1.1 	A bill for an act
1.2 	relating to human services; establish licensing standards for alternative adult day 
1.3 	services; establishing rates for alternative adult day services; extending the waiver 
1.4 	allowing remote delivery of adult day services;amending Minnesota Statutes 2020, 
1.5 	sections 245A.02, subdivisions 2a, 10; 256B.0913, subdivision 5; 256B.0922, 
1.6 	subdivision 1; 256B.4914, subdivisions 3, 5, 7; 256S.12, subdivision 1; 256S.215, 
1.7 	by adding subdivisions; Laws 2020, First Special Session chapter 7, section 1, as 
1.8 	amended; proposing coding for new law in Minnesota Statutes, chapter 245A.
1.9 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.10 	Section 1. Minnesota Statutes 2020, section 245A.02, subdivision 2a, is amended to read:
1.11 		Subd. 2a.Adult day care or family adult day services. "Adult day care," "adult day 
1.12 	services," "alternative adult day services," and "family adult day services" mean a program 
1.13 	operating less than 24 hours per day that provides functionally impaired adults with an 
1.14 	individualized and coordinated set of services including health services, social services, and 
1.15 	nutritional services that are directed at maintaining or improving the participants' capabilities 
1.16 	for self-care. Adult day care, adult day services, alternative adult day services, and family 
1.17 	adult day services do not include programs where adults gather or congregate primarily for 
1.18 	purposes of socialization, education, supervision, caregiver respite, religious expression, 
1.19 	exercise, or nutritious meals.

1.20 	Sec. 2. Minnesota Statutes 2020, section 245A.02, subdivision 10, is amended to read:
1.21 		Subd. 10.Nonresidential program. "Nonresidential program" means care, supervision, 
1.22 	rehabilitation, training or habilitation of a person provided outside the person's own home 
1.23 	and provided for fewer than 24 hours a day, including adult day care programs; and chemical 
1.24 	dependency or chemical abuse programs that are located in a nursing home or hospital and 
2.1 	receive public funds for providing chemical abuse or chemical dependency treatment services 
2.2 	under chapter 254B. Nonresidential programs include home and community-based services 
2.3 	for persons with disabilities or persons age 65 and older that are provided in or outside of 
2.4 	a person's own home under chapter 245D. Nonresidential programs include alternative adult 
2.5 	day services delivered remotely or in a person's home or residence under section 245A.1432.

2.6 	Sec. 3. [245A.1432] ALTERNATIVE ADULT DAY SERVICES.
2.7 		Subdivision 1.Scope. A licensed adult day service provider may provide alternative 
2.8 	adult day services under the license holder's adult day services license if the license holder 
2.9 	meets the additional requirements of this section. Nothing in this section shall change 
2.10 	otherwise applicable adult day services licensing requirements under this chapter.
2.11 		Subd. 2.Definitions. (a) For the purposes of this section, the following terms have the 
2.12 	meanings given.
2.13 	(b) "Alternative adult day services" means the following adult day services when delivered 
2.14 	remotely, via two-way interactive video or audio communication, or in person in the person's 
2.15 	home or residence:
2.16 	(1) wellness checks and health-related services, including medication set-up and 
2.17 	administration overseen by a nurse;
2.18 	(2) socialization and companionship;
2.19 	(3) activities;
2.20 	(4) meals delivered to the person's home;
2.21 	(5) assistance with activities of daily living, including bathing; and
2.22 	(6) individual support to family caregivers.
2.23 		Subd. 3.Notice to commissioner required. Before delivering alternative adult day 
2.24 	services, a licensed adult day service provider must notify the commissioner of the license 
2.25 	holder's intention to provide alternative adult day services. The license holder must affirm 
2.26 	that the license holder will comply with the additional requirements of this section. The 
2.27 	commissioner shall determine the manner of notification and affirmation.
2.28 		Subd. 4.Availability of facility director. The director of an adult day care facility 
2.29 	providing alternative adult day services must be available by telephone to all staff delivering 
2.30 	alternative adult day services at any time that staff are delivering alternative adult day 
2.31 	services.
3.1 		Subd. 5.Service delivery records. A licensed adult day services program providing 
3.2 	alternative adult day services must maintain documentation of all alternative adult day 
3.3 	services delivered. The records must be accessible to the commissioner during the program's 
3.4 	hours of operation, must be completed on the actual day of service, and must include:
3.5 	(1) the date of service;
3.6 	(2) the first, middle, and last name of the person who receives services;
3.7 	(3) the beginning and ending time of the service with a.m. and p.m. designations;
3.8 	(4) the location of the service or method by which the service was delivered;
3.9 	(5) a brief description of the service and the person's response to the service; and
3.10 	(6) the full name of the staff person delivering the service.
3.11 		Subd. 6.Service plans for alternative adult day services. Licensed adult day service 
3.12 	providers must review and revise, as needed, each person's service plan to reflect the delivery 
3.13 	of alternative adult day services.
3.14 		Subd. 7.Training for alternative adult day services. Except as provided in subdivision 
3.15 	7a, in addition to meeting the training and orientation requirements for the provision of 
3.16 	adult day services, staff delivering alternative adult day services must receive:
3.17 	(1) four hours of supervised orientation before working unsupervised with people who 
3.18 	receive alternative adult day services;
3.19 	(2) orientation to the individual service plan for each person to whom the staff person 
3.20 	will deliver services;
3.21 	(3) training related to the specific needs of each person to whom the staff person will 
3.22 	deliver services;
3.23 	(4) training related to reporting and maintaining records of incidents; and
3.24 	(5) written procedures governing medical emergencies, including identified sources of 
3.25 	emergency medical care and transportation.
3.26 	A record of all training must be maintained at the adult day services facility.
3.27 		Subd. 7a.First-aid and CPR training exemptions. Notwithstanding Minnesota Rules, 
3.28 	parts 9555.9650, item A, subitem (7), and 9555.9690, subpart 2, item C, the requirement 
3.29 	for basic first-aid and CPR training and documentation for staff providing alternative adult 
3.30 	day services is waived.
4.1 		Subd. 8.Variances. The commissioner may grant a variance to any of the requirements 
4.2 	in this section if the conditions in section 245A.04, subdivision 9, are met.

4.3 	Sec. 4. Minnesota Statutes 2020, section 256B.0913, subdivision 5, is amended to read:
4.4 		Subd. 5.Services covered under alternative care. Alternative care funding may be 
4.5 	used for payment of costs of:
4.6 	(1) adult day services, alternative adult day services, and adult day services bath;
4.7 	(2) home care;
4.8 	(3) homemaker services;
4.9 	(4) personal care;
4.10 	(5) case management and conversion case management;
4.11 	(6) respite care;
4.12 	(7) specialized supplies and equipment;
4.13 	(8) home-delivered meals;
4.14 	(9) nonmedical transportation;
4.15 	(10) nursing services;
4.16 	(11) chore services;
4.17 	(12) companion services;
4.18 	(13) nutrition services;
4.19 	(14) family caregiver training and education;
4.20 	(15) coaching and counseling;
4.21 	(16) telehome care to provide services in their own homes in conjunction with in-home 
4.22 	visits;
4.23 	(17) consumer-directed community supports under the alternative care programs which 
4.24 	are available statewide and limited to the average monthly expenditures representative of 
4.25 	all alternative care program participants for the same case mix resident class assigned in 
4.26 	the most recent fiscal year for which complete expenditure data is available;
4.27 	(18) environmental accessibility and adaptations; and
5.1 	(19) discretionary services, for which lead agencies may make payment from their 
5.2 	alternative care program allocation for services not otherwise defined in this section or 
5.3 	section 256B.0625, following approval by the commissioner.
5.4 	Total annual payments for discretionary services for all clients served by a lead agency 
5.5 	must not exceed 25 percent of that lead agency's annual alternative care program base 
5.6 	allocation, except that when alternative care services receive federal financial participation 
5.7 	under the 1115 waiver demonstration, funding shall be allocated in accordance with 
5.8 	subdivision 17.

5.9 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
5.10 	end of the federal public health emergency, or upon federal approval, whichever is later. 
5.11 	The commissioner of human services shall notify the revisor of statutes when the federal 
5.12 	public health emergency ends and when federal approval is obtained.

5.13 	Sec. 5. Minnesota Statutes 2020, section 256B.0922, subdivision 1, is amended to read:
5.14 		Subdivision 1.Essential community supports. (a) The purpose of the essential 
5.15 	community supports program is to provide targeted services to persons age 65 and older 
5.16 	who need essential community support, but whose needs do not meet the level of care 
5.17 	required for nursing facility placement under section 144.0724, subdivision 11.
5.18 	(b) Essential community supports are available not to exceed $400 per person per month. 
5.19 	Essential community supports may be used as authorized within an authorization period 
5.20 	not to exceed 12 months. Services must be available to a person who:
5.21 	(1) is age 65 or older;
5.22 	(2) is not eligible for medical assistance;
5.23 	(3) has received a community assessment under section 256B.0911, subdivision 3a or 
5.24 	3b, and does not require the level of care provided in a nursing facility;
5.25 	(4) meets the financial eligibility criteria for the alternative care program under section 
5.26 	256B.0913, subdivision 4;
5.27 	(5) has a community support plan; and
5.28 	(6) has been determined by a community assessment under section 256B.0911, 
5.29 	subdivision 3a or 3b, to be a person who would require provision of at least one of the 
5.30 	following services, as defined in the approved elderly waiver plan, in order to maintain their 
5.31 	community residence:
5.32 	(i) adult day services and alternative adult day services;
6.1 	(ii) caregiver support;
6.2 	(iii) homemaker support;
6.3 	(iv) chores;
6.4 	(v) a personal emergency response device or system;
6.5 	(vi) home-delivered meals; or
6.6 	(vii) community living assistance as defined by the commissioner.
6.7 	(c) The person receiving any of the essential community supports in this subdivision 
6.8 	must also receive service coordination, not to exceed $600 in a 12-month authorization 
6.9 	period, as part of their community support plan.
6.10 	(d) A person who has been determined to be eligible for essential community supports 
6.11 	must be reassessed at least annually and continue to meet the criteria in paragraph (b) to 
6.12 	remain eligible for essential community supports.
6.13 	(e) The commissioner is authorized to use federal matching funds for essential community 
6.14 	supports as necessary and to meet demand for essential community supports as outlined in 
6.15 	subdivision 2, and that amount of federal funds is appropriated to the commissioner for this 
6.16 	purpose.

6.17 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
6.18 	end of the federal public health emergency, or upon federal approval, whichever is later. 
6.19 	The commissioner of human services shall notify the revisor of statutes when the federal 
6.20 	public health emergency ends and when federal approval is obtained.

6.21 	Sec. 6. Minnesota Statutes 2020, section 256B.4914, subdivision 3, is amended to read:
6.22 		Subd. 3.Applicable services. Applicable services are those authorized under the state's 
6.23 	home and community-based services waivers under sections 256B.092 and 256B.49, 
6.24 	including the following, as defined in the federally approved home and community-based 
6.25 	services plan:
6.26 	(1) 24-hour customized living;
6.27 	(2) adult day services, including alternative adult day services;
6.28 	(3) adult day services bath;
6.29 	(4) companion services;
6.30 	(5) community residential services;
7.1 	(6) customized living;
7.2 	(7) day support services;
7.3 	(8) day training and habilitation;
7.4 	(9) employment development services;
7.5 	(10) employment exploration services;
7.6 	(11) employment support services;
7.7 	(12) family residential services;
7.8 	(13) housing access coordination;
7.9 	(14) independent living skills;
7.10 	(15) individualized home supports;
7.11 	(16) individualized home supports with family training;
7.12 	(17) individualized home supports with training;
7.13 	(18) in-home family support;
7.14 	(19) integrated community supports;
7.15 	(20) night supervision;
7.16 	(21) personal support;
7.17 	(22) positive support services;
7.18 	(23) prevocational services;
7.19 	(24) residential support services;
7.20 	(25) respite services;
7.21 	(26) structured day services;
7.22 	(27) supported living services;
7.23 	(28) transportation services; and
7.24 	(29) other services as approved by the federal government in the state home and 
7.25 	community-based services plan.

7.26 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
7.27 	end of the federal public health emergency, or upon federal approval, whichever is later. 
8.1 	The commissioner of human services shall notify the revisor of statutes when the federal 
8.2 	public health emergency ends and when federal approval is obtained.

8.3 	Sec. 7. Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:
8.4 		Subd. 5.Base wage index and standard component values. (a) The base wage index 
8.5 	is established to determine staffing costs associated with providing services to individuals 
8.6 	receiving home and community-based services. For purposes of developing and calculating 
8.7 	the proposed base wage, Minnesota-specific wages taken from job descriptions and standard 
8.8 	occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in 
8.9 	the most recent edition of the Occupational Handbook must be used. The base wage index 
8.10 	must be calculated as follows:
8.11 	(1) for residential direct care staff, the sum of:
8.12 	(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home 
8.13 	health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC 
8.14 	code 31-1014); and 20 percent of the median wage for social and human services aide (SOC 
8.15 	code 21-1093); and
8.16 	(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide 
8.17 	(SOC code 31-1011); 20 percent of the median wage for personal and home health aide 
8.18 	(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code 
8.19 	31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 
8.20 	and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
8.21 	(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC 
8.22 	code 31-1014); and 30 percent of the median wage for personal care aide (SOC code 
8.23 	39-9021);
8.24 	(3) for day services, day support services, and prevocational services, 20 percent of the 
8.25 	median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for 
8.26 	psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social 
8.27 	and human services aide (SOC code 21-1093);
8.28 	(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota 
8.29 	for large employers, except in a family foster care setting, the wage is 36 percent of the 
8.30 	minimum wage in Minnesota for large employers;
8.31 	(5) for positive supports analyst staff, 100 percent of the median wage for mental health 
8.32 	counselors (SOC code 21-1014);
9.1 	(6) for positive supports professional staff, 100 percent of the median wage for clinical 
9.2 	counseling and school psychologist (SOC code 19-3031);
9.3 	(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric 
9.4 	technicians (SOC code 29-2053);
9.5 	(8) for supportive living services staff, 20 percent of the median wage for nursing assistant 
9.6 	(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code 
9.7 	29-2053); and 60 percent of the median wage for social and human services aide (SOC code 
9.8 	21-1093);
9.9 	(9) for housing access coordination staff, 100 percent of the median wage for community 
9.10 	and social services specialist (SOC code 21-1099);
9.11 	(10) for in-home family support and individualized home supports with family training 
9.12 	staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of 
9.13 	the median wage for community social service specialist (SOC code 21-1099); 40 percent 
9.14 	of the median wage for social and human services aide (SOC code 21-1093); and ten percent 
9.15 	of the median wage for psychiatric technician (SOC code 29-2053);
9.16 	(11) for individualized home supports with training services staff, 40 percent of the 
9.17 	median wage for community social service specialist (SOC code 21-1099); 50 percent of 
9.18 	the median wage for social and human services aide (SOC code 21-1093); and ten percent 
9.19 	of the median wage for psychiatric technician (SOC code 29-2053);
9.20 	(12) for independent living skills staff, 40 percent of the median wage for community 
9.21 	social service specialist (SOC code 21-1099); 50 percent of the median wage for social and 
9.22 	human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric 
9.23 	technician (SOC code 29-2053);
9.24 	(13) for employment support services staff, 50 percent of the median wage for 
9.25 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
9.26 	community and social services specialist (SOC code 21-1099);
9.27 	(14) for employment exploration services staff, 50 percent of the median wage for 
9.28 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
9.29 	community and social services specialist (SOC code 21-1099);
9.30 	(15) for employment development services staff, 50 percent of the median wage for 
9.31 	education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent 
9.32 	of the median wage for community and social services specialist (SOC code 21-1099);
10.1 	(16) for individualized home support staff, 50 percent of the median wage for personal 
10.2 	and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing 
10.3 	assistant (SOC code 31-1014);
10.4 	(17) for adult companion staff, 50 percent of the median wage for personal and home 
10.5 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant 
10.6 	(SOC code 31-1014);
10.7 	(18) for night supervision staff, 20 percent of the median wage for home health aide 
10.8 	(SOC code 31-1011); 20 percent of the median wage for personal and home health aide 
10.9 	(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code 
10.10 	31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053); 
10.11 	and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
10.12 	(19) for respite staff, 50 percent of the median wage for personal and home care aide 
10.13 	(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code 
10.14 	31-1014);
10.15 	(20) for personal support staff, 50 percent of the median wage for personal and home 
10.16 	care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant 
10.17 	(SOC code 31-1014);
10.18 	(21) for supervisory staff, 100 percent of the median wage for community and social 
10.19 	services specialist (SOC code 21-1099), with the exception of the supervisor of positive 
10.20 	supports professional, positive supports analyst, and positive supports specialists, which is 
10.21 	100 percent of the median wage for clinical counseling and school psychologist (SOC code 
10.22 	19-3031);
10.23 	(22) for registered nurse staff, 100 percent of the median wage for registered nurses 
10.24 	(SOC code 29-1141); and
10.25 	(23) for licensed practical nurse staff, 100 percent of the median wage for licensed 
10.26 	practical nurses (SOC code 29-2061).
10.27 	(b) Component values for corporate foster care services, corporate supportive living 
10.28 	services daily, community residential services, and integrated community support services 
10.29 	are:
10.30 	(1) competitive workforce factor: 4.7 percent;
10.31 	(2) supervisory span of control ratio: 11 percent;
10.32 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.1 	(4) employee-related cost ratio: 23.6 percent;
11.2 	(5) general administrative support ratio: 13.25 percent;
11.3 	(6) program-related expense ratio: 1.3 percent; and
11.4 	(7) absence and utilization factor ratio: 3.9 percent.
11.5 	(c) Component values for family foster care are:
11.6 	(1) competitive workforce factor: 4.7 percent;
11.7 	(2) supervisory span of control ratio: 11 percent;
11.8 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.9 	(4) employee-related cost ratio: 23.6 percent;
11.10 	(5) general administrative support ratio: 3.3 percent;
11.11 	(6) program-related expense ratio: 1.3 percent; and
11.12 	(7) absence factor: 1.7 percent.
11.13 	(d) Component values for day training and habilitation, day support services, and 
11.14 	prevocational services are:
11.15 	(1) competitive workforce factor: 4.7 percent;
11.16 	(2) supervisory span of control ratio: 11 percent;
11.17 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
11.18 	(4) employee-related cost ratio: 23.6 percent;
11.19 	(5) program plan support ratio: 5.6 percent;
11.20 	(6) client programming and support ratio: ten percent;
11.21 	(7) general administrative support ratio: 13.25 percent;
11.22 	(8) program-related expense ratio: 1.8 percent; and
11.23 	(9) absence and utilization factor ratio: 9.4 percent.
11.24 	(e) Component values for adult day services are:
11.25 	(1) competitive workforce factor: 4.7 percent;
11.26 	(2) supervisory span of control ratio: 11 percent;
11.27 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.1 	(4) employee-related cost ratio: 23.6 percent;
12.2 	(5) program plan support ratio: 5.6 percent;
12.3 	(6) client programming and support ratio: 7.4 percent;
12.4 	(7) general administrative support ratio: 13.25 percent;
12.5 	(8) program-related expense ratio: 1.8 percent; and
12.6 	(9) absence and utilization factor ratio: 9.4 percent.
12.7 	(f) Component values for unit-based services with programming are:
12.8 	(1) competitive workforce factor: 4.7 percent;
12.9 	(2) supervisory span of control ratio: 11 percent;
12.10 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.11 	(4) employee-related cost ratio: 23.6 percent;
12.12 	(5) program plan supports ratio: 15.5 percent;
12.13 	(6) client programming and supports ratio: 4.7 percent;
12.14 	(7) general administrative support ratio: 13.25 percent;
12.15 	(8) program-related expense ratio: 6.1 percent; and
12.16 	(9) absence and utilization factor ratio: 3.9 percent.
12.17 	(g) Component values for unit-based services without programming except respite are:
12.18 	(1) competitive workforce factor: 4.7 percent;
12.19 	(2) supervisory span of control ratio: 11 percent;
12.20 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.21 	(4) employee-related cost ratio: 23.6 percent;
12.22 	(5) program plan support ratio: 7.0 percent;
12.23 	(6) client programming and support ratio: 2.3 percent;
12.24 	(7) general administrative support ratio: 13.25 percent;
12.25 	(8) program-related expense ratio: 2.9 percent; and
12.26 	(9) absence and utilization factor ratio: 3.9 percent.
12.27 	(h) Component values for unit-based services without programming for respite are:
13.1 	(1) competitive workforce factor: 4.7 percent;
13.2 	(2) supervisory span of control ratio: 11 percent;
13.3 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
13.4 	(4) employee-related cost ratio: 23.6 percent;
13.5 	(5) general administrative support ratio: 13.25 percent;
13.6 	(6) program-related expense ratio: 2.9 percent; and
13.7 	(7) absence and utilization factor ratio: 3.9 percent.
13.8 	(i) On July 1, 2022, and every two years thereafter, the commissioner shall update the 
13.9 	base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor 
13.10 	Statistics available 30 months and one day prior to the scheduled update. The commissioner 
13.11 	shall publish these updated values and load them into the rate management system.
13.12 	(j) Beginning February 1, 2021, and every two years thereafter, the commissioner shall 
13.13 	report to the chairs and ranking minority members of the legislative committees and divisions 
13.14 	with jurisdiction over health and human services policy and finance an analysis of the 
13.15 	competitive workforce factor. The report must include recommendations to update the 
13.16 	competitive workforce factor using:
13.17 	(1) the most recently available wage data by SOC code for the weighted average wage 
13.18 	for direct care staff for residential services and direct care staff for day services;
13.19 	(2) the most recently available wage data by SOC code of the weighted average wage 
13.20 	of comparable occupations; and
13.21 	(3) workforce data as required under subdivision 10a, paragraph (g).
13.22 	The commissioner shall not recommend an increase or decrease of the competitive workforce 
13.23 	factor from the current value by more than two percentage points. If, after a biennial analysis 
13.24 	for the next report, the competitive workforce factor is less than or equal to zero, the 
13.25 	commissioner shall recommend a competitive workforce factor of zero.
13.26 	(k) On July 1, 2022, and every two years thereafter, the commissioner shall update the 
13.27 	framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph 
13.28 	(f), clause (6); ~~and~~ paragraph (g), clause (6); paragraph (o), clause (6); and paragraph (p), 
13.29 	clause (6); subdivision 6, paragraphs (b), clauses (9) and (10), and (e), clause (10); and 
13.30 	subdivision 7, clauses (11), ~~(17), and~~ (12), (18), and (19), for changes in the Consumer Price 
13.31 	Index. The commissioner shall adjust these values higher or lower by the percentage change 
13.32 	in the CPI-U from the date of the previous update to the data available 30 months and one 
14.1 	day prior to the scheduled update. The commissioner shall publish these updated values 
14.2 	and load them into the rate management system.
14.3 	(l) Upon the implementation of the updates under paragraphs (i) and (k), rate adjustments 
14.4 	authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108, article 7, section 
14.5 	60; and Laws 2014, chapter 312, article 27, section 75, shall be removed from service rates 
14.6 	calculated under this section.
14.7 	(m) Any rate adjustments applied to the service rates calculated under this section outside 
14.8 	of the cost components and rate methodology specified in this section shall be removed 
14.9 	from rate calculations upon implementation of the updates under paragraphs (i) and (k).
14.10 	(n) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer 
14.11 	Price Index items are unavailable in the future, the commissioner shall recommend to the 
14.12 	legislature codes or items to update and replace missing component values.
14.13 	(o) Component values for alternative adult day services delivered in person are:
14.14 	(1) competitive workforce factor: 4.7 percent;
14.15 	(2) supervisory span of control ratio: 11 percent;
14.16 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
14.17 	(4) employee-related cost ratio: 23.6 percent;
14.18 	(5) program plan support ratio: 5.6 percent;
14.19 	(6) client programming and support ratio: 7.4 percent;
14.20 	(7) general administrative support ratio: 13.25 percent;
14.21 	(8) program-related expense ratio: 1.8 percent; and
14.22 	(9) absence and utilization factor ratio: 9.4 percent.
14.23 	(p) Component values for alternative adult day services delivered remotely are:
14.24 	(1) competitive workforce factor: 4.7 percent;
14.25 	(2) supervisory span of control ratio: 11 percent;
14.26 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
14.27 	(4) employee-related cost ratio: 23.6 percent;
14.28 	(5) program plan support ratio: 5.6 percent;
14.29 	(6) client programming and support ratio: 7.4 percent;
15.1 	(7) general administrative support ratio: 13.25 percent;
15.2 	(8) program-related expense ratio: 1.8 percent; and
15.3 	(9) absence and utilization factor ratio: 9.4 percent.

15.4 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
15.5 	end of the federal public health emergency, or upon federal approval, whichever is later. 
15.6 	The commissioner of human services shall notify the revisor of statutes when the federal 
15.7 	public health emergency ends and when federal approval is obtained.

15.8 	Sec. 8. Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:
15.9 		Subd. 7.Payments for day programs. Payments for services with day programs 
15.10 	including adult day services, alternative adult day services delivered in person or remotely, 
15.11 	day treatment and habilitation, day support services, prevocational services, and structured 
15.12 	day services must be calculated as follows:
15.13 	(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
15.14 	(i) the staffing ratios for the units of service provided to a recipient in a typical week 
15.15 	must be averaged to determine an individual's staffing ratio; and
15.16 	(ii) the commissioner, in consultation with service providers, shall develop a uniform 
15.17 	staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
15.18 	(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics 
15.19 	Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 
15.20 	5;
15.21 	(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the 
15.22 	result of clause (2) by the product of one plus the competitive workforce factor in subdivision 
15.23 	5, paragraph (d), clause (1);
15.24 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
15.25 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
15.26 	to the result of clause (3);
15.27 	(5) multiply the number of day program direct staff hours and nursing hours by the 
15.28 	appropriate staff wage;
15.29 	(6) multiply the number of day direct staff hours by the product of the supervision span 
15.30 	of control ratio in subdivision 5, paragraph (d), clause (2), and the appropriate supervision 
15.31 	wage in subdivision 5, paragraph (a), clause (21)~~;~~, except:
16.1 	(i) for alternative adult day services delivered in person, multiply the number of day 
16.2 	direct staff hours by the product of the supervision span of control ratio in subdivision 5, 
16.3 	paragraph (o), clause (2), and the appropriate supervision wage in subdivision 5, paragraph 
16.4 	(a), clause (21); and
16.5 	(ii) for alternative adult day services delivered remotely, multiply the number of day 
16.6 	direct staff hours by the product of the supervision span of control ratio in subdivision 5, 
16.7 	paragraph (p), clause (2), and the appropriate supervision wage in subdivision 5, paragraph 
16.8 	(a), clause (21);
16.9 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
16.10 	employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause 
16.11 	(3)~~.~~, except:
16.12 	(i) for alternative adult day services delivered in person, combine the results of clauses 
16.13 	(5) and (6), and multiply the result by one plus the employee vacation, sick, and training 
16.14 	allowance ratio in subdivision 5, paragraph (o), clause (3); and
16.15 	(ii) for alternative adult day services delivered remotely, combine the results of clauses 
16.16 	(5) and (6), and multiply the result by one plus the employee vacation, sick, and training 
16.17 	allowance ratio in subdivision 5, paragraph (p), clause (3). This is defined as the direct 
16.18 	staffing rate;
16.19 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
16.20 	plan support ratio in subdivision 5, paragraph (d), clause (5)~~;~~, except:
16.21 	(i) for alternative adult day services delivered in person, for program plan support, 
16.22 	multiply the result of clause (7) by one plus the program plan support ratio in subdivision 
16.23 	5, paragraph (o), clause (5); and
16.24 	(ii) for alternative adult day services delivered remotely, for program plan support, 
16.25 	multiply the result of clause (7) by one plus the program plan support ratio in subdivision 
16.26 	5, paragraph (p), clause (5);
16.27 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
16.28 	employee-related cost ratio in subdivision 5, paragraph (d), clause (4)~~;~~, except:
16.29 	(i) for alternative adult day services delivered in person, for employee-related expenses, 
16.30 	multiply the result of clause (8) by one plus the employee-related cost ratio in subdivision 
16.31 	5, paragraph (o), clause (4); and
17.1 	(ii) for alternative adult day services delivered remotely, for employee-related expenses, 
17.2 	multiply the result of clause (8) by one plus the employee-related cost ratio in subdivision 
17.3 	5, paragraph (p), clause (4);
17.4 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
17.5 	the client programming and support ratio in subdivision 5, paragraph (d), clause (6)~~;~~, except:
17.6 	(i) for alternative adult day services delivered in person, for client programming and 
17.7 	supports, multiply the result of clause (9) by one plus the client programming and support 
17.8 	ratio in subdivision 5, paragraph (o), clause (6); and
17.9 	(ii) for alternative adult day services delivered remotely, for client programming and 
17.10 	supports, multiply the result of clause (9) by one plus the client programming and support 
17.11 	ratio in subdivision 5, paragraph (p), clause (6);
17.12 	(11) for program facility costs, add $19.30 per week with consideration of staffing ratios 
17.13 	to meet individual needs, including for alternative adult day services delivered in person;
17.14 	(12) for fixed costs of delivering alternative adult day services remotely, add $19.30 per 
17.15 	week with consideration of staffing ratios to meet individual needs for services delivered 
17.16 	remotely only;
17.17 	(13) for adult day bath services, add $7.01 per 15 minute unit;
17.18 	~~(13)~~ (14) this is the subtotal rate;
17.19 	~~(14)~~ (15) sum the standard general and administrative rate, the program-related expense 
17.20 	ratio, and the absence and utilization factor ratio;
17.21 	~~(15)~~ (16) divide the result of clause ~~(13)~~ (14) by one minus the result of clause ~~(14)~~ (15). 
17.22 	This is the total payment amount;
17.23 	~~(16)~~ (17) adjust the result of clause ~~(15)~~ (16) by a factor to be determined by the 
17.24 	commissioner to adjust for regional differences in the cost of providing services;
17.25 	~~(17)~~ (18) for transportation provided as part of day training and habilitation for an 
17.26 	individual who does not require a lift, add:
17.27 	(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without 
17.28 	a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a 
17.29 	vehicle with a lift;
17.30 	(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without 
17.31 	a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a 
17.32 	vehicle with a lift;
18.1 	(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without 
18.2 	a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a 
18.3 	vehicle with a lift; or
18.4 	(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift, 
18.5 	$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle 
18.6 	with a lift;
18.7 	~~(18)~~ (19) for transportation provided as part of day training and habilitation for an 
18.8 	individual who does require a lift, add:
18.9 	(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a 
18.10 	lift, and $15.05 for a shared ride in a vehicle with a lift;
18.11 	(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a 
18.12 	lift, and $28.16 for a shared ride in a vehicle with a lift;
18.13 	(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a 
18.14 	lift, and $58.76 for a shared ride in a vehicle with a lift; or
18.15 	(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift, 
18.16 	and $80.93 for a shared ride in a vehicle with a lift.

18.17 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
18.18 	end of the federal public health emergency, or upon federal approval, whichever is later. 
18.19 	The commissioner of human services shall notify the revisor of statutes when the federal 
18.20 	public health emergency ends and when federal approval is obtained.

18.21 	Sec. 9. Minnesota Statutes 2020, section 256S.12, subdivision 1, is amended to read:
18.22 		Subdivision 1.Adult day services authorization limits. Adult day services, including 
18.23 	alternative adult day services, may be authorized for up to 48 units, or 12 hours, per day 
18.24 	based on the needs of the participant and the participant's family caregivers.

18.25 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
18.26 	end of the federal public health emergency, or upon federal approval, whichever is later. 
18.27 	The commissioner of human services shall notify the revisor of statutes when the federal 
18.28 	public health emergency ends and when federal approval is obtained.

19.1 	Sec. 10. Minnesota Statutes 2020, section 256S.215, is amended by adding a subdivision 
19.2 	to read:
19.3 		Subd. 18.Alternative adult day services rate; delivered in person. The 15-minute 
19.4 	unit rate for alternative adult day services delivered in person, with an assumed staffing 
19.5 	ratio of one staff person to one participant, is the sum of:
19.6 	(1) 1/16 of the home care aide services adjusted base wage, except that the general and 
19.7 	administrative factor used to determine the home care aide services adjusted base wage is 
19.8 	20 percent;
19.9 	(2) one-fourth of the registered nurse management and supervision factor; and
19.10 	(3) $0.63 to cover the cost of meals.

19.11 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
19.12 	end of the federal public health emergency, or upon federal approval, whichever is later. 
19.13 	The commissioner of human services shall notify the revisor of statutes when the federal 
19.14 	public health emergency ends and when federal approval is obtained.

19.15 	Sec. 11. Minnesota Statutes 2020, section 256S.215, is amended by adding a subdivision 
19.16 	to read:
19.17 		Subd. 19.Alternative adult day services rate; delivered remotely. The 15-minute 
19.18 	unit rate for alternative adult day services delivered remotely, with an assumed staffing ratio 
19.19 	of one staff person to four participants, is the sum of:
19.20 	(1) 1/16 of the home care aide services adjusted base wage, except that the general and 
19.21 	administrative factor used to determine the home care aide services adjusted base wage is 
19.22 	20 percent; and
19.23 	(2) one-fourth of the registered nurse management and supervision factor.

19.24 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
19.25 	end of the federal public health emergency, or upon federal approval, whichever is later. 
19.26 	The commissioner of human services shall notify the revisor of statutes when the federal 
19.27 	public health emergency ends and when federal approval is obtained.

19.28 	Sec. 12. Laws 2020, First Special Session chapter 7, section 1, subdivision 2, as amended 
19.29 	by Laws 2020, Third Special Session chapter 1, section 3, is amended to read:
19.30 		Subd. 2.Waivers and modifications; extension to June 30, 2021. When the peacetime 
19.31 	emergency declared by the governor in response to the COVID-19 outbreak expires, is 
20.1 	terminated, or is rescinded by the proper authority, the following waivers and modifications 
20.2 	to human services programs issued by the commissioner of human services pursuant to 
20.3 	Executive Orders 20-11 and 20-12, including any amendments to the waivers or modifications 
20.4 	issued before the peacetime emergency expires, shall remain in effect until June 30, 2021, 
20.5 	unless necessary federal approval is not received at any time for a waiver or modification:
20.6 	(1) CV15: allowing phone or video visits for waiver programs;
20.7 	(2) CV16: expanding access to telemedicine services for Children's Health Insurance 
20.8 	Program, Medical Assistance, and MinnesotaCare enrollees;
20.9 	(3) CV21: allowing telemedicine alternative for school-linked mental health services 
20.10 	and intermediate school district mental health services;
20.11 	(4) CV24: allowing phone or video use for targeted case management visits;
20.12 	(5) CV30: expanding telemedicine in health care, mental health, and substance use 
20.13 	disorder settings;
20.14 	(6) CV31: allowing partial waiver of county cost when COVID-19 delays discharges 
20.15 	from DHS-operated psychiatric hospitals;
20.16 	(7) CV38: allowing flexibility in housing licensing requirements;
20.17 	(8) CV43: expanding remote home and community-based services waiver services;
20.18 	(9) ~~CV44: allowing remote delivery of adult day services;~~
20.19 	~~(10)~~ CV45: modifying certain licensing requirements for substance use disorder treatment, 
20.20 	except that the extension shall be limited to the portions of this modification requiring 
20.21 	programs to become and remain familiar with Minnesota Department of Health and Centers 
20.22 	for Disease Control and Prevention guidance on COVID-19; requiring programs to follow 
20.23 	Minnesota Department of Health and Centers for Disease Control and Prevention guidance 
20.24 	specific to the situation and program capabilities if a person receiving services or a staff 
20.25 	person tests positive for COVID-19; permitting programs to temporarily suspend group 
20.26 	counseling or limit attendance at sessions when unable to accommodate requirements for 
20.27 	social distancing and community mitigation; permitting comprehensive assessments to be 
20.28 	completed by telephone or video communication; permitting a counselor, recovery peer, or 
20.29 	treatment coordinator to provide treatment services from their home by telephone or video 
20.30 	communication to a client in their home; permitting programs to follow the Substance Abuse 
20.31 	and Mental Health Services Administration guidelines as directed by the State Opioid 
20.32 	Treatment Authority within the Department of Human Services Behavioral Health division 
20.33 	to allow for an increased number of take-home doses in accordance with an assessment 
21.1 	conducted under Minnesota Statutes, section 245G.22, subdivision 6; removing the 
21.2 	requirement for opioid treatment programs to conduct outreach activities in the community; 
21.3 	and permitting programs to document a client's verbal approval of a treatment plan instead 
21.4 	of requiring the client's signature;
21.5 	~~(11)~~(10) CV49: modifying certain license requirements for adult day services;
21.6 	~~(12)~~ (11) CV50: modifying certain requirements for early intensive developmental and 
21.7 	behavioral intervention (EIDBI) services;
21.8 	~~(13)~~ (12) CV53: allowing flexibility for personal care assistance service oversight, except 
21.9 	that the portion of this modification permitting personal care assistance workers to bill 310 
21.10 	hours per month shall expire upon the expiration of the peacetime emergency;
21.11 	~~(14)~~ (13) CV64: modifying certain certification requirements for mental health centers, 
21.12 	except that the extension shall be limited to the portions of this modification requiring 
21.13 	programs to become and remain familiar with Minnesota Department of Health and Centers 
21.14 	for Disease Control and Prevention guidance on COVID-19; requiring programs to follow 
21.15 	Minnesota Department of Health and Centers for Disease Control and Prevention guidance 
21.16 	specific to the situation and program capabilities if a person receiving services or a staff 
21.17 	person tests positive for COVID-19; permitting alternative mental health professional 
21.18 	supervision of clinical services at satellite locations; permitting an alternative process for 
21.19 	case consultation meetings; and permitting mental health professionals to provide required 
21.20 	client-specific supervisory contact by telephone or video communication instead of 
21.21 	face-to-face supervision; and
21.22 	~~(15)~~ (14) CV03: suspending application requirements for economic assistance programs, 
21.23 	except that the extension shall be limited to the portions of this modification allowing remote 
21.24 	interviews for the Minnesota family investment program, and allowing the use of electronic 
21.25 	signatures for enrollment verification. Verbal signatures shall not be permitted for enrollment 
21.26 	verification.

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

21.28 	Sec. 13. Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020, 
21.29 	Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
21.30 		Subd. 5.Waivers and modifications; extension to June 30, 2022. When the peacetime 
21.31 	emergency declared by the governor in response to the COVID-19 outbreak expires, is 
21.32 	terminated, or is rescinded by the proper authority, the modification in CV44 allowing 
21.33 	remote delivery of adult day services issued by the commissioner of human services pursuant 
22.1 	to Executive Orders 20-11 and 20-12, including any amendments to the modification issued 
22.2 	before the peacetime emergency expires, shall remain in effect until June 30, 2022, unless 
22.3 	necessary federal approval is not received at any time.

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

22.5 	Sec. 14. ESTABLISHMENT OF ALTERNATIVE ADULT DAY SERVICES RATES 
22.6 	AND RATE LIMITS.
 22.7 	The commissioner of human services shall establish under Minnesota Statutes, section 
22.8 	256S.15, subdivision 1, statewide service rates and service rate limits for alternative adult 
22.9 	day services provided under Minnesota Statutes, chapter 256S, and Minnesota Statutes, 
22.10 	sections 256B.0913 and 256B.0922. The commissioner shall set the rates and rate limits 
22.11 	for alternative adult day services, whether delivered remotely or in person, equal to the rates 
22.12 	and rate limits established under Minnesota Statutes, section 256S.15, for adult day services.

22.13 	EFFECTIVE DATE. This section is effective January 1, 2022, or six months after the 
22.14 	end of the federal public health emergency, or upon federal approval, whichever is later. 
22.15 	The commissioner of human services shall notify the revisor of statutes when the federal 
22.16 	public health emergency ends and when federal approval is obtained.

22.17 	Sec. 15. REVISOR INSTRUCTION.
 22.18 	The revisor of statutes, in consultation with the Senate Counsel, Research and Fiscal 
22.19 	Analysis Office, the House Research Department, and the commissioner of human services, 
22.20 	shall propose new legislation during the 2022 legislative session that recommends 
22.21 	renumbering the paragraphs of Minnesota Statutes, section 256B.4914, as subdivisions, 
22.22 	without changing the meaning or effect of these provisions, and minimizing the use of 
22.23 	internal cross-references, including by drafting new technical definitions as substitutes for 
22.24 	necessary cross-references or by other means acceptable to the commissioner of human 
22.25 	services.