Bill Text: MN SF1400 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Home and community-based services waivers payment methodologies modifications
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2013-03-14 - Referred to Finance [SF1400 Detail]
Download: Minnesota-2013-SF1400-Introduced.html
1.2relating to human services; modifying payment methodologies for home and
1.3community-based services waivers; amending Minnesota Statutes 2012, sections
1.4256B.0916, subdivision 2; 256B.092, subdivision 4; 256B.49, subdivision 17;
1.5256B.4913; proposing coding for new law in Minnesota Statutes, chapter 256B.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256B.0916, subdivision 2, is amended to
1.8read:
1.9 Subd. 2. Distribution of funds; partnerships. (a) Beginning with fiscal year 2000,
1.10the commissioner shall distribute all funding available for home and community-based
1.11waiver services for persons with developmental disabilities to individual counties or to
1.12groups of counties that form partnerships to jointly plan, and administer, and authorize
1.13funding services for eligible individuals. The commissioner shall encourage counties to
1.14form partnerships that have a sufficient number of recipients and funding to adequately
1.15manage the risk and maximize use of available resources.
1.16 (b)Counties must submit a request for funds and a plan for administering the program
1.17as required by the commissioner. The plan must identify the number of clients to be served,
1.18their ages, and their priority listing based on: Upon implementation of rate methodologies
1.19under section 256B.4914, the commissioner shall adjust the allocation methodology to
1.20lead agencies for home and community-based waivered service allocations to reflect the
1.21cost per recipient in their respective counties with disabilities in need of the level of care
1.22provided in an intermediate care facility for individuals with developmental disabilities,
1.23nursing facility, or a hospital as determined by the methodology in section 256B.4914.
1.24(1) requirements in Minnesota Rules, part 9525.1880; and
1.25(2) statewide priorities identified in section
256B.092, subdivision 12.
2.1The plan must also identify changes made to improve services to eligible persons and to
2.2improve program management.
2.3(c) In allocating resources to counties, priority must be given to groups of counties
2.4that form partnerships to jointly plan, administer, and authorize funding for eligible
2.5individuals and to counties determined by the commissioner to have sufficient waiver
2.6capacity to maximize resource use.
2.7(d) Within 30 days after receiving the county request for funds and plans, the
2.8commissioner shall provide a written response to the plan that includes the level of
2.9resources available to serve additional persons.
2.10(e) Counties are eligible to receive medical assistance administrative reimbursement
2.11for administrative costs under criteria established by the commissioner.
2.12 Sec. 2. Minnesota Statutes 2012, section 256B.092, subdivision 4, is amended to read:
2.13 Subd. 4. Home and community-based services for developmental disabilities.
2.14(a) The commissioner shall make payments to approved vendors participating in the
2.15medical assistance program to pay costs of providing home and community-based
2.16services, including case management service activities provided as an approved home and
2.17community-based service, to medical assistance eligible persons with developmental
2.18disabilities who have been screened under subdivision 7 and according to federal
2.19requirements. Federal requirements include those services and limitations included in the
2.20federally approved application for home and community-based services for persons with
2.21developmental disabilities and subsequent amendments.
2.22(b)Effective July 1, 1995, contingent upon federal approval and state appropriations
2.23made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
2.24section 40, The commissioner of human services shall allocate resources to county agencies
2.25for home and community-based waivered services for persons with developmental
2.26disabilitiesauthorized but not receiving those services as of June 30, 1995, based upon the
2.27average resource need of persons with similar functional characteristics. To ensure service
2.28continuity for service recipients receiving home and community-based waivered services
2.29for persons with developmental disabilities prior to July 1, 1995, the commissioner shall
2.30make available to the county of financial responsibility home and community-based
2.31waivered services resources based upon fiscal year 1995 authorized levels. number of
2.32recipients served and average cost for services per recipient under section 256B.4913:
2.33(1) on January 1, 2014, the cost for services is based on projected expenditures for
2.34all individuals and services under section 256B.4913; and
3.1(2) on January 1, 2017, the cost for services is based on historical expenditures for
3.2all individuals and services under section 256B.4913.
3.3(c) Home and community-based resources for all recipients shall be managed by the
3.4county of financial responsibility within an allowable reimbursement average established
3.5for each county. Payments for home and community-based services provided to individual
3.6recipients shall not exceed amounts authorized by the county of financial responsibility.
3.7For specifically identified former residents of nursing facilities, the commissioner shall be
3.8responsible for authorizing payments and payment limits under the appropriate home and
3.9community-based service program. Payment is available under this subdivision only for
3.10persons who, if not provided these services, would require the level of care provided in an
3.11intermediate care facility for persons with developmental disabilities.
3.12 Sec. 3. Minnesota Statutes 2012, section 256B.49, subdivision 17, is amended to read:
3.13 Subd. 17. Cost of services and supports. (a) The commissioner shall ensure that the
3.14average per capita expenditures estimated in any fiscal year for home and community-based
3.15waiver recipients does not exceed the average per capita expenditures that would have
3.16been made to provide institutional services for recipients in the absence of the waiver.
3.17(b) The commissioner shallimplement on January 1, 2002, one or more
3.18aggregate, need-based methods for allocating allocate to local agencies the home and
3.19community-based waivered service resources available to support recipients with
3.20disabilities in need of the level of care provided in a nursing facility or a hospital.The
3.21commissioner shall allocate resources to single counties and county partnerships in a
3.22manner that reflects consideration of Each allocation shall be based on the number of
3.23recipients and average cost for services under section 256B.4913. Allocations shall be
3.24made to single counties or county partnerships:
3.25(1)an incentive-based payment process for achieving outcomes on January 1, 2014,
3.26the average cost for services is determined based on projected expenditures; and
3.27(2)the need for a state-level risk pool; on January 1, 2017, the cost for services is
3.28based on historical expenditures for all individuals and services under section 256B.4913.
3.29(3) the need for retention of management responsibility at the state agency level; and
3.30(4) a phase-in strategy as appropriate.
3.31(c) Until the allocation methods described in paragraph (b) are implemented, the
3.32annual allowable reimbursement level of home and community-based waiver services
3.33shall be the greater of:
4.1(1) the statewide average payment amount which the recipient is assigned under the
4.2waiver reimbursement system in place on June 30, 2001, modified by the percentage of
4.3any provider rate increase appropriated for home and community-based services; or
4.4(2) an amount approved by the commissioner based on the recipient's extraordinary
4.5needs that cannot be met within the current allowable reimbursement level. The
4.6increased reimbursement level must be necessary to allow the recipient to be discharged
4.7from an institution or to prevent imminent placement in an institution. The additional
4.8reimbursement may be used to secure environmental modifications; assistive technology
4.9and equipment; and increased costs for supervision, training, and support services
4.10necessary to address the recipient's extraordinary needs. The commissioner may approve
4.11an increased reimbursement level for up to one year of the recipient's relocation from an
4.12institution or up to six months of a determination that a current waiver recipient is at
4.13imminent risk of being placed in an institution.
4.14(d) (c) Beginning July 1, 2001, medically necessary private duty nursing services
4.15will be authorized under this section as complex and regular care according to sections
4.16256B.0651
to
256B.0656 and
256B.0659 . The rate established by the commissioner for
4.17registered nurse or licensed practical nurse services under any home and community-based
4.18waiver as of January 1, 2001, shall not be reduced.
4.19(e) (d) Notwithstanding section
252.28, subdivision 3 , paragraph (d), if the 2009
4.20legislature adopts a rate reduction that impacts payment to providers of adult foster care
4.21services, the commissioner may issue adult foster care licenses that permit a capacity of
4.22five adults. The application for a five-bed license must meet the requirements of section
4.23245A.11, subdivision 2a
. Prior to admission of the fifth recipient of adult foster care
4.24services, the county must negotiate a revised per diem rate for room and board and waiver
4.25services that reflects the legislated rate reduction and results in an overall average per
4.26diem reduction for all foster care recipients in that home. The revised per diem must allow
4.27the provider to maintain, as much as possible, the level of services or enhanced services
4.28provided in the residence, while mitigating the losses of the legislated rate reduction.
4.29 Sec. 4. Minnesota Statutes 2012, section 256B.4913, is amended to read:
4.30256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.
4.31Subdivision 1. Research period and rates. (a) For the purposes of this
4.32section, "research rate" means a proposed payment rate for the provision of home
4.33and community-based waivered services to meet federal requirements and assess the
4.34implications of changing resources on the provision of services and "research period"
4.35means the time period during which the research rate is being assessed by the commissioner.
5.1(b) The commissioner shall determine and publish initial frameworks and values to
5.2generate research rates for individuals receiving home and community-based services.
5.3(c) The initial values issued by the commissioner shall ensure projected spending
5.4for home and community-based services for each service area is equivalent to projected
5.5spending under current law in the most recent expenditure forecast.
5.6(d) The initial values issued shall be based on the most updated information and cost
5.7data available on supervision, employee-related costs, client programming and supports,
5.8programming planning supports, transportation, administrative overhead, and utilization
5.9costs. These service areas are:
5.10(1) residential services, defined as corporate foster care, family foster care, residential
5.11care, supported living services, customized living, and 24-hour customized living;
5.12(2) day program services, defined as adult day care, day training and habilitation,
5.13prevocational services, structured day services, and transportation;
5.14(3) unit-based services with programming, defined as in-home family support,
5.15independent living services, supported living services, supported employment, behavior
5.16programming, and housing access coordination; and
5.17(4) unit-based services without programming, defined as respite, personal support,
5.18and night supervision.
5.19(e) The commissioner shall make available the underlying assessment information,
5.20without any identifying information, and the statistical modeling used to generate the
5.21initial research rate and calculate budget neutrality.
5.22Subd. 2. Framework values. (a) The commissioner shall propose legislation with
5.23the specific payment methodology frameworks, process for calculation, and specific
5.24values to populate the frameworks by February 15, 2013.
5.25(b) The commissioner shall provide underlying data and information used to
5.26formulate the final frameworks and values to the existing stakeholder workgroup by
5.27January 15, 2013.
5.28(c) The commissioner shall provide recommendations for the final frameworks
5.29and values, and the basis for the recommendations, to the legislative committees with
5.30jurisdiction over health and human services finance by February 15, 2013.
5.31(d) The commissioner shall review the following topics during the research period
5.32and propose, as necessary, recommendations to address the following research questions:
5.33(1) underlying differences in the cost to provide services throughout the state;
5.34(2) a data-driven process for determining labor costs and customizations for staffing
5.35classifications included in each rate framework based on the services performed;
6.1(3) the allocation of resources previously established under section
256B.501,
6.2subdivision 4b;
6.3(4) further definition and development of unit-based services;
6.4(5) the impact of splitting the allocation of resources for unit-based services for those
6.5with programming aspects and those without;
6.6(6) linking assessment criteria to future assessment processes for determination
6.7of customizations;
6.8(7) recognition of cost differences in the use of monitoring technology where it is
6.9appropriate to substitute for supervision;
6.10(8) implications for day services of reimbursement based on a unit rate and a daily
6.11rate;
6.12(9) a definition of shared and individual staffing for unit-based services;
6.13(10) the underlying costs of providing transportation associated with day services; and
6.14(11) an exception process for individuals with exceptional needs that cannot be met
6.15under the initial research rate, and an alternative payment structure for those individuals.
6.16(e) The commissioner shall develop a comprehensive plan based on information
6.17gathered during the research period that uses statistically reliable and valid assessment
6.18data to refine payment methodologies.
6.19(f) The commissioner shall make recommendations and provide underlying data and
6.20information used to formulate these research recommendations to the existing stakeholder
6.21workgroup by January 15, 2013.
6.22Subd. 3. Data collection. (a) The commissioner shall conduct any necessary
6.23research and gather additional data for the further development and refinement of payment
6.24methodology components. These include but are not limited to:
6.25(1) levels of service utilization and patterns of use;
6.26(2) staffing patterns for each service;
6.27(3) profiles of individual service needs; and
6.28(4) cost factors involved in providing transportation services.
6.29(b) The commissioner shall provide this information to the existing stakeholder
6.30workgroup by January 15, 2013.
6.31 Subd. 4. Rate stabilization adjustment.Beginning (a) The commissioner of
6.32human services shall adjust individual reimbursement rates by no more than one percent
6.33per year, effective January 1,2014, the commissioner shall adjust individual rates
6.34determined by 2016. Rates will be adjusted using the new payment methodology so
6.35that the new unit rate varies no more than one percent per year from the rate effective
6.36on December31 1 of the prior calendar year. This adjustment is made annually and is
7.1effective for three calendar years from the date of implementation. This subdivision
7.2expiresJanuary 1, 2017 December 31, 2019.
7.3(b) Rate stabilization adjustment applies to services that are authorized in each
7.4recipient's annual service review.
7.5(c) Exemptions will be made only when there is a significant change in the recipient's
7.6assessed needs that results in a service authorization change. Exemption adjustments will
7.7be limited to the difference in the authorized framework rate specific to a recipient's
7.8change in assessed need. Exemptions will be managed within lead agencies' budgets per
7.9existing allocation procedures that govern county waiver budget allocation.
7.10 Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
7.11on regular intervals with the existing stakeholder group established as part of the
7.12rate-setting methodology process and others to gather input, concerns, and data,and
7.13exchange ideas for the legislative proposals for to assist in the full implementation of
7.14 the new rate payment system and to make pertinent information available to the public
7.15through the department's Web site.
7.16 Subd. 6. Implementation. On January 1, 2016, the commissionermay shall
7.17 implement changesno sooner than January 1, 2014, to payment rates for individuals
7.18receiving home and community-based waivered services after the enactment of legislation
7.19that establishes specific payment methodology frameworks, processes for rate calculations,
7.20and specific values to populate thepayment methodology frameworks disability waiver
7.21rates system, under section 256B.4914.
7.22 Sec. 5. [256B.4914] HOME AND COMMUNITY-BASED WAIVERS; RATE
7.23SETTING.
7.24 Subdivision 1. Application. The payment methodologies in this section apply to
7.25home and community-based services waivers under sections 256B.092 and 256B.49.
7.26 Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
7.27meanings given them, unless the context clearly indicates otherwise.
7.28(b) "Commissioner" means the commissioner of human services.
7.29(c) "Component value" means underlying factors that are part of the cost of providing
7.30services that are built into the waiver rates methodology to calculate service rates.
7.31(d) "Customized living tool" means a methodology for setting service rates
7.32that delineates and documents the amount of each component service included in a
7.33recipient's customized living service plan, which must be approved by the recipient's
7.34full interdisciplinary team.
8.1(e) "Disability waiver rates system" means a statewide system that establishes rates
8.2that are based on uniform processes, and captures the individualized nature of waiver
8.3services and recipient needs.
8.4(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
8.5with administering waivered services under sections 256B.092 and 256B.49.
8.6(g) "Payment or rate" means reimbursement to an eligible provider for services
8.7provided to a qualified individual based on an approved service authorization.
8.8(h) "Rates management system" means a Web-based software application that uses
8.9a framework and component values, as determined by the commissioner, to establish
8.10service rates.
8.11(i) "Recipient" means a person receiving home and community-based services
8.12funded under any of the disability waivers.
8.13 Subd. 3. Applicable services. Applicable services are those authorized under the
8.14state's home and community-based services waivers in sections 256B.092 and 256B.49,
8.15including, as defined in the federally approved home and community-based services plan:
8.16(1) 24-hour customized living;
8.17(2) adult day care;
8.18(3) adult day care bath;
8.19(4) behavioral programming;
8.20(5) companion services;
8.21(6) customized living;
8.22(7) day training and habilitation;
8.23(8) housing access coordination;
8.24(9) independent living skills;
8.25(10) in-home family support;
8.26(11) night supervision;
8.27(12) personal support;
8.28(13) prevocational services;
8.29(14) residential care services;
8.30(15) residential support services;
8.31(16) respite services;
8.32(17) structured day services;
8.33(18) supported employment services;
8.34(19) supported living services;
8.35(20) transportation services; and
9.1(21) other services as approved by the federal government in the state home and
9.2community-based services plan.
9.3 Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
9.4and community-based waivered services, including rate exceptions under subdivision 13,
9.5are set via the rate management system.
9.6(b) Only data and information in the rate management system may be used to
9.7calculate an individual's rate.
9.8(c) Service providers, in consultation with lead agencies, shall enter values and
9.9information needed to calculate an individual's rate into the rate management system.
9.10These values and information include:
9.11(1) individual staffing hours;
9.12(2) shared staffing hours;
9.13(3) staffing ratios;
9.14(4) information to document variable levels of service qualification for variable
9.15levels of reimbursement in each framework;
9.16(5) number of trips and miles for transportation services;
9.17(6) individual nursing hours, for registered nursing and licensed practical nursing;
9.18(7) shared nursing hours, for registered nursing and licensed practical nursing;
9.19(8) shared or individualized arrangements for unit-based services, including the
9.20staffing ratio; and
9.21(9) the type of vehicle an individual requires.
9.22(d) Updates to individual data shall include:
9.23(1) data for each individual shall be updated annually when renewing service
9.24plans; and
9.25(2) individuals or providers may request an update to a rate whenever there is a
9.26change in an individual's service needs, with accompanying documentation.
9.27(e) Lead agencies shall review and approve values to calculate the final rate for
9.28each individual:
9.29(1) lead agencies shall provide the underlying values used to calculate an individual's
9.30rate to service providers upon request; and
9.31(2) if the values used differ from the initial values submitted, lead agencies must
9.32notify the individual and the service provider. That notification will include the original
9.33values, the final values, and justification for any adjustments.
9.34(f) Appeals of rate determination:
9.35(1) all aspects of rate determination are subject to appeals under section 256B.049;
9.36and
10.1(2) service providers may appeal a rate determination with lead agencies if any
10.2value used to calculate an individual's rate was different than what was submitted. Lead
10.3agencies shall review these requests within 30 calendar days.
10.4 Subd. 5. Base wage index and standard component values. (a) The base wage
10.5index is established to determine staffing costs associated with providing services to
10.6individuals receiving home and community-based services.
10.7(b) The commissioner shall calculate the base wage using a composite of wages
10.8taken from job descriptions and standard occupational codes (SOC) from the Bureau of
10.9Labor Statistics, as defined by values in the Occupational Outlook Handbook in 2009 for
10.10Minnesota. These wages will be entered into the rate management system. The base
10.11wage index shall be calculated as follows:
10.12(1) for day services, 20 percent of the median wage for nursing aide (SOC code
10.1331-1012); 20 percent of the median wage for psychiatric technicians (SOC code 29-2053);
10.14and 60 percent of the median wage for social and human services workers (SOC code
10.1521-1093);
10.16(2) for residential direct-care staff, 20 percent of the median wage for home health
10.17aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
10.18aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
10.1931-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
10.20and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
10.21(3) for residential asleep overnight staff, the wage will be $7.66 per hour;
10.22(4) for behavior program analyst staff, 100 percent of the median wage for mental
10.23health counselors (SOC code 21-1014);
10.24(5) for behavior program professional staff, 100 percent of the median wage for
10.25clinical counseling and school psychologist (SOC code 19-3031);
10.26(6) for behavior program specialist staff, 100 percent of the median wage for
10.27psychiatric technicians (SOC code 29-2053);
10.28(7) for supportive living services staff, 20 percent of the median wage for nursing
10.29aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
10.30code 29-2053); and 60 percent of the median wage for social and human services aide
10.31(SOC code 21-1093);
10.32(8) for housing access coordination staff, 50 percent of the median wage for
10.33community and social services specialist (SOC code 21-1099); and 50 percent of the
10.34median wage for social and human services aide (SOC code 21-1093);
10.35(9) for in-home family support staff, 20 percent of the median wage for nursing
10.36aide (SOC code 31-1012); 30 percent of the median wage for community social service
11.1specialist (SOC code 21-1099); 40 percent of the median wage for social and human
11.2services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
11.3technician (SOC code 29-2053);
11.4(10) for independent living skills staff, 100 percent of the median for community
11.5social service specialists (SOC code 21-1099);
11.6(11) for supported employment staff, 20 percent of the median wage for nursing aide
11.7(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
11.8code 29-2053); and 60 percent of the median wage for social and human services aide
11.9(SOC code 21-1093);
11.10(12) for adult companion staff, 50 percent of the median wage for personal and home
11.11care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
11.12orderlies, and attendants (SOC code 31-1012);
11.13(13) for night supervision staff, 20 percent of the median wage for home health aide
11.14(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
11.15(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
11.1620 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
11.17percent of the median wage for social and human services aide (SOC code 21-1093);
11.18(14) for respite staff, 50 percent of the median wage for personal and home care aide
11.19(SOC code 39-9032); and 50 percent of the median wage for nursing aides, orderlies, and
11.20attendants (SOC code 31-1012);
11.21(15) for personal support staff, 50 percent of the median wage for personal and home
11.22care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
11.23orderlies, and attendants (SOC code 31-1012);
11.24(16) for supervisory staff, 53 percent of the median wage for medical and health
11.25services managers (SOC code 11-9111);
11.26(17) for licensed practical nursing staff, 100 percent of the median wage for licensed
11.27practical and licensed vocational nurses (SOC code 29-2061); and
11.28(18) for registered nursing staff, 100 percent of the median wage for registered
11.29nurses (SOC code 29-1111).
11.30(c) The values for other components for calculating rates are defined as:
11.31(1) the hours of supervisory time included is 11 percent of each shared and individual
11.32hour of service;
11.33(2) the total add-on for employee-related expenses is 23.6 percent. Of that amount:
11.34(i) 11.56 percent is for the cost of taxes and workers' compensation; and
12.1(ii) 12.04 percent is for the cost of other benefits, including health insurance, dental
12.2insurance, life insurance, short-term disability insurance, long-term disability insurance,
12.3vision, retirement, and tuition reimbursement;
12.4(3) the add-on for the cost of employee vacation time, sick time, and training time is
12.510.3 percent;
12.6(4) the add-on for the cost of staff time for program plan support is 5.6 percent;
12.7(5) the add-on for general administrative costs is 13.25 percent;
12.8(6) the add-on for program-related expenses is 1.3 percent; and
12.9(7) the add-on for absence and utilization factors is 6.0 percent.
12.10(d) On July 1, 2017, the commissioner shall update the base wage index in paragraph
12.11(b) based on the release of the December 31 data of the most recent year from the
12.12Bureau of Labor Statistics, and publish the base wage index on the beginning of the
12.13upcoming state fiscal year on July 1. The updated staffing wages will be updated in the
12.14rate management system. This adjustment occurs every five years.
12.15(e) On July 1, 2017, the commissioner shall update the framework components in
12.16paragraph (c) for increases in the Consumer Price Index every five years. The commissioner
12.17will adjust these values by the percentage change in the Consumer Price Index-All Items
12.18(United States city average)(CPI-U) over the same period. The updated values will be
12.19loaded in the rate management system. This adjustment occurs every five years.
12.20 Subd. 6. Payments for residential support services. (a) Payments for residential
12.21support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
12.22subdivision 22, must be calculated under the methodology in this subdivision.
12.23(b) For supervision provided with direct staff, rates shall be calculated as follows:
12.24(1) units of service are taken from the rate management system;
12.25(2) personnel hourly wage rates are defined by the base wage index in subdivision
12.265 to define the direct-care rate;
12.27(3) if an individual qualifies for the add-on customization for deaf and
12.28hard-of-hearing language accessibility under subdivision 12, add the customization
12.29rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
12.30customized direct-care rate;
12.31(4) multiply the number of shared and direct staff hours and shared and direct nursing
12.32hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
12.33(5) multiply the number of direct staff hours by the product of the supervision span
12.34of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
13.1(6) combine the figures calculated in clauses (4) and (5), and multiply the result by
13.2one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
13.3(c), to define the direct staffing cost;
13.4(7) for employee-related expenses, multiply the direct staffing cost by one plus the
13.5add-on for employee-related costs in subdivision 5, paragraph (c);
13.6(8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
13.7(9) for individuals who had previously received an adjustment to rates under section
13.8256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
13.9(10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
13.10adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
13.11(11) the total rate shall be calculated using the following steps:
13.12(i) the subtotal of clauses (6) to (10);
13.13(ii) the sum of the standard general and administrative rate, the program-related
13.14expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
13.15(iii) divide the result of item (i) by one minus the total in item (ii) for the total
13.16payment amount; and
13.17(12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
13.18as defined in subdivision 14.
13.19(c) For supervision provided by remote monitoring technology, rates shall be
13.20calculated as follows:
13.21(1) units of service are taken from the rate management system;
13.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
13.235 to define the direct-care rate;
13.24(3) if an individual qualifies for the add-on customization for deaf and
13.25hard-of-hearing language accessibility under subdivision 12, add the customization
13.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
13.27customized direct-care rate;
13.28(4) multiply the number of shared and direct staff hours and shared and direct nursing
13.29hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
13.30(5) multiply the number of direct staff hours by the product of the supervision span
13.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
13.32This is defined as the direct staffing cost;
13.33(6) for client programming and supports, add $2,179 per year adjusted to a daily rate;
13.34(7) for individuals who had previously received an adjustment to rates under section
13.35256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
14.1(8) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
14.2adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
14.3(9) the total rate shall be calculated using the following steps:
14.4(i) the subtotal of clauses (5) to (8);
14.5(ii) the sum of the standard general and administrative rate, the program-related
14.6expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
14.7(iii) divide the result of item (i) by one minus the total in item (ii). This is the total
14.8payment amount; and
14.9(10) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
14.10as defined in subdivision 14.
14.11(d) For supervision provided with direct staff in a family foster care setting, rates
14.12shall be calculated as follows:
14.13(1) units of service are taken from the rate management system;
14.14(2) personnel hourly wage rates are defined by the base wage index in subdivision
14.155, to define the direct-care rate;
14.16(3) if an individual qualifies for the add-on customization for deaf and
14.17hard-of-hearing language accessibility under subdivision 12, add the customization
14.18rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
14.19customized direct-care rate;
14.20(4) multiply the number of shared and direct staff hours and shared and direct nursing
14.21hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
14.22(5) multiply the number of direct staff hours by the product of the supervision span
14.23of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
14.24(6) combine the figures calculated in clauses (4) and (5) and multiply the result by
14.25one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
14.26(c), to define the direct staffing cost;
14.27(7) for employee-related expenses, multiply the direct staffing cost by one plus
14.28two-thirds of the add-on for employee-related costs in subdivision 5, paragraph (c);
14.29(8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
14.30(9) for individuals who had previously received an adjustment to rates under section
14.31256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
14.32(10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
14.33adapted vehicle, or $3,000 for a full-size adapted van per year adjusted to an hourly rate;
14.34(11) the total rate shall be calculated using the following steps:
14.35(i) the subtotal of clauses (6) to (10);
15.1(ii) the sum of the standard general and administrative rate, the program-related
15.2expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
15.3(iii) divide the result of item (i) by one minus two-thirds of the total in item (ii) for
15.4the total payment amount; and
15.5(12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
15.6as defined in subdivision 14.
15.7 Subd. 7. Payments for day programs. (a) Payments for services with day
15.8programs, including adult day care, day treatment and habilitation, prevocational services,
15.9and structured day services must be calculated as follows:
15.10(1) units of service are taken from the rate management system;
15.11(2) personnel hourly wage rates are defined by the base wage index in subdivision
15.125 to define the direct-care rate;
15.13(3) if an individual qualifies for the add-on customization for deaf and
15.14hard-of-hearing language accessibility under subdivision 12, add the customization
15.15rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
15.16customized direct-care rate;
15.17(4) multiply the number of shared and direct staff hours by the appropriate staff
15.18wage in subdivision 5 or the customized direct-care rate;
15.19(5) multiply the number of direct staff hours by the product of the supervision span
15.20of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
15.21(6) for program plan support, multiply the result of clause (5) by one plus the add-on
15.22in subdivision 5, paragraph (c);
15.23(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
15.24one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
15.25(c), to define the direct staffing cost;
15.26(8) for employee-related expenses, multiply the direct staffing cost by one plus the
15.27add-on for employee-related costs in subdivision 5, paragraph (c);
15.28(9) for client programming and supports, multiply the result of clause (8) by one
15.29plus ten percent;
15.30(10) for program facility costs, add $31.69 per week adjusted for staffing ratios
15.31entered in the rate management system under subdivision 5;
15.32(11) for transportation to and from each individual's residence, add a base of $5.00,
15.33plus:
15.34(i) for a one-way trip between zero and ten miles, $7.00 for a vehicle without a lift
15.35and $7.77 for a vehicle with a lift;
16.1(ii) for a one-way trip between 11 and 20 miles, $7.87 for a vehicle without a lift and
16.2$10.27 for a vehicle with a lift;
16.3(iii) for a one-way trip between 21 and 50 miles, $17.75 for a vehicle without a lift
16.4and $50.76 for a vehicle with a lift;
16.5(iv) for a one-way trip of 51 miles or more, $25.50 for a vehicle without a lift and
16.6$72.93 for a vehicle with a lift; and
16.7(v) the mileage rate used in these calculations will be adjusted by January 1 of
16.8each year by the same percentage change in the IRS mileage rate compared to the IRS
16.9mileage rate for the previous year;
16.10(12) the total rate shall be calculated using the following steps:
16.11(i) the subtotal of clauses (7) to (11);
16.12(ii) the sum of the standard general and administrative rate, the program-related
16.13expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
16.14(iii) divide the result of item (i) by one minus the total in item (ii) for the total
16.15payment amount; and
16.16(13) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
16.17as defined in subdivision 14.
16.18(b) Adult day bath is reimbursed at $7.01 per 15-minute unit.
16.19 Subd. 8. Payments for unit-based services with programming. (a) Payments for
16.20unit-based services with programming include behavior programming, housing access
16.21coordination, in-home family support, independent living skills training, hourly supported
16.22living services, and supported employment provided to an individual outside of any day or
16.23residential service plan. Services, including the use of monitoring technology, are included.
16.24(b) The rate for individual services must be calculated as follows:
16.25(1) units of service are taken from the rate management system;
16.26(2) personnel hourly wage rates are defined by the base wage index in subdivision
16.275 to define the direct-care rate;
16.28(3) if an individual qualifies for the add-on customization for deaf and
16.29hard-of-hearing language accessibility under subdivision 12, add the customization
16.30rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
16.31customized direct-care rate;
16.32(4) multiply the number of shared and direct staff hours by the appropriate staff
16.33wage in subdivision 5 or the customized direct-care rate;
16.34(5) multiply the number of direct staff hours by the product of the supervision span
16.35of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
17.1If the supervision wage is lower than for direct staff, substitute the direct staff wage in
17.2subdivision 5;
17.3(6) for program plan support, multiply the result of clause (5) by one plus the add-on
17.4in subdivision 5, paragraph (c);
17.5(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
17.6one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
17.7(c), to define the direct staffing cost;
17.8(8) for employee-related expenses, multiply the direct staffing cost by one plus the
17.9add-on for employee-related costs in subdivision 5, paragraph (c);
17.10(9) for client programming and supports, multiply the result of clause (8) by one
17.11plus 8.6 percent;
17.12(10) the total rate shall be calculated using the following steps:
17.13(i) the subtotal of clauses (7) to (9);
17.14(ii) the sum of the standard general and administrative rate, the program-related
17.15expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
17.16(iii) divide the result of item (i) by one minus the total in item (ii) for the total
17.17payment amount; and
17.18(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
17.19as defined in subdivision 14.
17.20(c) The rate for shared services must be calculated as follows:
17.21(1) units of service are taken from the rate management system;
17.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
17.235 to define the direct-care rate;
17.24(3) if an individual qualifies for the add-on customization for deaf and
17.25hard-of-hearing language accessibility under subdivision 12, add the customization
17.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
17.27customized direct-care rate;
17.28(4) multiply the number of shared and direct staff hours by the appropriate staff
17.29wage in subdivision 5 or the customized direct-care rate;
17.30(5) multiply the number of direct staff hours by the product of the supervision span
17.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
17.32If the supervision wage is lower than for direct staff, substitute the direct staff wage in
17.33subdivision 5;
17.34(6) for program plan support, multiply the result of clause (5) by one plus the add-on
17.35in subdivision 5, paragraph (c);
18.1(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
18.2one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
18.3(c), to define the direct staffing cost;
18.4(8) for employee-related expenses, multiply the direct staffing cost by one plus the
18.5add-on for employee-related costs in subdivision 5, paragraph (c);
18.6(9) for client programming and supports, multiply the result of clause (8) by one
18.7plus 8.6 percent;
18.8(10) the total rate shall be calculated using the following steps:
18.9(i) the subtotal of clauses (7) to (9);
18.10(ii) the sum of the standard general and administrative rate, the program-related
18.11expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
18.12(iii) divide the result of item (i) by one minus the total in item (ii) for the total
18.13payment amount; and
18.14(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
18.15as defined in subdivision 14.
18.16 Subd. 9. Payments for unit-based services without programming. (a) Payments
18.17for unit-based services without programming include night supervision, personal support,
18.18respite, and companion care provided to an individual outside of any day or residential
18.19service plan. Services, including the use of monitoring technology, are included.
18.20(b) The rate for individual services must be calculated as follows:
18.21(1) units of service are taken from the rate management system;
18.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
18.235 to define the direct-care rate;
18.24(3) if an individual qualifies for the add-on customization for deaf and
18.25hard-of-hearing language accessibility under subdivision 12, add the customization
18.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
18.27customized direct-care rate;
18.28(4) multiply the number of shared and direct staff hours by the appropriate staff
18.29wage in subdivision 5 or the customized direct-care rate;
18.30(5) multiply the number of direct staff hours by the product of the supervision span
18.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
18.32(6) for program plan support, multiply the result of clause (5) by one plus the add-on
18.33in subdivision 5, paragraph (c);
18.34(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
18.35one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
18.36(c), to define the direct staffing cost;
19.1(8) for employee-related expenses, multiply the direct staffing cost by one plus the
19.2add-on for employee-related costs in subdivision 5, paragraph (c);
19.3(9) for client programming and supports, multiply the result of clause (8) by one
19.4plus 6.1 percent;
19.5(10) the total rate shall be calculated using the following steps:
19.6(i) the subtotal of clauses (7) to (9);
19.7(ii) the sum of the standard general and administrative rate, the program-related
19.8expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
19.9(iii) divide the result of item (i) by one minus the total in item (ii) for the total
19.10payment amount; and
19.11(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
19.12as defined in subdivision 14.
19.13(c) The rate for shared services must be calculated as follows:
19.14(1) units of service are taken from the rate management system;
19.15(2) personnel hourly wage rates are defined by the base wage index in subdivision
19.165 to define the direct-care rate;
19.17(3) if an individual qualifies for the add-on customization for deaf and
19.18hard-of-hearing language accessibility under subdivision 12, add the customization
19.19rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
19.20customized direct-care rate;
19.21(4) multiply the number of shared and direct staff hours by the appropriate staff
19.22wage in subdivision 5 or the customized direct-care rate;
19.23(5) multiply the number of direct staff hours by the product of the supervision span
19.24of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
19.25(6) for program plan support, multiply the result of clause (5) by one plus the add-on
19.26in subdivision 5, paragraph (c);
19.27(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
19.28one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
19.29(c), to define the direct staffing cost;
19.30(8) for employee-related expenses, multiply the direct staffing cost by one plus the
19.31add-on for employee-related costs in subdivision 5, paragraph (c);
19.32(9) for client programming and supports, multiply the result of clause (8) by one
19.33plus 6.1 percent;
19.34(10) the total rate shall be calculated using the following steps:
19.35(i) the subtotal of clauses (7) to (9);
20.1(ii) the sum of the standard general and administrative rate, the program-related
20.2expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
20.3(iii) divide the result of item (i) by one minus the total in item (ii) for the total
20.4payment amount; and
20.5(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
20.6as defined in subdivision 14.
20.7 Subd. 10. Updating payment values and additional information. (a) The
20.8commissioner shall develop and implement uniform procedures to refine terms and update
20.9recommended changes to values used to calculate payment rates in this section.
20.10(b) The commissioner shall work with stakeholders to assess efficacy of values
20.11and payment rates. The commissioner shall report back to the legislature with proposed
20.12changes for component values.
20.13(c) By February 15, 2015, the commissioner shall work with stakeholders to jointly
20.14collect and analyze data on the following topics:
20.15(1) that rates produced are sufficient to enlist enough providers so that care and
20.16services are available under the plan at least to the extent that the care and services are
20.17available to the general public in the geographic areas as required by section 1902(a)(3)(A)
20.18of the Social Security Act;
20.19(2) the cost of an increase in the state or federally required minimum wage and
20.20the impact on services;
20.21(3) the cost of complying with the insurance requirements under the Patient
20.22Protection and Affordable Care Act, Public Law 111-148, and the impact on services;
20.23(4) the impact of the methodology under section 256B.4914 on spending by county.
20.24The commissioner shall compare spending prior to and post implementation;
20.25(5) a survey of providers to determine differences in the underlying cost of care
20.26to measure if differences exist by region;
20.27(6) the utilization of transportation services for unit-based services;
20.28(7) detailed data on the number of trips, mileage, and utilization of transportation
20.29in all-day services; and
20.30(8) the occurrence of shared arrangements for unit-based services.
20.31(d) The commissioner shall report to the chairs and ranking minority members of the
20.32senate and house of representatives committees and divisions with primary jurisdiction
20.33over health and human services and finance by February 15, 2015, either with legislation
20.34or a detailed explanation of why no legislation is recommended to address these topics.
21.1 Subd. 11. Payment implementation. Upon implementation of the payment
21.2methodologies under this section, those payment rates supersede rates established in county
21.3contracts for recipients receiving waiver services under sections 256B.092 and 256B.49.
21.4 Subd. 12. Customization of rates for individuals. For persons determined to have
21.5higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
21.6by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8, and 9. The
21.7customization rate with respect to deaf and hard-of-hearing persons shall be $2.50 per hour
21.8for waiver recipients who meet the respective criteria as determined by the commissioner.
21.9 Subd. 13. Rates for individuals with exceptional needs. (a) Rates determined
21.10under subdivisions 6, 7, 8, and 9 are eligible for a rate exception under this subdivision.
21.11(b) Lead agencies shall consider exception requests by an individual or a provider
21.12agency.
21.13(c) An application for a rate exception may be submitted for the following criteria:
21.14(1) an individual has service needs that cannot be met through additional units
21.15of service; or
21.16(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
21.17individual being discharged.
21.18(d) Exception requests to lead agencies will include the following information:
21.19(1) the level of services needs required by each individual that are not accounted
21.20for in subdivisions 6, 7, 8, and 9;
21.21(2) the service rate requested and the difference from the rate determined in
21.22subdivisions 6, 7, 8, and 9;
21.23(3) a basis for the underlying costs used for the rate exception and any accompanying
21.24documentation;
21.25(4) the duration of the rate exception; and
21.26(5) any contingencies for approval.
21.27(e) Lead agencies shall review exception requests, attach their recommendation, and
21.28forward the request to the commissioner for approval.
21.29(f) The commissioner shall evaluate and approve rate exceptions, approve a
21.30modified rate exception, or reject the rate exception request. Within 30 calendar days,
21.31the commissioner shall notify individual and service providers, and provide justification
21.32for each rate exception decision.
21.33(g) Approved rate exceptions shall be managed within lead agency allocations under
21.34sections 256B.092 and 256B.49.
21.35(h) All aspects of the rate exception process are subject to appeals under section
21.36256B.49.
22.1 Subd. 14. Budget neutrality adjustment. The commissioner shall calculate the
22.2total spending for all home and community-based waiver services under the payments as
22.3defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
22.4spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
22.5for services in one particular subdivision differs, there will be a percentage adjustment
22.6to increase or decrease individual rates for the services defined in each subdivision so
22.7aggregate spending matches projections under current law.
22.8EFFECTIVE DATE.This section is effective January 1, 2016.
1.3community-based services waivers; amending Minnesota Statutes 2012, sections
1.4256B.0916, subdivision 2; 256B.092, subdivision 4; 256B.49, subdivision 17;
1.5256B.4913; proposing coding for new law in Minnesota Statutes, chapter 256B.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 256B.0916, subdivision 2, is amended to
1.8read:
1.9 Subd. 2. Distribution of funds; partnerships. (a) Beginning with fiscal year 2000,
1.10the commissioner shall distribute all funding available for home and community-based
1.11waiver services for persons with developmental disabilities to individual counties or to
1.12groups of counties that form partnerships to jointly plan
1.13
1.14form partnerships that have a sufficient number of recipients and funding to adequately
1.15manage the risk and maximize use of available resources.
1.16 (b)
1.17
1.18
1.19under section 256B.4914, the commissioner shall adjust the allocation methodology to
1.20lead agencies for home and community-based waivered service allocations to reflect the
1.21cost per recipient in their respective counties with disabilities in need of the level of care
1.22provided in an intermediate care facility for individuals with developmental disabilities,
1.23nursing facility, or a hospital as determined by the methodology in section 256B.4914.
1.24
1.25
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12 Sec. 2. Minnesota Statutes 2012, section 256B.092, subdivision 4, is amended to read:
2.13 Subd. 4. Home and community-based services for developmental disabilities.
2.14(a) The commissioner shall make payments to approved vendors participating in the
2.15medical assistance program to pay costs of providing home and community-based
2.16services, including case management service activities provided as an approved home and
2.17community-based service, to medical assistance eligible persons with developmental
2.18disabilities who have been screened under subdivision 7 and according to federal
2.19requirements. Federal requirements include those services and limitations included in the
2.20federally approved application for home and community-based services for persons with
2.21developmental disabilities and subsequent amendments.
2.22(b)
2.23
2.24
2.25for home and community-based waivered services for persons with developmental
2.26disabilities
2.27
2.28
2.29
2.30
2.31
2.32recipients served and average cost for services per recipient under section 256B.4913:
2.33(1) on January 1, 2014, the cost for services is based on projected expenditures for
2.34all individuals and services under section 256B.4913; and
3.1(2) on January 1, 2017, the cost for services is based on historical expenditures for
3.2all individuals and services under section 256B.4913.
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12 Sec. 3. Minnesota Statutes 2012, section 256B.49, subdivision 17, is amended to read:
3.13 Subd. 17. Cost of services and supports. (a) The commissioner shall ensure that the
3.14average per capita expenditures estimated in any fiscal year for home and community-based
3.15waiver recipients does not exceed the average per capita expenditures that would have
3.16been made to provide institutional services for recipients in the absence of the waiver.
3.17(b) The commissioner shall
3.18
3.19community-based waivered service resources available to support recipients with
3.20disabilities in need of the level of care provided in a nursing facility or a hospital.
3.21
3.22
3.23recipients and average cost for services under section 256B.4913. Allocations shall be
3.24made to single counties or county partnerships:
3.25(1)
3.26the average cost for services is determined based on projected expenditures; and
3.27(2)
3.28based on historical expenditures for all individuals and services under section 256B.4913.
3.29
3.30
3.31
3.32
3.33
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
4.15will be authorized under this section as complex and regular care according to sections
4.17registered nurse or licensed practical nurse services under any home and community-based
4.18waiver as of January 1, 2001, shall not be reduced.
4.19
4.20legislature adopts a rate reduction that impacts payment to providers of adult foster care
4.21services, the commissioner may issue adult foster care licenses that permit a capacity of
4.22five adults. The application for a five-bed license must meet the requirements of section
4.24services, the county must negotiate a revised per diem rate for room and board and waiver
4.25services that reflects the legislated rate reduction and results in an overall average per
4.26diem reduction for all foster care recipients in that home. The revised per diem must allow
4.27the provider to maintain, as much as possible, the level of services or enhanced services
4.28provided in the residence, while mitigating the losses of the legislated rate reduction.
4.29 Sec. 4. Minnesota Statutes 2012, section 256B.4913, is amended to read:
4.30256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.
4.31
4.32
4.33
4.34
4.35
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
5.12
5.13
5.14
5.15
5.16
5.17
5.18
5.19
5.20
5.21
5.22
5.23
5.24
5.25
5.26
5.27
5.28
5.29
5.30
5.31
5.32
5.33
5.34
5.35
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
6.10
6.11
6.12
6.13
6.14
6.15
6.16
6.17
6.18
6.19
6.20
6.21
6.22
6.23
6.24
6.25
6.26
6.27
6.28
6.29
6.30
6.31 Subd. 4. Rate stabilization adjustment.
6.32human services shall adjust individual reimbursement rates by no more than one percent
6.33per year, effective January 1,
6.34
6.35that the new unit rate varies no more than one percent per year from the rate effective
6.36on December
7.1
7.2expires
7.3(b) Rate stabilization adjustment applies to services that are authorized in each
7.4recipient's annual service review.
7.5(c) Exemptions will be made only when there is a significant change in the recipient's
7.6assessed needs that results in a service authorization change. Exemption adjustments will
7.7be limited to the difference in the authorized framework rate specific to a recipient's
7.8change in assessed need. Exemptions will be managed within lead agencies' budgets per
7.9existing allocation procedures that govern county waiver budget allocation.
7.10 Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
7.11on regular intervals with the existing stakeholder group established as part of the
7.12rate-setting methodology process and others to gather input, concerns, and data,
7.13
7.14 the new rate payment system and to make pertinent information available to the public
7.15through the department's Web site.
7.16 Subd. 6. Implementation. On January 1, 2016, the commissioner
7.17 implement changes
7.18receiving home and community-based waivered services after the enactment of legislation
7.19that establishes specific payment methodology frameworks, processes for rate calculations,
7.20and specific values to populate the
7.21rates system, under section 256B.4914.
7.22 Sec. 5. [256B.4914] HOME AND COMMUNITY-BASED WAIVERS; RATE
7.23SETTING.
7.24 Subdivision 1. Application. The payment methodologies in this section apply to
7.25home and community-based services waivers under sections 256B.092 and 256B.49.
7.26 Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
7.27meanings given them, unless the context clearly indicates otherwise.
7.28(b) "Commissioner" means the commissioner of human services.
7.29(c) "Component value" means underlying factors that are part of the cost of providing
7.30services that are built into the waiver rates methodology to calculate service rates.
7.31(d) "Customized living tool" means a methodology for setting service rates
7.32that delineates and documents the amount of each component service included in a
7.33recipient's customized living service plan, which must be approved by the recipient's
7.34full interdisciplinary team.
8.1(e) "Disability waiver rates system" means a statewide system that establishes rates
8.2that are based on uniform processes, and captures the individualized nature of waiver
8.3services and recipient needs.
8.4(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
8.5with administering waivered services under sections 256B.092 and 256B.49.
8.6(g) "Payment or rate" means reimbursement to an eligible provider for services
8.7provided to a qualified individual based on an approved service authorization.
8.8(h) "Rates management system" means a Web-based software application that uses
8.9a framework and component values, as determined by the commissioner, to establish
8.10service rates.
8.11(i) "Recipient" means a person receiving home and community-based services
8.12funded under any of the disability waivers.
8.13 Subd. 3. Applicable services. Applicable services are those authorized under the
8.14state's home and community-based services waivers in sections 256B.092 and 256B.49,
8.15including, as defined in the federally approved home and community-based services plan:
8.16(1) 24-hour customized living;
8.17(2) adult day care;
8.18(3) adult day care bath;
8.19(4) behavioral programming;
8.20(5) companion services;
8.21(6) customized living;
8.22(7) day training and habilitation;
8.23(8) housing access coordination;
8.24(9) independent living skills;
8.25(10) in-home family support;
8.26(11) night supervision;
8.27(12) personal support;
8.28(13) prevocational services;
8.29(14) residential care services;
8.30(15) residential support services;
8.31(16) respite services;
8.32(17) structured day services;
8.33(18) supported employment services;
8.34(19) supported living services;
8.35(20) transportation services; and
9.1(21) other services as approved by the federal government in the state home and
9.2community-based services plan.
9.3 Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
9.4and community-based waivered services, including rate exceptions under subdivision 13,
9.5are set via the rate management system.
9.6(b) Only data and information in the rate management system may be used to
9.7calculate an individual's rate.
9.8(c) Service providers, in consultation with lead agencies, shall enter values and
9.9information needed to calculate an individual's rate into the rate management system.
9.10These values and information include:
9.11(1) individual staffing hours;
9.12(2) shared staffing hours;
9.13(3) staffing ratios;
9.14(4) information to document variable levels of service qualification for variable
9.15levels of reimbursement in each framework;
9.16(5) number of trips and miles for transportation services;
9.17(6) individual nursing hours, for registered nursing and licensed practical nursing;
9.18(7) shared nursing hours, for registered nursing and licensed practical nursing;
9.19(8) shared or individualized arrangements for unit-based services, including the
9.20staffing ratio; and
9.21(9) the type of vehicle an individual requires.
9.22(d) Updates to individual data shall include:
9.23(1) data for each individual shall be updated annually when renewing service
9.24plans; and
9.25(2) individuals or providers may request an update to a rate whenever there is a
9.26change in an individual's service needs, with accompanying documentation.
9.27(e) Lead agencies shall review and approve values to calculate the final rate for
9.28each individual:
9.29(1) lead agencies shall provide the underlying values used to calculate an individual's
9.30rate to service providers upon request; and
9.31(2) if the values used differ from the initial values submitted, lead agencies must
9.32notify the individual and the service provider. That notification will include the original
9.33values, the final values, and justification for any adjustments.
9.34(f) Appeals of rate determination:
9.35(1) all aspects of rate determination are subject to appeals under section 256B.049;
9.36and
10.1(2) service providers may appeal a rate determination with lead agencies if any
10.2value used to calculate an individual's rate was different than what was submitted. Lead
10.3agencies shall review these requests within 30 calendar days.
10.4 Subd. 5. Base wage index and standard component values. (a) The base wage
10.5index is established to determine staffing costs associated with providing services to
10.6individuals receiving home and community-based services.
10.7(b) The commissioner shall calculate the base wage using a composite of wages
10.8taken from job descriptions and standard occupational codes (SOC) from the Bureau of
10.9Labor Statistics, as defined by values in the Occupational Outlook Handbook in 2009 for
10.10Minnesota. These wages will be entered into the rate management system. The base
10.11wage index shall be calculated as follows:
10.12(1) for day services, 20 percent of the median wage for nursing aide (SOC code
10.1331-1012); 20 percent of the median wage for psychiatric technicians (SOC code 29-2053);
10.14and 60 percent of the median wage for social and human services workers (SOC code
10.1521-1093);
10.16(2) for residential direct-care staff, 20 percent of the median wage for home health
10.17aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
10.18aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
10.1931-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
10.20and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
10.21(3) for residential asleep overnight staff, the wage will be $7.66 per hour;
10.22(4) for behavior program analyst staff, 100 percent of the median wage for mental
10.23health counselors (SOC code 21-1014);
10.24(5) for behavior program professional staff, 100 percent of the median wage for
10.25clinical counseling and school psychologist (SOC code 19-3031);
10.26(6) for behavior program specialist staff, 100 percent of the median wage for
10.27psychiatric technicians (SOC code 29-2053);
10.28(7) for supportive living services staff, 20 percent of the median wage for nursing
10.29aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
10.30code 29-2053); and 60 percent of the median wage for social and human services aide
10.31(SOC code 21-1093);
10.32(8) for housing access coordination staff, 50 percent of the median wage for
10.33community and social services specialist (SOC code 21-1099); and 50 percent of the
10.34median wage for social and human services aide (SOC code 21-1093);
10.35(9) for in-home family support staff, 20 percent of the median wage for nursing
10.36aide (SOC code 31-1012); 30 percent of the median wage for community social service
11.1specialist (SOC code 21-1099); 40 percent of the median wage for social and human
11.2services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
11.3technician (SOC code 29-2053);
11.4(10) for independent living skills staff, 100 percent of the median for community
11.5social service specialists (SOC code 21-1099);
11.6(11) for supported employment staff, 20 percent of the median wage for nursing aide
11.7(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
11.8code 29-2053); and 60 percent of the median wage for social and human services aide
11.9(SOC code 21-1093);
11.10(12) for adult companion staff, 50 percent of the median wage for personal and home
11.11care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
11.12orderlies, and attendants (SOC code 31-1012);
11.13(13) for night supervision staff, 20 percent of the median wage for home health aide
11.14(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
11.15(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
11.1620 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
11.17percent of the median wage for social and human services aide (SOC code 21-1093);
11.18(14) for respite staff, 50 percent of the median wage for personal and home care aide
11.19(SOC code 39-9032); and 50 percent of the median wage for nursing aides, orderlies, and
11.20attendants (SOC code 31-1012);
11.21(15) for personal support staff, 50 percent of the median wage for personal and home
11.22care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
11.23orderlies, and attendants (SOC code 31-1012);
11.24(16) for supervisory staff, 53 percent of the median wage for medical and health
11.25services managers (SOC code 11-9111);
11.26(17) for licensed practical nursing staff, 100 percent of the median wage for licensed
11.27practical and licensed vocational nurses (SOC code 29-2061); and
11.28(18) for registered nursing staff, 100 percent of the median wage for registered
11.29nurses (SOC code 29-1111).
11.30(c) The values for other components for calculating rates are defined as:
11.31(1) the hours of supervisory time included is 11 percent of each shared and individual
11.32hour of service;
11.33(2) the total add-on for employee-related expenses is 23.6 percent. Of that amount:
11.34(i) 11.56 percent is for the cost of taxes and workers' compensation; and
12.1(ii) 12.04 percent is for the cost of other benefits, including health insurance, dental
12.2insurance, life insurance, short-term disability insurance, long-term disability insurance,
12.3vision, retirement, and tuition reimbursement;
12.4(3) the add-on for the cost of employee vacation time, sick time, and training time is
12.510.3 percent;
12.6(4) the add-on for the cost of staff time for program plan support is 5.6 percent;
12.7(5) the add-on for general administrative costs is 13.25 percent;
12.8(6) the add-on for program-related expenses is 1.3 percent; and
12.9(7) the add-on for absence and utilization factors is 6.0 percent.
12.10(d) On July 1, 2017, the commissioner shall update the base wage index in paragraph
12.11(b) based on the release of the December 31 data of the most recent year from the
12.12Bureau of Labor Statistics, and publish the base wage index on the beginning of the
12.13upcoming state fiscal year on July 1. The updated staffing wages will be updated in the
12.14rate management system. This adjustment occurs every five years.
12.15(e) On July 1, 2017, the commissioner shall update the framework components in
12.16paragraph (c) for increases in the Consumer Price Index every five years. The commissioner
12.17will adjust these values by the percentage change in the Consumer Price Index-All Items
12.18(United States city average)(CPI-U) over the same period. The updated values will be
12.19loaded in the rate management system. This adjustment occurs every five years.
12.20 Subd. 6. Payments for residential support services. (a) Payments for residential
12.21support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
12.22subdivision 22, must be calculated under the methodology in this subdivision.
12.23(b) For supervision provided with direct staff, rates shall be calculated as follows:
12.24(1) units of service are taken from the rate management system;
12.25(2) personnel hourly wage rates are defined by the base wage index in subdivision
12.265 to define the direct-care rate;
12.27(3) if an individual qualifies for the add-on customization for deaf and
12.28hard-of-hearing language accessibility under subdivision 12, add the customization
12.29rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
12.30customized direct-care rate;
12.31(4) multiply the number of shared and direct staff hours and shared and direct nursing
12.32hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
12.33(5) multiply the number of direct staff hours by the product of the supervision span
12.34of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
13.1(6) combine the figures calculated in clauses (4) and (5), and multiply the result by
13.2one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
13.3(c), to define the direct staffing cost;
13.4(7) for employee-related expenses, multiply the direct staffing cost by one plus the
13.5add-on for employee-related costs in subdivision 5, paragraph (c);
13.6(8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
13.7(9) for individuals who had previously received an adjustment to rates under section
13.8256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
13.9(10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
13.10adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
13.11(11) the total rate shall be calculated using the following steps:
13.12(i) the subtotal of clauses (6) to (10);
13.13(ii) the sum of the standard general and administrative rate, the program-related
13.14expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
13.15(iii) divide the result of item (i) by one minus the total in item (ii) for the total
13.16payment amount; and
13.17(12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
13.18as defined in subdivision 14.
13.19(c) For supervision provided by remote monitoring technology, rates shall be
13.20calculated as follows:
13.21(1) units of service are taken from the rate management system;
13.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
13.235 to define the direct-care rate;
13.24(3) if an individual qualifies for the add-on customization for deaf and
13.25hard-of-hearing language accessibility under subdivision 12, add the customization
13.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
13.27customized direct-care rate;
13.28(4) multiply the number of shared and direct staff hours and shared and direct nursing
13.29hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
13.30(5) multiply the number of direct staff hours by the product of the supervision span
13.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
13.32This is defined as the direct staffing cost;
13.33(6) for client programming and supports, add $2,179 per year adjusted to a daily rate;
13.34(7) for individuals who had previously received an adjustment to rates under section
13.35256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
14.1(8) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
14.2adapted vehicle, or $3,000 for a full-size adapted van, per year adjusted to an hourly rate;
14.3(9) the total rate shall be calculated using the following steps:
14.4(i) the subtotal of clauses (5) to (8);
14.5(ii) the sum of the standard general and administrative rate, the program-related
14.6expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
14.7(iii) divide the result of item (i) by one minus the total in item (ii). This is the total
14.8payment amount; and
14.9(10) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
14.10as defined in subdivision 14.
14.11(d) For supervision provided with direct staff in a family foster care setting, rates
14.12shall be calculated as follows:
14.13(1) units of service are taken from the rate management system;
14.14(2) personnel hourly wage rates are defined by the base wage index in subdivision
14.155, to define the direct-care rate;
14.16(3) if an individual qualifies for the add-on customization for deaf and
14.17hard-of-hearing language accessibility under subdivision 12, add the customization
14.18rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
14.19customized direct-care rate;
14.20(4) multiply the number of shared and direct staff hours and shared and direct nursing
14.21hours by the appropriate staff wage in subdivision 5 or the customized direct-care rate;
14.22(5) multiply the number of direct staff hours by the product of the supervision span
14.23of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
14.24(6) combine the figures calculated in clauses (4) and (5) and multiply the result by
14.25one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
14.26(c), to define the direct staffing cost;
14.27(7) for employee-related expenses, multiply the direct staffing cost by one plus
14.28two-thirds of the add-on for employee-related costs in subdivision 5, paragraph (c);
14.29(8) for client programming and supports, add $2,179 per year adjusted to a daily rate;
14.30(9) for individuals who had previously received an adjustment to rates under section
14.31256B.501, subdivision 4, add $3,120 per year adjusted to a daily rate;
14.32(10) for transportation, if provided, add $2,100 for a standard vehicle, $2,600 for an
14.33adapted vehicle, or $3,000 for a full-size adapted van per year adjusted to an hourly rate;
14.34(11) the total rate shall be calculated using the following steps:
14.35(i) the subtotal of clauses (6) to (10);
15.1(ii) the sum of the standard general and administrative rate, the program-related
15.2expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
15.3(iii) divide the result of item (i) by one minus two-thirds of the total in item (ii) for
15.4the total payment amount; and
15.5(12) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
15.6as defined in subdivision 14.
15.7 Subd. 7. Payments for day programs. (a) Payments for services with day
15.8programs, including adult day care, day treatment and habilitation, prevocational services,
15.9and structured day services must be calculated as follows:
15.10(1) units of service are taken from the rate management system;
15.11(2) personnel hourly wage rates are defined by the base wage index in subdivision
15.125 to define the direct-care rate;
15.13(3) if an individual qualifies for the add-on customization for deaf and
15.14hard-of-hearing language accessibility under subdivision 12, add the customization
15.15rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
15.16customized direct-care rate;
15.17(4) multiply the number of shared and direct staff hours by the appropriate staff
15.18wage in subdivision 5 or the customized direct-care rate;
15.19(5) multiply the number of direct staff hours by the product of the supervision span
15.20of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
15.21(6) for program plan support, multiply the result of clause (5) by one plus the add-on
15.22in subdivision 5, paragraph (c);
15.23(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
15.24one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
15.25(c), to define the direct staffing cost;
15.26(8) for employee-related expenses, multiply the direct staffing cost by one plus the
15.27add-on for employee-related costs in subdivision 5, paragraph (c);
15.28(9) for client programming and supports, multiply the result of clause (8) by one
15.29plus ten percent;
15.30(10) for program facility costs, add $31.69 per week adjusted for staffing ratios
15.31entered in the rate management system under subdivision 5;
15.32(11) for transportation to and from each individual's residence, add a base of $5.00,
15.33plus:
15.34(i) for a one-way trip between zero and ten miles, $7.00 for a vehicle without a lift
15.35and $7.77 for a vehicle with a lift;
16.1(ii) for a one-way trip between 11 and 20 miles, $7.87 for a vehicle without a lift and
16.2$10.27 for a vehicle with a lift;
16.3(iii) for a one-way trip between 21 and 50 miles, $17.75 for a vehicle without a lift
16.4and $50.76 for a vehicle with a lift;
16.5(iv) for a one-way trip of 51 miles or more, $25.50 for a vehicle without a lift and
16.6$72.93 for a vehicle with a lift; and
16.7(v) the mileage rate used in these calculations will be adjusted by January 1 of
16.8each year by the same percentage change in the IRS mileage rate compared to the IRS
16.9mileage rate for the previous year;
16.10(12) the total rate shall be calculated using the following steps:
16.11(i) the subtotal of clauses (7) to (11);
16.12(ii) the sum of the standard general and administrative rate, the program-related
16.13expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
16.14(iii) divide the result of item (i) by one minus the total in item (ii) for the total
16.15payment amount; and
16.16(13) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
16.17as defined in subdivision 14.
16.18(b) Adult day bath is reimbursed at $7.01 per 15-minute unit.
16.19 Subd. 8. Payments for unit-based services with programming. (a) Payments for
16.20unit-based services with programming include behavior programming, housing access
16.21coordination, in-home family support, independent living skills training, hourly supported
16.22living services, and supported employment provided to an individual outside of any day or
16.23residential service plan. Services, including the use of monitoring technology, are included.
16.24(b) The rate for individual services must be calculated as follows:
16.25(1) units of service are taken from the rate management system;
16.26(2) personnel hourly wage rates are defined by the base wage index in subdivision
16.275 to define the direct-care rate;
16.28(3) if an individual qualifies for the add-on customization for deaf and
16.29hard-of-hearing language accessibility under subdivision 12, add the customization
16.30rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
16.31customized direct-care rate;
16.32(4) multiply the number of shared and direct staff hours by the appropriate staff
16.33wage in subdivision 5 or the customized direct-care rate;
16.34(5) multiply the number of direct staff hours by the product of the supervision span
16.35of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
17.1If the supervision wage is lower than for direct staff, substitute the direct staff wage in
17.2subdivision 5;
17.3(6) for program plan support, multiply the result of clause (5) by one plus the add-on
17.4in subdivision 5, paragraph (c);
17.5(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
17.6one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
17.7(c), to define the direct staffing cost;
17.8(8) for employee-related expenses, multiply the direct staffing cost by one plus the
17.9add-on for employee-related costs in subdivision 5, paragraph (c);
17.10(9) for client programming and supports, multiply the result of clause (8) by one
17.11plus 8.6 percent;
17.12(10) the total rate shall be calculated using the following steps:
17.13(i) the subtotal of clauses (7) to (9);
17.14(ii) the sum of the standard general and administrative rate, the program-related
17.15expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
17.16(iii) divide the result of item (i) by one minus the total in item (ii) for the total
17.17payment amount; and
17.18(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
17.19as defined in subdivision 14.
17.20(c) The rate for shared services must be calculated as follows:
17.21(1) units of service are taken from the rate management system;
17.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
17.235 to define the direct-care rate;
17.24(3) if an individual qualifies for the add-on customization for deaf and
17.25hard-of-hearing language accessibility under subdivision 12, add the customization
17.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
17.27customized direct-care rate;
17.28(4) multiply the number of shared and direct staff hours by the appropriate staff
17.29wage in subdivision 5 or the customized direct-care rate;
17.30(5) multiply the number of direct staff hours by the product of the supervision span
17.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5.
17.32If the supervision wage is lower than for direct staff, substitute the direct staff wage in
17.33subdivision 5;
17.34(6) for program plan support, multiply the result of clause (5) by one plus the add-on
17.35in subdivision 5, paragraph (c);
18.1(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
18.2one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
18.3(c), to define the direct staffing cost;
18.4(8) for employee-related expenses, multiply the direct staffing cost by one plus the
18.5add-on for employee-related costs in subdivision 5, paragraph (c);
18.6(9) for client programming and supports, multiply the result of clause (8) by one
18.7plus 8.6 percent;
18.8(10) the total rate shall be calculated using the following steps:
18.9(i) the subtotal of clauses (7) to (9);
18.10(ii) the sum of the standard general and administrative rate, the program-related
18.11expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
18.12(iii) divide the result of item (i) by one minus the total in item (ii) for the total
18.13payment amount; and
18.14(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
18.15as defined in subdivision 14.
18.16 Subd. 9. Payments for unit-based services without programming. (a) Payments
18.17for unit-based services without programming include night supervision, personal support,
18.18respite, and companion care provided to an individual outside of any day or residential
18.19service plan. Services, including the use of monitoring technology, are included.
18.20(b) The rate for individual services must be calculated as follows:
18.21(1) units of service are taken from the rate management system;
18.22(2) personnel hourly wage rates are defined by the base wage index in subdivision
18.235 to define the direct-care rate;
18.24(3) if an individual qualifies for the add-on customization for deaf and
18.25hard-of-hearing language accessibility under subdivision 12, add the customization
18.26rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
18.27customized direct-care rate;
18.28(4) multiply the number of shared and direct staff hours by the appropriate staff
18.29wage in subdivision 5 or the customized direct-care rate;
18.30(5) multiply the number of direct staff hours by the product of the supervision span
18.31of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
18.32(6) for program plan support, multiply the result of clause (5) by one plus the add-on
18.33in subdivision 5, paragraph (c);
18.34(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
18.35one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
18.36(c), to define the direct staffing cost;
19.1(8) for employee-related expenses, multiply the direct staffing cost by one plus the
19.2add-on for employee-related costs in subdivision 5, paragraph (c);
19.3(9) for client programming and supports, multiply the result of clause (8) by one
19.4plus 6.1 percent;
19.5(10) the total rate shall be calculated using the following steps:
19.6(i) the subtotal of clauses (7) to (9);
19.7(ii) the sum of the standard general and administrative rate, the program-related
19.8expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
19.9(iii) divide the result of item (i) by one minus the total in item (ii) for the total
19.10payment amount; and
19.11(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
19.12as defined in subdivision 14.
19.13(c) The rate for shared services must be calculated as follows:
19.14(1) units of service are taken from the rate management system;
19.15(2) personnel hourly wage rates are defined by the base wage index in subdivision
19.165 to define the direct-care rate;
19.17(3) if an individual qualifies for the add-on customization for deaf and
19.18hard-of-hearing language accessibility under subdivision 12, add the customization
19.19rate provided in subdivision 12 to the wage determined in subdivision 5 to define the
19.20customized direct-care rate;
19.21(4) multiply the number of shared and direct staff hours by the appropriate staff
19.22wage in subdivision 5 or the customized direct-care rate;
19.23(5) multiply the number of direct staff hours by the product of the supervision span
19.24of control ratio in subdivision 5, paragraph (c), and the supervision wage in subdivision 5;
19.25(6) for program plan support, multiply the result of clause (5) by one plus the add-on
19.26in subdivision 5, paragraph (c);
19.27(7) combine the figures calculated in clauses (5) and (6) and multiply the result by
19.28one plus the add-on for the vacation, sick, and training ratio in subdivision 5, paragraph
19.29(c), to define the direct staffing cost;
19.30(8) for employee-related expenses, multiply the direct staffing cost by one plus the
19.31add-on for employee-related costs in subdivision 5, paragraph (c);
19.32(9) for client programming and supports, multiply the result of clause (8) by one
19.33plus 6.1 percent;
19.34(10) the total rate shall be calculated using the following steps:
19.35(i) the subtotal of clauses (7) to (9);
20.1(ii) the sum of the standard general and administrative rate, the program-related
20.2expense ratio, the absence and utilization ratio defined in subdivision 5, paragraph (c); and
20.3(iii) divide the result of item (i) by one minus the total in item (ii) for the total
20.4payment amount; and
20.5(11) the total rate is adjusted by a onetime adjustment to achieve budget neutrality,
20.6as defined in subdivision 14.
20.7 Subd. 10. Updating payment values and additional information. (a) The
20.8commissioner shall develop and implement uniform procedures to refine terms and update
20.9recommended changes to values used to calculate payment rates in this section.
20.10(b) The commissioner shall work with stakeholders to assess efficacy of values
20.11and payment rates. The commissioner shall report back to the legislature with proposed
20.12changes for component values.
20.13(c) By February 15, 2015, the commissioner shall work with stakeholders to jointly
20.14collect and analyze data on the following topics:
20.15(1) that rates produced are sufficient to enlist enough providers so that care and
20.16services are available under the plan at least to the extent that the care and services are
20.17available to the general public in the geographic areas as required by section 1902(a)(3)(A)
20.18of the Social Security Act;
20.19(2) the cost of an increase in the state or federally required minimum wage and
20.20the impact on services;
20.21(3) the cost of complying with the insurance requirements under the Patient
20.22Protection and Affordable Care Act, Public Law 111-148, and the impact on services;
20.23(4) the impact of the methodology under section 256B.4914 on spending by county.
20.24The commissioner shall compare spending prior to and post implementation;
20.25(5) a survey of providers to determine differences in the underlying cost of care
20.26to measure if differences exist by region;
20.27(6) the utilization of transportation services for unit-based services;
20.28(7) detailed data on the number of trips, mileage, and utilization of transportation
20.29in all-day services; and
20.30(8) the occurrence of shared arrangements for unit-based services.
20.31(d) The commissioner shall report to the chairs and ranking minority members of the
20.32senate and house of representatives committees and divisions with primary jurisdiction
20.33over health and human services and finance by February 15, 2015, either with legislation
20.34or a detailed explanation of why no legislation is recommended to address these topics.
21.1 Subd. 11. Payment implementation. Upon implementation of the payment
21.2methodologies under this section, those payment rates supersede rates established in county
21.3contracts for recipients receiving waiver services under sections 256B.092 and 256B.49.
21.4 Subd. 12. Customization of rates for individuals. For persons determined to have
21.5higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
21.6by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8, and 9. The
21.7customization rate with respect to deaf and hard-of-hearing persons shall be $2.50 per hour
21.8for waiver recipients who meet the respective criteria as determined by the commissioner.
21.9 Subd. 13. Rates for individuals with exceptional needs. (a) Rates determined
21.10under subdivisions 6, 7, 8, and 9 are eligible for a rate exception under this subdivision.
21.11(b) Lead agencies shall consider exception requests by an individual or a provider
21.12agency.
21.13(c) An application for a rate exception may be submitted for the following criteria:
21.14(1) an individual has service needs that cannot be met through additional units
21.15of service; or
21.16(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
21.17individual being discharged.
21.18(d) Exception requests to lead agencies will include the following information:
21.19(1) the level of services needs required by each individual that are not accounted
21.20for in subdivisions 6, 7, 8, and 9;
21.21(2) the service rate requested and the difference from the rate determined in
21.22subdivisions 6, 7, 8, and 9;
21.23(3) a basis for the underlying costs used for the rate exception and any accompanying
21.24documentation;
21.25(4) the duration of the rate exception; and
21.26(5) any contingencies for approval.
21.27(e) Lead agencies shall review exception requests, attach their recommendation, and
21.28forward the request to the commissioner for approval.
21.29(f) The commissioner shall evaluate and approve rate exceptions, approve a
21.30modified rate exception, or reject the rate exception request. Within 30 calendar days,
21.31the commissioner shall notify individual and service providers, and provide justification
21.32for each rate exception decision.
21.33(g) Approved rate exceptions shall be managed within lead agency allocations under
21.34sections 256B.092 and 256B.49.
21.35(h) All aspects of the rate exception process are subject to appeals under section
21.36256B.49.
22.1 Subd. 14. Budget neutrality adjustment. The commissioner shall calculate the
22.2total spending for all home and community-based waiver services under the payments as
22.3defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
22.4spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
22.5for services in one particular subdivision differs, there will be a percentage adjustment
22.6to increase or decrease individual rates for the services defined in each subdivision so
22.7aggregate spending matches projections under current law.
22.8EFFECTIVE DATE.This section is effective January 1, 2016.
