1.1                          A bill for an act 
  1.2             relating to human services; changing provisions for 
  1.3             variances for payment rate on day training and 
  1.4             habilitation services; amending Minnesota Statutes 
  1.5             1994, section 252.46, subdivision 6.  
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1994, section 252.46, 
  1.8   subdivision 6, is amended to read: 
  1.9      Subd. 6.  [VARIANCES.] (a) A variance from the minimum or 
  1.10  maximum payment rates in subdivisions 2 and 3 may be granted by 
  1.11  the commissioner when the vendor requests and the county board 
  1.12  submits to the commissioner a written variance request on forms 
  1.13  supplied by the commissioner with the recommended payment rates. 
  1.14  A variance to the rate maximum may be utilized for costs 
  1.15  associated with compliance with state administrative rules, 
  1.16  compliance with court orders, capital costs required for 
  1.17  continued licensure, increased insurance costs, start-up and 
  1.18  conversion costs for supported employment, direct service staff 
  1.19  salaries and benefits, transportation, and other program related 
  1.20  costs when any one of the criteria in clauses (1) to ~~(3)~~ (5) is 
  1.21  also met: 
  1.22     (1) a change is necessary to comply with licensing 
  1.23  citations; 
  1.24     (2) a change in a client or clients' transportation rate, 
  1.25  as requested by the vendor and approved by the county board, is 
  2.1   necessary to meet the goals specified in a client or clients' 
  2.2   individual service plan (ISP); 
  2.3      (3) a change is necessary to help include the client or 
  2.4   clients in the community; 
  2.5      (4) a significant change is approved by the commissioner 
  2.6   under section 252.28 that is necessary to provide authorized 
  2.7   services to ~~new~~ a client or clients with very severe 
  2.8   self-injurious or assaultive behavior, or medical conditions 
  2.9   requiring delivery of physician-prescribed medical interventions 
  2.10  requiring one-to-one staffing for at least 15 minutes each time 
  2.11  they are performed, or to a client or clients whose service 
  2.12  needs have changed significantly, or to ~~new~~ a client or clients 
  2.13  directly discharged to the vendor's program from a regional 
  2.14  treatment center; or 
  2.15     ~~(3)~~ (5) a significant increase in the average level of 
  2.16  staffing is needed to provide authorized services approved by 
  2.17  the commissioner under section 252.28, that is necessitated by a 
  2.18  decrease in licensed capacity or loss of clientele when counties 
  2.19  choose alternative services under Laws 1992, chapter 513, 
  2.20  article 9, section 41. 
  2.21     A variance under this paragraph may be approved only if the 
  2.22  costs to the medical assistance program do not exceed the 
  2.23  medical assistance costs for all clients served by the 
  2.24  alternatives and all clients remaining in the existing services. 
  2.25     (b) A variance to the rate minimum may be granted when (1) 
  2.26  the county board contracts for increased services from a vendor 
  2.27  and for some or all individuals receiving services from the 
  2.28  vendor lower per unit fixed costs result or (2) when the actual 
  2.29  costs of delivering authorized service over a 12-month contract 
  2.30  period have decreased. 
  2.31     (c) The written variance request under this subdivision 
  2.32  must include documentation that all the following criteria have 
  2.33  been met: 
  2.34     (1) The commissioner and the county board have both 
  2.35  conducted a review and have identified a need for a change in 
  2.36  the payment rates and recommended an effective date for the 
  3.1   change in the rate. 
  3.2      (2) The vendor documents efforts to reallocate current 
  3.3   staff and any additional staffing needs cannot be met by using 
  3.4   temporary special needs rate exceptions under Minnesota Rules, 
  3.5   parts 9510.1020 to 9510.1140. 
  3.6      (3) The vendor documents that financial resources have been 
  3.7   reallocated before applying for a variance.  No variance may be 
  3.8   granted for equipment, supplies, or other capital expenditures 
  3.9   when depreciation expense for repair and replacement of such 
  3.10  items is part of the current rate. 
  3.11     (4) For variances related to loss of clientele, the vendor 
  3.12  documents the other program and administrative expenses, if any, 
  3.13  that have been reduced. 
  3.14     (5) The county board submits verification of the conditions 
  3.15  for which the variance is requested, a description of the nature 
  3.16  and cost of the proposed changes, and how the county will 
  3.17  monitor the use of money by the vendor to make necessary changes 
  3.18  in services.  
  3.19     (6) The county board's recommended payment rates do not 
  3.20  exceed 95 percent of the greater of 125 percent of the current 
  3.21  statewide median or 125 percent of the regional average payment 
  3.22  rates, whichever is higher, for each of the regional commission 
  3.23  districts under sections 462.381 to 462.396 in which the vendor 
  3.24  is located except for the following:  when a variance is 
  3.25  recommended to allow authorized service delivery to new clients 
  3.26  with severe self-injurious or assaultive behaviors or with 
  3.27  medical conditions requiring delivery of physician prescribed 
  3.28  medical interventions, or to persons being directly discharged 
  3.29  from a regional treatment center to the vendor's program, those 
  3.30  persons must be assigned a payment rate of 200 percent of the 
  3.31  current statewide average rates.  All other clients receiving 
  3.32  services from the vendor must be assigned a payment rate equal 
  3.33  to the vendor's current rate unless the vendor's current rate 
  3.34  exceeds 95 percent of 125 percent of the statewide median or 125 
  3.35  percent of the regional average payment rates, whichever is 
  3.36  higher.  When the vendor's rates exceed 95 percent of 125 
  4.1   percent of the statewide median or 125 percent of the regional 
  4.2   average rates, the maximum rates assigned to all other clients 
  4.3   must be equal to the greater of 95 percent of 125 percent of the 
  4.4   statewide median or 125 percent of the regional average rates.  
  4.5   The maximum payment rate that may be recommended for the vendor 
  4.6   under these conditions is determined by multiplying the number 
  4.7   of clients at each limit by the rate corresponding to that limit 
  4.8   and then dividing the sum by the total number of clients. 
  4.9      (7) The vendor has not received a variance under this 
  4.10  subdivision in the past 12 months.  
  4.11     (d) The commissioner shall have 60 calendar days from the 
  4.12  date of the receipt of the complete request to accept or reject 
  4.13  it, or the request shall be deemed to have been granted.  If the 
  4.14  commissioner rejects the request, the commissioner shall state 
  4.15  in writing the specific objections to the request and the 
  4.16  reasons for its rejection.