SF 2140

as introduced - 87th Legislature (2011 - 2012) Posted on 03/02/2012 08:44am

A bill for an act
relating to human services; establishing new payment rate-setting methodologies
for home and community-based waiver services; providing rulemaking authority;
amending Minnesota Statutes 2010, sections 245A.11, subdivision 8; 256B.0911,
by adding a subdivision; 256B.0916, subdivision 2; 256B.092, subdivision
4; 256B.49, subdivision 17; 256B.4912; proposing coding for new law in
Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:

Subd. 8.

Community residential setting license.

(a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2011.

(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts
9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
(b), must be required to obtain a community residential setting license.

new text begin (c) Individuals receiving services under the community residential setting license
shall have a team to support them in making decisions regarding services. These teams
shall be called "support teams" and be composed of the person; the case manager or
services coordinator; the person's legal representative; the person's advocate, if any; other
people chosen by the person receiving services; and the representatives of providers of
service areas relevant to the needs of the person as described in the coordinated service
and support plan.
new text end

new text begin (d) The support team shall have access to information or data included in the
assessment conducted under section 256B.0911, subdivision 10, that is needed to complete
treatment and risk assessment plans.
new text end

new text begin (e) Support teams shall have the final decision regarding plans to mitigate
vulnerabilities identified for an individual. Based on an assessment, the individual and
support team can choose not to create a plan for identified vulnerabilities that do not rise
to the level of self neglect, maltreatment, or violations of the law, if the team accepts the
vulnerability as part of a person's qualify of life. Any licensing review or other oversight
shall review that the team has gone through the process of an assessment and has come to
an agreement on whether a plan will be developed for any individual vulnerability. The
licensing review shall not include authority to challenge the decision of the team.
new text end

new text begin (f) Support teams shall be included in any formal or informal evaluation of the
quality of services provided to an individual.
new text end

new text begin (g) Region 10 staff shall be consulted regarding establishing a system for evaluating
the quality of services provided under the community residential setting license.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 10. new text end

new text begin Disability waivered services assessment requirements. new text end

new text begin The
commissioner of human services shall establish an assessment methodology to determine
reimbursement classifications based upon each individual's assessed needs for services
reimbursed under section 256B.4913.
new text end

new text begin (a) For purposes of this subdivision, the following terms have the meanings given
them:
new text end

new text begin (1) "high medical needs" means complex health-related needs that require on-site
medical attention and are specified in the coordinated service and support plan;
new text end

new text begin (2) "high behavioral needs" means a history of observable behavior that deviates
from social norms as defined and counted in the assessment that require comprehensive
training in behavior management, behavior programming, de-escalation techniques, or
medication management training for behavior medications. Examples of participant needs
include, but are not limited to, a participant at risk of or with a history of:
new text end

new text begin (i) elopement, defined as when a patient or resident who is cognitively, physically,
mentally, emotionally, or chemically impaired wanders away, walks away, runs away,
escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed,
or prior to their scheduled discharge; or
new text end

new text begin (ii) serious harm to self or others;
new text end

new text begin (3) "high mental health needs" means a history of a mental disorder, diagnosed by a
physician and confirmed in the assessment, that requires constant staff oversight without
which the consequences of the participant's behaviors are severe. The management of
these needs requires comprehensive training in mental health issues, dual diagnosis, and
medication management training. This means a current diagnosis of severe and persistent
mental illness or severe emotional disturbance that manifests itself through one of the
following:
new text end

new text begin (i) serious harm to self or others; or
new text end

new text begin (ii) other extreme behaviors that interfere with major life activities; and
new text end

new text begin (4) "deaf or hard-of-hearing" means a loss of hearing diagnosed by a physician and
confirmed in the assessment that requires staff proficient in one or more of the following
to communicate:
new text end

new text begin (i) American sign language;
new text end

new text begin (ii) tactile interpretation; or
new text end

new text begin (iii) other sign language.
new text end

new text begin (b) The commissioner shall ensure that:
new text end

new text begin (1) the assessment includes a full and accurate accounting of each individual's
need for supports;
new text end

new text begin (2) the results of the methodology for each individual are statistically valid and
reliable, and for each individual's result, there is a statistically significant level of
interrated reliability; and
new text end

new text begin (3) the assessment determines if an individual fits the definitions of high medical
needs, high behavioral needs, high mental health needs, or deaf or hard-of-hearing.
new text end

new text begin (c) The assessment methodology must be completed prior to the implementation of
any changes to rates determined under section 246B.4913.
new text end

new text begin (d) Any individual may appeal the results of the individual's assessment as outlined
in section 256.045.
new text end

new text begin (e) The commissioner shall adopt rules under section 14.05 to implement this
methodology.
new text end

Sec. 3.

Minnesota Statutes 2010, section 256B.0916, subdivision 2, is amended to read:

Subd. 2.

Distribution of funds; partnerships.

(a) Beginning with fiscal year 2000,
the commissioner shall distribute all funding available for home and community-based
waiver services for persons with developmental disabilities to individual counties or to
groups of counties that form partnerships to jointly plan, administer, and authorize funding
for eligible individuals. The commissioner shall encourage counties to form partnerships
that have a sufficient number of recipients and funding to adequately manage the risk
and maximize use of available resources.

(b) Counties must submit a request for funds and a plan for administering the
program as required by the commissioner. The plan must identify the number of clients to
be served, their ages, and their priority listing based on:

(1) requirements in Minnesota Rules, part 9525.1880; and

(2) statewide priorities identified in section 256B.092, subdivision 12.

The plan must also identify changes made to improve services to eligible persons and to
improve program management.

(c) In allocating resources to counties, priority must be given to groups of counties
that form partnerships to jointly plan, administer, and authorize funding for eligible
individuals and to counties determined by the commissioner to have sufficient waiver
capacity to maximize resource use.

(d) Within 30 days after receiving the county request for funds and plans, the
commissioner shall provide a written response to the plan that includes the level of
resources available to serve additional persons.

(e) Counties are eligible to receive medical assistance administrative reimbursement
for administrative costs under criteria established by the commissioner.

new text begin (f) Upon implementation of rate methodologies developed under section 256B.4913,
the commissioner shall adjust allocations to local agencies for home and community-based
waivered service allocations to reflect the total amount of spending for all recipients
with disabilities in their respective counties in need of the level of care provided in an
intermediate care facility for individuals with developmental disabilities, a nursing facility,
or a hospital as determined by the methodology in section 256B.4913.
new text end

Sec. 4.

Minnesota Statutes 2010, section 256B.092, subdivision 4, is amended to read:

Subd. 4.

Home and community-based services for developmental disabilities.

(a) The commissioner shall make payments to approved vendors participating in the
medical assistance program to pay costs of providing home and community-based
services, including case management service activities provided as an approved home and
community-based service, to medical assistance eligible persons with developmental
disabilities who have been screened under subdivision 7 and according to federal
requirements. Federal requirements include those services and limitations included in the
federally approved application for home and community-based services for persons with
developmental disabilities and subsequent amendments.

(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental
disabilities authorized but not receiving those services as of June 30, 1995, based upon the
average resource need of persons with similar functional characteristics. To ensure service
continuity for service recipients receiving home and community-based waivered services
for persons with developmental disabilities prior to July 1, 1995, the commissioner shall
make available to the county of financial responsibility home and community-based
waivered services resources based upon fiscal year 1995 authorized levels.

(c) Home and community-based resources for all recipients shall be managed by deleted text begin the
county of financial responsibility within an allowable reimbursement average established
for deleted text end each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.

new text begin (d) Resources and payment rates for all recipients of home and community-based
services shall remain as negotiated by each county of fiscal responsibility as of January
1, 2012.
new text end

new text begin (e) Resources and payment rates for recipients of home and community-based
services enrolled prior to January 1, 2012, may be adjusted for changes in needs using
processes by county agencies established as of January 1, 2012.
new text end

new text begin (f) Any new recipients of home and community-based services after January 1,
2012, shall have resources managed by the county using the process in place in each
county as of January 1, 2012.
new text end

new text begin (g) Counties may not implement changes to resources for individuals under section
256B.4913, until the implementation of a statistically valid and reliable process for
assessing each individual's needs under section 256B.0911, subdivision 10.
new text end

Sec. 5.

Minnesota Statutes 2010, section 256B.49, subdivision 17, is amended to read:

Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.

(b) deleted text begin The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. deleted text end new text begin Upon implementation
of rate methodologies developed under section 256B.4913, the commissioner shall
adjust allocations to local agencies for home and community-based waivered service
allocations to reflect the total amount of spending for all recipients with disabilities in their
respective counties in need of the level of care provided in an intermediate care facility for
individuals with developmental disabilities, a nursing facility, or a hospital as determined
by the methodology in section 256B.4913:
new text end

new text begin (1) the commissioner shall set each county's allocation to include resources for
the total amount of spending for each respective county based on the total number of
individuals estimated to be served multiplied by each individual's service rate determined
under section 256B.4913; and
new text end

new text begin (2) if an individual relocates from one county to another within a calendar year, the
commissioner shall adjust county allocations to reflect where the individual is receiving
services.
new text end

new text begin (c) Until the allocation method described in paragraph (b) is implemented, new text end the
commissioner shall allocate resources to single counties and county partnerships in a
manner that reflects consideration of:

(1) an incentive-based payment process for achieving outcomes;

(2) the need for a state-level risk pool;

(3) the need for retention of management responsibility at the state agency level; and

(4) a phase-in strategy as appropriate.

deleted text begin (c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:
deleted text end

deleted text begin (1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or
deleted text end

deleted text begin (2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
deleted text end

(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
to 256B.0656 and 256B.0659. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.

(e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
services, the county must negotiate a revised per diem rate for room and board and waiver
services that reflects the legislated rate reduction and results in an overall average per
diem reduction for all foster care recipients in that home. The revised per diem must allow
the provider to maintain, as much as possible, the level of services or enhanced services
provided in the residence, while mitigating the losses of the legislated rate reduction.

Sec. 6.

Minnesota Statutes 2010, section 256B.4912, is amended to read:

256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS
AND PAYMENT.

Subdivision 1.

Provider qualifications.

new text begin (a) new text end For the home and community-based
waivers providing services to seniors and individuals with disabilities, the commissioner
shall establish:

(1) agreements with enrolled waiver service providers to ensure providers meet
deleted text begin qualifications defined in the waiver plans deleted text end new text begin Minnesota health care program requirements new text end ;

(2) regular reviews of provider qualifications new text begin , including requests of proof of
documentation new text end ; and

(3) processes to gather the necessary information to determine provider
qualifications.

deleted text begin By July 2010 deleted text end new text begin (b) Beginning July 2011 new text end , staff that provide direct contact deleted text begin , as defined
in section 245C.02, subdivision 11, that are employees of waiver service providers deleted text end new text begin for
services specified in the federally approved waiver plans new text end must meet the requirements
of chapter 245C prior to providing waiver services and as part of ongoing enrollment.
Upon federal approval, this requirement must also apply to consumer-directed community
supports.

new text begin (c) Upon enactment of section 256B.4913, providers of waiver services must
reenroll with the state. County and tribal agency contracts existing prior to January 1,
2013, are not effective beginning January 1, 2013.
new text end

Subd. 2.

Rate-setting methodologies.

new text begin (a) new text end The commissioner shall establish
statewide new text begin prospective new text end rate-setting methodologies that meet federal waiver requirements
for home and community-based waiver services for individuals with disabilities. The
rate-setting methodologies must abide by the principles of transparency and equitability
across the state. The methodologies must involve a uniform process of structuring rates
for each service and must promote quality and participant choice.

new text begin (b) No changes in existing provider rates are effective until the development and
implementation of an assessment methodology for individuals assessed under section
256B.0911, subdivision 10, that provides a statistically reliable and valid means for
assessing each individual's support needs.
new text end

new text begin Subd. 3. new text end

new text begin Payment rate criteria. new text end

new text begin (a) The payment structures and methodologies
under this section shall reflect the payment rate criteria in paragraphs (b) and (c).
new text end

new text begin (b) Payment rates shall be determined according to reasonable, ordinary, and
necessary costs that accurately reflect the actual cost of service delivery.
new text end

new text begin (c) Payment rates shall be sufficient to enlist enough providers so that care and
services are available under the plan at least to the extent that care and services are
available to the general population in the geographic area as required by section
1902(a)(30)(A) of the Social Security Act.
new text end

new text begin (d) The commissioner must not reimburse:
new text end

new text begin (1) unauthorized service delivery;
new text end

new text begin (2) services provided under a receipt of a special grant;
new text end

new text begin (3) services provided under contract to a local school district;
new text end

new text begin (4) extended employment services under Minnesota Rules, parts 3300.2005 to
3300.3100; or vocational rehabilitation services provided under the federal Rehabilitation
Act, United States Code, title I, section 110, as amended; or United States Code, title VI,
part C, and not through use of medical assistance or county social service funds; or
new text end

new text begin (5) services provided to a client by a licensed medical, therapeutic, or rehabilitation
practitioner, or any other vendor of medical care that are billed separately on a
fee-for-service basis.
new text end

new text begin (e) Payment rates are set prospectively and may not be enforced retroactively.
new text end

Sec. 7.

new text begin [256B.4913] HOME AND COMMUNITY-BASED WAIVERS;
RATE-SETTING METHODOLOGIES.
new text end

new text begin Subdivision 1. new text end

new text begin Applicable services. new text end

new text begin "Applicable services" are those authorized
under the state's home and community-based waivers under sections 256B.092 and
256B.49, including those defined in the federally approved home and community-based
services plan, as follows:
new text end

new text begin (1) adult day care;
new text end

new text begin (2) family adult day services;
new text end

new text begin (3) day training and habilitation;
new text end

new text begin (4) prevocational services;
new text end

new text begin (5) structured day services;
new text end

new text begin (6) supported employment services;
new text end

new text begin (7) behavioral programming;
new text end

new text begin (8) housing access coordination;
new text end

new text begin (9) independent living services;
new text end

new text begin (10) in-home family supports;
new text end

new text begin (11) night supervision;
new text end

new text begin (12) personal support;
new text end

new text begin (13) supported living services;
new text end

new text begin (14) transportation services;
new text end

new text begin (15) respite services;
new text end

new text begin (16) residential services; or
new text end

new text begin (17) any other services approved as part of the state's home and community-based
services plan.
new text end

new text begin Subd. 2. new text end

new text begin Base wage index. new text end

new text begin (a) The base wage index is established to determine
staffing costs associated with providing services to individuals receiving home and
community-based services.
new text end

new text begin (b) The base wage shall be calculated using a composite of wages taken from job
descriptions and standard occupational classification (SOC) codes from the Bureau
of Labor Statistics, as defined in the most recent edition of the Occupational Outlook
Handbook. The base wage index shall be calculated as follows:
new text end

new text begin (1) for day services, 20 percent of the median wage for nursing aide (SOC code
31-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 60 percent of the median wage for social and human services workers (SOC code
21-1093);
new text end

new text begin (2) for residential direct care staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
31-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code
21-1093);
new text end

new text begin (3) for residential awake overnight staff, 20 percent of the median wage for home
health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC
code 31-1012); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093);
new text end

new text begin (4) for residential asleep overnight staff, the wage will be $7.66 per hour, adjusted
annually by the Consumer Price Index for urban wage earners;
new text end

new text begin (5) for supported living services hourly staff, 20 percent of the median wage
for nursing aide (SOC code 31-1012); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);
new text end

new text begin (6) for behavior programming aide staff, 20 percent of the median wage for nursing
aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
new text end

new text begin (7) for behavioral programming professional staff, 100 percent of the median wage
for clinical counseling and school psychologist (SOC code 19-3031);
new text end

new text begin (8) for supported employment job coach staff, 20 percent of the median wage
for nursing aide (SOC code 31-1012); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);
new text end

new text begin (9) for supported employment job developer staff, 50 percent of the median wage
for rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
social and human services aide (SOC code 21-1093);
new text end

new text begin (10) for in-home family support, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
new text end

new text begin (11) for housing access coordination staff, 50 percent of the median wage for
community and social services specialist (SOC code 21-1099); and 50 percent of the
median wage for social and human services aide (SOC code 21-1093);
new text end

new text begin (12) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
percent of the median wage for social and human services aide (SOC code 21-1093);
new text end

new text begin (13) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
attendants (SOC code 31-1012);
new text end

new text begin (14) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012);
new text end

new text begin (15) for transportation staff, 20 percent of the median wage for nursing aide (SOC
code 31-1012); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC
code 21-1093);
new text end

new text begin (16) for independent living skills staff, ten percent of the median wage for nursing
aides, orderlies, and attendants (SOC code 31-1012); 30 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093); and
new text end

new text begin (17) for supervisory staff, 55 percent of the median wage for medical and health
services managers (SOC code 11-9111).
new text end

new text begin (c) The commissioner shall update the base wage index on an annual basis upon
the release of the December 31 data of the most recent year from the Bureau of Labor
Statistics and publish the base wage index on July 1 of the beginning of the next fiscal year.
new text end

new text begin (d) The commissioner shall adjust payment rates for changes in the base wage index
on an annual basis for each individual receiving waivered services.
new text end

new text begin (e) The commissioner shall determine the staffing component of each individual's
payment rate receiving services under sections 256B.092 and 256B.49 using the base
wage index.
new text end

new text begin Subd. 3. new text end

new text begin Payments for residential services. new text end

new text begin (a) Payments for services in residential
settings include supported living services, foster care, residential care, customized living,
and 24-hour customized living.
new text end

new text begin (b) The separate components of each individual's payment rate for residential
services shall be calculated as follows:
new text end

new text begin (1) for direct supervision, the commissioner shall determine the number of units of
service to be used utilizing the assessment process in section 256B.0911, subdivision 10.
The support team in section 245A.11, subdivision 8, shall determine the number of hours
of direct supervision to be comprised of direct staff and supervision technology:
new text end

new text begin (i) for direct staff cost:
new text end

new text begin (A) the commissioner shall determine staff wages for shared staff, individual
staffing, and supervision staffing using the base wage index in subdivision 2. The direct
care cost is the staff wage multiplied by the number of direct staff hours specified by
each individual's support team;
new text end

new text begin (B) for individuals that qualify for a customization under subdivision 6, add the
customization rate provided in subdivision 6 to the base wage amount determined in
the direct care cost;
new text end

new text begin (C) multiply the number of direct staff hours by the staff wage; and
new text end

new text begin (D) multiply the result of the previous calculation by one plus 9.4 percent;
new text end

new text begin (ii) for supervision technology cost:
new text end

new text begin (A) the commissioner shall determine supervision technology wages using the base
wage index in subdivision 2. The supervision technology cost is the staff wage multiplied
by the number of supervision technology hours specified by each individual's support team;
new text end

new text begin (B) for individuals that qualify for a customization under subdivision 6, add the
customization rate provided in subdivision 6 to the base wage amount determined in
the supervision technology cost;
new text end

new text begin (C) multiply the number of supervision technology hours by the staff wage; and
new text end

new text begin (D) add the amounts under subitems (B) and (C) to obtain the direct staffing cost;
new text end

new text begin (iii) add the amounts from items (i) and (ii) to obtain the direct supervision cost;
new text end

new text begin (2) for employee-related expenses:
new text end

new text begin (i) the commissioner shall include an adjustment of 10.3 percent for the cost of
taxes and workers' compensation;
new text end

new text begin (ii) the commissioner shall include an adjustment of 16.2 percent for the cost of
other benefits, including health insurance, dental insurance, life insurance, short-term
disability insurance, long-term disability insurance, vision insurance, retirement, and
tuition reimbursement; and
new text end

new text begin (iii) the total of the two percentages under items (i) and (ii) is the total percentage
for employee-related expenses;
new text end

new text begin (3) for transportation:
new text end

new text begin (i) the commissioner shall include an amount for the costs of acquiring and
maintaining vehicles for the transportation of individuals, as follows: $1,875 for a
standard vehicle; $3,803 for a full-size adapted van; and $2,208 for a minivan;
new text end

new text begin (ii) for individuals requiring individualized customization, the commissioner shall
include the number of miles multiplied by $0.51 per mile for a standard vehicle, $1.43 for
a full-size adapted van, and $0.61 for a minivan. The amount of miles for customization
shall be determined by each individual's support team under section 245A.11, subdivision
8; and
new text end

new text begin (iii) the total under items (i) and (ii) is the total for transportation;
new text end

new text begin (4) for client programming and supports:
new text end

new text begin (i) the commissioner shall add $2,179 for the cost of client programming and
supports; and
new text end

new text begin (ii) for individuals that had previously received an adjustment to rates under section
256B.501, subdivision 4, the commissioner shall add an amount to reflect the costs of
providing services allowable under title XIX of the Social Security Act to obtain the
total for client programming and supports;
new text end

new text begin (5) for support costs:
new text end

new text begin (i) the commissioner shall include an adjustment of 16.5 percent for standard and
general administrative support;
new text end

new text begin (ii) the commissioner shall include an adjustment of 2.65 percent for program
support; and
new text end

new text begin (iii) the total of the adjustments under items (i) and (ii) is the total percentage for
support costs; and
new text end

new text begin (6) for administrative overhead:
new text end

new text begin (i) the commissioner shall include an adjustment of 6.58 percent for costs associated
with absence overhead;
new text end

new text begin (ii) the commissioner shall include an adjustment of 3.8 percent for utilization
overhead; and
new text end

new text begin (iii) the total of the adjustments under items (i) and (ii) is the total percentage for
administrative overhead.
new text end

new text begin (c) The total rate shall be calculated using the following steps:
new text end

new text begin (1) the direct supervision cost multiplied by one plus the total percentage for
employee-related expenses;
new text end

new text begin (2) plus the total for transportation;
new text end

new text begin (3) plus the total for client programming and supports;
new text end

new text begin (4) the subtotal of clauses (1) to (3), multiplied by one plus the total percentage for
support costs;
new text end

new text begin (5) the subtotal of clauses (1) to (4), multiplied by one plus the total percentage
for administrative overhead; and
new text end

new text begin (6) divide the total of clause (5) by 365 to obtain the daily rate.
new text end

new text begin Subd. 4. new text end

new text begin Payment for day program services. new text end

new text begin (a) Payments for services with day
programs include adult day care, family adult day care, day training and habilitation,
prevocational services, and structured day services.
new text end

new text begin (b) The separate components of each individual's payment rate for day program
services shall be calculated as follows:
new text end

new text begin (1) for direct staffing:
new text end

new text begin (i) the commissioner shall determine the number of units of service to be used and
each individual's support ratio utilizing the assessment process in section 256B.0911,
subdivision 10;
new text end

new text begin (ii) the commissioner shall determine staff wages using the base wage index in
subdivision 2. The direct care cost is the staff wage multiplied by the number of units
of service. The commissioner shall include 4.5 supervisory hours per week for each
individual at a staffing ratio of 1:1. Supervisory hours will reduce as ratios increase, but
shall not be less than 2.5 hours per week. The number of hours shall be prorated for
less than full-day participation;
new text end

new text begin (iii) for individuals that qualify for a customization under subdivision 6, add the
customization rate provided in subdivision 6 to the base wage amount determined in
the direct care cost;
new text end

new text begin (iv) multiply the units of service by the staff wage;
new text end

new text begin (v) multiply the result of the calculation in item (iv) by 9.4 percent; and
new text end

new text begin (vi) add the amounts under items (iv) and (v) to obtain the direct staffing cost;
new text end

new text begin (2) for employee-related expenses:
new text end

new text begin (i) the commissioner shall include an adjustment of 10.3 percent for the cost of
taxes and workers' compensation;
new text end

new text begin (ii) the commissioner shall include an adjustment of 16.2 percent for the cost of
other benefits, including health insurance, dental insurance, life insurance, short-term
disability insurance, long-term disability insurance, vision insurance, retirement, and
tuition reimbursement; and
new text end

new text begin (iii) the total of the two percentages under items (i) and (ii) is the total percentage
for employee-related expenses;
new text end

new text begin (3) for transportation:
new text end

new text begin (i) the commissioner shall determine the number of trips required, as determined
under the assessment process in section 256B.0911, subdivision 10;
new text end

new text begin (ii) the commissioner shall determine the total distance transported from the person's
residence to the initial day service destination and whether an individual requires the use
of a lift;
new text end

new text begin (iii) for each trip to and from each individual's residence, the commissioner shall
add a value of:
new text end

new text begin (A) for distances of zero to ten miles, the commissioner shall pay $7.77 per trip for
individuals transported in a vehicle equipped with a wheelchair lift, and $7.00 for those
who are transported in other vehicles;
new text end

new text begin (B) for individuals who are transported 11 to 20 miles, the commissioner shall pay
$10.27 per trip for individuals transported in a vehicle equipped with a wheelchair lift,
and $7.87 for those who are transported in other vehicles;
new text end

new text begin (C) for individuals who are transported 21 to 50 miles, the commissioner shall pay
$15.04 per trip for individuals transported in a vehicle equipped with a wheelchair lift, and
$9.53 for those who are transported in other vehicles; and
new text end

new text begin (D) for individuals transported 51 or more miles, the commissioner shall pay $18.74
per trip for individuals transported in a vehicle equipped with a wheelchair lift, and $10.80
for those who are transported in other vehicles;
new text end

new text begin (iv) these rates shall apply regardless of whether the person is being transported
alone or with others;
new text end

new text begin (v) the rates identified in paragraph (c) shall be adjusted within 30 days by the
commissioner using the same percentage as used by the Internal Revenue Service when
adjusting standard mileage rates for business purposes; and
new text end

new text begin (vi) the rates determined in this clause are the total for transportation;
new text end

new text begin (4) for program plan and supports, the commissioner shall add 16.6 percent for the
cost of program plan and supports;
new text end

new text begin (5) the commissioner shall include an adjustment of ten percent for the cost of
client programming and supports;
new text end

new text begin (6) for support costs:
new text end

new text begin (i) the commissioner shall include an adjustment of 16.5 percent for standard and
general administrative support;
new text end

new text begin (ii) the commissioner shall include an adjustment of 2.65 percent for program
support;
new text end

new text begin (iii) the commissioner shall add $31.69 per week for the facility reasonable-use
rate; and
new text end

new text begin (iv) the total of the adjustments under items (i) to (iii) is the total percentage for
support costs; and
new text end

new text begin (7) for administrative overhead:
new text end

new text begin (i) the commissioner shall include an adjustment of 6.58 percent for costs associated
with absence overhead;
new text end

new text begin (ii) the commissioner shall include an adjustment of 3.8 percent for utilization
overhead; and
new text end

new text begin (iii) the total of the adjustments under items (i) and (ii) is the total percentage for
administrative overhead.
new text end

new text begin (c) The total rate shall be calculated using the following steps:
new text end

new text begin (1) the direct staffing cost multiplied by one plus the total percentage for
employee-related expenses;
new text end

new text begin (2) plus the total for transportation;
new text end

new text begin (3) plus the cost for program plan and supports;
new text end

new text begin (4) plus the cost for client programming and supports;
new text end

new text begin (5) the subtotal of clauses (1) to (4), multiplied by one plus the total percentage for
support costs;
new text end

new text begin (6) the subtotal of clauses (1) to (5), multiplied by one plus the total percentage
for administrative overhead; and
new text end

new text begin (7) divide the total in clause (6) by 365 to obtain the daily rate.
new text end

new text begin Subd. 5. new text end

new text begin Payment for individualized services. new text end

new text begin (a) Payments for individualized
services include supported employment, behavioral programming, housing access
coordination, independent living services, in-home family supports, night supervision,
personal support, and respite services.
new text end

new text begin (b) The separate components of each individual's payment rate for individualized
services shall be calculated as follows:
new text end

new text begin (1) for direct staffing:
new text end

new text begin (i) the commissioner shall determine the number of units of service to be used
utilizing the assessment process in section 256B.0911, subdivision 10;
new text end

new text begin (ii) the commissioner shall determine staff wages for shared staff, individual staffing,
and supervision staffing using the base wage index in subdivision 2. The direct care cost is
the staff wage multiplied by the number of units of service;
new text end

new text begin (iii) for individuals that qualify for a customization under subdivision 6, add the
customization rate provided in subdivision 6 to the base wage amount determined in
the direct care cost;
new text end

new text begin (iv) multiply the units of service by the staff wage;
new text end

new text begin (v) multiply the result of the calculation in item (iv) by 9.4 percent; and
new text end

new text begin (vi) add the amounts under items (iv) and (v) to obtain the direct staffing cost;
new text end

new text begin (2) for employee-related expenses:
new text end

new text begin (i) the commissioner shall include an adjustment of 10.3 percent for the cost of
taxes and workers' compensation;
new text end

new text begin (ii) the commissioner shall include an adjustment of 16.2 percent for the cost of
other benefits, including health insurance, dental insurance, life insurance, short-term
disability insurance, long-term disability insurance, vision insurance, retirement, and
tuition reimbursement; and
new text end

new text begin (iii) the total of the percentages under items (i) and (ii) is the total percentage for
employee-related expenses;
new text end

new text begin (3) for program plan and supports, the commissioner shall add 16.6 percent for the
cost of program plan supports;
new text end

new text begin (4) for client programming and supports, the commissioner shall include an
adjustment of ten percent for the cost of client programming and supports; and
new text end

new text begin (5) for support costs:
new text end

new text begin (i) the commissioner shall include an adjustment of 16.5 percent for standard and
general administrative support;
new text end

new text begin (ii) the commissioner shall include an adjustment of 2.65 percent for program
support; and
new text end

new text begin (iii) the total of the adjustments under the two previous items is the total percentage
for support costs; and
new text end

new text begin (6) for administrative overhead:
new text end

new text begin (i) the commissioner shall include an adjustment of 6.58 percent for costs associated
with absence overhead;
new text end

new text begin (ii) the commissioner shall include an adjustment of 3.8 percent for utilization
overhead; and
new text end

new text begin (iii) the total of the adjustments under items (i) and (ii) is the total percentage for
administrative overhead.
new text end

new text begin (c) The total rate shall be calculated using the following steps:
new text end

new text begin (1) the direct staffing cost multiplied by one plus the total percentage for
employee-related expenses;
new text end

new text begin (2) plus the cost for program plan supports;
new text end

new text begin (3) plus the cost for client programming and supports;
new text end

new text begin (4) the subtotal of clauses (1) to (3), multiplied by one plus the total percentage for
support costs;
new text end

new text begin (5) the subtotal of clauses (1) to (4), multiplied by one plus the total percentage
for administrative overhead; and
new text end

new text begin (6) adjust the total in clause (5) to reflect the hourly units of service that will be
provided to the individual per year, and divide by four to obtain the 15-minute rate.
new text end

new text begin Subd. 6. new text end

new text begin Customization of rates for individuals. new text end

new text begin For persons determined to have
higher needs based on their assessed needs, as determined by the process in section
256B.0911, subdivision 10, those individuals will receive an increase in staffing wages.
The customization add-on shall be:
new text end

new text begin (1) for individuals assessed as having high medical needs, $1.79 per authorized hour;
new text end

new text begin (2) for individuals assessed as having high behavioral needs, $2.01 per authorized
hour;
new text end

new text begin (3) for individuals assessed as having high mental health needs, $2.01 per authorized
hour; and
new text end

new text begin (4) for individuals assessed as being deaf or hard-of-hearing, $1.79 per authorized
hour.
new text end

new text begin Subd. 7. new text end

new text begin Rate exception process. new text end

new text begin (a) A variance from rates determined in
subdivisions 3, 4, and 5 may be granted by the lead agency when:
new text end

new text begin (1) an individual is set to be discharged; and
new text end

new text begin (2) the rate determined is inadequate to meet the health and safety needs of that
individual.
new text end

new text begin (b) The lead agency shall have 30 calendar days from the date of the receipt of the
complete request from the vendor for a rate variance to accept or reject it, or the request
shall be deemed to have been granted. The lead agency shall state in writing the specific
objections to the request and the reasons for its rejection.
new text end

new text begin (c) If the lead agency rejects the request from the vendor for a rate variance, the
vendor may appeal the decision to the commissioner of human services. The commissioner
shall have 30 calendar days to consider the appeal. The commissioner shall state in writing
the specific objections to the request and the reasons for its rejection of the appeal.
new text end

new text begin (d) The commissioner shall collect information annually and report on the number of
exceptions granted under this subdivision.
new text end

new text begin Subd. 8. new text end

new text begin Cost neutrality adjustment. new text end

new text begin (a) The commissioner shall calculate the
spending for all long-term care waivered services under the payments as defined in
subdivisions 3, 4, and 5 for each group of service. These groups are defined as:
new text end

new text begin (1) residential services, including corporate foster care, family foster care, residential
care, supported living services, customized living, and 24-hour customized living;
new text end

new text begin (2) day program services, including adult day care, day training and habilitation,
prevocational services, and structured day services;
new text end

new text begin (3) hourly services with programming, including in-home family support,
independent living services, supported living services, supported employment, behavior
programming, and housing access coordination;
new text end

new text begin (4) hourly services without programming, including respite, personal support, and
night supervision; and
new text end

new text begin (5) individualized services, including 24-hour emergency assistance, assistive
technology, caregiver training and education, consumer education and training, crisis
respite, family counseling and training, independent living service therapies, live-in
caregiver expenses, modification and adaptations, specialist services, specialized supplies
and equipment, transitional, and transportation services.
new text end

new text begin (b) If spending for each group of service does not equal the total spending under
current law, the commissioner shall apply an across-the-board adjustment to payment rates
to align the levels of overall spending under current law.
new text end

new text begin Subd. 9. new text end

new text begin Budget neutrality adjustment. new text end

new text begin (a) The commissioner shall calculate the
total spending for all long-term care waivered services under the payments as defined in
subdivisions 3, 4, and 5, and total spending under current law for the fiscal year beginning
July 1, 2013. If total spending under subdivisions 3, 4, and 5 is projected to be higher than
under current law, the commissioner shall adjust the rate by whatever percentage is needed
to reduce aggregate spending to the same level as projected under current law.
new text end

new text begin (b) The commissioner shall make any future across-the-board adjustment to provider
rates in this portion of the rate calculation.
new text end

new text begin Subd. 10. new text end

new text begin Individual rate notification. new text end

new text begin Upon request, the commissioner shall
make available the rate calculation for each individual to any member of the individual's
support team under sections 245A.11, subdivision 8, and 256B.4913, subdivisions 3, 4,
and 5, prior to any cost or budget neutrality adjustments.
new text end

new text begin Subd. 11. new text end

new text begin Rulemaking authority. new text end

new text begin The commissioner shall adopt rules under
section 14.05 to address the implementation of the payment methodology system. These
rules will address processes for detailing the implementation of this payment methodology
system, including the roles and responsibilities of the department, lead agencies, and
service providers.
new text end

new text begin Subd. 12. new text end

new text begin Rate review and adjustments. new text end

new text begin (a) If an individual's needs change,
the commissioner shall reassess that individual's needs under the process as outlined in
section 256B.0911, subdivision 10.
new text end

new text begin (b) If there is a material change to an individual's existing services, the commissioner
shall reassess that individual's needs under the assessment process outlined in section
256B.0911, subdivision 10.
new text end

new text begin Subd. 13. new text end

new text begin Reports and data. new text end

new text begin Twelve months prior to final implementation, the
commissioner shall:
new text end

new text begin (1) generate and publish provider rates calculated under this section;
new text end

new text begin (2) provide an analysis of the impact of the rate methodology system to the
legislature that includes:
new text end

new text begin (i) the average individual rate for residential services and day training and
habilitation services under the new and previous methodologies; and
new text end

new text begin (ii) the projected supply of service providers prior to and after implementation.
new text end

Sec. 8. new text begin EFFECTIVE DATE; APPLICATION.
new text end

new text begin Sections 1 to 7 are effective the day following final enactment. The rate-setting
methodologies in section 7 apply on January 1, 2013, following the implementation of the
assessment methodology under Minnesota Statutes, section 256B.0911, subdivision 10.
new text end