Minnesota 2023-2024 Regular Session

Minnesota House Bill HF32 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to human services; modifying rates for certain disability waiver services;
3	3	1.3 modifying rates for certain elderly waiver services; modifying rate floors for certain
4	4	1.4 customized living services; modifying rates for nursing facilities; establishing rate
5	5	1.5 floors for intermediate care facilities for persons with developmental disabilities;
6	6	1.6 modifying rates for intermediate care facilities for persons with developmental
7	7	1.7 disabilities; modifying rates for community first services and supports; modifying
8	8	1.8 rates for personal care assistance services; modifying rates for certain home care
9	9	1.9 services; modifying rates for nonemergency medical transportation services;
10	10	1.10 establishing a fuel cost rate adjustment for medical transportation services;
11	11	1.11 modifying provisions related to home and community-based services; modifying
12	12	1.12 provisions related to the emergency staffing pool; establishing a residential settings
13	13	1.13 closure prevention grant program; appropriating money; amending Minnesota
14	14	1.14 Statutes 2022, sections 256B.0625, subdivisions 17, 17a; 256B.0659, subdivisions
15	15	1.15 1, 12, 17a, 19, 24; 256B.0913, subdivisions 4, 5; 256B.4911, by adding a
16	16	1.16 subdivision; 256B.4912, by adding a subdivision; 256B.4914, subdivisions 3, as
17	17	1.17 amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by adding a subdivision;
18	18	1.18 256B.5012, by adding subdivisions; 256B.85, subdivisions 7, 7a, by adding a
19	19	1.19 subdivision; 256B.851, subdivision 5; 256E.35, subdivisions 1, 2, 4a, 6, 7; 256P.02,
20	20	1.20 by adding a subdivision; 256R.02, subdivisions 16, 24, 26, 29, 34, by adding
21	21	1.21 subdivisions; 256R.23, subdivisions 2, 3; 256R.24, subdivision 1; 256R.25;
22	22	1.22 256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision
23	23	1.23 3; 256S.205, subdivisions 3, 5; 256S.2101, subdivisions 1, 2, by adding
24	24	1.24 subdivisions; 256S.212; 256S.213; 256S.214; 256S.215; Laws 2022, chapter 40,
25	25	1.25 section 6; proposing coding for new law in Minnesota Statutes, chapter 256;
26	26	1.26 repealing Minnesota Statutes 2022, sections 256B.4914, subdivision 9a; 256S.19,
27	27	1.27 subdivision 4.
28	28	1.28BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
29	29	1.29 ARTICLE 1
30	30	1.30 CAREGIVERS STABILIZATION ACT
31	31	1.31 Section 1. TITLE.
32	32	1.32 This act may be cited as the "Caregivers Stabilization Act of 2023."
33	33	1Article 1 Section 1.
34	34	REVISOR AGW/HL 23-0127812/21/22
35	35	State of Minnesota
36	36	This Document can be made available
37	37	in alternative formats upon request
38	38	HOUSE OF REPRESENTATIVES
39	39	H. F. No. 32
40	40	NINETY-THIRD SESSION
41	41	Authored by Noor01/04/2023
42	42	The bill was read for the first time and referred to the Committee on Human Services Finance 2.1 ARTICLE 2
43	43	2.2 DISABILITY WAIVERS
44	44	2.3 Section 1. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
45	45	2.4to read:
46	46	2.5 Subd. 16.Rates established by the commissioner.For homemaker services eligible
47	47	2.6for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
48	48	2.7community alternative care waiver, and the community access for disability inclusion waiver,
49	49	2.8the commissioner must establish rates equal to the rates established under sections 256S.21
50	50	2.9to 256S.215 for the corresponding homemaker services.
51	51	2.10 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
52	52	2.11whichever is later. The commissioner of human services shall notify the revisor of statutes
53	53	2.12when federal approval is obtained.
54	54	2.13 Sec. 2. Minnesota Statutes 2022, section 256B.4914, subdivision 3, is amended to read:
55	55	2.14 Subd. 3.Applicable services.Applicable services are those authorized under the state's
56	56	2.15home and community-based services waivers under sections 256B.092 and 256B.49,
57	57	2.16including the following, as defined in the federally approved home and community-based
58	58	2.17services plan:
59	59	2.18 (1) 24-hour customized living;
60	60	2.19 (2) adult day services;
61	61	2.20 (3) adult day services bath;
62	62	2.21 (4) community residential services;
63	63	2.22 (5) customized living;
64	64	2.23 (6) day support services;
65	65	2.24 (7) employment development services;
66	66	2.25 (8) employment exploration services;
67	67	2.26 (9) employment support services;
68	68	2.27 (10) family residential services;
69	69	2.28 (11) individualized home supports;
70	70	2.29 (12) individualized home supports with family training;
71	71	2Article 2 Sec. 2.
72	72	REVISOR AGW/HL 23-0127812/21/22 3.1 (13) individualized home supports with training;
73	73	3.2 (14) integrated community supports;
74	74	3.3 (15) night supervision;
75	75	3.4 (16) positive support services;
76	76	3.5 (17) prevocational services;
77	77	3.6 (18) residential support services;
78	78	3.7 (19) respite services;
79	79	3.8 (20) transportation services; and
80	80	3.9 (21) (20) other services as approved by the federal government in the state home and
81	81	3.10community-based services waiver plan.
82	82	3.11 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
83	83	3.12whichever is later. The commissioner of human services shall notify the revisor of statutes
84	84	3.13when federal approval is obtained.
85	85	3.14 Sec. 3. Minnesota Statutes 2022, section 256B.4914, subdivision 4, is amended to read:
86	86	3.15 Subd. 4.Data collection for rate determination.(a) Rates for applicable home and
87	87	3.16community-based waivered services, including customized rates under subdivision 12, are
88	88	3.17set by the rates management system.
89	89	3.18 (b) Data and information in the rates management system must be used to calculate an
90	90	3.19individual's rate.
91	91	3.20 (c) Service providers, with information from the support plan and oversight by lead
92	92	3.21agencies, shall provide values and information needed to calculate an individual's rate in
93	93	3.22the rates management system. The determination of service levels must be part of a discussion
94	94	3.23with members of the support team as defined in section 245D.02, subdivision 34. This
95	95	3.24discussion must occur prior to the final establishment of each individual's rate. The values
96	96	3.25and information include:
97	97	3.26 (1) shared staffing hours;
98	98	3.27 (2) individual staffing hours;
99	99	3.28 (3) direct registered nurse hours;
100	100	3.29 (4) direct licensed practical nurse hours;
101	101	3.30 (5) staffing ratios;
102	102	3Article 2 Sec. 3.
103	103	REVISOR AGW/HL 23-0127812/21/22 4.1 (6) information to document variable levels of service qualification for variable levels
104	104	4.2of reimbursement in each framework;
105	105	4.3 (7) shared or individualized arrangements for unit-based services, including the staffing
106	106	4.4ratio;
107	107	4.5 (8) number of trips and miles for transportation services; and
108	108	4.6 (9) service hours provided through monitoring technology.
109	109	4.7 (d) Updates to individual data must include:
110	110	4.8 (1) data for each individual that is updated annually when renewing service plans; and
111	111	4.9 (2) requests by individuals or lead agencies to update a rate whenever there is a change
112	112	4.10in an individual's service needs, with accompanying documentation.
113	113	4.11 (e) Lead agencies shall review and approve all services reflecting each individual's needs,
114	114	4.12and the values to calculate the final payment rate for services with variables under
115	115	4.13subdivisions 6 to 9a 9 for each individual. Lead agencies must notify the individual and the
116	116	4.14service provider of the final agreed-upon values and rate, and provide information that is
117	117	4.15identical to what was entered into the rates management system. If a value used was
118	118	4.16mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead
119	119	4.17agencies to correct it. Lead agencies must respond to these requests. When responding to
120	120	4.18the request, the lead agency must consider:
121	121	4.19 (1) meeting the health and welfare needs of the individual or individuals receiving
122	122	4.20services by service site, identified in their support plan under section 245D.02, subdivision
123	123	4.214b, and any addendum under section 245D.02, subdivision 4c;
124	124	4.22 (2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and
125	125	4.23(o); and meeting or exceeding the licensing standards for staffing required under section
126	126	4.24245D.09, subdivision 1; and
127	127	4.25 (3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and
128	128	4.26meeting or exceeding the licensing standards for staffing required under section 245D.31.
129	129	4.27 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
130	130	4.28whichever is later. The commissioner of human services shall notify the revisor of statutes
131	131	4.29when federal approval is obtained.
132	132	4Article 2 Sec. 3.
133	133	REVISOR AGW/HL 23-0127812/21/22 5.1 Sec. 4. Minnesota Statutes 2022, section 256B.4914, subdivision 5, is amended to read:
134	134	5.2 Subd. 5.Base wage index; establishment and updates.(a) The base wage index is
135	135	5.3established to determine staffing costs associated with providing services to individuals
136	136	5.4receiving home and community-based services. For purposes of calculating the base wage,
137	137	5.5Minnesota-specific wages taken from job descriptions and standard occupational
138	138	5.6classification (SOC) codes from the Bureau of Labor Statistics as defined in the Occupational
139	139	5.7Handbook must be used.
140	140	5.8 (b) The commissioner shall update the base wage index in subdivision 5a, publish these
141	141	5.9updated values, and load them into the rate management system as follows:
142	142	5.10 (1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics
143	143	5.11available as of December 31, 2019; and
144	144	5.12 (2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics
145	145	5.13available as of December 31, 2021; and
146	146	5.14 (3) (2) on July 1, 2026 January 1, 2024, and every two years thereafter, based on wage
147	147	5.15data by SOC from the Bureau of Labor Statistics available 30 24 months and one day prior
148	148	5.16to the scheduled update.
149	149	5.17 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
150	150	5.18whichever is later. The commissioner of human services shall notify the revisor of statutes
151	151	5.19when federal approval is obtained.
152	152	5.20 Sec. 5. Minnesota Statutes 2022, section 256B.4914, subdivision 5a, is amended to read:
153	153	5.21 Subd. 5a.Base wage index; calculations.The base wage index must be calculated as
154	154	5.22follows:
155	155	5.23 (1) for supervisory staff, 100 percent of the median wage for community and social
156	156	5.24services specialist (SOC code 21-1099), with the exception of the supervisor of positive
157	157	5.25supports professional, positive supports analyst, and positive supports specialist, which is
158	158	5.26100 percent of the median wage for clinical counseling and school psychologist (SOC code
159	159	5.2719-3031);
160	160	5.28 (2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC
161	161	5.29code 29-1141);
162	162	5.30 (3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical
163	163	5.31nurses (SOC code 29-2061);
164	164	5Article 2 Sec. 5.
165	165	REVISOR AGW/HL 23-0127812/21/22 6.1 (4) for residential asleep-overnight staff, the minimum wage in Minnesota for large
166	166	6.2employers, with the exception of asleep-overnight staff for family residential services, which
167	167	6.3is 36 percent of the minimum wage in Minnesota for large employers;
168	168	6.4 (5) for residential direct care staff, the sum of:
169	169	6.5 (i) 15 percent of the subtotal of 50 percent of the median wage for home health and
170	170	6.6personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant
171	171	6.7(SOC code 31-1131); and 20 percent of the median wage for social and human services
172	172	6.8aide (SOC code 21-1093); and
173	173	6.9 (ii) 85 percent of the subtotal of 40 percent of the median wage for home health and
174	174	6.10personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
175	175	6.11(SOC code 31-1014 31-1131); 20 percent of the median wage for psychiatric technician
176	176	6.12(SOC code 29-2053); and 20 percent of the median wage for social and human services
177	177	6.13aide (SOC code 21-1093);
178	178	6.14 (6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC
179	179	6.15code 31-1131); and 30 percent of the median wage for home health and personal care aide
180	180	6.16(SOC code 31-1120);
181	181	6.17 (7) for day support services staff and prevocational services staff, 20 percent of the
182	182	6.18median wage for nursing assistant (SOC code 31-1131); 20 percent of the median wage for
183	183	6.19psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
184	184	6.20and human services aide (SOC code 21-1093);
185	185	6.21 (8) for positive supports analyst staff, 100 percent of the median wage for substance
186	186	6.22abuse, behavioral disorder, and mental health counselor (SOC code 21-1018);
187	187	6.23 (9) for positive supports professional staff, 100 percent of the median wage for clinical
188	188	6.24counseling and school psychologist (SOC code 19-3031);
189	189	6.25 (10) for positive supports specialist staff, 100 percent of the median wage for psychiatric
190	190	6.26technicians (SOC code 29-2053);
191	191	6.27 (11) for individualized home supports with family training staff, 20 percent of the median
192	192	6.28wage for nursing aide (SOC code 31-1131); 30 percent of the median wage for community
193	193	6.29social service specialist (SOC code 21-1099); 40 percent of the median wage for social and
194	194	6.30human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
195	195	6.31technician (SOC code 29-2053);
196	196	6.32 (12) for individualized home supports with training services staff, 40 percent of the
197	197	6.33median wage for community social service specialist (SOC code 21-1099); 50 percent of
198	198	6Article 2 Sec. 5.
199	199	REVISOR AGW/HL 23-0127812/21/22 7.1the median wage for social and human services aide (SOC code 21-1093); and ten percent
200	200	7.2of the median wage for psychiatric technician (SOC code 29-2053);
201	201	7.3 (13) for employment support services staff, 50 percent of the median wage for
202	202	7.4rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
203	203	7.5community and social services specialist (SOC code 21-1099);
204	204	7.6 (14) for employment exploration services staff, 50 percent of the median wage for
205	205	7.7rehabilitation counselor (SOC code 21-1015) education, guidance, school, and vocational
206	206	7.8counselor (SOC code 21-1012); and 50 percent of the median wage for community and
207	207	7.9social services specialist (SOC code 21-1099);
208	208	7.10 (15) for employment development services staff, 50 percent of the median wage for
209	209	7.11education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
210	210	7.12of the median wage for community and social services specialist (SOC code 21-1099);
211	211	7.13 (16) for individualized home support without training staff, 50 percent of the median
212	212	7.14wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the
213	213	7.15median wage for nursing assistant (SOC code 31-1131); and
214	214	7.16 (17) for night supervision staff, 40 percent of the median wage for home health and
215	215	7.17personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
216	216	7.18(SOC code 31-1131); 20 percent of the median wage for psychiatric technician (SOC code
217	217	7.1929-2053); and 20 percent of the median wage for social and human services aide (SOC code
218	218	7.2021-1093); and.
219	219	7.21 (18) for respite staff, 50 percent of the median wage for home health and personal care
220	220	7.22aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC
221	221	7.23code 31-1014).
222	222	7.24 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
223	223	7.25whichever is later. The commissioner of human services shall notify the revisor of statutes
224	224	7.26when federal approval is obtained.
225	225	7.27 Sec. 6. Minnesota Statutes 2022, section 256B.4914, subdivision 5b, is amended to read:
226	226	7.28 Subd. 5b.Standard component value adjustments.The commissioner shall update
227	227	7.29the client and programming support, transportation, and program facility cost component
228	228	7.30values as required in subdivisions 6 to 9a 9 for changes in the Consumer Price Index. The
229	229	7.31commissioner shall adjust these values higher or lower, publish these updated values, and
230	230	7.32load them into the rate management system as follows:
231	231	7Article 2 Sec. 6.
232	232	REVISOR AGW/HL 23-0127812/21/22 8.1 (1) on January 1, 2022, by the percentage change in the CPI-U from the date of the
233	233	8.2previous update to the data available on December 31, 2019; and
234	234	8.3 (2) on November 1, 2024, by the percentage change in the CPI-U from the date of the
235	235	8.4previous update to the data available as of December 31, 2021; and
236	236	8.5 (3) (2) on July January 1, 2026 2024, and every two years thereafter, by the percentage
237	237	8.6change in the CPI-U from the date of the previous update to the data available 30 12 months
238	238	8.7and one day prior to the scheduled update.
239	239	8.8 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
240	240	8.9whichever is later. The commissioner of human services shall notify the revisor of statutes
241	241	8.10when federal approval is obtained.
242	242	8.11 Sec. 7. Minnesota Statutes 2022, section 256B.4914, subdivision 5c, is amended to read:
243	243	8.12 Subd. 5c.Removal of after-framework adjustments.Any rate adjustments applied to
244	244	8.13the service rates calculated under this section outside of the cost components and rate
245	245	8.14methodology specified in this section shall be removed from rate calculations upon
246	246	8.15implementation of the updates under subdivisions 5 and, 5b, and 5f.
247	247	8.16 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
248	248	8.17whichever is later. The commissioner of human services shall notify the revisor of statutes
249	249	8.18when federal approval is obtained.
250	250	8.19 Sec. 8. Minnesota Statutes 2022, section 256B.4914, subdivision 5d, is amended to read:
251	251	8.20 Subd. 5d.Unavailable data for updates and adjustments.If Bureau of Labor Statistics
252	252	8.21occupational codes or Consumer Price Index items specified in subdivision 5 or, 5b, or 5f
253	253	8.22are unavailable in the future, the commissioner shall recommend to the legislature codes or
254	254	8.23items to update and replace.
255	255	8.24 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
256	256	8.25whichever is later. The commissioner of human services shall notify the revisor of statutes
257	257	8.26when federal approval is obtained.
258	258	8.27 Sec. 9. Minnesota Statutes 2022, section 256B.4914, subdivision 5e, is amended to read:
259	259	8.28 Subd. 5e.Inflationary update spending requirement.(a) At least 80 percent of the
260	260	8.29marginal increase in revenue from the rate adjustment applied to the service rates adjustments
261	261	8.30calculated under subdivisions 5 and, 5b beginning on January 1, 2022, and 5f for services
262	262	8.31rendered between January 1, 2022, and March 31, 2024, on or after the day of implementation
263	263	8Article 2 Sec. 9.
264	264	REVISOR AGW/HL 23-0127812/21/22 9.1of the adjustment must be used to increase compensation-related costs for employees directly
265	265	9.2employed by the program on or after January 1, 2022.
266	266	9.3 (b) For the purposes of this subdivision, compensation-related costs include:
267	267	9.4 (1) wages and salaries;
268	268	9.5 (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
269	269	9.6taxes, workers' compensation, and mileage reimbursement;
270	270	9.7 (3) the employer's paid share of health and dental insurance, life insurance, disability
271	271	9.8insurance, long-term care insurance, uniform allowance, pensions, and contributions to
272	272	9.9employee retirement accounts; and
273	273	9.10 (4) benefits that address direct support professional workforce needs above and beyond
274	274	9.11what employees were offered prior to January 1, 2022 implementation of the applicable
275	275	9.12rate adjustment, including retention and recruitment bonuses and tuition reimbursement.
276	276	9.13 (c) Compensation-related costs for persons employed in the central office of a corporation
277	277	9.14or entity that has an ownership interest in the provider or exercises control over the provider,
278	278	9.15or for persons paid by the provider under a management contract, do not count toward the
279	279	9.1680 percent requirement under this subdivision.
280	280	9.17 (d) A provider agency or individual provider that receives a rate subject to the
281	281	9.18requirements of this subdivision shall prepare, and upon request submit to the commissioner,
282	282	9.19a distribution plan that specifies the amount of money the provider expects to receive that
283	283	9.20is subject to the requirements of this subdivision, including how that money was or will be
284	284	9.21distributed to increase compensation-related costs for employees. Within 60 days of final
285	285	9.22implementation of a rate adjustment subject to the requirements of this subdivision, the
286	286	9.23provider must post the distribution plan and leave it posted for a period of at least six months
287	287	9.24in an area of the provider's operation to which all direct support professionals have access.
288	288	9.25The posted distribution plan must include instructions regarding how to contact the
289	289	9.26commissioner or commissioner's representative if an employee believes the employee has
290	290	9.27not received the compensation-related increase described in the plan.
291	291	9.28 (e) This subdivision expires June 30, 2024.
292	292	9.29 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
293	293	9.30whichever is later. The commissioner of human services shall notify the revisor of statutes
294	294	9.31when federal approval is obtained.
295	295	9Article 2 Sec. 9.
296	296	REVISOR AGW/HL 23-0127812/21/22 10.1 Sec. 10. Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision
297	297	10.2to read:
298	298	10.3 Subd. 5f.Competitive workforce factor adjustments.(a) On January 1, 2024, and
299	299	10.4every two years thereafter, the commissioner shall update the competitive workforce factor
300	300	10.5to equal the differential between:
301	301	10.6 (1) the most recently available wage data by SOC code for the weighted average wage
302	302	10.7for direct care staff for residential support services and direct care staff for day programs;
303	303	10.8and
304	304	10.9 (2) the most recently available wage data by SOC code of the weighted average wage
305	305	10.10of comparable occupations.
306	306	10.11 (b) For each update of the competitive workforce factor, the update must not decrease
307	307	10.12the competitive workforce factor by more than 2.0. If the competitive workforce factor is
308	308	10.13less than or equal to zero, then the competitive workforce factor is zero.
309	309	10.14 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
310	310	10.15whichever is later. The commissioner of human services shall notify the revisor of statutes
311	311	10.16when federal approval is obtained.
312	312	10.17Sec. 11. Minnesota Statutes 2022, section 256B.4914, subdivision 8, is amended to read:
313	313	10.18 Subd. 8. Unit-based services with programming; component values and calculation
314	314	10.19of payment rates.(a) For the purpose of this section, unit-based services with programming
315	315	10.20include employment exploration services, employment development services, employment
316	316	10.21support services, individualized home supports with family training, individualized home
317	317	10.22supports with training, and positive support services provided to an individual outside of
318	318	10.23any service plan for a day program or residential support service.
319	319	10.24 (b) Component values for unit-based services with programming are:
320	320	10.25 (1) competitive workforce factor: 4.7 percent;
321	321	10.26 (2) supervisory span of control ratio: 11 percent;
322	322	10.27 (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
323	323	10.28 (4) employee-related cost ratio: 23.6 percent;
324	324	10.29 (5) program plan support ratio: 15.5 percent;
325	325	10.30 (6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
326	326	10.315b;
327	327	10Article 2 Sec. 11.
328	328	REVISOR AGW/HL 23-0127812/21/22 11.1 (7) general administrative support ratio: 13.25 percent;
329	329	11.2 (8) program-related expense ratio: 6.1 percent; and
330	330	11.3 (9) absence and utilization factor ratio: 3.9 percent.
331	331	11.4 (c) A unit of service for unit-based services with programming is 15 minutes.
332	332	11.5 (d) Payments for unit-based services with programming must be calculated as follows,
333	333	11.6unless the services are reimbursed separately as part of a residential support services or day
334	334	11.7program payment rate:
335	335	11.8 (1) determine the number of units of service to meet a recipient's needs;
336	336	11.9 (2) determine the appropriate hourly staff wage rates derived by the commissioner as
337	337	11.10provided in subdivisions 5 and 5a;
338	338	11.11 (3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
339	339	11.12product of one plus the competitive workforce factor;
340	340	11.13 (4) for a recipient requiring customization for deaf and hard-of-hearing language
341	341	11.14accessibility under subdivision 12, add the customization rate provided in subdivision 12
342	342	11.15to the result of clause (3);
343	343	11.16 (5) multiply the number of direct staffing hours by the appropriate staff wage;
344	344	11.17 (6) multiply the number of direct staffing hours by the product of the supervisory span
345	345	11.18of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
346	346	11.19 (7) combine the results of clauses (5) and (6), and multiply the result by one plus the
347	347	11.20employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
348	348	11.21rate;
349	349	11.22 (8) for program plan support, multiply the result of clause (7) by one plus the program
350	350	11.23plan support ratio;
351	351	11.24 (9) for employee-related expenses, multiply the result of clause (8) by one plus the
352	352	11.25employee-related cost ratio;
353	353	11.26 (10) for client programming and supports, multiply the result of clause (9) by one plus
354	354	11.27the client programming and support ratio;
355	355	11.28 (11) this is the subtotal rate;
356	356	11.29 (12) sum the standard general administrative support ratio, the program-related expense
357	357	11.30ratio, and the absence and utilization factor ratio;
358	358	11Article 2 Sec. 11.
359	359	REVISOR AGW/HL 23-0127812/21/22 12.1 (13) divide the result of clause (11) by one minus the result of clause (12). This is the
360	360	12.2total payment amount;
361	361	12.3 (14) for services provided in a shared manner, divide the total payment in clause (13)
362	362	12.4as follows:
363	363	12.5 (i) for employment exploration services, divide by the number of service recipients, not
364	364	12.6to exceed five;
365	365	12.7 (ii) for employment support services, divide by the number of service recipients, not to
366	366	12.8exceed six; and
367	367	12.9 (iii) for individualized home supports with training and individualized home supports
368	368	12.10with family training, divide by the number of service recipients, not to exceed two three;
369	369	12.11and
370	370	12.12 (15) adjust the result of clause (14) by a factor to be determined by the commissioner
371	371	12.13to adjust for regional differences in the cost of providing services.
372	372	12.14 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
373	373	12.15whichever is later. The commissioner of human services shall notify the revisor of statutes
374	374	12.16when federal approval is obtained.
375	375	12.17Sec. 12. Minnesota Statutes 2022, section 256B.4914, subdivision 9, is amended to read:
376	376	12.18 Subd. 9. Unit-based services without programming; component values and
377	377	12.19calculation of payment rates.(a) For the purposes of this section, unit-based services
378	378	12.20without programming include individualized home supports without training and night
379	379	12.21supervision provided to an individual outside of any service plan for a day program or
380	380	12.22residential support service. Unit-based services without programming do not include respite.
381	381	12.23 (b) Component values for unit-based services without programming are:
382	382	12.24 (1) competitive workforce factor: 4.7 percent;
383	383	12.25 (2) supervisory span of control ratio: 11 percent;
384	384	12.26 (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
385	385	12.27 (4) employee-related cost ratio: 23.6 percent;
386	386	12.28 (5) program plan support ratio: 7.0 percent;
387	387	12.29 (6) client programming and support ratio: 2.3 percent, updated as specified in subdivision
388	388	12.305b;
389	389	12Article 2 Sec. 12.
390	390	REVISOR AGW/HL 23-0127812/21/22 13.1 (7) general administrative support ratio: 13.25 percent;
391	391	13.2 (8) program-related expense ratio: 2.9 percent; and
392	392	13.3 (9) absence and utilization factor ratio: 3.9 percent.
393	393	13.4 (c) A unit of service for unit-based services without programming is 15 minutes.
394	394	13.5 (d) Payments for unit-based services without programming must be calculated as follows
395	395	13.6unless the services are reimbursed separately as part of a residential support services or day
396	396	13.7program payment rate:
397	397	13.8 (1) determine the number of units of service to meet a recipient's needs;
398	398	13.9 (2) determine the appropriate hourly staff wage rates derived by the commissioner as
399	399	13.10provided in subdivisions 5 to 5a;
400	400	13.11 (3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
401	401	13.12product of one plus the competitive workforce factor;
402	402	13.13 (4) for a recipient requiring customization for deaf and hard-of-hearing language
403	403	13.14accessibility under subdivision 12, add the customization rate provided in subdivision 12
404	404	13.15to the result of clause (3);
405	405	13.16 (5) multiply the number of direct staffing hours by the appropriate staff wage;
406	406	13.17 (6) multiply the number of direct staffing hours by the product of the supervisory span
407	407	13.18of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
408	408	13.19 (7) combine the results of clauses (5) and (6), and multiply the result by one plus the
409	409	13.20employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
410	410	13.21rate;
411	411	13.22 (8) for program plan support, multiply the result of clause (7) by one plus the program
412	412	13.23plan support ratio;
413	413	13.24 (9) for employee-related expenses, multiply the result of clause (8) by one plus the
414	414	13.25employee-related cost ratio;
415	415	13.26 (10) for client programming and supports, multiply the result of clause (9) by one plus
416	416	13.27the client programming and support ratio;
417	417	13.28 (11) this is the subtotal rate;
418	418	13.29 (12) sum the standard general administrative support ratio, the program-related expense
419	419	13.30ratio, and the absence and utilization factor ratio;
420	420	13Article 2 Sec. 12.
421	421	REVISOR AGW/HL 23-0127812/21/22 14.1 (13) divide the result of clause (11) by one minus the result of clause (12). This is the
422	422	14.2total payment amount;
423	423	14.3 (14) for individualized home supports without training provided in a shared manner,
424	424	14.4divide the total payment amount in clause (13) by the number of service recipients, not to
425	425	14.5exceed two three; and
426	426	14.6 (15) adjust the result of clause (14) by a factor to be determined by the commissioner
427	427	14.7to adjust for regional differences in the cost of providing services.
428	428	14.8 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
429	429	14.9whichever is later. The commissioner of human services shall notify the revisor of statutes
430	430	14.10when federal approval is obtained.
431	431	14.11Sec. 13. Minnesota Statutes 2022, section 256B.4914, subdivision 10, is amended to read:
432	432	14.12 Subd. 10.Evaluation of information and data.(a) The commissioner shall, within
433	433	14.13available resources, conduct research and gather data and information from existing state
434	434	14.14systems or other outside sources on the following items:
435	435	14.15 (1) differences in the underlying cost to provide services and care across the state;
436	436	14.16 (2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
437	437	14.17units of transportation for all day services, which must be collected from providers using
438	438	14.18the rate management worksheet and entered into the rates management system; and
439	439	14.19 (3) the distinct underlying costs for services provided by a license holder under sections
440	440	14.20245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
441	441	14.21by a license holder certified under section 245D.33.
442	442	14.22 (b) The commissioner, in consultation with stakeholders, shall review and evaluate the
443	443	14.23following values already in subdivisions 6 to 9a 9, or issues that impact all services, including,
444	444	14.24but not limited to:
445	445	14.25 (1) values for transportation rates;
446	446	14.26 (2) values for services where monitoring technology replaces staff time;
447	447	14.27 (3) values for indirect services;
448	448	14.28 (4) values for nursing;
449	449	14.29 (5) values for the facility use rate in day services, and the weightings used in the day
450	450	14.30service ratios and adjustments to those weightings;
451	451	14.31 (6) values for workers' compensation as part of employee-related expenses;
452	452	14Article 2 Sec. 13.
453	453	REVISOR AGW/HL 23-0127812/21/22 15.1 (7) values for unemployment insurance as part of employee-related expenses;
454	454	15.2 (8) direct care workforce labor market measures;
455	455	15.3 (9) any changes in state or federal law with a direct impact on the underlying cost of
456	456	15.4providing home and community-based services;
457	457	15.5 (10) outcome measures, determined by the commissioner, for home and community-based
458	458	15.6services rates determined under this section; and
459	459	15.7 (11) different competitive workforce factors by service, as determined under subdivision
460	460	15.810b.
461	461	15.9 (c) The commissioner shall report to the chairs and the ranking minority members of
462	462	15.10the legislative committees and divisions with jurisdiction over health and human services
463	463	15.11policy and finance with the information and data gathered under paragraphs (a) and (b) on
464	464	15.12January 15, 2021, with a full report, and a full report once every four years thereafter.
465	465	15.13 (d) Beginning July 1, 2022, the commissioner shall renew analysis and implement
466	466	15.14changes to the regional adjustment factors once every six years. Prior to implementation,
467	467	15.15the commissioner shall consult with stakeholders on the methodology to calculate the
468	468	15.16adjustment.
469	469	15.17 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
470	470	15.18whichever is later. The commissioner of human services shall notify the revisor of statutes
471	471	15.19when federal approval is obtained.
472	472	15.20Sec. 14. Minnesota Statutes 2022, section 256B.4914, subdivision 10a, is amended to
473	473	15.21read:
474	474	15.22 Subd. 10a.Reporting and analysis of cost data.(a) The commissioner must ensure
475	475	15.23that wage values and component values in subdivisions 5 to 9a 9 reflect the cost to provide
476	476	15.24the service. As determined by the commissioner, in consultation with stakeholders identified
477	477	15.25in subdivision 17, a provider enrolled to provide services with rates determined under this
478	478	15.26section must submit requested cost data to the commissioner to support research on the cost
479	479	15.27of providing services that have rates determined by the disability waiver rates system.
480	480	15.28Requested cost data may include, but is not limited to:
481	481	15.29 (1) worker wage costs;
482	482	15.30 (2) benefits paid;
483	483	15.31 (3) supervisor wage costs;
484	484	15Article 2 Sec. 14.
485	485	REVISOR AGW/HL 23-0127812/21/22 16.1 (4) executive wage costs;
486	486	16.2 (5) vacation, sick, and training time paid;
487	487	16.3 (6) taxes, workers' compensation, and unemployment insurance costs paid;
488	488	16.4 (7) administrative costs paid;
489	489	16.5 (8) program costs paid;
490	490	16.6 (9) transportation costs paid;
491	491	16.7 (10) vacancy rates; and
492	492	16.8 (11) other data relating to costs required to provide services requested by the
493	493	16.9commissioner.
494	494	16.10 (b) At least once in any five-year period, a provider must submit cost data for a fiscal
495	495	16.11year that ended not more than 18 months prior to the submission date. The commissioner
496	496	16.12shall provide each provider a 90-day notice prior to its submission due date. If a provider
497	497	16.13fails to submit required reporting data, the commissioner shall provide notice to providers
498	498	16.14that have not provided required data 30 days after the required submission date, and a second
499	499	16.15notice for providers who have not provided required data 60 days after the required
500	500	16.16submission date. The commissioner shall temporarily suspend payments to the provider if
501	501	16.17cost data is not received 90 days after the required submission date. Withheld payments
502	502	16.18shall be made once data is received by the commissioner.
503	503	16.19 (c) The commissioner shall conduct a random validation of data submitted under
504	504	16.20paragraph (a) to ensure data accuracy.
505	505	16.21 (d) The commissioner shall analyze cost data submitted under paragraph (a) and, in
506	506	16.22consultation with stakeholders identified in subdivision 17, may submit recommendations
507	507	16.23on component values and inflationary factor adjustments to the chairs and ranking minority
508	508	16.24members of the legislative committees with jurisdiction over human services once every
509	509	16.25four years beginning January 1, 2021. The commissioner shall make recommendations in
510	510	16.26conjunction with reports submitted to the legislature according to subdivision 10, paragraph
511	511	16.27(c).
512	512	16.28 (e) The commissioner shall release cost data in an aggregate form, and cost data from
513	513	16.29individual providers shall not be released except as provided for in current law.
514	514	16.30 (f) The commissioner, in consultation with stakeholders identified in subdivision 17,
515	515	16.31shall develop and implement a process for providing training and technical assistance
516	516	16Article 2 Sec. 14.
517	517	REVISOR AGW/HL 23-0127812/21/22 17.1necessary to support provider submission of cost documentation required under paragraph
518	518	17.2(a).
519	519	17.3 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
520	520	17.4whichever is later. The commissioner of human services shall notify the revisor of statutes
521	521	17.5when federal approval is obtained.
522	522	17.6 Sec. 15. Minnesota Statutes 2022, section 256B.4914, subdivision 10c, is amended to
523	523	17.7read:
524	524	17.8 Subd. 10c.Reporting and analysis of competitive workforce factor.(a) Beginning
525	525	17.9February 1, 2021 2025, and every two years thereafter, the commissioner shall report to the
526	526	17.10chairs and ranking minority members of the legislative committees and divisions with
527	527	17.11jurisdiction over health and human services policy and finance an analysis of the competitive
528	528	17.12workforce factor.
529	529	17.13 (b) The report must include recommendations to update the competitive workforce factor
530	530	17.14using:
531	531	17.15 (1) the most recently available wage data by SOC code for the weighted average wage
532	532	17.16for direct care staff for residential services and direct care staff for day services;
533	533	17.17 (2) the most recently available wage data by SOC code of the weighted average wage
534	534	17.18of comparable occupations; and
535	535	17.19 (3) workforce data as required under subdivision 10b.
536	536	17.20 (c) The commissioner shall not recommend an increase or decrease of the competitive
537	537	17.21workforce factor from the current value by more than two percentage points. If, after a
538	538	17.22biennial analysis for the next report, the competitive workforce factor is less than or equal
539	539	17.23to zero, the commissioner shall recommend a competitive workforce factor of zero. This
540	540	17.24subdivision expires upon submission of the calendar year 2030 report.
541	541	17.25 EFFECTIVE DATE.This section is effective July 1, 2023.
542	542	17.26Sec. 16. Minnesota Statutes 2022, section 256B.4914, subdivision 12, is amended to read:
543	543	17.27 Subd. 12.Customization of rates for individuals.(a) For persons determined to have
544	544	17.28higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
545	545	17.29by an adjustment factor prior to calculating the rate under subdivisions 6 to 9a 9. The
546	546	17.30customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour
547	547	17.31for waiver recipients who meet the respective criteria as determined by the commissioner.
548	548	17Article 2 Sec. 16.
549	549	REVISOR AGW/HL 23-0127812/21/22 18.1 (b) For the purposes of this section, "deaf and hard-of-hearing" means:
550	550	18.2 (1) the person has a developmental disability and:
551	551	18.3 (i) an assessment score which indicates a hearing impairment that is severe or that the
552	552	18.4person has no useful hearing;
553	553	18.5 (ii) an expressive communications score that indicates the person uses single signs or
554	554	18.6gestures, uses an augmentative communication aid, or does not have functional
555	555	18.7communication, or the person's expressive communications is unknown; and
556	556	18.8 (iii) a communication score which indicates the person comprehends signs, gestures,
557	557	18.9and modeling prompts or does not comprehend verbal, visual, or gestural communication,
558	558	18.10or that the person's receptive communication score is unknown; or
559	559	18.11 (2) the person receives long-term care services and has an assessment score that indicates
560	560	18.12the person hears only very loud sounds, the person has no useful hearing, or a determination
561	561	18.13cannot be made; and the person receives long-term care services and has an assessment that
562	562	18.14indicates the person communicates needs with sign language, symbol board, written
563	563	18.15messages, gestures, or an interpreter; communicates with inappropriate content, makes
564	564	18.16garbled sounds or displays echolalia, or does not communicate needs.
565	565	18.17 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
566	566	18.18whichever is later. The commissioner of human services shall notify the revisor of statutes
567	567	18.19when federal approval is obtained.
568	568	18.20Sec. 17. Minnesota Statutes 2022, section 256B.4914, subdivision 14, is amended to read:
569	569	18.21 Subd. 14.Exceptions.(a) In a format prescribed by the commissioner, lead agencies
570	570	18.22must identify individuals with exceptional needs that cannot be met under the disability
571	571	18.23waiver rate system. The commissioner shall use that information to evaluate and, if necessary,
572	572	18.24approve an alternative payment rate for those individuals. Whether granted, denied, or
573	573	18.25modified, the commissioner shall respond to all exception requests in writing. The
574	574	18.26commissioner shall include in the written response the basis for the action and provide
575	575	18.27notification of the right to appeal under paragraph (h).
576	576	18.28 (b) Lead agencies must act on an exception request within 30 days and notify the initiator
577	577	18.29of the request of their recommendation in writing. A lead agency shall submit all exception
578	578	18.30requests along with its recommendation to the commissioner.
579	579	18.31 (c) An application for a rate exception may be submitted for the following criteria:
580	580	18.32 (1) an individual has service needs that cannot be met through additional units of service;
581	581	18Article 2 Sec. 17.
582	582	REVISOR AGW/HL 23-0127812/21/22 19.1 (2) an individual's rate determined under subdivisions 6 to 9a 9 is so insufficient that it
583	583	19.2has resulted in an individual receiving a notice of discharge from the individual's provider;
584	584	19.3or
585	585	19.4 (3) an individual's service needs, including behavioral changes, require a level of service
586	586	19.5which necessitates a change in provider or which requires the current provider to propose
587	587	19.6service changes beyond those currently authorized.
588	588	19.7 (d) Exception requests must include the following information:
589	589	19.8 (1) the service needs required by each individual that are not accounted for in subdivisions
590	590	19.96 to 9a 9;
591	591	19.10 (2) the service rate requested and the difference from the rate determined in subdivisions
592	592	19.116 to 9a 9;
593	593	19.12 (3) a basis for the underlying costs used for the rate exception and any accompanying
594	594	19.13documentation; and
595	595	19.14 (4) any contingencies for approval.
596	596	19.15 (e) Approved rate exceptions shall be managed within lead agency allocations under
597	597	19.16sections 256B.092 and 256B.49.
598	598	19.17 (f) Individual disability waiver recipients, an interested party, or the license holder that
599	599	19.18would receive the rate exception increase may request that a lead agency submit an exception
600	600	19.19request. A lead agency that denies such a request shall notify the individual waiver recipient,
601	601	19.20interested party, or license holder of its decision and the reasons for denying the request in
602	602	19.21writing no later than 30 days after the request has been made and shall submit its denial to
603	603	19.22the commissioner in accordance with paragraph (b). The reasons for the denial must be
604	604	19.23based on the failure to meet the criteria in paragraph (c).
605	605	19.24 (g) The commissioner shall determine whether to approve or deny an exception request
606	606	19.25no more than 30 days after receiving the request. If the commissioner denies the request,
607	607	19.26the commissioner shall notify the lead agency and the individual disability waiver recipient,
608	608	19.27the interested party, and the license holder in writing of the reasons for the denial.
609	609	19.28 (h) The individual disability waiver recipient may appeal any denial of an exception
610	610	19.29request by either the lead agency or the commissioner, pursuant to sections 256.045 and
611	611	19.30256.0451. When the denial of an exception request results in the proposed demission of a
612	612	19.31waiver recipient from a residential or day habilitation program, the commissioner shall issue
613	613	19.32a temporary stay of demission, when requested by the disability waiver recipient, consistent
614	614	19.33with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary
615	615	19Article 2 Sec. 17.
616	616	REVISOR AGW/HL 23-0127812/21/22 20.1stay shall remain in effect until the lead agency can provide an informed choice of
617	617	20.2appropriate, alternative services to the disability waiver.
618	618	20.3 (i) Providers may petition lead agencies to update values that were entered incorrectly
619	619	20.4or erroneously into the rate management system, based on past service level discussions
620	620	20.5and determination in subdivision 4, without applying for a rate exception.
621	621	20.6 (j) The starting date for the rate exception will be the later of the date of the recipient's
622	622	20.7change in support or the date of the request to the lead agency for an exception.
623	623	20.8 (k) The commissioner shall track all exception requests received and their dispositions.
624	624	20.9The commissioner shall issue quarterly public exceptions statistical reports, including the
625	625	20.10number of exception requests received and the numbers granted, denied, withdrawn, and
626	626	20.11pending. The report shall include the average amount of time required to process exceptions.
627	627	20.12 (l) Approved rate exceptions remain in effect in all cases until an individual's needs
628	628	20.13change as defined in paragraph (c).
629	629	20.14 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
630	630	20.15whichever is later. The commissioner of human services shall notify the revisor of statutes
631	631	20.16when federal approval is obtained.
632	632	20.17Sec. 18. Minnesota Statutes 2022, section 256S.2101, subdivision 1, is amended to read:
633	633	20.18 Subdivision 1.Phase-in for disability waiver customized living rates.All rates and
634	634	20.19rate components for community access for disability inclusion customized living and brain
635	635	20.20injury customized living under section 256B.4914 shall must be the sum of ten 21.6 percent
636	636	20.21of the rates calculated under sections 256S.211 to 256S.215 and 90 78.4 percent of the rates
637	637	20.22calculated using the rate methodology in effect as of June 30, 2017.
638	638	20.23 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
639	639	20.24whichever is later. The commissioner of human services shall notify the revisor of statutes
640	640	20.25when federal approval is obtained.
641	641	20.26Sec. 19. DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
642	642	20.27SERVICES RATES.
643	643	20.28 The commissioner of human services shall establish a rate system for shared homemaker
644	644	20.29services and shared chore services provided under Minnesota Statutes, sections 256B.092
645	645	20.30and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed
646	646	20.311-1/2 times the rate paid for serving a single individual, and for three persons sharing
647	647	20.32services, the rate paid to a provider must not exceed two times the rate paid for serving a
648	648	20Article 2 Sec. 19.
649	649	REVISOR AGW/HL 23-0127812/21/22 21.1single individual. These rates apply only when all of the criteria for the shared service have
650	650	21.2been met.
651	651	21.3 Sec. 20. DIRECTION TO COMMISSIONER; SHARED SERVICES.
652	652	21.4 (a) By December 1, 2023, the commissioner of human services shall seek any necessary
653	653	21.5changes to home and community-based services waiver plans regarding sharing services in
654	654	21.6order to:
655	655	21.7 (1) permit shared services for additional services, including chore, homemaker, and
656	656	21.8night supervision;
657	657	21.9 (2) permit existing shared services at higher ratios, including individualized home
658	658	21.10supports without training, individualized home supports with training, and individualized
659	659	21.11home supports with family training at a ratio of one staff person to three recipients;
660	660	21.12 (3) ensure that individuals who are seeking to share services permitted under the waiver
661	661	21.13plans in an own-home setting are not required to live in a licensed setting in order to share
662	662	21.14services so long as all other requirements are met; and
663	663	21.15 (4) issue guidance for shared services, including:
664	664	21.16 (i) informed choice for all individuals sharing the services;
665	665	21.17 (ii) guidance for when multiple shared services by different providers occur in one home
666	666	21.18and how lead agencies and individuals shall determine that shared service is appropriate to
667	667	21.19meet the needs, health, and safety of each individual for whom the lead agency provides
668	668	21.20case management or care coordination; and
669	669	21.21 (iii) guidance clarifying that an individual's decision to share services does not reduce
670	670	21.22any determination of the individual's overall or assessed needs for services.
671	671	21.23 (b) The commissioner shall develop or provide guidance outlining:
672	672	21.24 (1) instructions for shared services support planning;
673	673	21.25 (2) person-centered approaches and informed choice in shared services support planning;
674	674	21.26and
675	675	21.27 (3) required contents of shared services agreements.
676	676	21.28 (c) The commissioner shall seek and utilize stakeholder input for any proposed changes
677	677	21.29to waiver plans and any shared services guidance.
678	678	21Article 2 Sec. 20.
679	679	REVISOR AGW/HL 23-0127812/21/22 22.1 Sec. 21. DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.
680	680	22.2 Subdivision 1.Recommendations required.The commissioner of human services shall
681	681	22.3develop recommendations for establishing life sharing as a covered medical assistance
682	682	22.4waiver service.
683	683	22.5 Subd. 2.Definition.For the purposes of this section, "life sharing" means a
684	684	22.6relationship-based living arrangement between an adult with a disability and an individual
685	685	22.7or family in which they share their lives and experiences while the adult with a disability
686	686	22.8receives support from the individual or family using person-centered practices.
687	687	22.9 Subd. 3.Stakeholder engagement and consultation.(a) The commissioner must
688	688	22.10proactively solicit participation in the development of the life-sharing medical assistance
689	689	22.11service through a robust stakeholder engagement process that results in the inclusion of a
690	690	22.12racially, culturally, and geographically diverse group of interested stakeholders from each
691	691	22.13of the following groups:
692	692	22.14 (1) providers currently providing or interested in providing life-sharing services;
693	693	22.15 (2) people with disabilities accessing or interested in accessing life-sharing services;
694	694	22.16 (3) disability advocacy organizations; and
695	695	22.17 (4) lead agencies.
696	696	22.18 (b) The commissioner must proactively seek input into and assistance with the
697	697	22.19development of recommendations for establishing the life-sharing service from interested
698	698	22.20stakeholders.
699	699	22.21 (c) The commissioner must provide a method for the commissioner and interested
700	700	22.22stakeholders to cofacilitate public meetings. The first meeting must occur before January
701	701	22.2331, 2023. The commissioner must host the cofacilitated meetings at least monthly through
702	702	22.24December 31, 2023. All meetings must be accessible to all interested stakeholders, recorded,
703	703	22.25and posted online within one week of the meeting date.
704	704	22.26 Subd. 4.Required topics to be discussed during development of the
705	705	22.27recommendations.The commissioner and the interested stakeholders must discuss the
706	706	22.28following topics:
707	707	22.29 (1) the distinction between life sharing and adult family foster care;
708	708	22.30 (2) successful life-sharing models used in other states;
709	709	22.31 (3) services and supports that could be included in a life-sharing service;
710	710	22Article 2 Sec. 21.
711	711	REVISOR AGW/HL 23-0127812/21/22 23.1 (4) potential barriers to providing or accessing life-sharing services;
712	712	23.2 (5) solutions to remove identified barriers to providing or accessing life-sharing services;
713	713	23.3 (6) potential medical assistance payment methodologies for life-sharing services;
714	714	23.4 (7) expanding awareness of the life-sharing model; and
715	715	23.5 (8) draft language for legislation necessary to define and implement life-sharing services.
716	716	23.6 Subd. 5.Report to the legislature.By December 31, 2024, the commissioner must
717	717	23.7provide to the chairs and ranking minority members of the house of representatives and
718	718	23.8senate committees and divisions with jurisdiction over direct care services a report
719	719	23.9summarizing the discussions between the commissioner and the interested stakeholders and
720	720	23.10the commissioner's recommendations. The report must also include any draft legislation
721	721	23.11necessary to define and implement life-sharing services.
722	722	23.12Sec. 22. REPEALER.
723	723	23.13 Minnesota Statutes 2022, section 256B.4914, subdivision 9a, is repealed.
724	724	23.14 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
725	725	23.15whichever is later. The commissioner of human services shall notify the revisor of statutes
726	726	23.16when federal approval is obtained.
727	727	23.17 ARTICLE 3
728	728	23.18 ELDERLY WAIVER
729	729	23.19Section 1. Minnesota Statutes 2022, section 256B.0913, subdivision 4, is amended to read:
730	730	23.20 Subd. 4.Eligibility for funding for services for nonmedical assistance recipients.(a)
731	731	23.21Funding for services under the alternative care program is available to persons who meet
732	732	23.22the following criteria:
733	733	23.23 (1) the person is a citizen of the United States or a United States national;
734	734	23.24 (2) the person has been determined by a community assessment under section 256B.0911
735	735	23.25to be a person who would require the level of care provided in a nursing facility, as
736	736	23.26determined under section 256B.0911, subdivision 26, but for the provision of services under
737	737	23.27the alternative care program;
738	738	23.28 (3) the person is age 65 or older;
739	739	23.29 (4) the person would be eligible for medical assistance within 135 days of admission to
740	740	23.30a nursing facility;
741	741	23Article 3 Section 1.
742	742	REVISOR AGW/HL 23-0127812/21/22 24.1 (5) the person is not ineligible for the payment of long-term care services by the medical
743	743	24.2assistance program due to an asset transfer penalty under section 256B.0595 or equity
744	744	24.3interest in the home exceeding $500,000 as stated in section 256B.056;
745	745	24.4 (6) the person needs long-term care services that are not funded through other state or
746	746	24.5federal funding, or other health insurance or other third-party insurance such as long-term
747	747	24.6care insurance;
748	748	24.7 (7) except for individuals described in clause (8), the monthly cost of the alternative
749	749	24.8care services funded by the program for this person does not exceed 75 percent of the
750	750	24.9monthly limit described under section 256S.18. This monthly limit does not prohibit the
751	751	24.10alternative care client from payment for additional services, but in no case may the cost of
752	752	24.11additional services purchased under this section exceed the difference between the client's
753	753	24.12monthly service limit defined under section 256S.04, and the alternative care program
754	754	24.13monthly service limit defined in this paragraph. If care-related supplies and equipment or
755	755	24.14environmental modifications and adaptations are or will be purchased for an alternative
756	756	24.15care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive
757	757	24.16months beginning with the month of purchase. If the monthly cost of a recipient's other
758	758	24.17alternative care services exceeds the monthly limit established in this paragraph, the annual
759	759	24.18cost of the alternative care services shall must be determined. In this event, the annual cost
760	760	24.19of alternative care services shall must not exceed 12 times the monthly limit described in
761	761	24.20this paragraph;
762	762	24.21 (8) for individuals assigned a case mix classification A as described under section
763	763	24.22256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies
764	764	24.23in bathing, dressing, grooming, walking, and eating when the dependency score in eating
765	765	24.24is three or greater as determined by an assessment performed under section 256B.0911, the
766	766	24.25monthly cost of alternative care services funded by the program cannot exceed $593 per
767	767	24.26month for all new participants enrolled in the program on or after July 1, 2011. This monthly
768	768	24.27limit shall be applied to all other participants who meet this criteria at reassessment. This
769	769	24.28monthly limit shall must be increased annually as described in section 256S.18. This monthly
770	770	24.29limit does not prohibit the alternative care client from payment for additional services, but
771	771	24.30in no case may the cost of additional services purchased exceed the difference between the
772	772	24.31client's monthly service limit defined in this clause and the limit described in clause (7) for
773	773	24.32case mix classification A; and
774	774	24.33 (9) the person is making timely payments of the assessed monthly fee; and
775	775	24Article 3 Section 1.
776	776	REVISOR AGW/HL 23-0127812/21/22 25.1 (10) for a person participating in consumer-directed community supports, the person's
777	777	25.2monthly service limit must be equal to the monthly service limits in clause (7), except that
778	778	25.3a person assigned a case mix classification L must receive the monthly service limit for
779	779	25.4case mix classification A.
780	780	25.5 A person is ineligible if payment of the fee is over 60 days past due, unless the person
781	781	25.6agrees to:
782	782	25.7 (i) the appointment of a representative payee;
783	783	25.8 (ii) automatic payment from a financial account;
784	784	25.9 (iii) the establishment of greater family involvement in the financial management of
785	785	25.10payments; or
786	786	25.11 (iv) another method acceptable to the lead agency to ensure prompt fee payments.
787	787	25.12 (b) The lead agency may extend the client's eligibility as necessary while making
788	788	25.13arrangements to facilitate payment of past-due amounts and future premium payments.
789	789	25.14Following disenrollment due to nonpayment of a monthly fee, eligibility shall must not be
790	790	25.15reinstated for a period of 30 days.
791	791	25.16 (c) Alternative care funding under this subdivision is not available for a person who is
792	792	25.17a medical assistance recipient or who would be eligible for medical assistance without a
793	793	25.18spenddown or waiver obligation. A person whose initial application for medical assistance
794	794	25.19and the elderly waiver program is being processed may be served under the alternative care
795	795	25.20program for a period up to 60 days. If the individual is found to be eligible for medical
796	796	25.21assistance, medical assistance must be billed for services payable under the federally
797	797	25.22approved elderly waiver plan and delivered from the date the individual was found eligible
798	798	25.23for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
799	799	25.24care funds may not be used to pay for any service the cost of which: (i) is payable by medical
800	800	25.25assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a
801	801	25.26medical assistance income spenddown for a person who is eligible to participate in the
802	802	25.27federally approved elderly waiver program under the special income standard provision.
803	803	25.28 (d) Alternative care funding is not available for a person who resides in a licensed nursing
804	804	25.29home, certified boarding care home, hospital, or intermediate care facility, except for case
805	805	25.30management services which are provided in support of the discharge planning process for
806	806	25.31a nursing home resident or certified boarding care home resident to assist with a relocation
807	807	25.32process to a community-based setting.
808	808	25Article 3 Section 1.
809	809	REVISOR AGW/HL 23-0127812/21/22 26.1 (e) Alternative care funding is not available for a person whose income is greater than
810	810	26.2the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent
811	811	26.3of the federal poverty guideline effective July 1 in the fiscal year for which alternative care
812	812	26.4eligibility is determined, who would be eligible for the elderly waiver with a waiver
813	813	26.5obligation.
814	814	26.6 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
815	815	26.7whichever is later. The commissioner of human services shall notify the revisor of statutes
816	816	26.8when federal approval is obtained.
817	817	26.9 Sec. 2. Minnesota Statutes 2022, section 256B.0913, subdivision 5, is amended to read:
818	818	26.10 Subd. 5.Services covered under alternative care.Alternative care funding may be
819	819	26.11used for payment of costs of:
820	820	26.12 (1) adult day services and adult day services bath;
821	821	26.13 (2) home care;
822	822	26.14 (3) homemaker services;
823	823	26.15 (4) personal care;
824	824	26.16 (5) case management and conversion case management;
825	825	26.17 (6) respite care;
826	826	26.18 (7) specialized supplies and equipment;
827	827	26.19 (8) home-delivered meals;
828	828	26.20 (9) nonmedical transportation;
829	829	26.21 (10) nursing services;
830	830	26.22 (11) chore services;
831	831	26.23 (12) companion services;
832	832	26.24 (13) nutrition services;
833	833	26.25 (14) family caregiver training and education;
834	834	26.26 (15) coaching and counseling;
835	835	26.27 (16) telehome care to provide services in their own homes in conjunction with in-home
836	836	26.28visits;
837	837	26Article 3 Sec. 2.
838	838	REVISOR AGW/HL 23-0127812/21/22 27.1 (17) consumer-directed community supports under the alternative care programs which
839	839	27.2are available statewide and limited to the average monthly expenditures representative of
840	840	27.3all alternative care program participants for the same case mix resident class assigned in
841	841	27.4the most recent fiscal year for which complete expenditure data is available;
842	842	27.5 (18) environmental accessibility and adaptations; and
843	843	27.6 (19) discretionary services, for which lead agencies may make payment from their
844	844	27.7alternative care program allocation for services not otherwise defined in this section or
845	845	27.8section 256B.0625, following approval by the commissioner.
846	846	27.9 Total annual payments for discretionary services for all clients served by a lead agency
847	847	27.10must not exceed 25 percent of that lead agency's annual alternative care program base
848	848	27.11allocation, except that when alternative care services receive federal financial participation
849	849	27.12under the 1115 waiver demonstration, funding shall be allocated in accordance with
850	850	27.13subdivision 17.
851	851	27.14 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
852	852	27.15whichever is later. The commissioner of human services shall notify the revisor of statutes
853	853	27.16when federal approval is obtained.
854	854	27.17Sec. 3. Minnesota Statutes 2022, section 256S.15, subdivision 2, is amended to read:
855	855	27.18 Subd. 2.Foster care limit.The elderly waiver payment for the foster care service in
856	856	27.19combination with the payment for all other elderly waiver services, including case
857	857	27.20management, must not exceed the monthly case mix budget cap for the participant as
858	858	27.21specified in sections 256S.18, subdivision 3, and 256S.19, subdivisions subdivision 3 and
859	859	27.224.
860	860	27.23 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
861	861	27.24whichever is later. The commissioner of human services shall notify the revisor of statutes
862	862	27.25when federal approval is obtained.
863	863	27.26Sec. 4. Minnesota Statutes 2022, section 256S.18, is amended by adding a subdivision to
864	864	27.27read:
865	865	27.28 Subd. 3a.Monthly case mix budget caps for consumer-directed community
866	866	27.29supports.The monthly case mix budget caps for each case mix classification for
867	867	27.30consumer-directed community supports must be equal to the monthly case mix budget caps
868	868	27.31in subdivision 3.
869	869	27.32 EFFECTIVE DATE.This section is effective January 1, 2024.
870	870	27Article 3 Sec. 4.
871	871	REVISOR AGW/HL 23-0127812/21/22 28.1 Sec. 5. Minnesota Statutes 2022, section 256S.19, subdivision 3, is amended to read:
872	872	28.2 Subd. 3.Calculation of monthly conversion budget cap without consumer-directed
873	873	28.3community supports caps.(a) The elderly waiver monthly conversion budget cap for the
874	874	28.4cost of elderly waiver services without consumer-directed community supports must be
875	875	28.5based on the nursing facility case mix adjusted total payment rate of the nursing facility
876	876	28.6where the elderly waiver applicant currently resides for the applicant's case mix classification
877	877	28.7as determined according to section 256R.17.
878	878	28.8 (b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver
879	879	28.9services without consumer-directed community supports shall must be calculated by
880	880	28.10multiplying the applicable nursing facility case mix adjusted total payment rate by 365,
881	881	28.11dividing by 12, and subtracting the participant's maintenance needs allowance.
882	882	28.12 (c) A participant's initially approved monthly conversion budget cap for elderly waiver
883	883	28.13services without consumer-directed community supports shall must be adjusted at least
884	884	28.14annually as described in section 256S.18, subdivision 5.
885	885	28.15 (d) Conversion budget caps for individuals participating in consumer-directed community
886	886	28.16supports must also be set as described in paragraphs (a) to (c).
887	887	28.17 EFFECTIVE DATE.This section is effective January 1, 2024.
888	888	28.18Sec. 6. Minnesota Statutes 2022, section 256S.205, subdivision 3, is amended to read:
889	889	28.19 Subd. 3.Rate adjustment eligibility criteria.Only facilities satisfying all of the
890	890	28.20following conditions on September 1 of the application year are eligible for designation as
891	891	28.21a disproportionate share facility:
892	892	28.22 (1) at least 83.5 80 percent of the residents of the facility are customized living residents;
893	893	28.23and
894	894	28.24 (2) at least 70 50 percent of the customized living residents are elderly waiver participants.
895	895	28.25 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
896	896	28.26whichever is later. The commissioner of human services shall notify the revisor of statutes
897	897	28.27when federal approval is obtained.
898	898	28.28Sec. 7. Minnesota Statutes 2022, section 256S.205, subdivision 5, is amended to read:
899	899	28.29 Subd. 5.Rate adjustment; rate floor.(a) Notwithstanding the 24-hour customized
900	900	28.30living monthly service rate limits under section 256S.202, subdivision 2, and the component
901	901	28.31service rates established under section 256S.201, subdivision 4, the commissioner must
902	902	28Article 3 Sec. 7.
903	903	REVISOR AGW/HL 23-0127812/21/22 29.1establish a rate floor equal to $119 $139 per resident per day for 24-hour customized living
904	904	29.2services provided to an elderly waiver participant in a designated disproportionate share
905	905	29.3facility.
906	906	29.4 (b) The commissioner must apply the rate floor to the services described in paragraph
907	907	29.5(a) provided during the rate year.
908	908	29.6 (c) The commissioner must adjust the rate floor by the same amount and at the same
909	909	29.7time as any adjustment to the 24-hour customized living monthly service rate limits under
910	910	29.8section 256S.202, subdivision 2.
911	911	29.9 (d) The commissioner shall not implement the rate floor under this section if the
912	912	29.10customized living rates established under sections 256S.21 to 256S.215 will be implemented
913	913	29.11at 100 percent on January 1 of the year following an application year.
914	914	29.12 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
915	915	29.13whichever is later. The commissioner of human services shall notify the revisor of statutes
916	916	29.14when federal approval is obtained.
917	917	29.15Sec. 8. Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:
918	918	29.16 Subd. 2.Phase-in for elderly waiver rates.Except for home-delivered meals as
919	919	29.17described in section 256S.215, subdivision 15 the services in subdivisions 4 and 5, all rates
920	920	29.18and rate components for elderly waiver, elderly waiver customized living, and elderly waiver
921	921	29.19foster care under this chapter; alternative care under section 256B.0913; and essential
922	922	29.20community supports under section 256B.0922 shall must be the sum of 18.8 21.6 percent
923	923	29.21of the rates calculated under sections 256S.211 to 256S.215, and 81.2 78.4 percent of the
924	924	29.22rates calculated using the rate methodology in effect as of June 30, 2017. The rate for
925	925	29.23home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019,
926	926	29.24and the increases described in section 256S.215, subdivision 15.
927	927	29.25 EFFECTIVE DATE.This section is effective January 1, 2024.
928	928	29.26Sec. 9. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
929	929	29.27to read:
930	930	29.28 Subd. 3.Spending requirements.(a) At least 80 percent of the marginal increase in
931	931	29.29revenue from the implementation of any adjustments to a phase-in proportion under this
932	932	29.30section, or any adjustments to the base wage indices under section 256S.212, for services
933	933	29.31rendered on or after the day of implementation of the modified phase-in proportion or
934	934	29Article 3 Sec. 9.
935	935	REVISOR AGW/HL 23-0127812/21/22 30.1applicable adjustment to the base wage indices must be used to increase compensation-related
936	936	30.2costs for employees directly employed by the provider.
937	937	30.3 (b) For the purposes of this subdivision, compensation-related costs include:
938	938	30.4 (1) wages and salaries;
939	939	30.5 (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
940	940	30.6taxes, workers' compensation, and mileage reimbursement;
941	941	30.7 (3) the employer's paid share of health and dental insurance, life insurance, disability
942	942	30.8insurance, long-term care insurance, uniform allowance, pensions, and contributions to
943	943	30.9employee retirement accounts; and
944	944	30.10 (4) benefits that address direct support professional workforce needs above and beyond
945	945	30.11what employees were offered prior to the implementation of adjusted phase-in proportions
946	946	30.12under this section, including any concurrent or subsequent adjustments to the base wage
947	947	30.13indices.
948	948	30.14 (c) Compensation-related costs for persons employed in the central office of a corporation
949	949	30.15or entity that has an ownership interest in the provider or exercises control over the provider,
950	950	30.16or for persons paid by the provider under a management contract, do not count toward the
951	951	30.1780 percent requirement under this subdivision.
952	952	30.18 (d) A provider agency or individual provider that receives additional revenue subject to
953	953	30.19the requirements of this subdivision shall prepare, and upon request submit to the
954	954	30.20commissioner, a distribution plan that specifies the amount of money the provider expects
955	955	30.21to receive that is subject to the requirements of this subdivision, including how that money
956	956	30.22was or will be distributed to increase compensation-related costs for employees. Within 60
957	957	30.23days of final implementation of the new phase-in proportion or adjustment to the base wage
958	958	30.24indices subject to the requirements of this subdivision, the provider must post the distribution
959	959	30.25plan and leave it posted for a period of at least six months in an area of the provider's
960	960	30.26operation to which all direct support professionals have access. The posted distribution plan
961	961	30.27must include instructions regarding how to contact the commissioner, or the commissioner's
962	962	30.28representative, if an employee has not received the compensation-related increase described
963	963	30.29in the plan.
964	964	30.30 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
965	965	30.31whichever is later. The commissioner of human services shall notify the revisor of statutes
966	966	30.32when federal approval is obtained.
967	967	30Article 3 Sec. 9.
968	968	REVISOR AGW/HL 23-0127812/21/22 31.1 Sec. 10. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
969	969	31.2to read:
970	970	31.3 Subd. 4.Phase-in for home-delivered meals rate.The home-delivered meals rate for
971	971	31.4the elderly waiver under this chapter; alternative care under section 256B.0913; and essential
972	972	31.5community supports under section 256B.0922 must be the sum of 65 percent of the rate in
973	973	31.6section 256S.215, subdivision 15, and 35 percent of the rate calculated using the rate
974	974	31.7methodology in effect as of June 30, 2017.
975	975	31.8 EFFECTIVE DATE.This section is effective January 1, 2024.
976	976	31.9 Sec. 11. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
977	977	31.10to read:
978	978	31.11 Subd. 5.Service rates exempt from phase-in.Subdivision 2 does not apply to rates
979	979	31.12for homemaker services described in section 256S.215, subdivisions 9 to 11.
980	980	31.13 EFFECTIVE DATE.This section is effective January 1, 2024.
981	981	31.14Sec. 12. Minnesota Statutes 2022, section 256S.212, is amended to read:
982	982	31.15 256S.212 RATE SETTING; BASE WAGE INDEX.
983	983	31.16 Subdivision 1.Updating SOC codes.If any of the SOC codes and positions used in
984	984	31.17this section are no longer available, the commissioner shall, in consultation with stakeholders,
985	985	31.18select a new SOC code and position that is the closest match to the previously used SOC
986	986	31.19position.
987	987	31.20 Subd. 1a.Updating base wages.(a) On January 1, 2024, and every two years thereafter,
988	988	31.21the commissioner must update the base wages for the services listed in paragraph (b) based
989	989	31.22on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington,
990	990	31.23MN-WI MetroSA data. Any marginal increase in revenue from implementation of any
991	991	31.24adjustment to base wages under this section, including any modifications to SOC codes or
992	992	31.25positions, is subject to the spending requirements under section 256S.2101, subdivision 3.
993	993	31.26 (b) This subdivision applies to:
994	994	31.27 (1) the homemaker services and assistance with personal care base wage under subdivision
995	995	31.288;
996	996	31.29 (2) the homemaker services and cleaning base wage under subdivision 9;
997	997	31.30 (3) the homemaker services and home management base wage under subdivision 10;
998	998	31.31and
999	999	31Article 3 Sec. 12.
1000	1000	REVISOR AGW/HL 23-0127812/21/22 32.1 (4) for the purposes of calculating the unlicensed supervisor supervision wage component
1001	1001	32.2used to calculate the homemaker services rates under section 256S.215, subdivisions 9 to
1002	1002	32.311, the unlicensed supervisor base wage under subdivision 15.
1003	1003	32.4 Subd. 2.Home management and support services base wage.For customized living,
1004	1004	32.5and foster care, and residential care component services, the home management and support
1005	1005	32.6services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
1006	1006	32.7MetroSA average wage for home health and personal and home care aide aides (SOC code
1007	1007	32.839-9021 31-1120); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
1008	1008	32.9average wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the
1009	1009	32.10Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
1010	1010	32.11housekeeping cleaners (SOC code 37-2012).
1011	1011	32.12 Subd. 3.Home care aide base wage.For customized living, and foster care, and
1012	1012	32.13residential care component services, the home care aide base wage equals 50 75 percent of
1013	1013	32.14the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
1014	1014	32.15and personal care aides (SOC code 31-1011 31-1120); and 50 25 percent of the
1015	1015	32.16Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
1016	1016	32.17(SOC code 31-1014 31-1131).
1017	1017	32.18 Subd. 4.Home health aide base wage.For customized living, and foster care, and
1018	1018	32.19residential care component services, the home health aide base wage equals 20 33.33 percent
1019	1019	32.20of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed
1020	1020	32.21practical and licensed vocational nurses (SOC code 29-2061); and 80 33.33 percent of the
1021	1021	32.22Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
1022	1022	32.23(SOC code 31-1014 31-1131); and 33.34 percent of the Minneapolis-St. Paul-Bloomington,
1023	1023	32.24MN-WI MetroSA average wage for home health and personal care aides (SOC code
1024	1024	32.2531-1120).
1025	1025	32.26 Subd. 5.Medication setups by licensed nurse base wage.For customized living, and
1026	1026	32.27foster care, and residential care component services, the medication setups by licensed nurse
1027	1027	32.28base wage equals ten 25 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
1028	1028	32.29average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);
1029	1029	32.30and 90 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
1030	1030	32.31wage for registered nurses (SOC code 29-1141).
1031	1031	32.32 Subd. 6.Chore services base wage.The chore services base wage equals 100 50 percent
1032	1032	32.33of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping
1033	1033	32.34and groundskeeping workers (SOC code 37-3011); and 50 percent of the Minneapolis-St.
1034	1034	32Article 3 Sec. 12.
1035	1035	REVISOR AGW/HL 23-0127812/21/22 33.1Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners
1036	1036	33.2(SOC code 37-2012).
1037	1037	33.3 Subd. 7.Companion services base wage.The companion services base wage equals
1038	1038	33.450 80 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
1039	1039	33.5for home health and personal and home care aides (SOC code 39-9021 31-1120); and 50
1040	1040	33.620 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
1041	1041	33.7maids and housekeeping cleaners (SOC code 37-2012).
1042	1042	33.8 Subd. 8.Homemaker services and assistance with personal care base wage.The
1043	1043	33.9homemaker services and assistance with personal care base wage equals 60 50 percent of
1044	1044	33.10the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
1045	1045	33.11and personal and home care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of
1046	1046	33.12the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
1047	1047	33.13(SOC code 31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington,
1048	1048	33.14MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
1049	1049	33.15 Subd. 9.Homemaker services and cleaning base wage.The homemaker services and
1050	1050	33.16cleaning base wage equals 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
1051	1051	33.17MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent
1052	1052	33.18of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing
1053	1053	33.19assistants (SOC code 31-1014); and 20 100 percent of the Minneapolis-St. Paul-Bloomington,
1054	1054	33.20MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
1055	1055	33.21 Subd. 10.Homemaker services and home management base wage.The homemaker
1056	1056	33.22services and home management base wage equals 60 50 percent of the Minneapolis-St.
1057	1057	33.23Paul-Bloomington, MN-WI MetroSA average wage for home health and personal and home
1058	1058	33.24care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of the Minneapolis-St.
1059	1059	33.25Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
1060	1060	33.2631-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
1061	1061	33.27MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
1062	1062	33.28 Subd. 11.In-home respite care services base wage.The in-home respite care services
1063	1063	33.29base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
1064	1064	33.30average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St.
1065	1065	33.31Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants home health and
1066	1066	33.32personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of the Minneapolis-St.
1067	1067	33.33Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
1068	1068	33.34vocational nurses (SOC code 29-2061).
1069	1069	33Article 3 Sec. 12.
1070	1070	REVISOR AGW/HL 23-0127812/21/22 34.1 Subd. 12.Out-of-home respite care services base wage.The out-of-home respite care
1071	1071	34.2services base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
1072	1072	34.3MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the
1073	1073	34.4Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
1074	1074	34.5home health and personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of
1075	1075	34.6the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
1076	1076	34.7and licensed vocational nurses (SOC code 29-2061).
1077	1077	34.8 Subd. 13.Individual community living support base wage.The individual community
1078	1078	34.9living support base wage equals 20 60 percent of the Minneapolis-St. Paul-Bloomington,
1079	1079	34.10MN-WI MetroSA average wage for licensed practical and licensed vocational nurses social
1080	1080	34.11and human services aides (SOC code 29-2061 21-1093); and 80 40 percent of the
1081	1081	34.12Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
1082	1082	34.13(SOC code 31-1014 31-1131).
1083	1083	34.14 Subd. 14.Registered nurse base wage.The registered nurse base wage equals 100
1084	1084	34.15percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
1085	1085	34.16registered nurses (SOC code 29-1141).
1086	1086	34.17 Subd. 15.Social worker Unlicensed supervisor base wage.The social worker
1087	1087	34.18unlicensed supervisor base wage equals 100 percent of the Minneapolis-St.
1088	1088	34.19Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
1089	1089	34.20first-line supervisors of personal service workers (SOC code 21-1022 39-1098).
1090	1090	34.21 Subd. 16.Adult day services base wage.The adult day services base wage equals 75
1091	1091	34.22percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home
1092	1092	34.23health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St.
1093	1093	34.24Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
1094	1094	34.2531-1131).
1095	1095	34.26 EFFECTIVE DATE.This section is effective January 1, 2024.
1096	1096	34.27Sec. 13. Minnesota Statutes 2022, section 256S.213, is amended to read:
1097	1097	34.28 256S.213 RATE SETTING; FACTORS AND SUPERVISION WAGE
1098	1098	34.29COMPONENTS .
1099	1099	34.30 Subdivision 1.Payroll taxes and benefits factor.The payroll taxes and benefits factor
1100	1100	34.31is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing
1101	1101	34.32facilities on the most recent and available cost report.
1102	1102	34Article 3 Sec. 13.
1103	1103	REVISOR AGW/HL 23-0127812/21/22 35.1 Subd. 2.General and administrative factor.The general and administrative factor is
1104	1104	35.2the difference of net general and administrative expenses and administrative salaries, divided
1105	1105	35.3by total operating expenses for all nursing facilities on the most recent and available cost
1106	1106	35.4report 14.4 percent.
1107	1107	35.5 Subd. 3.Program plan support factor.(a) The program plan support factor is 12.8 ten
1108	1108	35.6percent for the following services to cover the cost of direct service staff needed to provide
1109	1109	35.7support for home and community-based the service when not engaged in direct contact with
1110	1110	35.8participants.:
1111	1111	35.9 (1) adult day services;
1112	1112	35.10 (2) customized living; and
1113	1113	35.11 (3) foster care.
1114	1114	35.12 (b) The program plan support factor is 15.5 percent for the following services to cover
1115	1115	35.13the cost of direct service staff needed to provide support for the service when not engaged
1116	1116	35.14in direct contact with participants:
1117	1117	35.15 (1) chore services;
1118	1118	35.16 (2) companion services;
1119	1119	35.17 (3) homemaker services and assistance with personal care;
1120	1120	35.18 (4) homemaker services and cleaning;
1121	1121	35.19 (5) homemaker services and home management;
1122	1122	35.20 (6) in-home respite care;
1123	1123	35.21 (7) individual community living support; and
1124	1124	35.22 (8) out-of-home respite care.
1125	1125	35.23 Subd. 4.Registered nurse management and supervision factor wage component.The
1126	1126	35.24registered nurse management and supervision factor wage component equals 15 percent of
1127	1127	35.25the registered nurse adjusted base wage as defined in section 256S.214.
1128	1128	35.26 Subd. 5.Social worker Unlicensed supervisor supervision factor wage
1129	1129	35.27component.The social worker unlicensed supervisor supervision factor wage component
1130	1130	35.28equals 15 percent of the social worker unlicensed supervisor adjusted base wage as defined
1131	1131	35.29in section 256S.214.
1132	1132	35.30 Subd. 6.Facility and equipment factor.The facility and equipment factor for adult
1133	1133	35.31day services is 16.2 percent.
1134	1134	35Article 3 Sec. 13.
1135	1135	REVISOR AGW/HL 23-0127812/21/22 36.1 Subd. 7.Food, supplies, and transportation factor.The food, supplies, and
1136	1136	36.2transportation factor for adult day services is 24 percent.
1137	1137	36.3 Subd. 8.Supplies and transportation factor.The supplies and transportation factor
1138	1138	36.4for the following services is 1.56 percent:
1139	1139	36.5 (1) chore services;
1140	1140	36.6 (2) companion services;
1141	1141	36.7 (3) homemaker services and assistance with personal care;
1142	1142	36.8 (4) homemaker services and cleaning;
1143	1143	36.9 (5) homemaker services and home management;
1144	1144	36.10 (6) in-home respite care;
1145	1145	36.11 (7) individual community living support; and
1146	1146	36.12 (8) out-of-home respite care.
1147	1147	36.13 Subd. 9.Absence factor.The absence factor for the following services is 4.5 percent:
1148	1148	36.14 (1) adult day services;
1149	1149	36.15 (2) chore services;
1150	1150	36.16 (3) companion services;
1151	1151	36.17 (4) homemaker services and assistance with personal care;
1152	1152	36.18 (5) homemaker services and cleaning;
1153	1153	36.19 (6) homemaker services and home management;
1154	1154	36.20 (7) in-home respite care;
1155	1155	36.21 (8) individual community living support; and
1156	1156	36.22 (9) out-of-home respite care.
1157	1157	36.23 EFFECTIVE DATE.This section is effective January 1, 2024.
1158	1158	36.24Sec. 14. Minnesota Statutes 2022, section 256S.214, is amended to read:
1159	1159	36.25 256S.214 RATE SETTING; ADJUSTED BASE WAGE.
1160	1160	36.26 For the purposes of section 256S.215, the adjusted base wage for each position equals
1161	1161	36.27the position's base wage under section 256S.212 plus:
1162	1162	36Article 3 Sec. 14.
1163	1163	REVISOR AGW/HL 23-0127812/21/22 37.1 (1) the position's base wage multiplied by the payroll taxes and benefits factor under
1164	1164	37.2section 256S.213, subdivision 1;
1165	1165	37.3 (2) the position's base wage multiplied by the general and administrative factor under
1166	1166	37.4section 256S.213, subdivision 2; and
1167	1167	37.5 (3) (2) the position's base wage multiplied by the applicable program plan support factor
1168	1168	37.6under section 256S.213, subdivision 3.; and
1169	1169	37.7 (3) the position's base wage multiplied by the absence factor under section 256S.213,
1170	1170	37.8subdivision 9, if applicable.
1171	1171	37.9 EFFECTIVE DATE.This section is effective January 1, 2024.
1172	1172	37.10Sec. 15. Minnesota Statutes 2022, section 256S.215, is amended to read:
1173	1173	37.11 256S.215 RATE SETTING; COMPONENT RATES.
1174	1174	37.12 Subdivision 1.Medication setups by licensed nurse component rate.The component
1175	1175	37.13rate for medication setups by a licensed nurse equals the medication setups by licensed
1176	1176	37.14nurse adjusted base wage.
1177	1177	37.15 Subd. 2.Home management and support services component rate.The component
1178	1178	37.16rate for home management and support services is calculated as follows:
1179	1179	37.17 (1) sum the home management and support services adjusted base wage plus and the
1180	1180	37.18registered nurse management and supervision factor. wage component;
1181	1181	37.19 (2) multiply the result of clause (1) by the general and administrative factor; and
1182	1182	37.20 (3) sum the results of clauses (1) and (2).
1183	1183	37.21 Subd. 3.Home care aide services component rate.The component rate for home care
1184	1184	37.22aide services is calculated as follows:
1185	1185	37.23 (1) sum the home health aide services adjusted base wage plus and the registered nurse
1186	1186	37.24management and supervision factor. wage component;
1187	1187	37.25 (2) multiply clause (1) by the general and administrative factor; and
1188	1188	37.26 (3) sum the results of clauses (1) and (2).
1189	1189	37.27 Subd. 4.Home health aide services component rate.The component rate for home
1190	1190	37.28health aide services is calculated as follows:
1191	1191	37.29 (1) sum the home health aide services adjusted base wage plus and the registered nurse
1192	1192	37.30management and supervision factor. wage component;
1193	1193	37Article 3 Sec. 15.
1194	1194	REVISOR AGW/HL 23-0127812/21/22 38.1 (2) multiply the result of clause (1) by the general and administrative factor; and
1195	1195	38.2 (3) sum the results of clauses (1) and (2).
1196	1196	38.3 Subd. 5.Socialization component rate.The component rate under elderly waiver
1197	1197	38.4customized living for one-to-one socialization equals the home management and support
1198	1198	38.5services component rate.
1199	1199	38.6 Subd. 6.Transportation component rate.The component rate under elderly waiver
1200	1200	38.7customized living for one-to-one transportation equals the home management and support
1201	1201	38.8services component rate.
1202	1202	38.9 Subd. 7.Chore services rate.The 15-minute unit rate for chore services is calculated
1203	1203	38.10as follows:
1204	1204	38.11 (1) sum the chore services adjusted base wage and the social worker unlicensed supervisor
1205	1205	38.12supervision factor wage component; and
1206	1206	38.13 (2) multiply the result of clause (1) by the general and administrative factor;
1207	1207	38.14 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1208	1208	38.15 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1209	1209	38.16 Subd. 8.Companion services rate.The 15-minute unit rate for companion services is
1210	1210	38.17calculated as follows:
1211	1211	38.18 (1) sum the companion services adjusted base wage and the social worker unlicensed
1212	1212	38.19supervisor supervision factor wage component; and
1213	1213	38.20 (2) multiply the result of clause (1) by the general and administrative factor;
1214	1214	38.21 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1215	1215	38.22 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1216	1216	38.23 Subd. 9.Homemaker services and assistance with personal care rate.The 15-minute
1217	1217	38.24unit rate for homemaker services and assistance with personal care is calculated as follows:
1218	1218	38.25 (1) sum the homemaker services and assistance with personal care adjusted base wage
1219	1219	38.26and the registered nurse management and unlicensed supervisor supervision factor wage
1220	1220	38.27component; and
1221	1221	38.28 (2) multiply the result of clause (1) by the general and administrative factor;
1222	1222	38.29 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1223	1223	38.30 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1224	1224	38Article 3 Sec. 15.
1225	1225	REVISOR AGW/HL 23-0127812/21/22 39.1 Subd. 10.Homemaker services and cleaning rate.The 15-minute unit rate for
1226	1226	39.2homemaker services and cleaning is calculated as follows:
1227	1227	39.3 (1) sum the homemaker services and cleaning adjusted base wage and the registered
1228	1228	39.4nurse management and unlicensed supervisor supervision factor base wage; and
1229	1229	39.5 (2) multiply the result of clause (1) by the general and administrative factor;
1230	1230	39.6 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1231	1231	39.7 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1232	1232	39.8 Subd. 11.Homemaker services and home management rate.The 15-minute unit rate
1233	1233	39.9for homemaker services and home management is calculated as follows:
1234	1234	39.10 (1) sum the homemaker services and home management adjusted base wage and the
1235	1235	39.11registered nurse management and unlicensed supervisor supervision factor wage component;
1236	1236	39.12and
1237	1237	39.13 (2) multiply the result of clause (1) by the general and administrative factor;
1238	1238	39.14 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1239	1239	39.15 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1240	1240	39.16 Subd. 12.In-home respite care services rates.(a) The 15-minute unit rate for in-home
1241	1241	39.17respite care services is calculated as follows:
1242	1242	39.18 (1) sum the in-home respite care services adjusted base wage and the registered nurse
1243	1243	39.19management and supervision factor wage component; and
1244	1244	39.20 (2) multiply the result of clause (1) by the general and administrative factor;
1245	1245	39.21 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1246	1246	39.22 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1247	1247	39.23 (b) The in-home respite care services daily rate equals the in-home respite care services
1248	1248	39.2415-minute unit rate multiplied by 18.
1249	1249	39.25 Subd. 13.Out-of-home respite care services rates.(a) The 15-minute unit rate for
1250	1250	39.26out-of-home respite care is calculated as follows:
1251	1251	39.27 (1) sum the out-of-home respite care services adjusted base wage and the registered
1252	1252	39.28nurse management and supervision factor wage component; and
1253	1253	39.29 (2) multiply the result of clause (1) by the general and administrative factor;
1254	1254	39.30 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1255	1255	39Article 3 Sec. 15.
1256	1256	REVISOR AGW/HL 23-0127812/21/22 40.1 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1257	1257	40.2 (b) The out-of-home respite care services daily rate equals the 15-minute unit rate for
1258	1258	40.3out-of-home respite care services multiplied by 18.
1259	1259	40.4 Subd. 14.Individual community living support rate.The individual community living
1260	1260	40.5support rate is calculated as follows:
1261	1261	40.6 (1) sum the home care aide individual community living support adjusted base wage
1262	1262	40.7and the social worker registered nurse management and supervision factor wage component;
1263	1263	40.8and
1264	1264	40.9 (2) multiply the result of clause (1) by the general and administrative factor;
1265	1265	40.10 (3) multiply the result of clause (1) by the supplies and transportation factor; and
1266	1266	40.11 (4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
1267	1267	40.12 Subd. 15.Home-delivered meals rate.The home-delivered meals rate equals $9.30
1268	1268	40.13$8.17. On July 1 of each year, the commissioner shall increase update the home delivered
1269	1269	40.14meals rate every July 1 by the percent increase in the nursing facility dietary per diem using
1270	1270	40.15the two most recent and available nursing facility cost reports.
1271	1271	40.16 Subd. 16.Adult day services rate.The 15-minute unit rate for adult day services, with
1272	1272	40.17an assumed staffing ratio of one staff person to four participants, is the sum of is calculated
1273	1273	40.18as follows:
1274	1274	40.19 (1) one-sixteenth of the home care aide divide the adult day services adjusted base wage,
1275	1275	40.20except that the general and administrative factor used to determine the home care aide
1276	1276	40.21services adjusted base wage is 20 percent by five to reflect an assumed staffing ratio of one
1277	1277	40.22to five;
1278	1278	40.23 (2) one-fourth of the registered nurse management and supervision factor sum the result
1279	1279	40.24of clause (1) and the registered nurse management and supervision wage component; and
1280	1280	40.25 (3) $0.63 to cover the cost of meals. multiply the result of clause (2) by the general and
1281	1281	40.26administrative factor;
1282	1282	40.27 (4) multiply the result of clause (2) by the facility and equipment factor;
1283	1283	40.28 (5) multiply the result of clause (2) by the food, supplies, and transportation factor; and
1284	1284	40.29 (6) sum the results of clauses (2) to (5) and divide the result by four.
1285	1285	40.30 Subd. 17.Adult day services bath rate.The 15-minute unit rate for adult day services
1286	1286	40.31bath is the sum of calculated as follows:
1287	1287	40Article 3 Sec. 15.
1288	1288	REVISOR AGW/HL 23-0127812/21/22 41.1 (1) one-fourth of the home care aide sum the adult day services adjusted base wage,
1289	1289	41.2except that the general and administrative factor used to determine the home care aide
1290	1290	41.3services adjusted base wage is 20 percent and the registered nurse management and
1291	1291	41.4supervision wage component;
1292	1292	41.5 (2) one-fourth of the registered nurse management and supervision factor multiply the
1293	1293	41.6result of clause (1) by the general and administrative factor; and
1294	1294	41.7 (3) $0.63 to cover the cost of meals. multiply the result of clause (1) by the facility and
1295	1295	41.8equipment factor;
1296	1296	41.9 (4) multiply the result of clause (1) by the food, supplies, and transportation factor; and
1297	1297	41.10 (5) sum the results of clauses (1) to (4) and divide the result by four.
1298	1298	41.11 EFFECTIVE DATE.This section is effective the January 1, 2024.
1299	1299	41.12Sec. 16. DIRECTION TO COMMISSIONER; ESTABLISHING SHARED SERVICE
1300	1300	41.13RATES.
1301	1301	41.14 The commissioner shall establish a rate system for shared homemaker services and
1302	1302	41.15shared chore services based on homemaker rates for a single individual under section
1303	1303	41.16256S.215, subdivisions 9 to 11, and the chore rate for a single individual under section
1304	1304	41.17256S.215, subdivision 7. For two persons sharing services, the rate paid to a provider must
1305	1305	41.18not exceed 1-1/2 times the rate paid for serving a single individual, and for three persons
1306	1306	41.19sharing services, the rate paid to a provider must not exceed two times the rate paid for
1307	1307	41.20serving a single individual. These rates apply only when all of the criteria for the shared
1308	1308	41.21service have been met.
1309	1309	41.22Sec. 17. REVISOR INSTRUCTION.
1310	1310	41.23 (a) In Minnesota Statutes, chapter 256S, the revisor of statutes shall change the following
1311	1311	41.24terms wherever the terms appear:
1312	1312	41.25 (1) "homemaker services and assistance with personal care" to "homemaker assistance
1313	1313	41.26with personal care services";
1314	1314	41.27 (2) "homemaker services and cleaning" to "homemaker cleaning services"; and
1315	1315	41.28 (3) "homemaker services and home management" to "homemaker home management
1316	1316	41.29services."
1317	1317	41.30 (b) The revisor shall make any necessary grammatical changes related to the changes
1318	1318	41.31in terms under paragraph (a).
1319	1319	41Article 3 Sec. 17.
1320	1320	REVISOR AGW/HL 23-0127812/21/22 42.1 EFFECTIVE DATE.This section is effective July 1, 2023.
1321	1321	42.2 Sec. 18. REPEALER.
1322	1322	42.3 Minnesota Statutes 2022, section 256S.19, subdivision 4, is repealed.
1323	1323	42.4 EFFECTIVE DATE.This section is effective January 1, 2024.
1324	1324	42.5 ARTICLE 4
1325	1325	42.6 HOME CARE
1326	1326	42.7 Section 1. Minnesota Statutes 2022, section 256B.0659, subdivision 1, is amended to read:
1327	1327	42.8 Subdivision 1.Definitions.(a) For the purposes of this section, the terms defined in
1328	1328	42.9paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
1329	1329	42.10 (b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
1330	1330	42.11positioning, eating, and toileting.
1331	1331	42.12 (c) "Behavior," effective January 1, 2010, means a category to determine the home care
1332	1332	42.13rating and is based on the criteria found in this section. "Level I behavior" means physical
1333	1333	42.14aggression towards toward self, others, or destruction of property that requires the immediate
1334	1334	42.15response of another person.
1335	1335	42.16 (d) "Complex health-related needs," effective January 1, 2010, means a category to
1336	1336	42.17determine the home care rating and is based on the criteria found in this section.
1337	1337	42.18 (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
1338	1338	42.19mobility, eating, and toileting.
1339	1339	42.20 (f) "Dependency in activities of daily living" means a person requires assistance to begin
1340	1340	42.21and complete one or more of the activities of daily living.
1341	1341	42.22 (g) "Extended personal care assistance service" means personal care assistance services
1342	1342	42.23included in a service plan under one of the home and community-based services waivers
1343	1343	42.24authorized under chapter 256S and sections 256B.092, subdivision 5, and 256B.49, which
1344	1344	42.25exceed the amount, duration, and frequency of the state plan personal care assistance services
1345	1345	42.26for participants who:
1346	1346	42.27 (1) need assistance provided periodically during a week, but less than daily will not be
1347	1347	42.28able to remain in their homes without the assistance, and other replacement services are
1348	1348	42.29more expensive or are not available when personal care assistance services are to be reduced;
1349	1349	42.30or
1350	1350	42Article 4 Section 1.
1351	1351	REVISOR AGW/HL 23-0127812/21/22 43.1 (2) need additional personal care assistance services beyond the amount authorized by
1352	1352	43.2the state plan personal care assistance assessment in order to ensure that their safety, health,
1353	1353	43.3and welfare are provided for in their homes.
1354	1354	43.4 (h) "Health-related procedures and tasks" means procedures and tasks that can be
1355	1355	43.5delegated or assigned by a licensed health care professional under state law to be performed
1356	1356	43.6by a personal care assistant.
1357	1357	43.7 (i) "Instrumental activities of daily living" means activities to include meal planning and
1358	1358	43.8preparation; basic assistance with paying bills; shopping for food, clothing, and other
1359	1359	43.9essential items; performing household tasks integral to the personal care assistance services;
1360	1360	43.10communication by telephone and other media; and traveling, including to medical
1361	1361	43.11appointments and to participate in the community. For purposes of this paragraph, traveling
1362	1362	43.12includes driving and accompanying the recipient in the recipient's chosen mode of
1363	1363	43.13transportation and according to the recipient's personal care assistance care plan.
1364	1364	43.14 (j) "Managing employee" has the same definition as Code of Federal Regulations, title
1365	1365	43.1542, section 455.
1366	1366	43.16 (k) "Qualified professional" means a professional providing supervision of personal care
1367	1367	43.17assistance services and staff as defined in section 256B.0625, subdivision 19c.
1368	1368	43.18 (l) "Personal care assistance provider agency" means a medical assistance enrolled
1369	1369	43.19provider that provides or assists with providing personal care assistance services and includes
1370	1370	43.20a personal care assistance provider organization, personal care assistance choice agency,
1371	1371	43.21class A licensed nursing agency, and Medicare-certified home health agency.
1372	1372	43.22 (m) "Personal care assistant" or "PCA" means an individual employed by a personal
1373	1373	43.23care assistance agency who provides personal care assistance services.
1374	1374	43.24 (n) "Personal care assistance care plan" means a written description of personal care
1375	1375	43.25assistance services developed by the personal care assistance provider according to the
1376	1376	43.26service plan.
1377	1377	43.27 (o) "Responsible party" means an individual who is capable of providing the support
1378	1378	43.28necessary to assist the recipient to live in the community.
1379	1379	43.29 (p) "Self-administered medication" means medication taken orally, by injection, nebulizer,
1380	1380	43.30or insertion, or applied topically without the need for assistance.
1381	1381	43.31 (q) "Service plan" means a written summary of the assessment and description of the
1382	1382	43.32services needed by the recipient.
1383	1383	43Article 4 Section 1.
1384	1384	REVISOR AGW/HL 23-0127812/21/22 44.1 (r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes,
1385	1385	44.2Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
1386	1386	44.3reimbursement, health and dental insurance, life insurance, disability insurance, long-term
1387	1387	44.4care insurance, uniform allowance, and contributions to employee retirement accounts.
1388	1388	44.5 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1389	1389	44.6whichever is later. The commissioner of human services shall notify the revisor of statutes
1390	1390	44.7when federal approval is obtained.
1391	1391	44.8 Sec. 2. Minnesota Statutes 2022, section 256B.0659, subdivision 12, is amended to read:
1392	1392	44.9 Subd. 12.Documentation of personal care assistance services provided.(a) Personal
1393	1393	44.10care assistance services for a recipient must be documented daily by each personal care
1394	1394	44.11assistant, on a time sheet form approved by the commissioner. All documentation may be
1395	1395	44.12web-based, electronic, or paper documentation. The completed form must be submitted on
1396	1396	44.13a monthly basis to the provider and kept in the recipient's health record.
1397	1397	44.14 (b) The activity documentation must correspond to the personal care assistance care plan
1398	1398	44.15and be reviewed by the qualified professional.
1399	1399	44.16 (c) The personal care assistant time sheet must be on a form approved by the
1400	1400	44.17commissioner documenting time the personal care assistant provides services in the home.
1401	1401	44.18The following criteria must be included in the time sheet:
1402	1402	44.19 (1) full name of personal care assistant and individual provider number;
1403	1403	44.20 (2) provider name and telephone numbers;
1404	1404	44.21 (3) full name of recipient and either the recipient's medical assistance identification
1405	1405	44.22number or date of birth;
1406	1406	44.23 (4) consecutive dates, including month, day, and year, and arrival and departure times
1407	1407	44.24with a.m. or p.m. notations;
1408	1408	44.25 (5) signatures of recipient or the responsible party;
1409	1409	44.26 (6) personal signature of the personal care assistant;
1410	1410	44.27 (7) any shared care provided, if applicable;
1411	1411	44.28 (8) a statement that it is a federal crime to provide false information on personal care
1412	1412	44.29service billings for medical assistance payments; and
1413	1413	44.30 (9) dates and location of recipient stays in a hospital, care facility, or incarceration; and
1414	1414	44Article 4 Sec. 2.
1415	1415	REVISOR AGW/HL 23-0127812/21/22 45.1 (10) any time spent traveling, as described in subdivision 1, paragraph (i), including
1416	1416	45.2start and stop times with a.m. and p.m. designations, the origination site, and the destination
1417	1417	45.3site.
1418	1418	45.4 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1419	1419	45.5whichever is later. The commissioner of human services shall notify the revisor of statutes
1420	1420	45.6when federal approval is obtained.
1421	1421	45.7 Sec. 3. Minnesota Statutes 2022, section 256B.0659, subdivision 17a, is amended to read:
1422	1422	45.8 Subd. 17a.Enhanced rate.An enhanced rate of 107.5 143 percent of the rate paid for
1423	1423	45.9personal care assistance services shall be paid for services provided to persons who qualify
1424	1424	45.10for ten or more hours of personal care assistance services per day when provided by a
1425	1425	45.11personal care assistant who meets the requirements of subdivision 11, paragraph (d). Any
1426	1426	45.12change in the eligibility criteria for the enhanced rate for personal care assistance services
1427	1427	45.13as described in this subdivision and referenced in subdivision 11, paragraph (d), does not
1428	1428	45.14constitute a change in a term or condition for individual providers as defined in section
1429	1429	45.15256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter
1430	1430	45.16179A.
1431	1431	45.17 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1432	1432	45.18whichever is later. The commissioner of human services shall notify the revisor of statutes
1433	1433	45.19when federal approval is obtained.
1434	1434	45.20Sec. 4. Minnesota Statutes 2022, section 256B.0659, subdivision 19, is amended to read:
1435	1435	45.21 Subd. 19.Personal care assistance choice option; qualifications; duties.(a) Under
1436	1436	45.22personal care assistance choice, the recipient or responsible party shall:
1437	1437	45.23 (1) recruit, hire, schedule, and terminate personal care assistants according to the terms
1438	1438	45.24of the written agreement required under subdivision 20, paragraph (a);
1439	1439	45.25 (2) develop a personal care assistance care plan based on the assessed needs and
1440	1440	45.26addressing the health and safety of the recipient with the assistance of a qualified professional
1441	1441	45.27as needed;
1442	1442	45.28 (3) orient and train the personal care assistant with assistance as needed from the qualified
1443	1443	45.29professional;
1444	1444	45.30 (4) supervise and evaluate the personal care assistant with the qualified professional,
1445	1445	45.31who is required to visit the recipient at least every 180 days;
1446	1446	45Article 4 Sec. 4.
1447	1447	REVISOR AGW/HL 23-0127812/21/22 46.1 (5) monitor and verify in writing and report to the personal care assistance choice agency
1448	1448	46.2the number of hours worked by the personal care assistant and the qualified professional;
1449	1449	46.3 (6) engage in an annual reassessment as required in subdivision 3a to determine
1450	1450	46.4continuing eligibility and service authorization; and
1451	1451	46.5 (7) use the same personal care assistance choice provider agency if shared personal
1452	1452	46.6assistance care is being used; and
1453	1453	46.7 (8) ensure that a personal care assistant driving the recipient under subdivision 1,
1454	1454	46.8paragraph (i), has a valid driver's license and the vehicle used is registered and insured
1455	1455	46.9according to Minnesota law.
1456	1456	46.10 (b) The personal care assistance choice provider agency shall:
1457	1457	46.11 (1) meet all personal care assistance provider agency standards;
1458	1458	46.12 (2) enter into a written agreement with the recipient, responsible party, and personal
1459	1459	46.13care assistants;
1460	1460	46.14 (3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
1461	1461	46.15care assistant; and
1462	1462	46.16 (4) ensure arm's-length transactions without undue influence or coercion with the recipient
1463	1463	46.17and personal care assistant.
1464	1464	46.18 (c) The duties of the personal care assistance choice provider agency are to:
1465	1465	46.19 (1) be the employer of the personal care assistant and the qualified professional for
1466	1466	46.20employment law and related regulations including but not limited to purchasing and
1467	1467	46.21maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
1468	1468	46.22and liability insurance, and submit any or all necessary documentation including but not
1469	1469	46.23limited to workers' compensation, unemployment insurance, and labor market data required
1470	1470	46.24under section 256B.4912, subdivision 1a;
1471	1471	46.25 (2) bill the medical assistance program for personal care assistance services and qualified
1472	1472	46.26professional services;
1473	1473	46.27 (3) request and complete background studies that comply with the requirements for
1474	1474	46.28personal care assistants and qualified professionals;
1475	1475	46.29 (4) pay the personal care assistant and qualified professional based on actual hours of
1476	1476	46.30services provided;
1477	1477	46.31 (5) withhold and pay all applicable federal and state taxes;
1478	1478	46Article 4 Sec. 4.
1479	1479	REVISOR AGW/HL 23-0127812/21/22 47.1 (6) verify and keep records of hours worked by the personal care assistant and qualified
1480	1480	47.2professional;
1481	1481	47.3 (7) make the arrangements and pay taxes and other benefits, if any, and comply with
1482	1482	47.4any legal requirements for a Minnesota employer;
1483	1483	47.5 (8) enroll in the medical assistance program as a personal care assistance choice agency;
1484	1484	47.6and
1485	1485	47.7 (9) enter into a written agreement as specified in subdivision 20 before services are
1486	1486	47.8provided.
1487	1487	47.9 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1488	1488	47.10whichever is later. The commissioner of human services shall notify the revisor of statutes
1489	1489	47.11when federal approval is obtained.
1490	1490	47.12Sec. 5. Minnesota Statutes 2022, section 256B.0659, subdivision 24, is amended to read:
1491	1491	47.13 Subd. 24.Personal care assistance provider agency; general duties.A personal care
1492	1492	47.14assistance provider agency shall:
1493	1493	47.15 (1) enroll as a Medicaid provider meeting all provider standards, including completion
1494	1494	47.16of the required provider training;
1495	1495	47.17 (2) comply with general medical assistance coverage requirements;
1496	1496	47.18 (3) demonstrate compliance with law and policies of the personal care assistance program
1497	1497	47.19to be determined by the commissioner;
1498	1498	47.20 (4) comply with background study requirements;
1499	1499	47.21 (5) verify and keep records of hours worked by the personal care assistant and qualified
1500	1500	47.22professional;
1501	1501	47.23 (6) not engage in any agency-initiated direct contact or marketing in person, by phone,
1502	1502	47.24or other electronic means to potential recipients, guardians, or family members;
1503	1503	47.25 (7) pay the personal care assistant and qualified professional based on actual hours of
1504	1504	47.26services provided;
1505	1505	47.27 (8) withhold and pay all applicable federal and state taxes;
1506	1506	47.28 (9) document that the agency uses a minimum of 72.5 percent of the revenue generated
1507	1507	47.29by the medical assistance rate for personal care assistance services for employee personal
1508	1508	47.30care assistant wages and benefits. The revenue generated by the qualified professional and
1509	1509	47Article 4 Sec. 5.
1510	1510	REVISOR AGW/HL 23-0127812/21/22 48.1the reasonable costs associated with the qualified professional shall not be used in making
1511	1511	48.2this calculation;
1512	1512	48.3 (10) make the arrangements and pay unemployment insurance, taxes, workers'
1513	1513	48.4compensation, liability insurance, and other benefits, if any;
1514	1514	48.5 (11) enter into a written agreement under subdivision 20 before services are provided;
1515	1515	48.6 (12) report suspected neglect and abuse to the common entry point according to section
1516	1516	48.7256B.0651;
1517	1517	48.8 (13) provide the recipient with a copy of the home care bill of rights at start of service;
1518	1518	48.9 (14) request reassessments at least 60 days prior to the end of the current authorization
1519	1519	48.10for personal care assistance services, on forms provided by the commissioner;
1520	1520	48.11 (15) comply with the labor market reporting requirements described in section 256B.4912,
1521	1521	48.12subdivision 1a; and
1522	1522	48.13 (16) document that the agency uses the additional revenue due to the enhanced rate under
1523	1523	48.14subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements
1524	1524	48.15under subdivision 11, paragraph (d); and
1525	1525	48.16 (17) ensure that a personal care assistant driving a recipient under subdivision 1,
1526	1526	48.17paragraph (i), has a valid driver's license and the vehicle used is registered and insured
1527	1527	48.18according to Minnesota law.
1528	1528	48.19 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1529	1529	48.20whichever is later. The commissioner of human services shall notify the revisor of statutes
1530	1530	48.21when federal approval is obtained.
1531	1531	48.22Sec. 6. Minnesota Statutes 2022, section 256B.4911, is amended by adding a subdivision
1532	1532	48.23to read:
1533	1533	48.24 Subd. 6.Services provided by parents and spouses.(a) This subdivision limits medical
1534	1534	48.25assistance payments under the consumer-directed community supports option for personal
1535	1535	48.26assistance services provided by a parent to the parent's minor child or by a participant's
1536	1536	48.27spouse. This subdivision applies to the consumer-directed community supports option
1537	1537	48.28available under all of the following:
1538	1538	48.29 (1) alternative care program;
1539	1539	48.30 (2) brain injury waiver;
1540	1540	48.31 (3) community alternative care waiver;
1541	1541	48Article 4 Sec. 6.
1542	1542	REVISOR AGW/HL 23-0127812/21/22 49.1 (4) community access for disability inclusion waiver;
1543	1543	49.2 (5) developmental disabilities waiver;
1544	1544	49.3 (6) elderly waiver; and
1545	1545	49.4 (7) Minnesota senior health option.
1546	1546	49.5 (b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal
1547	1547	49.6guardian of a minor.
1548	1548	49.7 (c) If multiple parents are providing personal assistance services to their minor child or
1549	1549	49.8children, each parent may provide up to 40 hours of personal assistance services in any
1550	1550	49.9seven-day period regardless of the number of children served. The total number of hours
1551	1551	49.10of personal assistance services provided by all of the parents must not exceed 80 hours in
1552	1552	49.11a seven-day period regardless of the number of children served.
1553	1553	49.12 (d) If only one parent is providing personal assistance services to a minor child or
1554	1554	49.13children, the parent may provide up to 60 hours of personal assistance services in a seven-day
1555	1555	49.14period regardless of the number of children served.
1556	1556	49.15 (e) If a participant's spouse is providing personal assistance services, the spouse may
1557	1557	49.16provide up to 60 hours of personal assistance services in a seven-day period.
1558	1558	49.17 (f) This subdivision must not be construed to permit an increase in the total authorized
1559	1559	49.18consumer-directed community supports budget for an individual.
1560	1560	49.19 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1561	1561	49.20whichever is later. The commissioner of human services shall notify the revisor of statutes
1562	1562	49.21when federal approval is obtained.
1563	1563	49.22Sec. 7. Minnesota Statutes 2022, section 256B.85, subdivision 7, is amended to read:
1564	1564	49.23 Subd. 7.Community first services and supports; covered services.Services and
1565	1565	49.24supports covered under CFSS include:
1566	1566	49.25 (1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
1567	1567	49.26daily living (IADLs), and health-related procedures and tasks through hands-on assistance
1568	1568	49.27to accomplish the task or constant supervision and cueing to accomplish the task;
1569	1569	49.28 (2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
1570	1570	49.29accomplish activities of daily living, instrumental activities of daily living, or health-related
1571	1571	49.30tasks;
1572	1572	49Article 4 Sec. 7.
1573	1573	REVISOR AGW/HL 23-0127812/21/22 50.1 (3) expenditures for items, services, supports, environmental modifications, or goods,
1574	1574	50.2including assistive technology. These expenditures must:
1575	1575	50.3 (i) relate to a need identified in a participant's CFSS service delivery plan; and
1576	1576	50.4 (ii) increase independence or substitute for human assistance, to the extent that
1577	1577	50.5expenditures would otherwise be made for human assistance for the participant's assessed
1578	1578	50.6needs;
1579	1579	50.7 (4) observation and redirection for behavior or symptoms where there is a need for
1580	1580	50.8assistance;
1581	1581	50.9 (5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
1582	1582	50.10to ensure continuity of the participant's services and supports;
1583	1583	50.11 (6) services provided by a consultation services provider as defined under subdivision
1584	1584	50.1217, that is under contract with the department and enrolled as a Minnesota health care
1585	1585	50.13program provider;
1586	1586	50.14 (7) services provided by an FMS provider as defined under subdivision 13a, that is an
1587	1587	50.15enrolled provider with the department;
1588	1588	50.16 (8) CFSS services provided by a support worker who is a parent, stepparent, or legal
1589	1589	50.17guardian of a participant under age 18, or who is the participant's spouse. These support
1590	1590	50.18workers shall not: Covered services under this clause are subject to the limitations described
1591	1591	50.19in subdivision 7b; and
1592	1592	50.20 (i) provide any medical assistance home and community-based services in excess of 40
1593	1593	50.21hours per seven-day period regardless of the number of parents providing services,
1594	1594	50.22combination of parents and spouses providing services, or number of children who receive
1595	1595	50.23medical assistance services; and
1596	1596	50.24 (ii) have a wage that exceeds the current rate for a CFSS support worker including the
1597	1597	50.25wage, benefits, and payroll taxes; and
1598	1598	50.26 (9) worker training and development services as described in subdivision 18a.
1599	1599	50.27 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1600	1600	50.28whichever is later. The commissioner of human services shall notify the revisor of statutes
1601	1601	50.29when federal approval is obtained.
1602	1602	50Article 4 Sec. 7.
1603	1603	REVISOR AGW/HL 23-0127812/21/22 51.1 Sec. 8. Minnesota Statutes 2022, section 256B.85, subdivision 7a, is amended to read:
1604	1604	51.2 Subd. 7a.Enhanced rate.An enhanced rate of 107.5 143 percent of the rate paid for
1605	1605	51.3CFSS must be paid for services provided to persons who qualify for ten or more hours of
1606	1606	51.4CFSS per day when provided by a support worker who meets the requirements of subdivision
1607	1607	51.516, paragraph (e). Any change in the eligibility criteria for the enhanced rate for CFSS as
1608	1608	51.6described in this subdivision and referenced in subdivision 16, paragraph (e), does not
1609	1609	51.7constitute a change in a term or condition for individual providers as defined in section
1610	1610	51.8256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter
1611	1611	51.9179A.
1612	1612	51.10 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1613	1613	51.11whichever is later. The commissioner of human services shall notify the revisor of statutes
1614	1614	51.12when federal approval is obtained.
1615	1615	51.13Sec. 9. Minnesota Statutes 2022, section 256B.85, is amended by adding a subdivision to
1616	1616	51.14read:
1617	1617	51.15 Subd. 7b.Services provided by parents and spouses.(a) This subdivision applies to
1618	1618	51.16services and supports described in subdivision 7, clause (8).
1619	1619	51.17 (b) If multiple parents are support workers providing CFSS services to their minor child
1620	1620	51.18or children, each parent may provide up to 40 hours of medical assistance home and
1621	1621	51.19community-based services in any seven-day period regardless of the number of children
1622	1622	51.20served. The total number of hours of medical assistance home and community-based services
1623	1623	51.21provided by all of the parents must not exceed 80 hours in a seven-day period regardless of
1624	1624	51.22the number of children served.
1625	1625	51.23 (c) If only one parent is a support worker providing CFSS services to the parent's minor
1626	1626	51.24child or children, the parent may provide up to 60 hours of medical assistance home and
1627	1627	51.25community-based services in a seven-day period regardless of the number of children served.
1628	1628	51.26 (d) If a participant's spouse is a support worker providing CFSS services, the spouse
1629	1629	51.27may provide up to 60 hours of medical assistance home and community-based services in
1630	1630	51.28a seven-day period.
1631	1631	51.29 (e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total
1632	1632	51.30authorized service budget for an individual or the total number of authorized service units.
1633	1633	51.31 (f) A parent or participant's spouse must not receive a wage that exceeds the current rate
1634	1634	51.32for a CFSS support worker, including wages, benefits, and payroll taxes.
1635	1635	51Article 4 Sec. 9.
1636	1636	REVISOR AGW/HL 23-0127812/21/22 52.1 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1637	1637	52.2whichever is later. The commissioner of human services shall notify the revisor of statutes
1638	1638	52.3when federal approval is obtained.
1639	1639	52.4 Sec. 10. Minnesota Statutes 2022, section 256B.851, subdivision 5, is amended to read:
1640	1640	52.5 Subd. 5.Payment rates; component values.(a) The commissioner must use the
1641	1641	52.6following component values:
1642	1642	52.7 (1) employee vacation, sick, and training factor, 8.71 percent;
1643	1643	52.8 (2) employer taxes and workers' compensation factor, 11.56 percent;
1644	1644	52.9 (3) employee benefits factor, 12.04 percent;
1645	1645	52.10 (4) client programming and supports factor, 2.30 percent;
1646	1646	52.11 (5) program plan support factor, 7.00 percent;
1647	1647	52.12 (6) general business and administrative expenses factor, 13.25 percent;
1648	1648	52.13 (7) program administration expenses factor, 2.90 percent; and
1649	1649	52.14 (8) absence and utilization factor, 3.90 percent.
1650	1650	52.15 (b) For purposes of implementation, the commissioner shall use the following
1651	1651	52.16implementation components:
1652	1652	52.17 (1) personal care assistance services and CFSS: 75.45 ... percent;
1653	1653	52.18 (2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45 ...
1654	1654	52.19percent; and
1655	1655	52.20 (3) qualified professional services and CFSS worker training and development: 75.45
1656	1656	52.21... percent.
1657	1657	52.22 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1658	1658	52.23whichever is later. The commissioner of human services shall notify the revisor of statutes
1659	1659	52.24when federal approval is obtained.
1660	1660	52.25Sec. 11. PERSONAL CARE ASSISTANCE ENHANCED RATE FOR PERSONS
1661	1661	52.26USING CONSUMER-DIRECTED COMMUNITY SUPPORTS.
1662	1662	52.27 The commissioner of human services shall increase the annual budgets for participants
1663	1663	52.28who use consumer-directed community supports under Minnesota Statutes, sections
1664	1664	52.29256B.0913, subdivision 5, clause (17); 256B.092, subdivision 1b, paragraph (a), clause (4);
1665	1665	52Article 4 Sec. 11.
1666	1666	REVISOR AGW/HL 23-0127812/21/22 53.1and 256B.49, subdivision 16, paragraph (c); and chapter 256S, by 43 percent for participants
1667	1667	53.2who: (1) are determined by assessment to be eligible for ten or more hours of personal care
1668	1668	53.3assistance services or community first services and supports per day; and (2) use direct
1669	1669	53.4support services provided by a worker employed by the participant who has completed
1670	1670	53.5training identified in Minnesota Statutes, section 256B.0659, subdivision 11, paragraph (d),
1671	1671	53.6or 256B.85, subdivision 16, paragraph (e).
1672	1672	53.7 EFFECTIVE DATE.This section is effective January 1, 2024, or upon federal approval,
1673	1673	53.8whichever is later. The commissioner of human services shall notify the revisor of statutes
1674	1674	53.9when federal approval is obtained.
1675	1675	53.10Sec. 12. RATE INCREASE FOR CERTAIN HOME CARE SERVICES.
1676	1676	53.11 Subdivision 1.Rate increases.(a) Effective January 1, 2024, or upon federal approval,
1677	1677	53.12whichever is later, the commissioner of human services shall increase payment rates for
1678	1678	53.13home health aide visits by 14 percent from the rates in effect on December 31, 2023. The
1679	1679	53.14commissioner must apply the annual rate increases under Minnesota Statutes, section
1680	1680	53.15256B.0653, subdivision 8, to the rates resulting from the application of the rate increases
1681	1681	53.16under this paragraph.
1682	1682	53.17 (b) Effective January 1, 2024, or upon federal approval, whichever is later, the
1683	1683	53.18commissioner shall increase payment rates for respiratory therapy under Minnesota Rules,
1684	1684	53.19part 9505.0295, subpart 2, item E, and for home health services and home care nursing
1685	1685	53.20services, except home health aide visits, under Minnesota Statutes, section 256B.0651,
1686	1686	53.21subdivision 2, clauses (1) to (3), by 38.8 percent from the rates in effect on December 31,
1687	1687	53.222023. The commissioner must apply the annual rate increases under Minnesota Statutes,
1688	1688	53.23sections 256B.0653, subdivision 8, and 256B.0654, subdivision 5, to the rates resulting
1689	1689	53.24from the application of the rate increase under this paragraph.
1690	1690	53.25 Subd. 2.Spending requirements.(a) At least 80 percent of the marginal increase in
1691	1691	53.26revenue for home care services resulting from implementation of the rate increases under
1692	1692	53.27this section for services rendered on or after the day of implementation of the increase must
1693	1693	53.28be used to increase compensation-related costs for employees directly employed by the
1694	1694	53.29provider to provide the services.
1695	1695	53.30 (b) For the purposes of this subdivision, compensation-related costs include:
1696	1696	53.31 (1) wages and salaries;
1697	1697	53.32 (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
1698	1698	53.33taxes, workers' compensation, and mileage reimbursement;
1699	1699	53Article 4 Sec. 12.
1700	1700	REVISOR AGW/HL 23-0127812/21/22 54.1 (3) the employer's paid share of health and dental insurance, life insurance, disability
1701	1701	54.2insurance, long-term care insurance, uniform allowance, pensions, and contributions to
1702	1702	54.3employee retirement accounts; and
1703	1703	54.4 (4) benefits that address direct support professional workforce needs above and beyond
1704	1704	54.5what employees were offered prior to implementation of the rate increases.
1705	1705	54.6 (c) Compensation-related costs for persons employed in the central office of a corporation
1706	1706	54.7or entity that has an ownership interest in the provider or exercises control over the provider,
1707	1707	54.8or for persons paid by the provider under a management contract, do not count toward the
1708	1708	54.980 percent requirement under this subdivision.
1709	1709	54.10 (d) A provider agency or individual provider that receives additional revenue subject to
1710	1710	54.11the requirements of this subdivision shall prepare, and upon request submit to the
1711	1711	54.12commissioner, a distribution plan that specifies the amount of money the provider expects
1712	1712	54.13to receive that is subject to the requirements of this subdivision, including how that money
1713	1713	54.14was or will be distributed to increase compensation-related costs for employees. Within 60
1714	1714	54.15days of final implementation of the new rate methodology or any rate adjustment subject
1715	1715	54.16to the requirements of this subdivision, the provider must post the distribution plan and
1716	1716	54.17leave it posted for a period of at least six months in an area of the provider's operation to
1717	1717	54.18which all direct support professionals have access. The posted distribution plan must include
1718	1718	54.19instructions regarding how to contact the commissioner, or the commissioner's representative,
1719	1719	54.20if an employee has not received the compensation-related increase described in the plan.
1720	1720	54.21 ARTICLE 5
1721	1721	54.22 NURSING FACILITIES
1722	1722	54.23Section 1. Minnesota Statutes 2022, section 256R.02, subdivision 16, is amended to read:
1723	1723	54.24 Subd. 16.Dietary costs."Dietary costs" means the costs for the salaries and wages of
1724	1724	54.25the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other employees assigned
1725	1725	54.26to the kitchen and dining room, and associated fringe benefits and payroll taxes. Dietary
1726	1726	54.27costs also includes the salaries or fees of dietary consultants, dietary supplies, and food
1727	1727	54.28preparation and serving.
1728	1728	54.29 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1729	1729	54.302025, or upon federal approval, whichever is later. The commissioner of human services
1730	1730	54.31shall notify the revisor of statutes when federal approval is obtained.
1731	1731	54Article 5 Section 1.
1732	1732	REVISOR AGW/HL 23-0127812/21/22 55.1 Sec. 2. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
1733	1733	55.2read:
1734	1734	55.3 Subd. 16a.Dietary labor costs."Dietary labor costs" means the costs for the salaries
1735	1735	55.4and wages of the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other
1736	1736	55.5employees assigned to the kitchen and dining room, and associated fringe benefits and
1737	1737	55.6payroll taxes.
1738	1738	55.7 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1739	1739	55.82025, or upon federal approval, whichever is later. The commissioner of human services
1740	1740	55.9shall notify the revisor of statutes when federal approval is obtained.
1741	1741	55.10Sec. 3. Minnesota Statutes 2022, section 256R.02, subdivision 24, is amended to read:
1742	1742	55.11 Subd. 24.Housekeeping costs."Housekeeping costs" means the costs for the salaries
1743	1743	55.12and wages of the housekeeping supervisor, housekeepers, and other cleaning employees
1744	1744	55.13and associated fringe benefits and payroll taxes. It also includes the cost of housekeeping
1745	1745	55.14supplies, including, but not limited to, cleaning and lavatory supplies and contract services.
1746	1746	55.15 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1747	1747	55.162025, or upon federal approval, whichever is later. The commissioner of human services
1748	1748	55.17shall notify the revisor of statutes when federal approval is obtained.
1749	1749	55.18Sec. 4. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
1750	1750	55.19read:
1751	1751	55.20 Subd. 24a.Housekeeping labor costs."Housekeeping labor costs" means the costs for
1752	1752	55.21the salaries and wages of the housekeeping supervisor, housekeepers, and other cleaning
1753	1753	55.22employees, and associated fringe benefits and payroll taxes.
1754	1754	55.23 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1755	1755	55.242025, or upon federal approval, whichever is later. The commissioner of human services
1756	1756	55.25shall notify the revisor of statutes when federal approval is obtained.
1757	1757	55.26Sec. 5. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
1758	1758	55.27read:
1759	1759	55.28 Subd. 25b.Known cost change factor."Known cost change factor" means 1.00 plus
1760	1760	55.29the forecasted percentage change in the CPI-U index from July 1 of the reporting period to
1761	1761	55.30July 1 of the rate year as determined by the national economic consultant used by the
1762	1762	55.31commissioner of management and budget.
1763	1763	55Article 5 Sec. 5.
1764	1764	REVISOR AGW/HL 23-0127812/21/22 56.1 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1765	1765	56.22025, or upon federal approval, whichever is later. The commissioner of human services
1766	1766	56.3shall notify the revisor of statutes when federal approval is obtained.
1767	1767	56.4 Sec. 6. Minnesota Statutes 2022, section 256R.02, subdivision 26, is amended to read:
1768	1768	56.5 Subd. 26.Laundry costs."Laundry costs" means the costs for the salaries and wages
1769	1769	56.6of the laundry supervisor and other laundry employees, associated fringe benefits, and
1770	1770	56.7payroll taxes. It also includes the costs of linen and bedding, the laundering of resident
1771	1771	56.8clothing, laundry supplies, and contract services.
1772	1772	56.9 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1773	1773	56.102025, or upon federal approval, whichever is later. The commissioner of human services
1774	1774	56.11shall notify the revisor of statutes when federal approval is obtained.
1775	1775	56.12Sec. 7. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
1776	1776	56.13read:
1777	1777	56.14 Subd. 26a.Laundry labor costs."Laundry labor costs" means the costs for the salaries
1778	1778	56.15and wages of the laundry supervisor and other laundry employees, and associated fringe
1779	1779	56.16benefits and payroll taxes.
1780	1780	56.17 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1781	1781	56.182025, or upon federal approval, whichever is later. The commissioner of human services
1782	1782	56.19shall notify the revisor of statutes when federal approval is obtained.
1783	1783	56.20Sec. 8. Minnesota Statutes 2022, section 256R.02, subdivision 29, is amended to read:
1784	1784	56.21 Subd. 29.Maintenance and plant operations costs."Maintenance and plant operations
1785	1785	56.22costs" means the costs for the salaries and wages of the maintenance supervisor, engineers,
1786	1786	56.23heating-plant employees, and other maintenance employees and associated fringe benefits
1787	1787	56.24and payroll taxes. It also includes identifiable costs for maintenance and operation of the
1788	1788	56.25building and grounds, including, but not limited to, fuel, electricity, plastic waste bags,
1789	1789	56.26medical waste and garbage removal, water, sewer, supplies, tools, repairs, and minor
1790	1790	56.27equipment not requiring capitalization under Medicare guidelines.
1791	1791	56.28 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1792	1792	56.292025, or upon federal approval, whichever is later. The commissioner of human services
1793	1793	56.30shall notify the revisor of statutes when federal approval is obtained.
1794	1794	56Article 5 Sec. 8.
1795	1795	REVISOR AGW/HL 23-0127812/21/22 57.1 Sec. 9. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to
1796	1796	57.2read:
1797	1797	57.3 Subd. 29a.Maintenance and plant operations labor costs."Maintenance and plant
1798	1798	57.4operations labor costs" means the costs for the salaries and wages of the maintenance
1799	1799	57.5supervisor, engineers, heating-plant employees, and other maintenance employees, and
1800	1800	57.6associated fringe benefits and payroll taxes.
1801	1801	57.7 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1802	1802	57.82025, or upon federal approval, whichever is later. The commissioner of human services
1803	1803	57.9shall notify the revisor of statutes when federal approval is obtained.
1804	1804	57.10Sec. 10. Minnesota Statutes 2022, section 256R.02, subdivision 34, is amended to read:
1805	1805	57.11 Subd. 34.Other care-related costs."Other care-related costs" means the sum of activities
1806	1806	57.12costs, other direct care costs, raw food costs, dietary labor costs, housekeeping labor costs,
1807	1807	57.13laundry labor costs, maintenance and plant operations labor costs, therapy costs, and social
1808	1808	57.14services costs.
1809	1809	57.15 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1810	1810	57.162025, or upon federal approval, whichever is later. The commissioner of human services
1811	1811	57.17shall notify the revisor of statutes when federal approval is obtained.
1812	1812	57.18Sec. 11. Minnesota Statutes 2022, section 256R.23, subdivision 2, is amended to read:
1813	1813	57.19 Subd. 2.Calculation of direct care cost per standardized day.Each facility's direct
1814	1814	57.20care cost per standardized day is (1) the product of the facility's direct care costs and the
1815	1815	57.21known cost change factor, (2) divided by the sum of the facility's standardized days. A
1816	1816	57.22facility's direct care cost per standardized day is the facility's cost per day for direct care
1817	1817	57.23services associated with a case mix index of 1.00.
1818	1818	57.24 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1819	1819	57.252025, or upon federal approval, whichever is later. The commissioner of human services
1820	1820	57.26shall notify the revisor of statutes when federal approval is obtained.
1821	1821	57.27Sec. 12. Minnesota Statutes 2022, section 256R.23, subdivision 3, is amended to read:
1822	1822	57.28 Subd. 3.Calculation of other care-related cost per resident day.Each facility's other
1823	1823	57.29care-related cost per resident day is (1) the product of its other care-related costs and the
1824	1824	57.30known cost change factor, (2) divided by the sum of the facility's resident days.
1825	1825	57Article 5 Sec. 12.
1826	1826	REVISOR AGW/HL 23-0127812/21/22 58.1 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1827	1827	58.22025, or upon federal approval, whichever is later. The commissioner of human services
1828	1828	58.3shall notify the revisor of statutes when federal approval is obtained.
1829	1829	58.4 Sec. 13. Minnesota Statutes 2022, section 256R.24, subdivision 1, is amended to read:
1830	1830	58.5 Subdivision 1.Determination of other operating cost per day.Each facility's other
1831	1831	58.6operating cost per day is (1) the product of its other operating costs and the known cost
1832	1832	58.7change factor, (2) divided by the sum of the facility's resident days.
1833	1833	58.8 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1834	1834	58.92025, or upon federal approval, whichever is later. The commissioner of human services
1835	1835	58.10shall notify the revisor of statutes when federal approval is obtained.
1836	1836	58.11Sec. 14. Minnesota Statutes 2022, section 256R.25, is amended to read:
1837	1837	58.12 256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.
1838	1838	58.13 (a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
1839	1839	58.14(b) to (o).
1840	1840	58.15 (b) For a facility licensed as a nursing home, the portion related to the provider surcharge
1841	1841	58.16under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
1842	1842	58.17nursing home and a boarding care home, the portion related to the provider surcharge under
1843	1843	58.18section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
1844	1844	58.19of nursing home beds divided by its total number of licensed beds.
1845	1845	58.20 (c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
1846	1846	58.21amount of the fee divided by the sum of the facility's resident days.
1847	1847	58.22 (d) The portion related to development and education of resident and family advisory
1848	1848	58.23councils under section 144A.33 is $5 per resident day divided by 365.
1849	1849	58.24 (e) The portion related to scholarships is determined under section 256R.37.
1850	1850	58.25 (f) The portion related to planned closure rate adjustments is as determined under section
1851	1851	58.26256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.
1852	1852	58.27 (g) The portion related to consolidation rate adjustments shall be as determined under
1853	1853	58.28section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
1854	1854	58.29 (h) The portion related to single-bed room incentives is as determined under section
1855	1855	58.30256R.41.
1856	1856	58Article 5 Sec. 14.
1857	1857	REVISOR AGW/HL 23-0127812/21/22 59.1 (i) The portions related to real estate taxes, special assessments, and payments made in
1858	1858	59.2lieu of real estate taxes directly identified or allocated to the nursing facility are the allowable
1859	1859	59.3amounts divided by the sum of the facility's resident days. Allowable costs under this
1860	1860	59.4paragraph for payments made by a nonprofit nursing facility that are in lieu of real estate
1861	1861	59.5taxes shall not exceed the amount which the nursing facility would have paid to a city or
1862	1862	59.6township and county for fire, police, sanitation services, and road maintenance costs had
1863	1863	59.7real estate taxes been levied on that property for those purposes.
1864	1864	59.8 (j) The portion related to employer health insurance costs is (1) the product of the
1865	1865	59.9allowable costs and the known cost change factor, (2) divided by the sum of the facility's
1866	1866	59.10resident days.
1867	1867	59.11 (k) The portion related to the Public Employees Retirement Association is the allowable
1868	1868	59.12costs divided by the sum of the facility's resident days.
1869	1869	59.13 (l) The portion related to quality improvement incentive payment rate adjustments is
1870	1870	59.14the amount determined under section 256R.39.
1871	1871	59.15 (m) The portion related to performance-based incentive payments is the amount
1872	1872	59.16determined under section 256R.38.
1873	1873	59.17 (n) The portion related to special dietary needs is the amount determined under section
1874	1874	59.18256R.51.
1875	1875	59.19 (o) The portion related to the rate adjustments for border city facilities is the amount
1876	1876	59.20determined under section 256R.481.
1877	1877	59.21 EFFECTIVE DATE.This section is effective for the rate year beginning January 1,
1878	1878	59.222025, or upon federal approval, whichever is later. The commissioner of human services
1879	1879	59.23shall notify the revisor of statutes when federal approval is obtained.
1880	1880	59.24Sec. 15. NURSING FACILITY FUNDING.
1881	1881	59.25 (a) Effective July 1, 2023, through December 31, 2025, the total payment rate for all
1882	1882	59.26facilities reimbursed under Minnesota Statutes, chapter 256R, must be increased by $28.65
1883	1883	59.27per resident day.
1884	1884	59.28 (b) To be eligible to receive a payment under this section, a nursing facility must attest
1885	1885	59.29to the commissioner of human services that the additional revenue will be used exclusively
1886	1886	59.30to increase compensation-related costs for employees directly employed by the facility on
1887	1887	59.31or after July 1, 2023, excluding:
1888	1888	59.32 (1) owners of the building and operation;
1889	1889	59Article 5 Sec. 15.
1890	1890	REVISOR AGW/HL 23-0127812/21/22 60.1 (2) persons employed in the central office of an entity that has any ownership interest
1891	1891	60.2in the nursing facility or exercises control over the nursing facility;
1892	1892	60.3 (3) persons paid by the nursing facility under a management contract; and
1893	1893	60.4 (4) persons providing separately billable services.
1894	1894	60.5 (c) Contracted housekeeping, dietary, and laundry employees providing services on site
1895	1895	60.6at the nursing facility are eligible for compensation-related cost increases under this section,
1896	1896	60.7provided the agency that employs them submits to the nursing facility proof of the costs of
1897	1897	60.8the increases provided to those employees.
1898	1898	60.9 (d) For purposes of this section, compensation-related costs include:
1899	1899	60.10 (1) permanent new increases to wages and salaries implemented on or after July 1, 2023,
1900	1900	60.11and before September 1, 2023, for nursing facility employees;
1901	1901	60.12 (2) permanent new increases to wages and salaries implemented on or after July 1, 2023,
1902	1902	60.13and before September 1, 2023, for employees in the organization's shared services
1903	1903	60.14departments of hospital-attached nursing facilities for the nursing facility allocated share
1904	1904	60.15of wages; and
1905	1905	60.16 (3) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
1906	1906	60.17taxes, PERA, workers' compensation, and pension and employee retirement accounts directly
1907	1907	60.18associated with the wage and salary increases in clauses (1) and (2) incurred no later than
1908	1908	60.19December 31, 2025, and paid for no later than June 30, 2026.
1909	1909	60.20 (e) A facility that receives a rate increase under this section must complete a distribution
1910	1910	60.21plan in the form and manner determined by the commissioner. This plan must specify the
1911	1911	60.22total amount of money the facility is estimated to receive from this rate increase and how
1912	1912	60.23that money will be distributed to increase the allowable compensation-related costs described
1913	1913	60.24in paragraph (d) for employees described in paragraphs (b) and (c). This estimate must be
1914	1914	60.25computed by multiplying $28.65 by the sum of the medical assistance and private pay
1915	1915	60.26resident days as defined in Minnesota Statutes, section 256R.02, subdivision 45, for the
1916	1916	60.27period beginning October 1, 2021, through September 30, 2022, dividing this sum by 365
1917	1917	60.28and multiplying the result by 915. A facility must submit its distribution plan to the
1918	1918	60.29commissioner by October 1, 2023. The commissioner may review the distribution plan to
1919	1919	60.30ensure that the payment rate adjustment per resident day is used in accordance with this
1920	1920	60.31section. The commissioner may allow for a distribution plan amendment under exceptional
1921	1921	60.32circumstances to be determined at the sole discretion of the commissioner.
1922	1922	60Article 5 Sec. 15.
1923	1923	REVISOR AGW/HL 23-0127812/21/22 61.1 (f) By September 1, 2023, a facility must post the distribution plan summary and leave
1924	1924	61.2it posted for a period of at least six months in an area of the facility to which all employees
1925	1925	61.3have access. The posted distribution plan summary must be in the form and manner
1926	1926	61.4determined by the commissioner. The distribution plan summary must include instructions
1927	1927	61.5regarding how to contact the commissioner, or the commissioner's representative, if an
1928	1928	61.6employee believes the employee is covered by paragraph (b) or (c) and has not received the
1929	1929	61.7compensation-related increases described in paragraph (d). The instruction to such employees
1930	1930	61.8must include the e-mail address and telephone number that may be used by the employee
1931	1931	61.9to contact the commissioner's representative. The posted distribution plan summary must
1932	1932	61.10demonstrate how the increase in paragraph (a) received by the nursing facility from July 1,
1933	1933	61.112023, through December 1, 2025, will be used in full to pay the compensation-related costs
1934	1934	61.12in paragraph (d) for employees described in paragraphs (b) and (c).
1935	1935	61.13 (g) If the nursing facility expends less on new compensation-related costs than the amount
1936	1936	61.14that was made available by the rate increase in this section for that purpose, the amount of
1937	1937	61.15this rate adjustment must be reduced to equal the amount utilized by the facility for purposes
1938	1938	61.16authorized under this section. If the facility fails to post the distribution plan summary in
1939	1939	61.17its facility as required, fails to submit its distribution plan to the commissioner by the due
1940	1940	61.18date, or uses these funds for unauthorized purposes, these rate increases must be treated as
1941	1941	61.19an overpayment and subsequently recovered.
1942	1942	61.20 (h) The commissioner shall not treat payments received under this section as an applicable
1943	1943	61.21credit for purposes of setting total payment rates under Minnesota Statutes, chapter 256R.
1944	1944	61.22 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1945	1945	61.23whichever is later. The commissioner of human services shall notify the revisor of statutes
1946	1946	61.24when federal approval is obtained.
1947	1947	61.25 ARTICLE 6
1948	1948	61.26 INTERMEDIATE CARE FACILITIES
1949	1949	61.27Section 1. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
1950	1950	61.28to read:
1951	1951	61.29 Subd. 19.ICF/DD rate increase effective July 1, 2023.(a) Effective July 1, 2023, the
1952	1952	61.30daily operating payment rate for a class A intermediate care facility for persons with
1953	1953	61.31developmental disabilities is increased by $50.
1954	1954	61.32 (b) Effective July 1, 2023, the daily operating payment rate for a class B intermediate
1955	1955	61.33care facility for persons with developmental disabilities is increased by $50.
1956	1956	61Article 6 Section 1.
1957	1957	REVISOR AGW/HL 23-0127812/21/22 62.1 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1958	1958	62.2whichever is later. The commissioner of human services shall notify the revisor of statutes
1959	1959	62.3when federal approval is obtained.
1960	1960	62.4 Sec. 2. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
1961	1961	62.5to read:
1962	1962	62.6 Subd. 20.ICF/DD minimum daily operating payment rates.(a) The minimum daily
1963	1963	62.7operating payment rate for a class A intermediate care facility for persons with developmental
1964	1964	62.8disabilities is $300.
1965	1965	62.9 (b) The minimum daily operating payment rate for a class B intermediate care facility
1966	1966	62.10for persons with developmental disabilities is $400.
1967	1967	62.11 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
1968	1968	62.12whichever is later. The commissioner of human services shall notify the revisor of statutes
1969	1969	62.13when federal approval is obtained.
1970	1970	62.14Sec. 3. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
1971	1971	62.15to read:
1972	1972	62.16 Subd. 21.Spending requirements.(a) At least 80 percent of the marginal increase in
1973	1973	62.17revenue resulting from implementation of the rate increases under subdivisions 19 and 20
1974	1974	62.18for services rendered on or after the day of implementation of the increases must be used
1975	1975	62.19to increase compensation-related costs for employees directly employed by the facility.
1976	1976	62.20 (b) For the purposes of this subdivision, compensation-related costs include:
1977	1977	62.21 (1) wages and salaries;
1978	1978	62.22 (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
1979	1979	62.23taxes, workers' compensation, and mileage reimbursement;
1980	1980	62.24 (3) the employer's paid share of health and dental insurance, life insurance, disability
1981	1981	62.25insurance, long-term care insurance, uniform allowance, pensions, and contributions to
1982	1982	62.26employee retirement accounts; and
1983	1983	62.27 (4) benefits that address direct support professional workforce needs above and beyond
1984	1984	62.28what employees were offered prior to implementation of the rate increases.
1985	1985	62.29 (c) Compensation-related costs for persons employed in the central office of a corporation
1986	1986	62.30or entity that has an ownership interest in the provider or exercises control over the provider,
1987	1987	62Article 6 Sec. 3.
1988	1988	REVISOR AGW/HL 23-0127812/21/22 63.1or for persons paid by the provider under a management contract, do not count toward the
1989	1989	63.280 percent requirement under this subdivision.
1990	1990	63.3 (d) A provider agency or individual provider that receives additional revenue subject to
1991	1991	63.4the requirements of this subdivision shall prepare, and upon request submit to the
1992	1992	63.5commissioner, a distribution plan that specifies the amount of money the provider expects
1993	1993	63.6to receive that is subject to the requirements of this subdivision, including how that money
1994	1994	63.7was or will be distributed to increase compensation-related costs for employees. Within 60
1995	1995	63.8days of final implementation of the new rate methodology or any rate adjustment subject
1996	1996	63.9to the requirements of this subdivision, the provider must post the distribution plan and
1997	1997	63.10leave it posted for a period of at least six months in an area of the provider's operation to
1998	1998	63.11which all direct support professionals have access. The posted distribution plan must include
1999	1999	63.12instructions regarding how to contact the commissioner, or the commissioner's representative,
2000	2000	63.13if an employee has not received the compensation-related increase described in the plan.
2001	2001	63.14Sec. 4. DIRECTION TO COMMISSIONER; APPLICATION OF INTERMEDIATE
2002	2002	63.15CARE FACILITIES FOR PERSONS WITH DEVELOPMENT AL DISABILITIES
2003	2003	63.16RATE INCREASES.
2004	2004	63.17 The commissioner of human services shall apply the rate increases under Minnesota
2005	2005	63.18Statutes, section 256B.5012, subdivisions 19 and 20, as follows:
2006	2006	63.19 (1) apply Minnesota Statutes, section 256B.5012, subdivision 19; and
2007	2007	63.20 (2) apply any required rate increase as required under Minnesota Statutes, section
2008	2008	63.21256B.5012, subdivision 20, to the results of clause (1).
2009	2009	63.22 ARTICLE 7
2010	2010	63.23 EMERGENCY AND NONEMERGENCY MEDICAL TRANSPORTATION
2011	2011	63.24Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to
2012	2012	63.25read:
2013	2013	63.26 Subd. 17.Transportation costs.(a) "Nonemergency medical transportation service"
2014	2014	63.27means motor vehicle transportation provided by a public or private person that serves
2015	2015	63.28Minnesota health care program beneficiaries who do not require emergency ambulance
2016	2016	63.29service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
2017	2017	63.30 (b) Medical assistance covers medical transportation costs incurred solely for obtaining
2018	2018	63.31emergency medical care or transportation costs incurred by eligible persons in obtaining
2019	2019	63.32emergency or nonemergency medical care when paid directly to an ambulance company,
2020	2020	63Article 7 Section 1.
2021	2021	REVISOR AGW/HL 23-0127812/21/22 64.1nonemergency medical transportation company, or other recognized providers of
2022	2022	64.2transportation services. Medical transportation must be provided by:
2023	2023	64.3 (1) nonemergency medical transportation providers who meet the requirements of this
2024	2024	64.4subdivision;
2025	2025	64.5 (2) ambulances, as defined in section 144E.001, subdivision 2;
2026	2026	64.6 (3) taxicabs that meet the requirements of this subdivision;
2027	2027	64.7 (4) public transit, as defined in section 174.22, subdivision 7; or
2028	2028	64.8 (5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
2029	2029	64.9subdivision 1, paragraph (h).
2030	2030	64.10 (c) Medical assistance covers nonemergency medical transportation provided by
2031	2031	64.11nonemergency medical transportation providers enrolled in the Minnesota health care
2032	2032	64.12programs. All nonemergency medical transportation providers must comply with the
2033	2033	64.13operating standards for special transportation service as defined in sections 174.29 to 174.30
2034	2034	64.14and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
2035	2035	64.15commissioner and reported on the claim as the individual who provided the service. All
2036	2036	64.16nonemergency medical transportation providers shall bill for nonemergency medical
2037	2037	64.17transportation services in accordance with Minnesota health care programs criteria. Publicly
2038	2038	64.18operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
2039	2039	64.19requirements outlined in this paragraph.
2040	2040	64.20 (d) An organization may be terminated, denied, or suspended from enrollment if:
2041	2041	64.21 (1) the provider has not initiated background studies on the individuals specified in
2042	2042	64.22section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
2043	2043	64.23 (2) the provider has initiated background studies on the individuals specified in section
2044	2044	64.24174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
2045	2045	64.25 (i) the commissioner has sent the provider a notice that the individual has been
2046	2046	64.26disqualified under section 245C.14; and
2047	2047	64.27 (ii) the individual has not received a disqualification set-aside specific to the special
2048	2048	64.28transportation services provider under sections 245C.22 and 245C.23.
2049	2049	64.29 (e) The administrative agency of nonemergency medical transportation must:
2050	2050	64.30 (1) adhere to the policies defined by the commissioner;
2051	2051	64Article 7 Section 1.
2052	2052	REVISOR AGW/HL 23-0127812/21/22 65.1 (2) pay nonemergency medical transportation providers for services provided to
2053	2053	65.2Minnesota health care programs beneficiaries to obtain covered medical services;
2054	2054	65.3 (3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
2055	2055	65.4trips, and number of trips by mode; and
2056	2056	65.5 (4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
2057	2057	65.6administrative structure assessment tool that meets the technical requirements established
2058	2058	65.7by the commissioner, reconciles trip information with claims being submitted by providers,
2059	2059	65.8and ensures prompt payment for nonemergency medical transportation services.
2060	2060	65.9 (f) Until the commissioner implements the single administrative structure and delivery
2061	2061	65.10system under subdivision 18e, clients shall obtain their level-of-service certificate from the
2062	2062	65.11commissioner or an entity approved by the commissioner that does not dispatch rides for
2063	2063	65.12clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
2064	2064	65.13 (g) The commissioner may use an order by the recipient's attending physician, advanced
2065	2065	65.14practice registered nurse, physician assistant, or a medical or mental health professional to
2066	2066	65.15certify that the recipient requires nonemergency medical transportation services.
2067	2067	65.16Nonemergency medical transportation providers shall perform driver-assisted services for
2068	2068	65.17eligible individuals, when appropriate. Driver-assisted service includes passenger pickup
2069	2069	65.18at and return to the individual's residence or place of business, assistance with admittance
2070	2070	65.19of the individual to the medical facility, and assistance in passenger securement or in securing
2071	2071	65.20of wheelchairs, child seats, or stretchers in the vehicle.
2072	2072	65.21 Nonemergency medical transportation providers must take clients to the health care
2073	2073	65.22provider using the most direct route, and must not exceed 30 miles for a trip to a primary
2074	2074	65.23care provider or 60 miles for a trip to a specialty care provider, unless the client receives
2075	2075	65.24authorization from the local agency.
2076	2076	65.25 Nonemergency medical transportation providers may not bill for separate base rates for
2077	2077	65.26the continuation of a trip beyond the original destination. Nonemergency medical
2078	2078	65.27transportation providers must maintain trip logs, which include pickup and drop-off times,
2079	2079	65.28signed by the medical provider or client, whichever is deemed most appropriate, attesting
2080	2080	65.29to mileage traveled to obtain covered medical services. Clients requesting client mileage
2081	2081	65.30reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
2082	2082	65.31services.
2083	2083	65.32 (h) The administrative agency shall use the level of service process established by the
2084	2084	65.33commissioner to determine the client's most appropriate mode of transportation. If public
2085	2085	65Article 7 Section 1.
2086	2086	REVISOR AGW/HL 23-0127812/21/22 66.1transit or a certified transportation provider is not available to provide the appropriate service
2087	2087	66.2mode for the client, the client may receive a onetime service upgrade.
2088	2088	66.3 (i) The covered modes of transportation are:
2089	2089	66.4 (1) client reimbursement, which includes client mileage reimbursement provided to
2090	2090	66.5clients who have their own transportation, or to family or an acquaintance who provides
2091	2091	66.6transportation to the client;
2092	2092	66.7 (2) volunteer transport, which includes transportation by volunteers using their own
2093	2093	66.8vehicle;
2094	2094	66.9 (3) unassisted transport, which includes transportation provided to a client by a taxicab
2095	2095	66.10or public transit. If a taxicab or public transit is not available, the client can receive
2096	2096	66.11transportation from another nonemergency medical transportation provider;
2097	2097	66.12 (4) assisted transport, which includes transport provided to clients who require assistance
2098	2098	66.13by a nonemergency medical transportation provider;
2099	2099	66.14 (5) lift-equipped/ramp transport, which includes transport provided to a client who is
2100	2100	66.15dependent on a device and requires a nonemergency medical transportation provider with
2101	2101	66.16a vehicle containing a lift or ramp;
2102	2102	66.17 (6) protected transport, which includes transport provided to a client who has received
2103	2103	66.18a prescreening that has deemed other forms of transportation inappropriate and who requires
2104	2104	66.19a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
2105	2105	66.20locks, a video recorder, and a transparent thermoplastic partition between the passenger and
2106	2106	66.21the vehicle driver; and (ii) who is certified as a protected transport provider; and
2107	2107	66.22 (7) stretcher transport, which includes transport for a client in a prone or supine position
2108	2108	66.23and requires a nonemergency medical transportation provider with a vehicle that can transport
2109	2109	66.24a client in a prone or supine position.
2110	2110	66.25 (j) The local agency shall be the single administrative agency and shall administer and
2111	2111	66.26reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
2112	2112	66.27commissioner has developed, made available, and funded the web-based single administrative
2113	2113	66.28structure, assessment tool, and level of need assessment under subdivision 18e. The local
2114	2114	66.29agency's financial obligation is limited to funds provided by the state or federal government.
2115	2115	66.30 (k) The commissioner shall:
2116	2116	66.31 (1) verify that the mode and use of nonemergency medical transportation is appropriate;
2117	2117	66.32 (2) verify that the client is going to an approved medical appointment; and
2118	2118	66Article 7 Section 1.
2119	2119	REVISOR AGW/HL 23-0127812/21/22 67.1 (3) investigate all complaints and appeals.
2120	2120	67.2 (l) The administrative agency shall pay for the services provided in this subdivision and
2121	2121	67.3seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
2122	2122	67.4local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
2123	2123	67.5recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
2124	2124	67.6 (m) Payments for nonemergency medical transportation must be paid based on the client's
2125	2125	67.7assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
2126	2126	67.8medical assistance reimbursement rates for nonemergency medical transportation services
2127	2127	67.9that are payable by or on behalf of the commissioner for nonemergency medical
2128	2128	67.10transportation services are:
2129	2129	67.11 (1) $0.22 per mile for client reimbursement;
2130	2130	67.12 (2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
2131	2131	67.13transport;
2132	2132	67.14 (3) equivalent to the standard fare for unassisted transport when provided by public
2133	2133	67.15transit, and $11 $12.93 for the base rate and $1.30 $1.53 per mile when provided by a
2134	2134	67.16nonemergency medical transportation provider;
2135	2135	67.17 (4) $13 $15.28 for the base rate and $1.30 $1.53 per mile for assisted transport;
2136	2136	67.18 (5) $18 $21.15 for the base rate and $1.55 $1.82 per mile for lift-equipped/ramp transport;
2137	2137	67.19 (6) $75 for the base rate and $2.40 per mile for protected transport; and
2138	2138	67.20 (7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
2139	2139	67.21an additional attendant if deemed medically necessary.
2140	2140	67.22 (n) The base rate for nonemergency medical transportation services in areas defined
2141	2141	67.23under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
2142	2142	67.24paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
2143	2143	67.25services in areas defined under RUCA to be rural or super rural areas is:
2144	2144	67.26 (1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
2145	2145	67.27rate in paragraph (m), clauses (1) to (7); and
2146	2146	67.28 (2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
2147	2147	67.29rate in paragraph (m), clauses (1) to (7).
2148	2148	67.30 (o) For purposes of reimbursement rates for nonemergency medical transportation
2149	2149	67.31services under paragraphs (m) and (n), the zip code of the recipient's place of residence
2150	2150	67.32shall determine whether the urban, rural, or super rural reimbursement rate applies.
2151	2151	67Article 7 Section 1.
2152	2152	REVISOR AGW/HL 23-0127812/21/22 68.1 (p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
2153	2153	68.2a census-tract based classification system under which a geographical area is determined
2154	2154	68.3to be urban, rural, or super rural.
2155	2155	68.4 (q) The commissioner, when determining reimbursement rates for nonemergency medical
2156	2156	68.5transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
2157	2157	68.6under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
2158	2158	68.7 (r) Effective for the first day of each calendar quarter in which the price of gasoline as
2159	2159	68.8posted publicly by the United States Energy Information Administration exceeds $3.00 per
2160	2160	68.9gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent
2161	2161	68.10up or down for every increase or decrease of ten cents for the price of gasoline. The increase
2162	2162	68.11or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
2163	2163	68.12or decrease must be calculated using the average of the most recently available price of all
2164	2164	68.13grades of gasoline for Minnesota as posted publicly by the United States Energy Information
2165	2165	68.14Administration.
2166	2166	68.15 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
2167	2167	68.16whichever is later. The commissioner of human services shall notify the revisor of statutes
2168	2168	68.17when federal approval is obtained.
2169	2169	68.18Sec. 2. Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read:
2170	2170	68.19 Subd. 17a.Payment for ambulance services.(a) Medical assistance covers ambulance
2171	2171	68.20services. Providers shall bill ambulance services according to Medicare criteria.
2172	2172	68.21Nonemergency ambulance services shall not be paid as emergencies. Effective for services
2173	2173	68.22rendered on or after July 1, 2001, medical assistance payments for ambulance services shall
2174	2174	68.23be paid at the Medicare reimbursement rate or at the medical assistance payment rate in
2175	2175	68.24effect on July 1, 2000, whichever is greater.
2176	2176	68.25 (b) Effective for services provided on or after July 1, 2016, medical assistance payment
2177	2177	68.26rates for ambulance services identified in this paragraph are increased by five percent.
2178	2178	68.27Capitation payments made to managed care plans and county-based purchasing plans for
2179	2179	68.28ambulance services provided on or after January 1, 2017, shall be increased to reflect this
2180	2180	68.29rate increase. The increased rate described in this paragraph applies to ambulance service
2181	2181	68.30providers whose base of operations as defined in section 144E.10 is located:
2182	2182	68.31 (1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
2183	2183	68.32the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or
2184	2184	68.33 (2) within a municipality with a population of less than 1,000.
2185	2185	68Article 7 Sec. 2.
2186	2186	REVISOR AGW/HL 23-0127812/21/22 69.1 (c) Effective for the first day of each calendar quarter in which the price of gasoline as
2187	2187	69.2posted publicly by the United States Energy Information Administration exceeds $3.00 per
2188	2188	69.3gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one
2189	2189	69.4percent up or down for every increase or decrease of ten cents for the price of gasoline. The
2190	2190	69.5increase or decrease must be calculated using a base gasoline price of $3.00. The percentage
2191	2191	69.6increase or decrease must be calculated using the average of the most recently available
2192	2192	69.7price of all grades of gasoline for Minnesota as posted publicly by the United States Energy
2193	2193	69.8Information Administration.
2194	2194	69.9 EFFECTIVE DATE.This section is effective July 1, 2023, or upon federal approval,
2195	2195	69.10whichever is later. The commissioner of human services shall notify the revisor of statutes
2196	2196	69.11when federal approval is obtained.
2197	2197	69.12Sec. 3. NONEMERGENCY MEDICAL TRANSPORTATION SPENDING
2198	2198	69.13REQUIREMENTS.
2199	2199	69.14 (a) At least 80 percent of the marginal increase in revenue from the implementation of
2200	2200	69.15rate increases in this act under Minnesota Statutes, section 256B.0625, subdivision 17,
2201	2201	69.16paragraph (m), clauses (3) to (5), for services rendered on or after the day of implementation
2202	2202	69.17of the rate increases must be used to increase compensation-related costs for drivers.
2203	2203	69.18 (b) For the purposes of this subdivision, compensation-related costs include:
2204	2204	69.19 (1) wages and salaries;
2205	2205	69.20 (2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
2206	2206	69.21taxes, workers' compensation, and mileage reimbursement;
2207	2207	69.22 (3) the employer's paid share of health and dental insurance, life insurance, disability
2208	2208	69.23insurance, long-term care insurance, uniform allowance, pensions, and contributions to
2209	2209	69.24employee retirement accounts; and
2210	2210	69.25 (4) benefits that address direct support professional workforce needs above and beyond
2211	2211	69.26what employees were offered prior to the implementation of the rate increases.
2212	2212	69.27 (c) Compensation-related costs for persons employed in the central office of a corporation
2213	2213	69.28or entity that has an ownership interest in the provider or exercises control over the provider,
2214	2214	69.29or for persons paid by the provider under a management contract, do not count toward the
2215	2215	69.3080 percent requirement under this subdivision.
2216	2216	69.31 (d) A provider agency or individual provider that receives additional revenue subject to
2217	2217	69.32the requirements of this subdivision shall prepare, and upon request submit to the
2218	2218	69Article 7 Sec. 3.
2219	2219	REVISOR AGW/HL 23-0127812/21/22 70.1commissioner, a distribution plan that specifies the amount of money the provider expects
2220	2220	70.2to receive that is subject to the requirements of this section, including how that money was
2221	2221	70.3or will be distributed to increase compensation-related costs for drivers. Within 60 days of
2222	2222	70.4final implementation of the new phase-in proportion or adjustment to the base wage indices
2223	2223	70.5subject to the requirements of this subdivision, the provider must post the distribution plan
2224	2224	70.6and leave it posted for a period of at least six months in an area of the provider's operation
2225	2225	70.7to which all drivers have access. The posted distribution plan must include instructions
2226	2226	70.8regarding how to contact the commissioner, or the commissioner's representative, if a driver
2227	2227	70.9has not received the compensation-related increase described in the plan.
2228	2228	70.10 ARTICLE 8
2229	2229	70.11 RESIDENTIAL SETTING CLOSURE PREVENTION GRANTS
2230	2230	70.12Section 1. [256.4795] RESIDENTIAL SETTING CLOSURE PREVENTION
2231	2231	70.13GRANTS.
2232	2232	70.14 Subdivision 1.Residential setting closure prevention grants established.The
2233	2233	70.15commissioner of human services shall establish a grant program to reduce the risk of
2234	2234	70.16residential settings in financial distress from closing. The commissioner shall limit
2235	2235	70.17expenditures under this subdivision to the amount appropriated for this purpose.
2236	2236	70.18 Subd. 2.Definitions.(a) For the purposes of this section, the terms in this subdivision
2237	2237	70.19have the meanings given them.
2238	2238	70.20 (b) "At risk of closure" or "at risk of closing" means a residential setting is in significant
2239	2239	70.21financial distress, and, in the judgment of the commissioner, the setting will close without
2240	2240	70.22additional funding from the commissioner.
2241	2241	70.23 (c) "Residential setting" means any of the following: (1) a nursing facility; (2) an assisted
2242	2242	70.24living facility with a majority of residents receiving services funded by medical assistance;
2243	2243	70.25(3) a setting exempt from assisted living facility licensure under section 144G.08, subdivision
2244	2244	70.267, clauses (10) to (13), with a majority of residents receiving services funded by medical
2245	2245	70.27assistance; (4) an intermediate care facility for persons with developmental disabilities; or
2246	2246	70.28(5) an adult foster care setting, a community residential setting, or an integrated community
2247	2247	70.29supports setting.
2248	2248	70.30 Subd. 3.Eligibility.(a) A license holder operating a residential setting in significant
2249	2249	70.31financial distress may apply to the commissioner for a grant under this section to relieve its
2250	2250	70.32immediate financial distress.
2251	2251	70Article 8 Section 1.
2252	2252	REVISOR AGW/HL 23-0127812/21/22 71.1 (b) Lead agencies that suspect a residential setting is in significant financial distress may
2253	2253	71.2refer the license holder to the commissioner for consideration by the commissioner for grant
2254	2254	71.3funding under this section. Upon a referral from a lead agency under this section, the
2255	2255	71.4commissioner shall immediately solicit an application from the license holder, providing
2256	2256	71.5individualized technical assistance to the license holder regarding the application process.
2257	2257	71.6 (c) The commissioner must give priority for closure prevention grants to residential
2258	2258	71.7settings that are the most significantly at risk of closing in violation of the applicable notice
2259	2259	71.8requirements prior to the termination of services.
2260	2260	71.9 Subd. 4.Criteria and limitations.(a) Within available appropriations for this purpose,
2261	2261	71.10the commissioner must award sufficient funding to a residential setting at risk of closure to
2262	2262	71.11ensure that the residential setting remains open long enough to comply with the applicable
2263	2263	71.12termination of services notification requirements.
2264	2264	71.13 (b) The commissioner may award additional funding to a residential setting at risk of
2265	2265	71.14closure if, in the judgment of the commissioner, the residential setting is likely to remain
2266	2266	71.15open and financially viable after receiving time-limited additional funding from the
2267	2267	71.16commissioner.
2268	2268	71.17 (c) Before receiving any additional funding under paragraph (b), grantees must work
2269	2269	71.18with the commissioner to develop a business plan and corrective action plan to reduce the
2270	2270	71.19risk of future financial distress. No residential setting may receive additional funding under
2271	2271	71.20paragraph (b) more than once.
2272	2272	71.21 Subd. 5.Interagency coordination.The commissioner must coordinate the grant
2273	2273	71.22activities under this section with any other impacted state agencies and lead agencies.
2274	2274	71.23 Subd. 6.Administrative funding.The commissioner may use up to 6.5 percent of the
2275	2275	71.24grant money appropriated for the commissioner's costs related to administration of this
2276	2276	71.25program.
2277	2277	71.26 EFFECTIVE DATE.This section is effective July 1, 2023.
2278	2278	71Article 8 Section 1.
2279	2279	REVISOR AGW/HL 23-0127812/21/22 72.1 ARTICLE 9
2280	2280	72.2 EXPANSION OF EMERGENCY STAFFING POOL
2281	2281	72.3 Section 1. Laws 2022, chapter 40, section 6, is amended to read:
2282	2282	72.4 Sec. 6. COMMISSIONER OF HUMAN SERVICES; TEMPORARY STAFFING
2283	2283	72.5POOL; APPROPRIATION.
2284	2284	72.6 (a) The commissioner of human services shall establish a temporary emergency staffing
2285	2285	72.7pool for congregate settings and for providers or recipients of home- and community-based
2286	2286	72.8services experiencing staffing crises. Vendor contracts may include retention bonuses,
2287	2287	72.9sign-on bonuses, and payment for hours on call. The commissioner may pay for necessary
2288	2288	72.10training, travel, and lodging expenses of the temporary staff. Contracts for temporary staffing
2289	2289	72.11executed under this section: (1) should minimize the recruitment away from providers'
2290	2290	72.12current workforces; and (2) may not be executed with an individual until at least 30 days
2291	2291	72.13since the individual was last employed in Minnesota by one of the types of facilities,
2292	2292	72.14providers, or individuals listed in paragraph (g).
2293	2293	72.15 (b) Temporary staff, at the request of the commissioner, may be deployed to providers
2294	2294	72.16of home- and community-based services, individual recipients of home- and
2295	2295	72.17community-based services, and long-term care facilities and other congregate care residential
2296	2296	72.18facilities and programs experiencing an emergency staffing crisis on or after the effective
2297	2297	72.19date of this section. Temporary staff must be provided at no cost to the provider, individual
2298	2298	72.20recipient, facility, or program receiving the temporary staff.
2299	2299	72.21 (c) Members of the temporary staffing pool under this section are not state employees.
2300	2300	72.22 (d) The commissioner must coordinate the activities under this section with any other
2301	2301	72.23impacted state agencies, to appropriately prioritize locations to deploy contracted temporary
2302	2302	72.24staff.
2303	2303	72.25 (e) The commissioner must give priority for deploying staff to providers, individual
2304	2304	72.26recipients, facilities, and programs with the most significant staffing crises and where, but
2305	2305	72.27for this assistance, residents or service recipients would be at significant risk of injury due
2306	2306	72.28to the need to transfer to another a facility or a hospital for adequately staffed care.
2307	2307	72.29 (f) A provider, individual recipient, facility, or program may seek onetime assistance
2308	2308	72.30per setting or individual service recipient from the temporary staffing pool only after the
2309	2309	72.31provider, individual recipient, facility, or program has used all resources available to obtain
2310	2310	72.32temporary staff but is unable to meet the provider's, individual's, facility's, or program's
2311	2311	72.33temporary staffing needs. A provider, individual, facility, or program may apply for
2312	2312	72Article 9 Section 1.
2313	2313	REVISOR AGW/HL 23-0127812/21/22 73.1temporary staff for up to 21 days. Applicants must submit a proposed plan for ensuring
2314	2314	73.2resident safety at the end of that time period.
2315	2315	73.3 (g) Providers, individuals, facilities, and programs eligible to obtain temporary staff
2316	2316	73.4from the temporary staffing pool include:
2317	2317	73.5 (1) nursing facilities;
2318	2318	73.6 (2) assisted living facilities;
2319	2319	73.7 (3) intermediate care facilities for persons with developmental disabilities;
2320	2320	73.8 (4) adult foster care or , community residential settings, or integrated community supports
2321	2321	73.9settings;
2322	2322	73.10 (5) licensed substance use disorder treatment facilities;
2323	2323	73.11 (6) unlicensed county-based substance use disorder treatment facilities;
2324	2324	73.12 (7) licensed facilities for adults with mental illness;
2325	2325	73.13 (8) licensed detoxification programs;
2326	2326	73.14 (9) licensed withdrawal management programs;
2327	2327	73.15 (10) licensed children's residential facilities;
2328	2328	73.16 (11) licensed child foster residence settings;
2329	2329	73.17 (12) unlicensed, Tribal-certified facilities that perform functions similar to the licensed
2330	2330	73.18facilities listed in this paragraph;
2331	2331	73.19 (13) boarding care homes;
2332	2332	73.20 (14) board and lodging establishments serving people with disabilities or disabling
2333	2333	73.21conditions;
2334	2334	73.22 (15) board and lodging establishments with special services;
2335	2335	73.23 (16) supervised living facilities;
2336	2336	73.24 (17) supportive housing;
2337	2337	73.25 (18) sober homes;
2338	2338	73.26 (19) community-based halfway houses for people exiting the correctional system;
2339	2339	73.27 (20) shelters serving people experiencing homelessness;
2340	2340	73.28 (21) drop-in centers for people experiencing homelessness;
2341	2341	73Article 9 Section 1.
2342	2342	REVISOR AGW/HL 23-0127812/21/22 74.1 (22) homeless outreach services for unsheltered individuals;
2343	2343	74.2 (23) shelters for people experiencing domestic violence; and
2344	2344	74.3 (24) temporary isolation spaces for people who test positive for COVID-19;
2345	2345	74.4 (25) individuals who use consumer-directed community supports;
2346	2346	74.5 (26) individuals who use the personal care assistance choice program;
2347	2347	74.6 (27) personal care assistance provider agencies;
2348	2348	74.7 (28) individuals who use the community first services and supports budget model;
2349	2349	74.8 (29) agency-providers of community first services and supports; and
2350	2350	74.9 (30) providers of individualized home supports.
2351	2351	74.10 (h) Notwithstanding Minnesota Statutes, chapter 16C, the commissioner may maintain,
2352	2352	74.11extend, or renew contracts for temporary staffing entered into on or after September 1, 2020.
2353	2353	74.12The commissioner may also enter into new contracts with eligible entities for temporary
2354	2354	74.13staff deployed in the temporary staffing pool. The commissioner may use up to 6.5 percent
2355	2355	74.14of this funding for the commissioner's costs related to administration of this program.
2356	2356	74.15 (i) The commissioner shall seek all allowable FEMA reimbursement for the costs of this
2357	2357	74.16activity.
2358	2358	74.17 ARTICLE 10
2359	2359	74.18 FAMILY ASSETS FOR INDEPENDENCE
2360	2360	74.19Section 1. Minnesota Statutes 2022, section 256E.35, subdivision 1, is amended to read:
2361	2361	74.20 Subdivision 1.Establishment.The Minnesota family assets for independence initiative
2362	2362	74.21is established to provide incentives for low-income families to accrue assets for education,
2363	2363	74.22housing, vehicles, emergencies, and economic development purposes.
2364	2364	74.23Sec. 2. Minnesota Statutes 2022, section 256E.35, subdivision 2, is amended to read:
2365	2365	74.24 Subd. 2.Definitions.(a) The definitions in this subdivision apply to this section.
2366	2366	74.25 (b) "Eligible educational institution" means the following:
2367	2367	74.26 (1) an institution of higher education described in section 101 or 102 of the Higher
2368	2368	74.27Education Act of 1965; or
2369	2369	74.28 (2) an area vocational education school, as defined in subparagraph (C) or (D) of United
2370	2370	74.29States Code, title 20, chapter 44, section 2302 (3) (the Carl D. Perkins Vocational and
2371	2371	74Article 10 Sec. 2.
2372	2372	REVISOR AGW/HL 23-0127812/21/22 75.1Applied Technology Education Act), which is located within any state, as defined in United
2373	2373	75.2States Code, title 20, chapter 44, section 2302 (30). This clause is applicable only to the
2374	2374	75.3extent section 2302 is in effect on August 1, 2008.
2375	2375	75.4 (c) "Family asset account" means a savings account opened by a household participating
2376	2376	75.5in the Minnesota family assets for independence initiative.
2377	2377	75.6 (d) "Fiduciary organization" means:
2378	2378	75.7 (1) a community action agency that has obtained recognition under section 256E.31;
2379	2379	75.8 (2) a federal community development credit union serving the seven-county metropolitan
2380	2380	75.9area; or
2381	2381	75.10 (3) a women-oriented economic development agency serving the seven-county
2382	2382	75.11metropolitan area.;
2383	2383	75.12 (4) a federally recognized Tribal nation; or
2384	2384	75.13 (5) a nonprofit organization, as defined under section 501(c)(3) of the Internal Revenue
2385	2385	75.14Code.
2386	2386	75.15 (e) "Financial coach" means a person who:
2387	2387	75.16 (1) has completed an intensive financial literacy training workshop that includes
2388	2388	75.17curriculum on budgeting to increase savings, debt reduction and asset building, building a
2389	2389	75.18good credit rating, and consumer protection;
2390	2390	75.19 (2) participates in ongoing statewide family assets for independence in Minnesota (FAIM)
2391	2391	75.20network training meetings under FAIM program supervision; and
2392	2392	75.21 (3) provides financial coaching to program participants under subdivision 4a.
2393	2393	75.22 (f) "Financial institution" means a bank, bank and trust, savings bank, savings association,
2394	2394	75.23or credit union, the deposits of which are insured by the Federal Deposit Insurance
2395	2395	75.24Corporation or the National Credit Union Administration.
2396	2396	75.25 (g) "Household" means all individuals who share use of a dwelling unit as primary
2397	2397	75.26quarters for living and eating separate from other individuals.
2398	2398	75.27 (h) "Permissible use" means:
2399	2399	75.28 (1) postsecondary educational expenses at an eligible educational institution as defined
2400	2400	75.29in paragraph (b), including books, supplies, and equipment required for courses of instruction;
2401	2401	75.30 (2) acquisition costs of acquiring, constructing, or reconstructing a residence, including
2402	2402	75.31any usual or reasonable settlement, financing, or other closing costs;
2403	2403	75Article 10 Sec. 2.
2404	2404	REVISOR AGW/HL 23-0127812/21/22 76.1 (3) business capitalization expenses for expenditures on capital, plant, equipment, working
2405	2405	76.2capital, and inventory expenses of a legitimate business pursuant to a business plan approved
2406	2406	76.3by the fiduciary organization;
2407	2407	76.4 (4) acquisition costs of a principal residence within the meaning of section 1034 of the
2408	2408	76.5Internal Revenue Code of 1986 which do not exceed 100 percent of the average area purchase
2409	2409	76.6price applicable to the residence determined according to section 143(e)(2) and (3) of the
2410	2410	76.7Internal Revenue Code of 1986; and
2411	2411	76.8 (5) acquisition costs of a personal vehicle only if approved by the fiduciary organization.;
2412	2412	76.9 (6) contribution to an emergency savings account; and
2413	2413	76.10 (7) contribution to a Minnesota 529 savings plan.
2414	2414	76.11Sec. 3. Minnesota Statutes 2022, section 256E.35, subdivision 4a, is amended to read:
2415	2415	76.12 Subd. 4a.Financial coaching.A financial coach shall provide the following to program
2416	2416	76.13participants:
2417	2417	76.14 (1) financial education relating to budgeting, debt reduction, asset-specific training,
2418	2418	76.15credit building, and financial stability activities;
2419	2419	76.16 (2) asset-specific training related to buying a home or vehicle, acquiring postsecondary
2420	2420	76.17education, or starting or expanding a small business, saving for emergencies, or saving for
2421	2421	76.18a child's education; and
2422	2422	76.19 (3) financial stability education and training to improve and sustain financial security.
2423	2423	76.20Sec. 4. Minnesota Statutes 2022, section 256E.35, subdivision 6, is amended to read:
2424	2424	76.21 Subd. 6.Withdrawal; matching; permissible uses.(a) To receive a match, a
2425	2425	76.22participating household must transfer funds withdrawn from a family asset account to its
2426	2426	76.23matching fund custodial account held by the fiscal agent, according to the family asset
2427	2427	76.24agreement. The fiscal agent must determine if the match request is for a permissible use
2428	2428	76.25consistent with the household's family asset agreement.
2429	2429	76.26 (b) The fiscal agent must ensure the household's custodial account contains the applicable
2430	2430	76.27matching funds to match the balance in the household's account, including interest, on at
2431	2431	76.28least a quarterly basis and at the time of an approved withdrawal. Matches must be a
2432	2432	76.29contribution of $3 from state grant or TANF funds for every $1 of funds withdrawn from
2433	2433	76.30the family asset account not to exceed a $6,000 $9,000 lifetime limit.
2434	2434	76Article 10 Sec. 4.
2435	2435	REVISOR AGW/HL 23-0127812/21/22 77.1 (c) Notwithstanding paragraph (b), if funds are appropriated for the Federal Assets for
2436	2436	77.2Independence Act of 1998, and a participating fiduciary organization is awarded a grant
2437	2437	77.3under that act, participating households with that fiduciary organization must be provided
2438	2438	77.4matches as follows:
2439	2439	77.5 (1) from state grant and TANF funds, a matching contribution of $1.50 for every $1 of
2440	2440	77.6funds withdrawn from the family asset account not to exceed a $3,000 $4,500 lifetime limit;
2441	2441	77.7and
2442	2442	77.8 (2) from nonstate funds, a matching contribution of not less than $1.50 for every $1 of
2443	2443	77.9funds withdrawn from the family asset account not to exceed a $3,000 $4,500 lifetime limit.
2444	2444	77.10 (d) Upon receipt of transferred custodial account funds, the fiscal agent must make a
2445	2445	77.11direct payment to the vendor of the goods or services for the permissible use.
2446	2446	77.12Sec. 5. Minnesota Statutes 2022, section 256E.35, subdivision 7, is amended to read:
2447	2447	77.13 Subd. 7.Program reporting.The fiscal agent on behalf of each fiduciary organization
2448	2448	77.14participating in a family assets for independence initiative must report quarterly to the
2449	2449	77.15commissioner of human services identifying the participants with accounts, the number of
2450	2450	77.16accounts, the amount of savings and matches for each participant's account, the uses of the
2451	2451	77.17account, and the number of businesses, homes, vehicles, and educational services paid for
2452	2452	77.18with money from the account, and the amount of contributions to Minnesota 529 savings
2453	2453	77.19plans and emergency savings accounts, as well as other information that may be required
2454	2454	77.20for the commissioner to administer the program and meet federal TANF reporting
2455	2455	77.21requirements.
2456	2456	77.22Sec. 6. Minnesota Statutes 2022, section 256P.02, is amended by adding a subdivision to
2457	2457	77.23read:
2458	2458	77.24 Subd. 4.Account exception.Family asset accounts under section 256E.35 and individual
2459	2459	77.25development accounts authorized under the Assets for Independence Act, Title IV of the
2460	2460	77.26Community Opportunities, Accountability, and Training and Educational Services Human
2461	2461	77.27Services Reauthorization Act of 1998, Public Law 105-285, must be excluded when
2462	2462	77.28determining the equity value of personal property.
2463	2463	77Article 10 Sec. 6.
2464	2464	REVISOR AGW/HL 23-0127812/21/22 78.1 ARTICLE 11
2465	2465	78.2 APPROPRIATIONS
2466	2466	78.3 Section 1. APPROPRIATION; FAMILY ASSETS FOR INDEPENDENCE.
2467	2467	78.4 $100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the
2468	2468	78.5general fund to the commissioner of human services for the purposes of the family assets
2469	2469	78.6for independence program in Minnesota Statutes, section 256E.35.
2470	2470	78.7 Sec. 2. APPROPRIATION; LIFESHARING SERVICE DEVELOPMENT .
2471	2471	78.8 $184,000 in fiscal year 2024 is appropriated from the general fund to the commissioner
2472	2472	78.9of human services for engaging stakeholders and developing a lifesharing service under the
2473	2473	78.10state's medical assistance disability waivers and elderly waiver. This is a onetime
2474	2474	78.11appropriation and is available until June 30, 2025.
2475	2475	78.12Sec. 3. APPROPRIATION; RESIDENTIAL SETTING CLOSURE PREVENTION
2476	2476	78.13GRANTS.
2477	2477	78.14 $6,671,000 in fiscal year 2024 and $6,671,000 in fiscal year 2025 are appropriated from
2478	2478	78.15the general fund to the commissioner of human services for residential setting closure
2479	2479	78.16prevention grants under Minnesota Statutes, section 256.4795.
2480	2480	78.17Sec. 4. APPROPRIATION; WELLNESS IN THE WOODS.
2481	2481	78.18 $100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the
2482	2482	78.19general fund to the commissioner of human services for a grant to Wellness in the Woods
2483	2483	78.20for daily peer support and special sessions for individuals who are in substance use disorder
2484	2484	78.21recovery, are transitioning out of incarceration, or have experienced trauma.
2485	2485	78Article 11 Sec. 4.
2486	2486	REVISOR AGW/HL 23-0127812/21/22 256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.
2487	2487	Subd. 9a.Respite services; component values and calculation of payment rates.(a) For the
2488	2488	purposes of this section, respite services include respite services provided to an individual outside
2489	2489	of any service plan for a day program or residential support service.
2490	2490	(b) Component values for respite services are:
2491	2491	(1) competitive workforce factor: 4.7 percent;
2492	2492	(2) supervisory span of control ratio: 11 percent;
2493	2493	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
2494	2494	(4) employee-related cost ratio: 23.6 percent;
2495	2495	(5) general administrative support ratio: 13.25 percent;
2496	2496	(6) program-related expense ratio: 2.9 percent; and
2497	2497	(7) absence and utilization factor ratio: 3.9 percent.
2498	2498	(c) A unit of service for respite services is 15 minutes.
2499	2499	(d) Payments for respite services must be calculated as follows unless the service is reimbursed
2500	2500	separately as part of a residential support services or day program payment rate:
2501	2501	(1) determine the number of units of service to meet an individual's needs;
2502	2502	(2) determine the appropriate hourly staff wage rates derived by the commissioner as provided
2503	2503	in subdivisions 5 and 5a;
2504	2504	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the product
2505	2505	of one plus the competitive workforce factor;
2506	2506	(4) for a recipient requiring deaf and hard-of-hearing customization under subdivision 12, add
2507	2507	the customization rate provided in subdivision 12 to the result of clause (3);
2508	2508	(5) multiply the number of direct staffing hours by the appropriate staff wage;
2509	2509	(6) multiply the number of direct staffing hours by the product of the supervisory span of control
2510	2510	ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
2511	2511	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the employee
2512	2512	vacation, sick, and training allowance ratio. This is defined as the direct staffing rate;
2513	2513	(8) for employee-related expenses, multiply the result of clause (7) by one plus the
2514	2514	employee-related cost ratio;
2515	2515	(9) this is the subtotal rate;
2516	2516	(10) sum the standard general administrative support ratio, the program-related expense ratio,
2517	2517	and the absence and utilization factor ratio;
2518	2518	(11) divide the result of clause (9) by one minus the result of clause (10). This is the total
2519	2519	payment amount;
2520	2520	(12) for respite services provided in a shared manner, divide the total payment amount in clause
2521	2521	(11) by the number of service recipients, not to exceed three; and
2522	2522	(13) adjust the result of clause (12) by a factor to be determined by the commissioner to adjust
2523	2523	for regional differences in the cost of providing services.
2524	2524	256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS.
2525	2525	Subd. 4.Calculation of monthly conversion budget cap with consumer-directed community
2526	2526	supports.For the elderly waiver monthly conversion budget cap for the cost of elderly waiver
2527	2527	services with consumer-directed community supports, the nursing facility case mix adjusted total
2528	2528	payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly
2529	2529	waiver services without consumer-directed community supports must be reduced by a percentage
2530	2530	equal to the percentage difference between the consumer-directed community supports budget limit
2531	2531	that would be assigned according to the elderly waiver plan and the corresponding monthly case
2532	2532	mix budget cap under this chapter, but not to exceed 50 percent.
2533	2533	1R
2534	2534	APPENDIX
2535	2535	Repealed Minnesota Statutes: 23-01278