1.1 	A bill for an act
1.2 	relating to human services; reorganizing provisions governing disability waiver 
1.3 	rate setting; requiring a report;amending Minnesota Statutes 2020, section 
1.4 	256B.4914, as amended.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2020, section 256B.4914, as amended by Laws 2021, First 
1.7 	Special Session chapter 7, article 13, sections 42 and 43, is amended to read:
1.8 	256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE 
1.9 	SETTING.
1.10 		Subdivision 1.Application. The payment methodologies in this section apply to home 
1.11 	and community-based services waivers under sections 256B.092 and 256B.49. This section 
1.12 	does not change existing waiver policies and procedures.
1.13 		Subd. 2.Definitions. (a) For purposes of this section, the following terms have the 
1.14 	meanings given them, unless the context clearly indicates otherwise.
1.15 	(b) "Commissioner" means the commissioner of human services.
1.16 	(c) "Comparable occupations" means the occupations, excluding direct care staff, as 
1.17 	represented by the Bureau of Labor Statistics standard occupational classification codes 
1.18 	that have the same classification for:
1.19 	(1) typical education needed for entry;
1.20 	(2) work experience in a related occupation; and
2.1 	(3) typical on-the-job training competency as the most predominant classification for 
2.2 	direct care staff.
2.3 	(d) "Component value" means underlying factors that are part of the cost of providing 
2.4 	services that are built into the waiver rates methodology to calculate service rates.
2.5 	(e) "Customized living tool" means a methodology for setting service rates that delineates 
2.6 	and documents the amount of each component service included in a recipient's customized 
2.7 	living service plan.
2.8 	(f) "Direct care staff" means employees providing direct service to people receiving 
2.9 	services under this section. Direct care staff excludes executive, managerial, and 
2.10 	administrative staff.
2.11 	(g) "Disability waiver rates system" means a statewide system that establishes rates that 
2.12 	are based on uniform processes and captures the individualized nature of waiver services 
2.13 	and recipient needs.
2.14 	(h) "Individual direct staffing hours" means the time spent as a one-to-one interaction 
2.15 	specific to an individual recipient by staff to provide direct support and assistance with 
2.16 	activities of daily living, instrumental activities of daily living, and training to participants, 
2.17 	and is based on the requirements in each individual's coordinated service and support plan 
2.18 	under section 245D.02, subdivision 4b; any coordinated service and support plan addendum 
2.19 	under section 245D.02, subdivision 4c; and an assessment tool. Provider observation of an 
2.20 	individual's needs must also be considered.
2.21 	(i) "Lead agency" means a county, partnership of counties, or Tribal agency charged 
2.22 	with administering waivered services under sections 256B.092 and 256B.49.
2.23 	(j) "Median" means the amount that divides distribution into two equal groups, one-half 
2.24 	above the median and one-half below the median.
2.25 	(k) (j) "Payment or rate" means reimbursement to an eligible provider for services 
2.26 	provided to a qualified individual based on an approved service authorization.
2.27 	(l) (k) "Rates management system" means a web-based software application that uses a 
2.28 	framework and component values, as determined by the commissioner, to establish service 
2.29 	rates.
2.30 	(m) (l) "Recipient" means a person receiving home and community-based services funded 
2.31 	under any of the disability waivers.
3.1 	(n) (m) "Shared direct staffing hours" means time spent by employees, not defined under 
3.2 	paragraph (f), providing or available to provide more than one individual with direct support 
3.3 	and assistance with activities of daily living as defined under section 256B.0659, subdivision 
3.4 	1, paragraph (b); instrumental activities of daily living as defined under section 256B.0659, 
3.5 	subdivision 1, paragraph (i); ancillary activities needed to support individual services; and 
3.6 	training to participants, and is based on the requirements in each individual's coordinated 
3.7 	service and support plan under section 245D.02, subdivision 4b; any coordinated service 
3.8 	and support plan addendum under section 245D.02, subdivision 4c; an assessment tool; and 
3.9 	provider observation of an individual's service need. Total shared staffing hours are divided 
3.10 	proportionally by the number of individuals who receive the shared service provisions.
3.11 	(o) (n) "Staffing ratio" means the number of recipients a service provider employee 
3.12 	supports during a unit of service based on a uniform assessment tool, provider observation, 
3.13 	case history, and the recipient's services of choice, and not based on the staffing ratios under 
3.14 	section 245D.31.
3.15 	(p) "Unit of service" means the following:
3.16 	(1) for residential support services under subdivision 6, a unit of service is a day. Any 
3.17 	portion of any calendar day, within allowable Medicaid rules, where an individual spends 
3.18 	time in a residential setting is billable as a day;
3.19 	(2) for day services under subdivision 7:
3.20 	(i) for day training and habilitation services, a unit of service is either:
3.21 	(A) a day unit of service is defined as six or more hours of time spent providing direct 
3.22 	services and transportation; or
3.23 	(B) a partial day unit of service is defined as fewer than six hours of time spent providing 
3.24 	direct services and transportation; and
3.25 	(C) for new day service recipients after January 1, 2014, 15 minute units of service must 
3.26 	be used for fewer than six hours of time spent providing direct services and transportation;
3.27 	(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A 
3.28 	day unit of service is six or more hours of time spent providing direct services;
3.29 	(iii) for day support services, a unit of service is 15 minutes; and
3.30 	(iv) for prevocational services, a unit of service is a day or 15 minutes. A day unit of 
3.31 	service is six or more hours of time spent providing direct service;
3.32 	(3) for unit-based services with programming under subdivision 8:
4.1 	(i) for supported living services, a unit of service is a day or 15 minutes. When a day 
4.2 	rate is authorized, any portion of a calendar day where an individual receives services is 
4.3 	billable as a day; and
4.4 	(ii) for all other services, a unit of service is 15 minutes; and
4.5 	(4) for unit-based services without programming under subdivision 9, a unit of service 
4.6 	is 15 minutes.
4.7 		Subd. 3.Applicable services. Applicable services are those authorized under the state's 
4.8 	home and community-based services waivers under sections 256B.092 and 256B.49, 
4.9 	including the following, as defined in the federally approved home and community-based 
4.10 	services plan:
4.11 	(1) 24-hour customized living;
4.12 	(2) adult day services;
4.13 	(3) adult day services bath;
4.14 	(4) companion services;
4.15 	(5) (4) community residential services;
4.16 	(6) (5) customized living;
4.17 	(7) (6) day support services;
4.18 	(8) day training and habilitation;
4.19 	(9) (7) employment development services;
4.20 	(10) (8) employment exploration services;
4.21 	(11) (9) employment support services;
4.22 	(12) (10) family residential services;
4.23 	(13) housing access coordination;
4.24 	(14) independent living skills;
4.25 	(15) (11) individualized home supports;
4.26 	(16) (12) individualized home supports with family training;
4.27 	(17) (13) individualized home supports with training;
4.28 	(18) in-home family support;
4.29 	(19) (14) integrated community supports;
5.1 	(20) (15) night supervision;
5.2 	(21) personal support;
5.3 	(22) (16) positive support services;
5.4 	(23) (17) prevocational services;
5.5 	(24) (18) residential support services;
5.6 	(25) (19) respite services;
5.7 	(26) structured day services;
5.8 	(27) supported living services;
5.9 	(28) (20) transportation services; and
5.10 	(29) (21) other services as approved by the federal government in the state home and 
5.11 	community-based services waiver plan.
5.12 		Subd. 4.Data collection for rate determination. (a) Rates for applicable home and 
5.13 	community-based waivered services, including rate exceptions customized rates under 
5.14 	subdivision 12, are set by the rates management system.
5.15 	(b) Data and information in the rates management system may must be used to calculate 
5.16 	an individual's rate.
5.17 	(c) Service providers, with information from the community coordinated service and
5.18 	support plan and oversight by lead agencies, shall provide values and information needed 
5.19 	to calculate an individual's rate into in the rates management system. The determination of 
5.20 	service levels must be part of a discussion with members of the support team as defined in 
5.21 	section 245D.02, subdivision 34. This discussion must occur prior to the final establishment 
5.22 	of each individual's rate. The values and information include:
5.23 	(1) shared staffing hours;
5.24 	(2) individual staffing hours;
5.25 	(3) direct registered nurse hours;
5.26 	(4) direct licensed practical nurse hours;
5.27 	(5) staffing ratios;
5.28 	(6) information to document variable levels of service qualification for variable levels 
5.29 	of reimbursement in each framework;
6.1 	(7) shared or individualized arrangements for unit-based services, including the staffing 
6.2 	ratio;
6.3 	(8) number of trips and miles for transportation services; and
6.4 	(9) service hours provided through monitoring technology.
6.5 	(d) Updates to individual data must include:
6.6 	(1) data for each individual that is updated annually when renewing service plans; and
6.7 	(2) requests by individuals or lead agencies to update a rate whenever there is a change 
6.8 	in an individual's service needs, with accompanying documentation.
6.9 	(e) Lead agencies shall review and approve all services reflecting each individual's needs, 
6.10 	and the values to calculate the final payment rate for services with variables under 
6.11 	subdivisions 6, 7, 8, and 9 to 9a for each individual. Lead agencies must notify the individual 
6.12 	and the service provider of the final agreed-upon values and rate, and provide information 
6.13 	that is identical to what was entered into the rates management system. If a value used was 
6.14 	mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead 
6.15 	agencies to correct it. Lead agencies must respond to these requests. When responding to 
6.16 	the request, the lead agency must consider:
6.17 	(1) meeting the health and welfare needs of the individual or individuals receiving 
6.18 	services by service site, identified in their coordinated service and support plan under section 
6.19 	245D.02, subdivision 4b, and any addendum under section 245D.02, subdivision 4c;
6.20 	(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and 
6.21 	(o); and meeting or exceeding the licensing standards for staffing required under section 
6.22 	245D.09, subdivision 1; and
6.23 	(3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and 
6.24 	meeting or exceeding the licensing standards for staffing required under section 245D.31.
6.25 		Subd. 5.Base wage index and standard component values; establishment and 
6.26 	updates. (a) The base wage index is established to determine staffing costs associated with 
6.27 	providing services to individuals receiving home and community-based services. For purposes 
6.28 	of developing and calculating the proposed base wage, Minnesota-specific wages taken 
6.29 	from job descriptions and standard occupational classification (SOC) codes from the Bureau 
6.30 	of Labor Statistics as defined in the most recent edition of the Occupational Handbook must 
6.31 	be used.
7.1 	(b) The commissioner shall update the base wage index in subdivision 5a, publish these 
7.2 	updated values, and load them into the rate management system as follows:
7.3 	(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics 
7.4 	available as of December 31, 2019;
7.5 	(2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics 
7.6 	available as of December 31, 2021; and
7.7 	(3) on July 1, 2026, and every two years thereafter, based on wage data by SOC from 
7.8 	the Bureau of Labor Statistics available 30 months and one day prior to the scheduled update.
7.9 		Subd. 5a.Base wage index; calculations. The base wage index must be calculated as 
7.10 	follows:
7.11 	(1) for supervisory staff, 100 percent of the median wage for community and social 
7.12 	services specialist (SOC code 21-1099), with the exception of the supervisor of positive 
7.13 	supports professional, positive supports analyst, and positive supports specialist, which is 
7.14 	100 percent of the median wage for clinical counseling and school psychologist (SOC code 
7.15 	19-3031);
7.16 	(2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC 
7.17 	code 29-1141);
7.18 	(3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical 
7.19 	nurses (SOC code 29-2061);
7.20 	(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large 
7.21 	employers, with the exception of asleep-overnight staff for family residential services, which 
7.22 	is 36 percent of the minimum wage in Minnesota for large employers;
7.23 	(1) (5) for residential direct care staff, the sum of:
7.24 	(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home 
7.25 	health and personal care aide (SOC code 39-9021 31-1120); 30 percent of the median wage 
7.26 	for nursing assistant (SOC code 31-1014 31-1131); and 20 percent of the median wage for 
7.27 	social and human services aide (SOC code 21-1093); and
7.28 	(ii) 85 percent of the subtotal of 20 40 percent of the median wage for home health and 
7.29 	personal care aide (SOC code 31-1011 31-1120); 20 percent of the median wage for personal 
7.30 	and home health aide (SOC code 39-9021); 20 percent of the median wage for nursing 
7.31 	assistant (SOC code 31-1014); 20 percent of the median wage for psychiatric technician 
8.1 	(SOC code 29-2053); and 20 percent of the median wage for social and human services 
8.2 	aide (SOC code 21-1093);
8.3 	(2) (6) for adult day services, 70 percent of the median wage for nursing assistant (SOC 
8.4 	code 31-1014 31-1131); and 30 percent of the median wage for home health and personal 
8.5 	care aide (SOC code 39-9021 31-1120);
8.6 	(3) (7) for day services, day support services, and prevocational services, 20 percent of 
8.7 	the median wage for nursing assistant (SOC code 31-1014 31-1131); 20 percent of the 
8.8 	median wage for psychiatric technician (SOC code 29-2053); and 60 percent of the median 
8.9 	wage for social and human services aide (SOC code 21-1093);
8.10 	(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota 
8.11 	for large employers, except in a family foster care setting, the wage is 36 percent of the 
8.12 	minimum wage in Minnesota for large employers;
8.13 	(5) (8) for positive supports analyst staff, 100 percent of the median wage for substance 
8.14 	abuse, behavioral disorder, and mental health counselors counselor (SOC code 21-1014
8.15 	21-1018);
8.16 	(6) (9) for positive supports professional staff, 100 percent of the median wage for 
8.17 	clinical counseling and school psychologist (SOC code 19-3031);
8.18 	(7) (10) for positive supports specialist staff, 100 percent of the median wage for 
8.19 	psychiatric technicians (SOC code 29-2053);
8.20 	(8) for supportive living services staff, 20 percent of the median wage for nursing assistant 
8.21 	(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code 
8.22 	29-2053); and 60 percent of the median wage for social and human services aide (SOC code 
8.23 	21-1093);
8.24 	(9) for housing access coordination staff, 100 percent of the median wage for community 
8.25 	and social services specialist (SOC code 21-1099);
8.26 	(10) (11) for in-home family support and individualized home supports with family 
8.27 	training staff, 20 percent of the median wage for nursing aide (SOC code 31-1012 31-1131); 
8.28 	30 percent of the median wage for community social service specialist (SOC code 21-1099); 
8.29 	40 percent of the median wage for social and human services aide (SOC code 21-1093); 
8.30 	and ten percent of the median wage for psychiatric technician (SOC code 29-2053);
8.31 	(11) (12) for individualized home supports with training services staff, 40 percent of the 
8.32 	median wage for community social service specialist (SOC code 21-1099); 50 percent of 
9.1 	the median wage for social and human services aide (SOC code 21-1093); and ten percent 
9.2 	of the median wage for psychiatric technician (SOC code 29-2053);
9.3 	(12) for independent living skills staff, 40 percent of the median wage for community 
9.4 	social service specialist (SOC code 21-1099); 50 percent of the median wage for social and 
9.5 	human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric 
9.6 	technician (SOC code 29-2053);
9.7 	(13) for employment support services staff, 50 percent of the median wage for 
9.8 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
9.9 	community and social services specialist (SOC code 21-1099);
9.10 	(14) for employment exploration services staff, 50 percent of the median wage for 
9.11 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
9.12 	community and social services specialist (SOC code 21-1099);
9.13 	(15) for employment development services staff, 50 percent of the median wage for 
9.14 	education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent 
9.15 	of the median wage for community and social services specialist (SOC code 21-1099);
9.16 	(16) for individualized home support without training staff, 50 percent of the median 
9.17 	wage for personal and home health and personal care aide (SOC code 39-9021 31-1120); 
9.18 	and 50 percent of the median wage for nursing assistant (SOC code 31-1014 31-1131);
9.19 	(17) for adult companion staff, 50 percent of the median wage for personal and home 
9.20 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant 
9.21 	(SOC code 31-1014);
9.22 	(18) (17) for night supervision staff, 20 40 percent of the median wage for home health
9.23 	and personal care aide (SOC code 31-1011 31-1120); 20 percent of the median wage for 
9.24 	personal and home health aide (SOC code 39-9021); 20 percent of the median wage for 
9.25 	nursing assistant (SOC code 31-1014 31-1131); 20 percent of the median wage for psychiatric 
9.26 	technician (SOC code 29-2053); and 20 percent of the median wage for social and human 
9.27 	services aide (SOC code 21-1093); and
9.28 	(19) (18) for respite staff, 50 percent of the median wage for personal and home health 
9.29 	and personal care aide (SOC code 39-9021 31-1131); and 50 percent of the median wage 
9.30 	for nursing assistant (SOC code 31-1014);.
9.31 	(20) for personal support staff, 50 percent of the median wage for personal and home 
9.32 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant 
9.33 	(SOC code 31-1014);
10.1 	(21) for supervisory staff, 100 percent of the median wage for community and social 
10.2 	services specialist (SOC code 21-1099), with the exception of the supervisor of positive 
10.3 	supports professional, positive supports analyst, and positive supports specialists, which is 
10.4 	100 percent of the median wage for clinical counseling and school psychologist (SOC code 
10.5 	19-3031);
10.6 	(22) for registered nurse staff, 100 percent of the median wage for registered nurses 
10.7 	(SOC code 29-1141); and
10.8 	(23) for licensed practical nurse staff, 100 percent of the median wage for licensed 
10.9 	practical nurses (SOC code 29-2061).
10.10 	(b) Component values for corporate foster care services, corporate supportive living 
10.11 	services daily, community residential services, and integrated community support services 
10.12 	are:
10.13 	(1) competitive workforce factor: 4.7 percent;
10.14 	(2) supervisory span of control ratio: 11 percent;
10.15 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
10.16 	(4) employee-related cost ratio: 23.6 percent;
10.17 	(5) general administrative support ratio: 13.25 percent;
10.18 	(6) program-related expense ratio: 1.3 percent; and
10.19 	(7) absence and utilization factor ratio: 3.9 percent.
10.20 	(c) Component values for family foster care are:
10.21 	(1) competitive workforce factor: 4.7 percent;
10.22 	(2) supervisory span of control ratio: 11 percent;
10.23 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
10.24 	(4) employee-related cost ratio: 23.6 percent;
10.25 	(5) general administrative support ratio: 3.3 percent;
10.26 	(6) program-related expense ratio: 1.3 percent; and
10.27 	(7) absence factor: 1.7 percent.
10.28 	(d) Component values for day training and habilitation, day support services, and 
10.29 	prevocational services are:
11.1 	(1) competitive workforce factor: 4.7 percent;
11.2 	(2) supervisory span of control ratio: 11 percent;
11.3 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.4 	(4) employee-related cost ratio: 23.6 percent;
11.5 	(5) program plan support ratio: 5.6 percent;
11.6 	(6) client programming and support ratio: ten percent;
11.7 	(7) general administrative support ratio: 13.25 percent;
11.8 	(8) program-related expense ratio: 1.8 percent; and
11.9 	(9) absence and utilization factor ratio: 9.4 percent.
11.10 	(e) Component values for adult day services are:
11.11 	(1) competitive workforce factor: 4.7 percent;
11.12 	(2) supervisory span of control ratio: 11 percent;
11.13 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.14 	(4) employee-related cost ratio: 23.6 percent;
11.15 	(5) program plan support ratio: 5.6 percent;
11.16 	(6) client programming and support ratio: 7.4 percent;
11.17 	(7) general administrative support ratio: 13.25 percent;
11.18 	(8) program-related expense ratio: 1.8 percent; and
11.19 	(9) absence and utilization factor ratio: 9.4 percent.
11.20 	(f) Component values for unit-based services with programming are:
11.21 	(1) competitive workforce factor: 4.7 percent;
11.22 	(2) supervisory span of control ratio: 11 percent;
11.23 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.24 	(4) employee-related cost ratio: 23.6 percent;
11.25 	(5) program plan supports ratio: 15.5 percent;
11.26 	(6) client programming and supports ratio: 4.7 percent;
11.27 	(7) general administrative support ratio: 13.25 percent;
12.1 	(8) program-related expense ratio: 6.1 percent; and
12.2 	(9) absence and utilization factor ratio: 3.9 percent.
12.3 	(g) Component values for unit-based services without programming except respite are:
12.4 	(1) competitive workforce factor: 4.7 percent;
12.5 	(2) supervisory span of control ratio: 11 percent;
12.6 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.7 	(4) employee-related cost ratio: 23.6 percent;
12.8 	(5) program plan support ratio: 7.0 percent;
12.9 	(6) client programming and support ratio: 2.3 percent;
12.10 	(7) general administrative support ratio: 13.25 percent;
12.11 	(8) program-related expense ratio: 2.9 percent; and
12.12 	(9) absence and utilization factor ratio: 3.9 percent.
12.13 	(h) Component values for unit-based services without programming for respite are:
12.14 	(1) competitive workforce factor: 4.7 percent;
12.15 	(2) supervisory span of control ratio: 11 percent;
12.16 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.17 	(4) employee-related cost ratio: 23.6 percent;
12.18 	(5) general administrative support ratio: 13.25 percent;
12.19 	(6) program-related expense ratio: 2.9 percent; and
12.20 	(7) absence and utilization factor ratio: 3.9 percent.
12.21 	(i) The commissioner shall update the base wage index in paragraph (a), publish these 
12.22 	updated values, and load them into the rate management system as follows:
12.23 	(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics 
12.24 	available as of December 31, 2019;
12.25 	(2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics 
12.26 	available as of December 31, 2021; and
12.27 	(3) on July 1, 2026, and every two years thereafter, based on wage data by SOC from 
12.28 	the Bureau of Labor Statistics available 30 months and one day prior to the scheduled update.
13.1 	(j) Beginning February 1, 2021, and every two years thereafter, the commissioner shall 
13.2 	report to the chairs and ranking minority members of the legislative committees and divisions 
13.3 	with jurisdiction over health and human services policy and finance an analysis of the 
13.4 	competitive workforce factor. The report must include recommendations to update the 
13.5 	competitive workforce factor using:
13.6 	(1) the most recently available wage data by SOC code for the weighted average wage 
13.7 	for direct care staff for residential services and direct care staff for day services;
13.8 	(2) the most recently available wage data by SOC code of the weighted average wage 
13.9 	of comparable occupations; and
13.10 	(3) workforce data as required under subdivision 10a, paragraph (g).
13.11 	The commissioner shall not recommend an increase or decrease of the competitive workforce 
13.12 	factor from the current value by more than two percentage points. If, after a biennial analysis 
13.13 	for the next report, the competitive workforce factor is less than or equal to zero, the 
13.14 	commissioner shall recommend a competitive workforce factor of zero.
13.15 		Subd. 5b.Standard component value adjustments. (k) The commissioner shall update 
13.16 	the framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph 
13.17 	(f), clause (6); and paragraph (g), clause (6); subdivision 6, paragraphs (b), clauses (9) and 
13.18 	(10), and (e), clause (10); and subdivision 7, clauses (11), (17), and (18), client and 
13.19 	programming support, transportation, and program facility cost component values as required 
13.20 	in subdivisions 6 to 9a for changes in the Consumer Price Index. The commissioner shall 
13.21 	adjust these values higher or lower, publish these updated values, and load them into the 
13.22 	rate management system as follows:
13.23 	(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the 
13.24 	previous update to the data available on December 31, 2019;
13.25 	(2) on November 1, 2024, by the percentage change in the CPI-U from the date of the 
13.26 	previous update to the data available as of December 31, 2021; and
13.27 	(3) on July 1, 2026, and every two years thereafter, by the percentage change in the 
13.28 	CPI-U from the date of the previous update to the data available 30 months and one day 
13.29 	prior to the scheduled update.
13.30 		Subd. 5c.Removal of after-framework adjustments. (l) Upon the implementation of 
13.31 	the updates under paragraphs (i) and (k), rate adjustments authorized under section 256B.439, 
13.32 	subdivision 7; Laws 2013, chapter 108, article 7, section 60; and Laws 2014, chapter 312, 
13.33 	article 27, section 75, shall be removed from service rates calculated under this section.
14.1 	(m) Any rate adjustments applied to the service rates calculated under this section outside 
14.2 	of the cost components and rate methodology specified in this section shall be removed 
14.3 	from rate calculations upon implementation of the updates under paragraphs (i) and (k)
14.4 	subdivisions 5 and 5b.
14.5 		Subd. 5d.Unavailable data for updates and adjustments. (n) In this subdivision, If 
14.6 	Bureau of Labor Statistics occupational codes or Consumer Price Index items specified in 
14.7 	subdivisions 5 or 5b are unavailable in the future, the commissioner shall recommend to 
14.8 	the legislature codes or items to update and replace missing component values.
14.9 		Subd. 5e.Inflationary update spending requirement. (o) (a) At least 80 percent of 
14.10 	the marginal increase in revenue from the rate adjustment applied to the service rates 
14.11 	calculated under this section in paragraphs (i) and (k) subdivisions 5 and 5b beginning on 
14.12 	January 1, 2022, for services rendered between January 1, 2022, and March 31, 2024, must 
14.13 	be used to increase compensation-related costs for employees directly employed by the 
14.14 	program on or after January 1, 2022.
14.15 	(b) For the purposes of this paragraph subdivision, compensation-related costs include:
14.16 	(1) wages and salaries;
14.17 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
14.18 	taxes, workers' compensation, and mileage reimbursement;
14.19 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
14.20 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
14.21 	employee retirement accounts; and
14.22 	(4) benefits that address direct support professional workforce needs above and beyond 
14.23 	what employees were offered prior to January 1, 2022, including retention and recruitment 
14.24 	bonuses and tuition reimbursement.
14.25 	(c) Compensation-related costs for persons employed in the central office of a corporation 
14.26 	or entity that has an ownership interest in the provider or exercises control over the provider, 
14.27 	or for persons paid by the provider under a management contract, do not count toward the 
14.28 	80 percent requirement under this paragraph subdivision.
14.29 	(d) A provider agency or individual provider that receives a rate subject to the 
14.30 	requirements of this paragraph subdivision shall prepare, and upon request submit to the 
14.31 	commissioner, a distribution plan that specifies the amount of money the provider expects 
14.32 	to receive that is subject to the requirements of this paragraph subdivision, including how 
14.33 	that money was or will be distributed to increase compensation-related costs for employees. 
15.1 	Within 60 days of final implementation of a rate adjustment subject to the requirements of 
15.2 	this paragraph subdivision, the provider must post the distribution plan and leave it posted 
15.3 	for a period of at least six months in an area of the provider's operation to which all direct 
15.4 	support professionals have access.
15.5 	(e) This subdivision expires June 30, 2024.
15.6 		Subd. 6.Payments for Residential support services; generally. (a) For purposes of 
15.7 	this subdivision section, residential support services includes 24-hour customized living 
15.8 	services, community residential services, customized living services, family residential 
15.9 	services, foster care services, and integrated community supports, and supportive living 
15.10 	services daily.
15.11 	(b) A unit of service for residential support services is a day. Any portion of any calendar 
15.12 	day, within allowable Medicaid rules, where an individual spends time in a residential setting 
15.13 	is billable as a day. The number of days authorized for all individuals enrolling in residential 
15.14 	support services must include every day that services start and end.
15.15 	(c) When the available shared staffing hours in a residential setting are insufficient to 
15.16 	meet the needs of an individual who enrolled in residential support services after January 
15.17 	1, 2014, then individual staffing hours shall be used.
15.18 		Subd. 6a.Community residential services; component values and calculation of 
15.19 	payment rates. (a) Component values for community residential services are:
15.20 	(1) competitive workforce factor: 4.7 percent;
15.21 	(2) supervisory span of control ratio: 11 percent;
15.22 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
15.23 	(4) employee-related cost ratio: 23.6 percent;
15.24 	(5) general administrative support ratio: 13.25 percent;
15.25 	(6) program-related expense ratio: 1.3 percent; and
15.26 	(7) absence and utilization factor ratio: 3.9 percent.
15.27 	(b) Payments for community residential services, corporate foster care services, corporate 
15.28 	supportive living services daily, family residential services, and family foster care services
15.29 	must be calculated as follows:
15.30 	(1) determine the number of shared direct staffing and individual direct staff staffing
15.31 	hours to meet a recipient's needs provided on site or through monitoring technology;
16.1 	(2) personnel determine the appropriate hourly staff wage rate must be based on the 
16.2 	2009 Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner 
16.3 	as provided in subdivision 5 subdivisions 5 and 5a;
16.4 	(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) subdivision 5a, 
16.5 	clauses (1) to (4), multiply the result of clause (2) by the product of one plus the competitive 
16.6 	workforce factor in subdivision 5, paragraph (b), clause (1);
16.7 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
16.8 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
16.9 	to the result of clause (3);
16.10 	(5) multiply the number of shared direct staffing and individual direct staff staffing hours 
16.11 	provided on site or through monitoring technology and nursing hours by the appropriate 
16.12 	staff wages;
16.13 	(6) multiply the number of shared direct staffing and individual direct staff staffing hours 
16.14 	provided on site or through monitoring technology and nursing hours by the product of the 
16.15 	supervision span of control ratio in subdivision 5, paragraph (b), clause (2), and the 
16.16 	appropriate supervision supervisory staff wage in subdivision 5, paragraph (a), clause (21)
16.17 	5a, clause (1);
16.18 	(7) combine the results of clauses (5) and (6), excluding any shared direct staffing and 
16.19 	individual direct staff staffing hours provided through monitoring technology, and multiply 
16.20 	the result by one plus the employee vacation, sick, and training allowance ratio in subdivision 
16.21 	5, paragraph (b), clause (3). This is defined as the direct staffing cost;
16.22 	(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared 
16.23 	direct staffing and individual direct staff hours provided through monitoring technology, 
16.24 	by one plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (4);
16.25 	(9) for client programming and supports, the commissioner shall add $2,179 $2,260.21 
16.26 	divided by 365. The commissioner shall update the amount in this clause as specified in 
16.27 	subdivision 5b; and
16.28 	(10) for transportation, if provided, the commissioner shall add $1,680 $1,742.62 divided 
16.29 	by 365, or $3,000 $3,111.81 divided by 365 if customized for adapted transport, based on 
16.30 	the resident with the highest assessed need. The commissioner shall update the amounts in 
16.31 	this clause as specified in subdivision 5b;
16.32 	(c) The total rate must be calculated using the following steps:
17.1 	(1) (11) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any 
17.2 	shared direct staffing and individual direct staffstaffing hours provided through monitoring 
17.3 	technology that was excluded in clause (8);
17.4 	(2) (12) sum the standard general and administrative rate support ratio, the 
17.5 	program-related expense ratio, and the absence and utilization factor ratio;
17.6 	(3) (13) divide the result of clause (1) (11) by one minus the result of clause (2) (12). 
17.7 	This is the total payment amount; and
17.8 	(4) (14) adjust the result of clause (3) (13) by a factor to be determined by the 
17.9 	commissioner to adjust for regional differences in the cost of providing services.
17.10 	(d) The payment methodology for customized living and 24-hour customized living 
17.11 	must be the customized living tool. The commissioner shall revise the customized living 
17.12 	tool to reflect the services and activities unique to disability-related recipient needs, and 
17.13 	adjust for regional differences in the cost of providing services.
17.14 	The rate adjustments described in section 256S.205 do not apply to rates paid under this 
17.15 	section.
17.16 	Customized living and 24-hour customized living rates determined under this section 
17.17 	shall not include more than 24 hours of support in a daily unit.
17.18 	The commissioner shall establish the following acuity-based customized living tool 
17.19 	input limits, based on case mix, for customized living and 24-hour customized living rates 
17.20 	determined under this section:
17.21 	(1) no more than two hours of mental health management per day for people assessed 
17.22 	for case mixes A, D, and G;
17.23 	(2) no more than four hours of activities of daily living assistance per day for people 
17.24 	assessed for case mix B; and
17.25 	(3) no more than six hours of activities of daily living assistance per day for people 
17.26 	assessed for case mix D.
17.27 		Subd. 6b.Family residential services; component values and calculation of payment 
17.28 	rates. (a) Component values for family residential services are:
17.29 	(1) competitive workforce factor: 4.7 percent;
17.30 	(2) supervisory span of control ratio: 11 percent;
17.31 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
18.1 	(4) employee-related cost ratio: 23.6 percent;
18.2 	(5) general administrative support ratio: 3.3 percent;
18.3 	(6) program-related expense ratio: 1.3 percent; and
18.4 	(7) absence factor: 1.7 percent.
18.5 	(b) Payments for family residential services must be calculated as follows:
18.6 	(1) determine the number of shared direct staffing and individual direct staffing hours 
18.7 	to meet a recipient's needs provided on site or through monitoring technology;
18.8 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
18.9 	provided in subdivisions 5 and 5a;
18.10 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
18.11 	product of one plus the competitive workforce factor;
18.12 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
18.13 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
18.14 	to the result of clause (3);
18.15 	(5) multiply the number of shared direct staffing and individual direct staffing hours 
18.16 	provided on site or through monitoring technology and nursing hours by the appropriate 
18.17 	staff wages;
18.18 	(6) multiply the number of shared direct staffing and individual direct staffing hours 
18.19 	provided on site or through monitoring technology and nursing hours by the product of the 
18.20 	supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 
18.21 	5a, clause (1);
18.22 	(7) combine the results of clauses (5) and (6), excluding any shared direct staffing and 
18.23 	individual direct staffing hours provided through monitoring technology, and multiply the 
18.24 	result by one plus the employee vacation, sick, and training allowance ratio. This is defined 
18.25 	as the direct staffing cost;
18.26 	(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared 
18.27 	and individual direct staffing hours provided through monitoring technology, by one plus 
18.28 	the employee-related cost ratio;
18.29 	(9) for client programming and supports, add $2,260.21 divided by 365. The 
18.30 	commissioner shall update the amount in this clause as specified in subdivision 5b;
19.1 	(10) for transportation, if provided, add $1,742.62 divided by 365, or $3,111.81 divided 
19.2 	by 365 if customized for adapted transport, based on the resident with the highest assessed 
19.3 	need. The commissioner shall update the amounts in this clause as specified in subdivision 
19.4 	5b;
19.5 	(11) subtotal clauses (8) to (10) and the direct staffing cost of any shared direct staffing 
19.6 	and individual direct staffing hours provided through monitoring technology that was 
19.7 	excluded in clause (8);
19.8 	(12) sum the standard general administrative support ratio, the program-related expense 
19.9 	ratio, and the absence and utilization factor ratio;
19.10 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
19.11 	total payment rate; and
19.12 	(14) adjust the result of clause (13) by a factor to be determined by the commissioner 
19.13 	to adjust for regional differences in the cost of providing services.
19.14 		Subd. 6c.Integrated community supports; component values and calculation of 
19.15 	payment rates.  (e) (a) Component values for integrated community supports are:
19.16 	(1) competitive workforce factor: 4.7 percent;
19.17 	(2) supervisory span of control ratio: 11 percent;
19.18 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
19.19 	(4) employee-related cost ratio: 23.6 percent;
19.20 	(5) general administrative support ratio: 13.25 percent;
19.21 	(6) program-related expense ratio: 1.3 percent; and
19.22 	(7) absence and utilization factor ratio: 3.9 percent.
19.23 	(b) Payments for integrated community support services supports must be calculated as 
19.24 	follows:
19.25 	(1) determine the number of shared direct staffing and individual direct staffing hours 
19.26 	to meet a recipient's needs. The base shared direct staffing hours must be eight hours divided 
19.27 	by the number of people receiving support in the integrated community support setting; (2), 
19.28 	and the individual direct staffing hours must be the average number of direct support hours 
19.29 	provided directly to the service recipient;
20.1 	(3) the personnel (2) determine the appropriate hourly staff wage rate must be based on 
20.2 	the most recent Bureau of Labor Statistics Minnesota-specific rates or rates derived by the 
20.3 	commissioner as provided in subdivision 5 subdivisions 5 and 5a;
20.4 	(4) (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) 5a, clauses 
20.5 	(1) to (4), multiply the result of clause (3) (2) by the product of one plus the competitive 
20.6 	workforce factor in subdivision 5, paragraph (b), clause (1);
20.7 	(5) (4) for a recipient requiring customization for deaf and hard-of-hearing language 
20.8 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
20.9 	to the result of clause (4) (3);
20.10 	(6) (5) multiply the number of shared direct staffing and individual direct staff staffing
20.11 	hours in clauses (1) and (2) clause (1) by the appropriate staff wages;
20.12 	(7) (6) multiply the number of shared direct staffing and individual direct staff staffing
20.13 	hours in clauses (1) and (2) clause (1) by the product of the supervisory span of control ratio 
20.14 	in subdivision 5, paragraph (b), clause (2), and the appropriate supervisory staff wage in 
20.15 	subdivision 5, paragraph (a), clause (21) 5a, clause (1);
20.16 	(8) (7) combine the results of clauses (6) (5) and (7) (6) and multiply the result by one 
20.17 	plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph 
20.18 	(b), clause (3). This is defined as the direct staffing cost;
20.19 	(9) (8) for employee-related expenses, multiply the direct staffing cost by one plus the 
20.20 	employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
20.21 	(10) (9) for client programming and supports, the commissioner shall add $2,260.21 
20.22 	divided by 365. The commissioner shall update the amount in this clause as specified in 
20.23 	subdivision 5b;
20.24 	(f) The total rate must be calculated as follows:
20.25 	(1) (10) add the results of paragraph (e), clauses (9) (8) and (10) (9);
20.26 	(2) (11) add the standard general and administrative rate support ratio, the program-related 
20.27 	expense ratio, and the absence and utilization factor ratio;
20.28 	(3) (12) divide the result of clause (1) (10) by one minus the result of clause (2) (11). 
20.29 	This is the total payment amount; and
20.30 	(4) (13) adjust the result of clause (3) (12) by a factor to be determined by the 
20.31 	commissioner to adjust for regional differences in the cost of providing services.
21.1 	(g) The number of days authorized for all individuals enrolling in residential services 
21.2 	must include every day that services start and end.
21.3 		Subd. 6d.Payment for customized living. (a) The payment methodology for customized 
21.4 	living and 24-hour customized living must be the customized living tool. The commissioner 
21.5 	shall revise the customized living tool to reflect the services and activities unique to 
21.6 	disability-related recipient needs and adjust for regional differences in the cost of providing 
21.7 	services.
21.8 	(b) The rate adjustments described in section 256S.205 do not apply to rates paid under 
21.9 	this section.
21.10 	(c) Customized living and 24-hour customized living rates determined under this section 
21.11 	shall not include more than 24 hours of support in a daily unit.
21.12 	(d) The commissioner shall establish the following acuity-based customized living tool 
21.13 	input limits, based on case mix, for customized living and 24-hour customized living rates 
21.14 	determined under this section:
21.15 	(1) no more than two hours of mental health management per day for people assessed 
21.16 	for case mixes A, D, and G;
21.17 	(2) no more than four hours of activities of daily living assistance per day for people 
21.18 	assessed for case mix B; and
21.19 	(3) no more than six hours of activities of daily living assistance per day for people 
21.20 	assessed for case mix D.
21.21 		Subd. 7.Payments for Day programs; generally. Payments for services with (a) For 
21.22 	the purposes of this section, day programs including include adult day services, day treatment 
21.23 	and habilitation, day support services, and prevocational services, and structured day services 
21.24 	must be calculated as follows:.
21.25 	(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
21.26 	(i) (b) The staffing ratios for the units of service provided by a day program to a recipient 
21.27 	in a typical week must be averaged to determine an individual's staffing ratio; and.
21.28 	(ii) (c) The commissioner, in consultation with service providers, shall develop a uniform 
21.29 	staffing ratio worksheet to be used by day programs to determine staffing ratios under this 
21.30 	subdivision; for day programs.
21.31 		Subd. 7a.Adult day services; component values and calculation of payment rates. (a) 
21.32 	Component values for adult day services are:
22.1 	(1) competitive workforce factor: 4.7 percent;
22.2 	(2) supervisory span of control ratio: 11 percent;
22.3 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
22.4 	(4) employee-related cost ratio: 23.6 percent;
22.5 	(5) program plan support ratio: 5.6 percent;
22.6 	(6) client programming and support ratio: 7.4 percent, updated as specified in subdivision 
22.7 	5b;
22.8 	(7) general administrative support ratio: 13.25 percent;
22.9 	(8) program-related expense ratio: 1.8 percent; and
22.10 	(9) absence and utilization factor ratio: 9.4 percent.
22.11 	(b) A unit of service for adult day services is either a day or 15 minutes. A day unit of 
22.12 	service is six or more hours of time spent providing direct service.
22.13 	(c) Payments for adult day services must be calculated as follows:
22.14 	(1) determine the number of units of service and the staffing ratio to meet a recipient's 
22.15 	needs;
22.16 	(2) personnel determine the appropriate hourly staff wage rates must be based on the 
22.17 	2009 Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner 
22.18 	as provided in subdivision 5 subdivisions 5 and 5a;
22.19 	(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) 5a, clauses (1) 
22.20 	to (4), multiply the result of clause (2) by the product of one plus the competitive workforce 
22.21 	factor in subdivision 5, paragraph (d), clause (1);
22.22 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
22.23 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
22.24 	to the result of clause (3);
22.25 	(5) multiply the number of day program direct staff staffing hours and nursing hours by 
22.26 	the appropriate staff wage;
22.27 	(6) multiply the number of day program direct staff staffing hours by the product of the 
22.28 	supervision supervisory span of control ratio in subdivision 5, paragraph (d), clause (2),
22.29 	and the appropriate supervision supervisory staff wage in subdivision 5, paragraph (a), 
22.30 	clause (21) 5a, clause (1);
23.1 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
23.2 	employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause 
23.3 	(3). This is defined as the direct staffing rate;
23.4 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
23.5 	plan support ratio in subdivision 5, paragraph (d), clause (5);
23.6 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
23.7 	employee-related cost ratio in subdivision 5, paragraph (d), clause (4);
23.8 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
23.9 	the client programming and support ratio in subdivision 5, paragraph (d), clause (6);
23.10 	(11) for program facility costs, add $19.30 per week with consideration of staffing ratios 
23.11 	to meet individual needs, updated as specified in subdivision 5b;
23.12 	(12) for adult day bath services, add $7.01 per 15 minute unit;
23.13 	(13) this is the subtotal rate;
23.14 	(14) sum the standard general and administrative rate support ratio, the program-related 
23.15 	expense ratio, and the absence and utilization factor ratio;
23.16 	(15) divide the result of clause (13) by one minus the result of clause (14). This is the 
23.17 	total payment amount; and
23.18 	(16) adjust the result of clause (15) by a factor to be determined by the commissioner 
23.19 	to adjust for regional differences in the cost of providing services;.
23.20 	(17) for transportation provided as part of day training and habilitation for an individual 
23.21 	who does not require a lift, add:
23.22 	(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without 
23.23 	a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a 
23.24 	vehicle with a lift;
23.25 	(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without 
23.26 	a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a 
23.27 	vehicle with a lift;
23.28 	(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without 
23.29 	a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a 
23.30 	vehicle with a lift; or
24.1 	(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift, 
24.2 	$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle 
24.3 	with a lift;
24.4 	(18) for transportation provided as part of day training and habilitation for an individual 
24.5 	who does require a lift, add:
24.6 	(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a 
24.7 	lift, and $15.05 for a shared ride in a vehicle with a lift;
24.8 	(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a 
24.9 	lift, and $28.16 for a shared ride in a vehicle with a lift;
24.10 	(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a 
24.11 	lift, and $58.76 for a shared ride in a vehicle with a lift; or
24.12 	(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift, 
24.13 	and $80.93 for a shared ride in a vehicle with a lift.
24.14 		Subd. 7b.Day support services; component values and calculation of payment 
24.15 	rates. (a) Component values for day support services are:
24.16 	(1) competitive workforce factor: 4.7 percent;
24.17 	(2) supervisory span of control ratio: 11 percent;
24.18 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
24.19 	(4) employee-related cost ratio: 23.6 percent;
24.20 	(5) program plan support ratio: 5.6 percent;
24.21 	(6) client programming and support ratio: 10.37 percent, updated as specified in 
24.22 	subdivision 5b;
24.23 	(7) general administrative support ratio: 13.25 percent;
24.24 	(8) program-related expense ratio: 1.8 percent; and
24.25 	(9) absence and utilization factor ratio: 9.4 percent.
24.26 	(b) A unit of service for day support services is 15 minutes.
24.27 	(c) Payments for day support services must be calculated as follows:
24.28 	(1) determine the number of units of service and the staffing ratio to meet a recipient's 
24.29 	needs;
25.1 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
25.2 	provided in subdivisions 5 and 5a;
25.3 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
25.4 	product of one plus the competitive workforce factor;
25.5 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
25.6 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
25.7 	to the result of clause (3);
25.8 	(5) multiply the number of day program direct staffing hours and nursing hours by the 
25.9 	appropriate staff wage;
25.10 	(6) multiply the number of day program direct staffing hours by the product of the 
25.11 	supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 
25.12 	5a, clause (1);
25.13 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
25.14 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
25.15 	rate;
25.16 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
25.17 	plan support ratio;
25.18 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
25.19 	employee-related cost ratio;
25.20 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
25.21 	the client programming and support ratio;
25.22 	(11) for program facility costs, add $19.30 per week with consideration of staffing ratios 
25.23 	to meet individual needs, updated as specified in subdivision 5b;
25.24 	(12) this is the subtotal rate;
25.25 	(13) sum the standard general administrative rate support ratio, the program-related 
25.26 	expense ratio, and the absence and utilization factor ratio;
25.27 	(14) divide the result of clause (12) by one minus the result of clause (13). This is the 
25.28 	total payment amount; and
25.29 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
25.30 	to adjust for regional differences in the cost of providing services.
26.1 		Subd. 7c.Prevocational services; component values and calculation of payment 
26.2 	rates. (a) Component values for prevocational services are:
26.3 	(1) competitive workforce factor: 4.7 percent;
26.4 	(2) supervisory span of control ratio: 11 percent;
26.5 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
26.6 	(4) employee-related cost ratio: 23.6 percent;
26.7 	(5) program plan support ratio: 5.6 percent;
26.8 	(6) client programming and support ratio: 10.37 percent, updated as specified in 
26.9 	subdivision 5b;
26.10 	(7) general administrative support ratio: 13.25 percent;
26.11 	(8) program-related expense ratio: 1.8 percent; and
26.12 	(9) absence and utilization factor ratio: 9.4 percent.
26.13 	(b) A unit of service for prevocational services is either a day or 15 minutes. A day unit 
26.14 	of service is six or more hours of time spent providing direct service.
26.15 	(c) Payments for prevocational services must be calculated as follows:
26.16 	(1) determine the number of units of service and the staffing ratio to meet a recipient's 
26.17 	needs;
26.18 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
26.19 	provided in subdivisions 5 and 5a;
26.20 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
26.21 	product of one plus the competitive workforce factor;
26.22 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
26.23 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
26.24 	to the result of clause (3);
26.25 	(5) multiply the number of day program direct staffing hours and nursing hours by the 
26.26 	appropriate staff wage;
26.27 	(6) multiply the number of day program direct staffing hours by the product of the 
26.28 	supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 
26.29 	5a, clause (1);
27.1 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
27.2 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
27.3 	rate;
27.4 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
27.5 	plan support ratio;
27.6 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
27.7 	employee-related cost ratio;
27.8 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
27.9 	the client programming and support ratio;
27.10 	(11) for program facility costs, add $19.30 per week with consideration of staffing ratios 
27.11 	to meet individual needs, updated as specified in subdivision 5b;
27.12 	(12) this is the subtotal rate;
27.13 	(13) sum the standard general administrative rate support ratio, the program-related 
27.14 	expense ratio, and the absence and utilization factor ratio;
27.15 	(14) divide the result of clause (12) by one minus the result of clause (13). This is the 
27.16 	total payment amount; and
27.17 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
27.18 	to adjust for regional differences in the cost of providing services.
27.19 		Subd. 8.Payments for Unit-based services with programming; component values 
27.20 	and calculation of payment rates. Payments for (a) For the purpose of this section,
27.21 	unit-based services with programming, including include employment exploration services, 
27.22 	employment development services, housing access coordination employment support 
27.23 	services, individualized home supports with family training, individualized home supports 
27.24 	with training, in-home family support, independent living skills training, and hourly supported 
27.25 	living positive support services provided to an individual outside of any service plan for a
27.26 	day program or residential support service plan.
27.27 	(b) Component values for unit-based services with programming are:
27.28 	(1) competitive workforce factor: 4.7 percent;
27.29 	(2) supervisory span of control ratio: 11 percent;
27.30 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
27.31 	(4) employee-related cost ratio: 23.6 percent;
28.1 	(5) program plan support ratio: 15.5 percent;
28.2 	(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision 
28.3 	5b;
28.4 	(7) general administrative support ratio: 13.25 percent;
28.5 	(8) program-related expense ratio: 6.1 percent; and
28.6 	(9) absence and utilization factor ratio: 3.9 percent.
28.7 	(c) A unit of service for unit-based services with programming is 15 minutes.
28.8 	(d) Payments for unit-based services with programming must be calculated as follows, 
28.9 	unless the services are authorized reimbursed separately under subdivision 6 or 7 as part of 
28.10 	a residential support services or day program payment rate:
28.11 	(1) determine the number of units of service to meet a recipient's needs;
28.12 	(2) personnel determine the appropriate hourly staff wage rate must be based on the 
28.13 	2009 Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner 
28.14 	as provided in subdivision 5 subdivisions 5 and 5a;
28.15 	(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) 5a, clauses (1) 
28.16 	to (4), multiply the result of clause (2) by the product of one plus the competitive workforce 
28.17 	factor in subdivision 5, paragraph (f), clause (1);
28.18 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
28.19 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
28.20 	to the result of clause (3);
28.21 	(5) multiply the number of direct staff staffing hours by the appropriate staff wage;
28.22 	(6) multiply the number of direct staff staffing hours by the product of the supervision
28.23 	supervisory span of control ratio in subdivision 5, paragraph (f), clause (2), and the 
28.24 	appropriate supervision supervisory staff wage in subdivision 5, paragraph (a), clause (21)
28.25 	5a, clause (1);
28.26 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
28.27 	employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause 
28.28 	(3). This is defined as the direct staffing rate;
28.29 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
28.30 	plan supports support ratio in subdivision 5, paragraph (f), clause (5);
29.1 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
29.2 	employee-related cost ratio in subdivision 5, paragraph (f), clause (4);
29.3 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
29.4 	the client programming and supports support ratio in subdivision 5, paragraph (f), clause 
29.5 	(6);
29.6 	(11) this is the subtotal rate;
29.7 	(12) sum the standard general and administrative rate support ratio, the program-related 
29.8 	expense ratio, and the absence and utilization factor ratio;
29.9 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
29.10 	total payment amount;
29.11 	(14) for services provided in a shared manner, divide the total payment in clause (13) 
29.12 	as follows:
29.13 	(i) for employment exploration services provided in a shared manner, divide the total 
29.14 	payment amount in clause (13) by the number of service recipients, not to exceed five.;
29.15 	(ii) for employment support services provided in a shared manner, divide the total 
29.16 	payment amount in clause (13) by the number of service recipients, not to exceed six.; and
29.17 	(iii) for independent living skills training, individualized home supports with training,
29.18 	and individualized home supports with family training provided in a shared manner, divide 
29.19 	the total payment amount in clause (13) by the number of service recipients, not to exceed 
29.20 	two; and
29.21 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
29.22 	to adjust for regional differences in the cost of providing services.
29.23 		Subd. 9.Payments for Unit-based services without programming; component values 
29.24 	and calculation of payment rates. Payments for(a) For the purposes of this subdivision, 
29.25 	unit-based services without programming, including include individualized home supports,
29.26 	without training and night supervision, personal support, respite, and companion care
29.27 	provided to an individual outside of any service plan for a day program or residential support
29.28 	service plan. Unit-based services without programming do not include respite.
29.29 	(b) Component values for unit-based services without programming are:
29.30 	(1) competitive workforce factor: 4.7 percent;
29.31 	(2) supervisory span of control ratio: 11 percent;
30.1 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
30.2 	(4) employee-related cost ratio: 23.6 percent;
30.3 	(5) program plan support ratio: 7.0 percent;
30.4 	(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision 
30.5 	5b;
30.6 	(7) general administrative support ratio: 13.25 percent;
30.7 	(8) program-related expense ratio: 2.9 percent; and
30.8 	(9) absence and utilization factor ratio: 3.9 percent.
30.9 	(c) A unit of service for unit-based services without programming is 15 minutes.
30.10 	(d) Payments for unit-based services without programming must be calculated as follows 
30.11 	unless the services are authorized reimbursed separately under subdivision 6 or 7 as part of 
30.12 	a residential support services or day program payment rate:
30.13 	(1) for all services except respite, determine the number of units of service to meet a 
30.14 	recipient's needs;
30.15 	(2) personnel determine the appropriate hourly staff wage rates must be based on the 
30.16 	2009 Bureau of Labor Statistics Minnesota-specific rate or rates derived by the commissioner 
30.17 	as provided in subdivision 5 subdivisions 5 to 5a;
30.18 	(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) 5a, clauses (1) 
30.19 	to (4), multiply the result of clause (2) by the product of one plus the competitive workforce 
30.20 	factor in subdivision 5, paragraph (g), clause (1);
30.21 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
30.22 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
30.23 	to the result of clause (3);
30.24 	(5) multiply the number of direct staff staffing hours by the appropriate staff wage;
30.25 	(6) multiply the number of direct staff staffing hours by the product of the supervision
30.26 	supervisory span of control ratio in subdivision 5, paragraph (g), clause (2), and the 
30.27 	appropriate supervision supervisory staff wage in subdivision 5, paragraph (a), clause (21)
30.28 	5a, clause (1);
30.29 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
30.30 	employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g), clause 
30.31 	(3). This is defined as the direct staffing rate;
31.1 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
31.2 	plan support ratio in subdivision 5, paragraph (g), clause (5);
31.3 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
31.4 	employee-related cost ratio in subdivision 5, paragraph (g), clause (4);
31.5 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
31.6 	the client programming and support ratio in subdivision 5, paragraph (g), clause (6);
31.7 	(11) this is the subtotal rate;
31.8 	(12) sum the standard general and administrative rate support ratio, the program-related 
31.9 	expense ratio, and the absence and utilization factor ratio;
31.10 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
31.11 	total payment amount;
31.12 	(14) for individualized home supports without training provided in a shared manner, 
31.13 	divide the total payment amount in clause (13) by the number of service recipients, not to 
31.14 	exceed two; and
31.15 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
31.16 	to adjust for region differences in the cost of providing services.
31.17 		Subd. 9a.Respite services; component values and calculation of payment rates. (a) 
31.18 	For the purposes of this section, respite services include respite services provided to an 
31.19 	individual outside of any service plan for a day program or residential support service.
31.20 	(b) Component values for respite services are:
31.21 	(1) competitive workforce factor: 4.7 percent;
31.22 	(2) supervisory span of control ratio: 11 percent;
31.23 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
31.24 	(4) employee-related cost ratio: 23.6 percent;
31.25 	(5) general administrative support ratio: 13.25 percent;
31.26 	(6) program-related expense ratio: 2.9 percent; and
31.27 	(7) absence and utilization factor ratio: 3.9 percent.
31.28 	(c) A unit of service for respite services is 15 minutes.
31.29 	(d) Payments for respite services must be calculated as follows unless the service is 
31.30 	reimbursed separately as part of a residential support services or day program payment rate:
32.1 	(14) for respite services, (1) determine the number of day units of service to meet an 
32.2 	individual's needs;
32.3 	(15) personnel (2) determine the appropriate hourly staff wage rates must be based on 
32.4 	the 2009 Bureau of Labor Statistics Minnesota-specific rate or rates derived by the 
32.5 	commissioner as provided in subdivision 5 subdivisions 5 and 5a;
32.6 	(16) (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23) 5a, clauses 
32.7 	(1) to (4), multiply the result of clause (15) (2) by the product of one plus the competitive 
32.8 	workforce factor in subdivision 5, paragraph (h), clause (1);
32.9 	(17) (4) for a recipient requiring deaf and hard-of-hearing customization under subdivision 
32.10 	12, add the customization rate provided in subdivision 12 to the result of clause (16) (3);
32.11 	(18) (5) multiply the number of direct staff staffing hours by the appropriate staff wage;
32.12 	(19) (6) multiply the number of direct staff staffing hours by the product of the 
32.13 	supervisory span of control ratio in subdivision 5, paragraph (h), clause (2), and the 
32.14 	appropriate supervision supervisory staff wage in subdivision 5, paragraph (a), clause (21)
32.15 	5a, clause (1);
32.16 	(20) (7) combine the results of clauses (18) (5) and (19) (6), and multiply the result by 
32.17 	one plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph 
32.18 	(h), clause (3). This is defined as the direct staffing rate;
32.19 	(21) (8) for employee-related expenses, multiply the result of clause (20) (7) by one plus 
32.20 	the employee-related cost ratio in subdivision 5, paragraph (h), clause (4);
32.21 	(22) (9) this is the subtotal rate;
32.22 	(23) (10) sum the standard general and administrative rate support ratio, the 
32.23 	program-related expense ratio, and the absence and utilization factor ratio;
32.24 	(24) (11) divide the result of clause (22) (9) by one minus the result of clause (23) (10). 
32.25 	This is the total payment amount;
32.26 	(25) for individualized home supports provided in a shared manner, divide the total 
32.27 	payment amount in clause (13) by the number of service recipients, not to exceed two;
32.28 	(26) (12) for respite care services provided in a shared manner, divide the total payment 
32.29 	amount in clause (24) (11) by the number of service recipients, not to exceed three; and
32.30 	(27) (13) adjust the result of clauses (13), (25), and (26) clause (12) by a factor to be 
32.31 	determined by the commissioner to adjust for regional differences in the cost of providing 
32.32 	services.
33.1 		Subd. 10.Updating payment values and additional Evaluation of information and 
33.2 	data. (a) The commissioner shall, within available resources, conduct research and gather 
33.3 	data and information from existing state systems or other outside sources on the following 
33.4 	items:
33.5 	(1) differences in the underlying cost to provide services and care across the state; and
33.6 	(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and 
33.7 	units of transportation for all day services, which must be collected from providers using 
33.8 	the rate management worksheet and entered into the rates management system; and
33.9 	(3) the distinct underlying costs for services provided by a license holder under sections 
33.10 	245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided 
33.11 	by a license holder certified under section 245D.33.
33.12 	(b) No later than July 1, 2014, The commissioner, in consultation with stakeholders, 
33.13 	shall begin the review and evaluation of evaluate the following values already in subdivisions 
33.14 	6 to 9 9a, or issues that impact all services, including, but not limited to:
33.15 	(1) values for transportation rates;
33.16 	(2) values for services where monitoring technology replaces staff time;
33.17 	(3) values for indirect services;
33.18 	(4) values for nursing;
33.19 	(5) values for the facility use rate in day services, and the weightings used in the day 
33.20 	service ratios and adjustments to those weightings;
33.21 	(6) values for workers' compensation as part of employee-related expenses;
33.22 	(7) values for unemployment insurance as part of employee-related expenses;
33.23 	(8) direct care workforce labor market measures;
33.24 	(9) any changes in state or federal law with a direct impact on the underlying cost of 
33.25 	providing home and community-based services;
33.26 	(10) outcome measures, determined by the commissioner, for home and community-based 
33.27 	services rates determined under this section; and
33.28 	(11) different competitive workforce factors by service, as determined under subdivision 
33.29 	5, paragraph (j) 10b.
33.30 	(c) The commissioner shall report to the chairs and the ranking minority members of 
33.31 	the legislative committees and divisions with jurisdiction over health and human services 
34.1 	policy and finance with the information and data gathered under paragraphs (a) and (b) on 
34.2 	January 15, 2021, with a full report, and a full report once every four years thereafter.
34.3 	(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement 
34.4 	changes to the regional adjustment factors once every six years. Prior to implementation, 
34.5 	the commissioner shall consult with stakeholders on the methodology to calculate the 
34.6 	adjustment.
34.7 	(e) The commissioner shall provide a public notice via LISTSERV in October of each 
34.8 	year containing information detailing legislatively approved changes in:
34.9 	(1) calculation values including derived wage rates and related employee and 
34.10 	administrative factors;
34.11 	(2) service utilization;
34.12 	(3) county and tribal allocation changes; and
34.13 	(4) information on adjustments made to calculation values and the timing of those 
34.14 	adjustments.
34.15 	The information in this notice must be effective January 1 of the following year.
34.16 	(f) When the available shared staffing hours in a residential setting are insufficient to 
34.17 	meet the needs of an individual who enrolled in residential services after January 1, 2014, 
34.18 	then individual staffing hours shall be used.
34.19 	(g) The commissioner shall collect transportation and trip information for all day services 
34.20 	through the rates management system.
34.21 	(h) The commissioner, in consultation with stakeholders, shall study value-based models 
34.22 	and outcome-based payment strategies for fee-for-service home and community-based 
34.23 	services and report to the legislative committees with jurisdiction over the disability waiver 
34.24 	rate system by October 1, 2020, with recommended strategies to: (1) promote new models 
34.25 	of care, services, and reimbursement structures that require more efficient use of public 
34.26 	dollars while improving the outcomes most valued by the individuals served; (2) assist 
34.27 	clients and their families in evaluating options and stretching individual budget funds; (3) 
34.28 	support individualized, person-centered planning and individual budget choices; and (4) 
34.29 	create a broader range of client options geographically or targeted at culturally competent 
34.30 	models for racial and ethnic minority groups.
34.31 		Subd. 10a.Reporting and analysis of cost data. (a) The commissioner must ensure 
34.32 	that wage values and component values in subdivisions 5 to 9 9a reflect the cost to provide 
35.1 	the service. As determined by the commissioner, in consultation with stakeholders identified 
35.2 	in subdivision 17, a provider enrolled to provide services with rates determined under this 
35.3 	section must submit requested cost data to the commissioner to support research on the cost 
35.4 	of providing services that have rates determined by the disability waiver rates system. 
35.5 	Requested cost data may include, but is not limited to:
35.6 	(1) worker wage costs;
35.7 	(2) benefits paid;
35.8 	(3) supervisor wage costs;
35.9 	(4) executive wage costs;
35.10 	(5) vacation, sick, and training time paid;
35.11 	(6) taxes, workers' compensation, and unemployment insurance costs paid;
35.12 	(7) administrative costs paid;
35.13 	(8) program costs paid;
35.14 	(9) transportation costs paid;
35.15 	(10) vacancy rates; and
35.16 	(11) other data relating to costs required to provide services requested by the 
35.17 	commissioner.
35.18 	(b) At least once in any five-year period, a provider must submit cost data for a fiscal 
35.19 	year that ended not more than 18 months prior to the submission date. The commissioner 
35.20 	shall provide each provider a 90-day notice prior to its submission due date. If a provider 
35.21 	fails to submit required reporting data, the commissioner shall provide notice to providers 
35.22 	that have not provided required data 30 days after the required submission date, and a second 
35.23 	notice for providers who have not provided required data 60 days after the required 
35.24 	submission date. The commissioner shall temporarily suspend payments to the provider if 
35.25 	cost data is not received 90 days after the required submission date. Withheld payments 
35.26 	shall be made once data is received by the commissioner.
35.27 	(c) The commissioner shall conduct a random validation of data submitted under 
35.28 	paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation 
35.29 	in paragraph (a) and provide recommendations for adjustments to cost components.
35.30 	(d) The commissioner shall analyze cost documentation in data submitted under paragraph 
35.31 	(a) and, in consultation with stakeholders identified in subdivision 17, may submit 
36.1 	recommendations on component values and inflationary factor adjustments to the chairs 
36.2 	and ranking minority members of the legislative committees with jurisdiction over human 
36.3 	services once every four years beginning January 1, 2021. The commissioner shall make 
36.4 	recommendations in conjunction with reports submitted to the legislature according to 
36.5 	subdivision 10, paragraph (c).
36.6 	(e) The commissioner shall release cost data in an aggregate form, and cost data from 
36.7 	individual providers shall not be released except as provided for in current law.
36.8 	(e) (f) The commissioner, in consultation with stakeholders identified in subdivision 17, 
36.9 	shall develop and implement a process for providing training and technical assistance 
36.10 	necessary to support provider submission of cost documentation required under paragraph 
36.11 	(a).
36.12 	(f) By December 31, 2020, providers paid with rates calculated under subdivision 5, 
36.13 	paragraph (b), shall identify additional revenues from the competitive workforce factor and 
36.14 	prepare a written distribution plan for the revenues. A provider shall make the provider's 
36.15 	distribution plan available and accessible to all direct care staff for a minimum of one 
36.16 	calendar year. Upon request, a provider shall submit the written distribution plan to the 
36.17 	commissioner.
36.18 		Subd. 10b.Provider submission of labor market data. (g) (a) Providers enrolled to 
36.19 	provide services with rates determined under section 256B.4914, subdivision 3, shall submit 
36.20 	labor market data to the commissioner annually on or before November 1, including but 
36.21 	not limited to:
36.22 	(1) number of direct care staff;
36.23 	(2) wages of direct care staff;
36.24 	(3) overtime wages of direct care staff;
36.25 	(4) hours worked by direct care staff;
36.26 	(5) overtime hours worked by direct care staff;
36.27 	(6) benefits provided to direct care staff;
36.28 	(7) direct care staff job vacancies; and
36.29 	(8) direct care staff retention rates.
36.30 	(h) (b) The commissioner shall publish annual reports on provider and state-level labor 
36.31 	market data, including but not limited to the data obtained under paragraph (g) (a).
37.1 	(i) (c) The commissioner may temporarily suspend payments to the provider if data 
37.2 	requested under paragraph (g) (a) is not received 90 days after the required submission date. 
37.3 	Withheld payments shall be made once data is received by the commissioner.
37.4 	(j) (d) Providers who receive payment under this section for less than 25 percent of their 
37.5 	clients in the year prior to the report may attest to the commissioner in a manner determined 
37.6 	by the commissioner that they are declining to provide the data required under paragraph 
37.7 	(g) (a) and will not be subject to the payment suspension in paragraph (i) (c).
37.8 		Subd. 10c.Reporting and analysis of competitive workforce factor. (a) Beginning 
37.9 	February 1, 2021, and every two years thereafter, the commissioner shall report to the chairs 
37.10 	and ranking minority members of the legislative committees and divisions with jurisdiction 
37.11 	over health and human services policy and finance an analysis of the competitive workforce 
37.12 	factor.
37.13 	(b) The report must include recommendations to update the competitive workforce factor 
37.14 	using:
37.15 	(1) the most recently available wage data by SOC code for the weighted average wage 
37.16 	for direct care staff for residential services and direct care staff for day services;
37.17 	(2) the most recently available wage data by SOC code of the weighted average wage 
37.18 	of comparable occupations; and
37.19 	(3) workforce data as required under subdivision 10b.
37.20 	(c) The commissioner shall not recommend an increase or decrease of the competitive 
37.21 	workforce factor from the current value by more than two percentage points. If, after a 
37.22 	biennial analysis for the next report, the competitive workforce factor is less than or equal 
37.23 	to zero, the commissioner shall recommend a competitive workforce factor of zero.
37.24 		Subd. 11.Payment implementation. Upon implementation of the payment 
37.25 	methodologies under this section, those payment rates supersede rates established in county 
37.26 	contracts for recipients receiving waiver services under section 256B.092 or 256B.49.
37.27 		Subd. 12.Customization of rates for individuals.  (a) For persons determined to have 
37.28 	higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased 
37.29 	by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8, and 9 to 9a. 
37.30 	The customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per 
37.31 	hour for waiver recipients who meet the respective criteria as determined by the 
37.32 	commissioner.
37.33 	(b) For the purposes of this section, "deaf and hard-of-hearing" means:
38.1 	(1) the person has a developmental disability and an assessment score which indicates 
38.2 	a hearing impairment that is severe or that the person has no useful hearing;
38.3 	(2) the person has a developmental disability and an expressive communications score 
38.4 	that indicates the person uses single signs or gestures, uses an augmentative communication 
38.5 	aid, or does not have functional communication, or the person's expressive communications 
38.6 	is unknown; and
38.7 	(3) the person has a developmental disability and a communication score which indicates 
38.8 	the person comprehends signs, gestures, and modeling prompts or does not comprehend 
38.9 	verbal, visual, or gestural communication, or that the person's receptive communication 
38.10 	score is unknown; or
38.11 	(4) the person receives long-term care services and has an assessment score that indicates 
38.12 	they hear only very loud sounds, have no useful hearing, or a determination cannot be made; 
38.13 	and the person receives long-term care services and has an assessment that indicates the 
38.14 	person communicates needs with sign language, symbol board, written messages, gestures, 
38.15 	or an interpreter; communicates with inappropriate content, makes garbled sounds or displays 
38.16 	echolalia, or does not communicate needs.
38.17 		Subd. 13.Transportation. The commissioner shall require that the purchase of 
38.18 	transportation services be cost-effective and be limited to market rates where the 
38.19 	transportation mode is generally available and accessible.
38.20 		Subd. 14.Exceptions. (a) In a format prescribed by the commissioner, lead agencies 
38.21 	must identify individuals with exceptional needs that cannot be met under the disability 
38.22 	waiver rate system. The commissioner shall use that information to evaluate and, if necessary, 
38.23 	approve an alternative payment rate for those individuals. Whether granted, denied, or 
38.24 	modified, the commissioner shall respond to all exception requests in writing. The 
38.25 	commissioner shall include in the written response the basis for the action and provide 
38.26 	notification of the right to appeal under paragraph (h).
38.27 	(b) Lead agencies must act on an exception request within 30 days and notify the initiator 
38.28 	of the request of their recommendation in writing. A lead agency shall submit all exception 
38.29 	requests along with its recommendation to the commissioner.
38.30 	(c) An application for a rate exception may be submitted for the following criteria:
38.31 	(1) an individual has service needs that cannot be met through additional units of service;
39.1 	(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 to 9a is so insufficient 
39.2 	that it has resulted in an individual receiving a notice of discharge from the individual's 
39.3 	provider; or
39.4 	(3) an individual's service needs, including behavioral changes, require a level of service 
39.5 	which necessitates a change in provider or which requires the current provider to propose 
39.6 	service changes beyond those currently authorized.
39.7 	(d) Exception requests must include the following information:
39.8 	(1) the service needs required by each individual that are not accounted for in subdivisions 
39.9 	6, 7, 8, and 9 to 9a;
39.10 	(2) the service rate requested and the difference from the rate determined in subdivisions 
39.11 	6, 7, 8, and 9 to 9a;
39.12 	(3) a basis for the underlying costs used for the rate exception and any accompanying 
39.13 	documentation; and
39.14 	(4) any contingencies for approval.
39.15 	(e) Approved rate exceptions shall be managed within lead agency allocations under 
39.16 	sections 256B.092 and 256B.49.
39.17 	(f) Individual disability waiver recipients, an interested party, or the license holder that 
39.18 	would receive the rate exception increase may request that a lead agency submit an exception 
39.19 	request. A lead agency that denies such a request shall notify the individual waiver recipient, 
39.20 	interested party, or license holder of its decision and the reasons for denying the request in 
39.21 	writing no later than 30 days after the request has been made and shall submit its denial to 
39.22 	the commissioner in accordance with paragraph (b). The reasons for the denial must be 
39.23 	based on the failure to meet the criteria in paragraph (c).
39.24 	(g) The commissioner shall determine whether to approve or deny an exception request 
39.25 	no more than 30 days after receiving the request. If the commissioner denies the request, 
39.26 	the commissioner shall notify the lead agency and the individual disability waiver recipient, 
39.27 	the interested party, and the license holder in writing of the reasons for the denial.
39.28 	(h) The individual disability waiver recipient may appeal any denial of an exception 
39.29 	request by either the lead agency or the commissioner, pursuant to sections 256.045 and 
39.30 	256.0451. When the denial of an exception request results in the proposed demission of a 
39.31 	waiver recipient from a residential or day habilitation program, the commissioner shall issue 
39.32 	a temporary stay of demission, when requested by the disability waiver recipient, consistent 
39.33 	with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary 
40.1 	stay shall remain in effect until the lead agency can provide an informed choice of 
40.2 	appropriate, alternative services to the disability waiver.
40.3 	(i) Providers may petition lead agencies to update values that were entered incorrectly 
40.4 	or erroneously into the rate management system, based on past service level discussions 
40.5 	and determination in subdivision 4, without applying for a rate exception.
40.6 	(j) The starting date for the rate exception will be the later of the date of the recipient's 
40.7 	change in support or the date of the request to the lead agency for an exception.
40.8 	(k) The commissioner shall track all exception requests received and their dispositions. 
40.9 	The commissioner shall issue quarterly public exceptions statistical reports, including the 
40.10 	number of exception requests received and the numbers granted, denied, withdrawn, and 
40.11 	pending. The report shall include the average amount of time required to process exceptions.
40.12 	(l) Approved rate exceptions remain in effect in all cases until an individual's needs 
40.13 	change as defined in paragraph (c).
40.14 		Subd. 15.County or Tribal allocations. (a) The commissioner shall establish a method 
40.15 	of tracking and reporting the fiscal impact of the disability waiver rates management system 
40.16 	on individual lead agencies.
40.17 	(b) The commissioner shall make annual adjustments to lead agencies' home and 
40.18 	community-based waivered service budget allocations to adjust for rate differences and the 
40.19 	resulting impact on county allocations upon implementation of the disability waiver rates 
40.20 	system.
40.21 	(c) Lead agencies exceeding their allocations shall be subject to the provisions under 
40.22 	sections 256B.0916, subdivision 11, and 256B.49, subdivision 26.
40.23 		Subd. 17.Stakeholder consultation and county training. (a) The commissioner shall 
40.24 	continue consultation at regular intervals with the existing stakeholder group established 
40.25 	as part of the rate-setting methodology process and others, to gather input, concerns, and 
40.26 	data, to assist in the implementation of the rate payment system, and to make pertinent 
40.27 	information available to the public through the department's website.
40.28 	(b) The commissioner shall offer training at least annually for county personnel 
40.29 	responsible for administering the rate-setting framework in a manner consistent with this 
40.30 	section.
40.31 	(c) The commissioner shall maintain an online instruction manual explaining the 
40.32 	rate-setting framework. The manual shall be consistent with this section, and shall be 
41.1 	accessible to all stakeholders including recipients, representatives of recipients, county or 
41.2 	Tribal agencies, and license holders.
41.3 	(d) The commissioner shall not defer to the county or Tribal agency on matters of 
41.4 	technical application of the rate-setting framework, and a county or Tribal agency shall not 
41.5 	set rates in a manner that conflicts with this section.
41.6 		Subd. 18.Legislatively approved changes; public notice. (a) The commissioner shall 
41.7 	provide a public notice via LISTSERV in October of each year containing information 
41.8 	detailing legislatively approved changes in:
41.9 	(1) calculation values including derived wage rates and related employee and 
41.10 	administrative factors;
41.11 	(2) service utilization;
41.12 	(3) county and Tribal allocation changes; and
41.13 	(4) information on adjustments made to calculation values and the timing of those 
41.14 	adjustments.
41.15 	(b) The information in this notice must be effective January 1 of the following year.

41.16 	Sec. 2. DIRECTION TO COMMISSIONER; TRANSITION PROCESS.
 41.17 	(a) The commissioner of human services shall update references to statutes recodified 
41.18 	in this act when printed material is replaced and new printed material is obtained in the 
41.19 	normal course of business. The commissioner is not required to replace existing printed 
41.20 	material to comply with this act.
41.21 	(b) The commissioner of human services shall update references to statutes recodified 
41.22 	in this act when online documents and websites are edited in the normal course of business. 
41.23 	The commissioner is not required to edit online documents and websites merely to comply 
41.24 	with this act.
41.25 	(c) The commissioner of human services shall update references to statutes recodified 
41.26 	in this act when the home and community-based service waiver plans are updated in the 
41.27 	normal course of business. The commissioner is not required to update the home and 
41.28 	community-based service waiver plans merely to comply with this act.

41.29 	Sec. 3. REVISOR INSTRUCTION.
 41.30 	The revisor of statutes, in consultation with the House Research Department; the Office 
41.31 	of Senate Counsel, Research, and Fiscal Analysis; and the Department of Human Services, 
42.1 	shall make necessary cross-reference changes and remove statutory cross-references in 
42.2 	Minnesota Statutes to conform with the recodification in this act. The revisor may make 
42.3 	technical and other necessary changes to sentence structure to preserve the meaning of the 
42.4 	text. The revisor may alter the coding in this act to incorporate statutory changes made by 
42.5 	other law in the 2022 regular legislative session. If a provision repealed in this act is also 
42.6 	amended in the 2022 regular legislative session by other law, the revisor shall merge the 
42.7 	amendment into the recodification, notwithstanding Minnesota Statutes, section 645.30.

42.8 	Sec. 4. EFFECTIVE DATE.
 42.9 	Sections 1 to 3 are effective July 1, 2022.