforce 
16.3 	and publish findings in a direct care workforce report each August beginning August 1, 
16.4 	2020. This report shall consider the number of workers employed, the number of regular 
16.5 	hours worked, the number of overtime hours worked, the regular wages and benefits paid, 
16.6 	the overtime wages paid, retention rates, and job vacancies across providers of home and 
16.7 	community-based services disability waiver services, state plan home care services, and 
16.8 	state plan personal care assistance services.

16.9 	EFFECTIVE DATE. This section is effective the day following final enactment.

16.10 	Sec. 14. Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:
16.11 		Subd. 3a.Elderly waiver cost limits. (a) Effective on the first day of the state fiscal 
16.12 	year in which the resident assessment system as described in section 256R.17 for nursing 
16.13 	home rate determination is implemented and the first day of each subsequent state fiscal 
16.14 	year, the monthly limit for the cost of waivered services to an individual elderly waiver 
16.15 	client shall be the monthly limit of the case mix resident class to which the waiver client 
16.16 	would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the 
16.17 	last day of the previous state fiscal year, adjusted by any legislatively adopted home and 
16.18 	community-based services percentage rate adjustment. If a legislatively authorized increase 
16.19 	is service-specific, the monthly cost limit shall be adjusted based on the overall average 
16.20 	increase to the elderly waiver program.
16.21 	(b) The monthly limit for the cost of waivered services under paragraph (a) to an 
16.22 	individual elderly waiver client assigned to a case mix classification A with:
16.23 	(1) no dependencies in activities of daily living; or
16.24 	(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when 
16.25 	the dependency score in eating is three or greater as determined by an assessment performed 
16.26 	under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new 
16.27 	participants enrolled in the program on or after July 1, 2011. This monthly limit shall be 
16.28 	applied to all other participants who meet this criteria at reassessment. This monthly limit 
16.29 	shall be increased annually as described in paragraphs (a) and (e).
16.30 	(c) If extended medical supplies and equipment or environmental modifications are or 
16.31 	will be purchased for an elderly waiver client, the costs may be prorated for up to 12 
16.32 	consecutive months beginning with the month of purchase. If the monthly cost of a recipient's 
16.33 	waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e), 
17.1 	the annual cost of all waivered services shall be determined. In this event, the annual cost 
17.2 	of all waivered services shall not exceed 12 times the monthly limit of waivered services 
17.3 	as described in paragraph (a), (b), (d), or (e).
17.4 	(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any 
17.5 	necessary home care services described in section 256B.0651, subdivision 2, for individuals 
17.6 	who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1, 
17.7 	paragraph (g), shall be the average of the monthly medical assistance amount established 
17.8 	for home care services as described in section 256B.0652, subdivision 7, and the annual 
17.9 	average contracted amount established by the commissioner for nursing facility services 
17.10 	for ventilator-dependent individuals. This monthly limit shall be increased annually as 
17.11 	described in paragraphs (a) and (e).
17.12 	(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for 
17.13 	elderly waiver services in effect on the previous December 31 shall be increased by the 
17.14 	difference between any legislatively adopted home and community-based provider rate 
17.15 	increases effective on January 1 or since the previous January 1 and the average statewide 
17.16 	percentage increase in nursing facility operating payment rates under chapter 256R, effective 
17.17 	the previous January 1. This paragraph shall only apply if the average statewide percentage 
17.18 	increase in nursing facility operating payment rates is greater than any legislatively adopted 
17.19 	home and community-based provider rate increases effective on January 1, or occurring 
17.20 	since the previous January 1.
17.21 	(f) The commissioner shall approve an exception to the monthly case mix budget cap  
17.22 	in paragraph (a) to account for the additional cost of providing enhanced care personal care 
17.23 	assistance services under section 256B.0659. The commissioner shall calculate the difference 
17.24 	between the rate for personal care services and enhanced care personal care services. The 
17.25 	additional budget amount approved under an exception shall not exceed this difference.

17.26 	EFFECTIVE DATE. Paragraph (f) is effective July 1, 2020, or upon federal approval, 
17.27 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
17.28 	when federal approval is obtained.

17.29 	Sec. 15. Minnesota Statutes 2018, section 256B.69, subdivision 5a, is amended to read:
17.30 		Subd. 5a.Managed care contracts. (a) Managed care contracts under this section and 
17.31 	section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner 
17.32 	may issue separate contracts with requirements specific to services to medical assistance 
17.33 	recipients age 65 and older.
18.1 	(b) A prepaid health plan providing covered health services for eligible persons pursuant 
18.2 	to chapters 256B and 256L is responsible for complying with the terms of its contract with 
18.3 	the commissioner. Requirements applicable to managed care programs under chapters 256B
18.4 	and 256L established after the effective date of a contract with the commissioner take effect 
18.5 	when the contract is next issued or renewed.
18.6 	(c) The commissioner shall withhold five percent of managed care plan payments under 
18.7 	this section and county-based purchasing plan payments under section 256B.692 for the 
18.8 	prepaid medical assistance program pending completion of performance targets. Each 
18.9 	performance target must be quantifiable, objective, measurable, and reasonably attainable, 
18.10 	except in the case of a performance target based on a federal or state law or rule. Criteria 
18.11 	for assessment of each performance target must be outlined in writing prior to the contract 
18.12 	effective date. Clinical or utilization performance targets and their related criteria must 
18.13 	consider evidence-based research and reasonable interventions when available or applicable 
18.14 	to the populations served, and must be developed with input from external clinical experts 
18.15 	and stakeholders, including managed care plans, county-based purchasing plans, and 
18.16 	providers. The managed care or county-based purchasing plan must demonstrate, to the 
18.17 	commissioner's satisfaction, that the data submitted regarding attainment of the performance 
18.18 	target is accurate. The commissioner shall periodically change the administrative measures 
18.19 	used as performance targets in order to improve plan performance across a broader range 
18.20 	of administrative services. The performance targets must include measurement of plan 
18.21 	efforts to contain spending on health care services and administrative activities. The 
18.22 	commissioner may adopt plan-specific performance targets that take into account factors 
18.23 	affecting only one plan, including characteristics of the plan's enrollee population. The 
18.24 	withheld funds must be returned no sooner than July of the following year if performance 
18.25 	targets in the contract are achieved. The commissioner may exclude special demonstration 
18.26 	projects under subdivision 23.
18.27 	(d) The commissioner shall require that managed care plans:
18.28 	(1) use the assessment and authorization processes, forms, timelines, standards, 
18.29 	documentation, and data reporting requirements, protocols, billing processes, and policies 
18.30 	consistent with medical assistance fee-for-service or the Department of Human Services 
18.31 	contract requirements for all personal care assistance services under section 256B.0659.; 
18.32 	and
18.33 	(2) by January 30 of each year in which a rate increase occurs for any aspect of personal 
18.34 	care assistance services, enhanced care personal care assistance services, and qualified 
18.35 	professional services under section 256B.0659,  inform the commissioner and the chairs and 
19.1 	ranking minority members of the legislative committees with jurisdiction over personal care 
19.2 	assistance service rates of the amount of the rate increase that is paid to each  personal care 
19.3 	assistance agency with which the plan has a contract.
19.4 	(e) Effective for services rendered on or after January 1, 2012, the commissioner shall 
19.5 	include as part of the performance targets described in paragraph (c) a reduction in the health 
19.6 	plan's emergency department utilization rate for medical assistance and MinnesotaCare 
19.7 	enrollees, as determined by the commissioner. For 2012, the reduction shall be based on 
19.8 	the health plan's utilization in 2009. To earn the return of the withhold each subsequent 
19.9 	year, the managed care plan or county-based purchasing plan must achieve a qualifying 
19.10 	reduction of no less than ten percent of the plan's emergency department utilization rate for 
19.11 	medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described 
19.12 	in subdivisions 23 and 28, compared to the previous measurement year until the final 
19.13 	performance target is reached. When measuring performance, the commissioner must 
19.14 	consider the difference in health risk in a managed care or county-based purchasing plan's 
19.15 	membership in the baseline year compared to the measurement year, and work with the 
19.16 	managed care or county-based purchasing plan to account for differences that they agree 
19.17 	are significant.
19.18 	The withheld funds must be returned no sooner than July 1 and no later than July 31 of 
19.19 	the following calendar year if the managed care plan or county-based purchasing plan 
19.20 	demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate 
19.21 	was achieved. The commissioner shall structure the withhold so that the commissioner 
19.22 	returns a portion of the withheld funds in amounts commensurate with achieved reductions 
19.23 	in utilization less than the targeted amount.
19.24 	The withhold described in this paragraph shall continue for each consecutive contract 
19.25 	period until the plan's emergency room utilization rate for state health care program enrollees 
19.26 	is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance 
19.27 	and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the 
19.28 	health plans in meeting this performance target and shall accept payment withholds that 
19.29 	may be returned to the hospitals if the performance target is achieved.
19.30 	(f) Effective for services rendered on or after January 1, 2012, the commissioner shall 
19.31 	include as part of the performance targets described in paragraph (c) a reduction in the plan's 
19.32 	hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as 
19.33 	determined by the commissioner. To earn the return of the withhold each year, the managed 
19.34 	care plan or county-based purchasing plan must achieve a qualifying reduction of no less 
19.35 	than five percent of the plan's hospital admission rate for medical assistance and 
20.1 	MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 
20.2 	28, compared to the previous calendar year until the final performance target is reached. 
20.3 	When measuring performance, the commissioner must consider the difference in health risk 
20.4 	in a managed care or county-based purchasing plan's membership in the baseline year 
20.5 	compared to the measurement year, and work with the managed care or county-based 
20.6 	purchasing plan to account for differences that they agree are significant.
20.7 	The withheld funds must be returned no sooner than July 1 and no later than July 31 of 
20.8 	the following calendar year if the managed care plan or county-based purchasing plan 
20.9 	demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization 
20.10 	rate was achieved. The commissioner shall structure the withhold so that the commissioner 
20.11 	returns a portion of the withheld funds in amounts commensurate with achieved reductions 
20.12 	in utilization less than the targeted amount.
20.13 	The withhold described in this paragraph shall continue until there is a 25 percent 
20.14 	reduction in the hospital admission rate compared to the hospital admission rates in calendar 
20.15 	year 2011, as determined by the commissioner. The hospital admissions in this performance 
20.16 	target do not include the admissions applicable to the subsequent hospital admission 
20.17 	performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting 
20.18 	this performance target and shall accept payment withholds that may be returned to the 
20.19 	hospitals if the performance target is achieved.
20.20 	(g) Effective for services rendered on or after January 1, 2012, the commissioner shall 
20.21 	include as part of the performance targets described in paragraph (c) a reduction in the plan's 
20.22 	hospitalization admission rates for subsequent hospitalizations within 30 days of a previous 
20.23 	hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare 
20.24 	enrollees, as determined by the commissioner. To earn the return of the withhold each year, 
20.25 	the managed care plan or county-based purchasing plan must achieve a qualifying reduction 
20.26 	of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, 
20.27 	excluding enrollees in programs described in subdivisions 23 and 28, of no less than five 
20.28 	percent compared to the previous calendar year until the final performance target is reached.
20.29 	The withheld funds must be returned no sooner than July 1 and no later than July 31 of 
20.30 	the following calendar year if the managed care plan or county-based purchasing plan 
20.31 	demonstrates to the satisfaction of the commissioner that a qualifying reduction in the 
20.32 	subsequent hospitalization rate was achieved. The commissioner shall structure the withhold 
20.33 	so that the commissioner returns a portion of the withheld funds in amounts commensurate 
20.34 	with achieved reductions in utilization less than the targeted amount.
21.1 	The withhold described in this paragraph must continue for each consecutive contract 
21.2 	period until the plan's subsequent hospitalization rate for medical assistance and 
21.3 	MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 
21.4 	28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year 
21.5 	2011. Hospitals shall cooperate with the plans in meeting this performance target and shall 
21.6 	accept payment withholds that must be returned to the hospitals if the performance target 
21.7 	is achieved.
21.8 	(h) Effective for services rendered on or after January 1, 2013, through December 31, 
21.9 	2013, the commissioner shall withhold 4.5 percent of managed care plan payments under 
21.10 	this section and county-based purchasing plan payments under section 256B.692 for the 
21.11 	prepaid medical assistance program. The withheld funds must be returned no sooner than 
21.12 	July 1 and no later than July 31 of the following year. The commissioner may exclude 
21.13 	special demonstration projects under subdivision 23.
21.14 	(i) Effective for services rendered on or after January 1, 2014, the commissioner shall 
21.15 	withhold three percent of managed care plan payments under this section and county-based 
21.16 	purchasing plan payments under section 256B.692 for the prepaid medical assistance 
21.17 	program. The withheld funds must be returned no sooner than July 1 and no later than July 
21.18 	31 of the following year. The commissioner may exclude special demonstration projects 
21.19 	under subdivision 23.
21.20 	(j) A managed care plan or a county-based purchasing plan under section 256B.692 may 
21.21 	include as admitted assets under section 62D.044 any amount withheld under this section 
21.22 	that is reasonably expected to be returned.
21.23 	(k) Contracts between the commissioner and a prepaid health plan are exempt from the 
21.24 	set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and 
21.25 	7.
21.26 	(l) The return of the withhold under paragraphs (h) and (i) is not subject to the 
21.27 	requirements of paragraph (c).
21.28 	(m) Managed care plans and county-based purchasing plans shall maintain current and 
21.29 	fully executed agreements for all subcontractors, including bargaining groups, for 
21.30 	administrative services that are expensed to the state's public health care programs. 
21.31 	Subcontractor agreements determined to be material, as defined by the commissioner after 
21.32 	taking into account state contracting and relevant statutory requirements, must be in the 
21.33 	form of a written instrument or electronic document containing the elements of offer, 
21.34 	acceptance, consideration, payment terms, scope, duration of the contract, and how the 
22.1 	subcontractor services relate to state public health care programs. Upon request, the 
22.2 	commissioner shall have access to all subcontractor documentation under this paragraph. 
22.3 	Nothing in this paragraph shall allow release of information that is nonpublic data pursuant 
22.4 	to section 13.02.

22.5 	EFFECTIVE DATE. This section is effective the day following final enactment.