| 1 | 1 | | 1.1 A bill for an act |
|---|
| 2 | 2 | | 1.2 relating to human services; modifying policies related to establishing rates for |
|---|
| 3 | 3 | | 1.3 home and community-based waiver services; increasing room and board rates for |
|---|
| 4 | 4 | | 1.4 certain individuals receiving home and community-based services; amending |
|---|
| 5 | 5 | | 1.5 Minnesota Statutes 2024, sections 256B.4914, subdivisions 4, 14, 17; 256I.05, |
|---|
| 6 | 6 | | 1.6 subdivision 1c. |
|---|
| 7 | 7 | | 1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
|---|
| 8 | 8 | | 1.8 Section 1. Minnesota Statutes 2024, section 256B.4914, subdivision 4, is amended to read: |
|---|
| 9 | 9 | | 1.9 Subd. 4.Data collection for rate determination.(a) Rates for applicable home and |
|---|
| 10 | 10 | | 1.10community-based waivered services, including customized rates under subdivision 12, are |
|---|
| 11 | 11 | | 1.11set by the rates management system. |
|---|
| 12 | 12 | | 1.12 (b) Data and information in the rates management system must be used to calculate an |
|---|
| 13 | 13 | | 1.13individual's rate. |
|---|
| 14 | 14 | | 1.14 (c) Service providers, with information from the support plan and oversight by lead |
|---|
| 15 | 15 | | 1.15agencies, shall provide values and information needed to calculate an individual's rate in |
|---|
| 16 | 16 | | 1.16the rates management system. Lead agencies must use forms provided by the commissioner |
|---|
| 17 | 17 | | 1.17to collect this information. The determination of service levels must be part of a discussion |
|---|
| 18 | 18 | | 1.18with members of the support team as defined in section 245D.02, subdivision 34. This |
|---|
| 19 | 19 | | 1.19discussion must occur prior to the final establishment of each individual's rate. The values |
|---|
| 20 | 20 | | 1.20and information include: |
|---|
| 21 | 21 | | 1.21 (1) shared staffing hours; |
|---|
| 22 | 22 | | 1.22 (2) individual staffing hours; |
|---|
| 23 | 23 | | 1.23 (3) direct registered nurse hours; |
|---|
| 24 | 24 | | 1Section 1. |
|---|
| 25 | 25 | | REVISOR AGW/NS 25-0064811/21/24 |
|---|
| 26 | 26 | | State of Minnesota |
|---|
| 27 | 27 | | This Document can be made available |
|---|
| 28 | 28 | | in alternative formats upon request |
|---|
| 29 | 29 | | HOUSE OF REPRESENTATIVES |
|---|
| 30 | 30 | | H. F. No. 381 |
|---|
| 31 | 31 | | NINETY-FOURTH SESSION |
|---|
| 32 | 32 | | Authored by Curran, Gander, Baker, Schomacker, Noor and others02/13/2025 |
|---|
| 33 | 33 | | The bill was read for the first time and referred to the Committee on Human Services Finance and Policy 2.1 (4) direct licensed practical nurse hours; |
|---|
| 34 | 34 | | 2.2 (5) staffing ratios; |
|---|
| 35 | 35 | | 2.3 (6) information to document variable levels of service qualification for variable levels |
|---|
| 36 | 36 | | 2.4of reimbursement in each framework; |
|---|
| 37 | 37 | | 2.5 (7) shared or individualized arrangements for unit-based services, including the staffing |
|---|
| 38 | 38 | | 2.6ratio; |
|---|
| 39 | 39 | | 2.7 (8) number of trips and miles for transportation services; and |
|---|
| 40 | 40 | | 2.8 (9) service hours provided through monitoring technology. |
|---|
| 41 | 41 | | 2.9 (d) Updates to individual data must include: |
|---|
| 42 | 42 | | 2.10 (1) data for each individual that is updated annually when renewing service plans; and |
|---|
| 43 | 43 | | 2.11 (2) requests by individuals or lead agencies to update a rate whenever there is a change |
|---|
| 44 | 44 | | 2.12in an individual's service needs, with accompanying documentation. |
|---|
| 45 | 45 | | 2.13 (e) Within 30 business days of receiving from a service provider the values and |
|---|
| 46 | 46 | | 2.14information specified in paragraph (c), lead agencies shall review and approve (1) all services |
|---|
| 47 | 47 | | 2.15reflecting each individual's needs,; and (2) the values to calculate the final payment rate for |
|---|
| 48 | 48 | | 2.16services with variables under subdivisions 6 to 9 for each individual. If the lead agency fails |
|---|
| 49 | 49 | | 2.17to approve a final payment rate for services within 30 business days of receiving the values |
|---|
| 50 | 50 | | 2.18and information specified in paragraph (c), the lead agency must pay a late payment penalty |
|---|
| 51 | 51 | | 2.19from the lead agency's own sources of revenue. The late payment penalty is equal to ten |
|---|
| 52 | 52 | | 2.20percent of the total final payment rate for the service prorated as necessary from the end of |
|---|
| 53 | 53 | | 2.21the 30-business-day service authorization approval period to the date the service provider |
|---|
| 54 | 54 | | 2.22is notified of the final payment rate for the approved services. |
|---|
| 55 | 55 | | 2.23 (f) Lead agencies must notify the individual and the service provider of the final |
|---|
| 56 | 56 | | 2.24agreed-upon values and rate, and provide information that is identical to what was entered |
|---|
| 57 | 57 | | 2.25into the rates management system. If a value used was mistakenly or erroneously entered |
|---|
| 58 | 58 | | 2.26and used to calculate a rate, a provider may petition lead agencies to correct it. Lead agencies |
|---|
| 59 | 59 | | 2.27must respond to these requests. When responding to the request, the lead agency must |
|---|
| 60 | 60 | | 2.28consider: |
|---|
| 61 | 61 | | 2.29 (1) meeting the health and welfare needs of the individual or individuals receiving |
|---|
| 62 | 62 | | 2.30services by service site, identified in their support plan under section 245D.02, subdivision |
|---|
| 63 | 63 | | 2.314b, and any addendum under section 245D.02, subdivision 4c; |
|---|
| 64 | 64 | | 2Section 1. |
|---|
| 65 | 65 | | REVISOR AGW/NS 25-0064811/21/24 3.1 (2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and |
|---|
| 66 | 66 | | 3.2(o); and meeting or exceeding the licensing standards for staffing required under section |
|---|
| 67 | 67 | | 3.3245D.09, subdivision 1; and |
|---|
| 68 | 68 | | 3.4 (3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and |
|---|
| 69 | 69 | | 3.5meeting or exceeding the licensing standards for staffing required under section 245D.31. |
|---|
| 70 | 70 | | 3.6 EFFECTIVE DATE.This section is effective July 1, 2025. |
|---|
| 71 | 71 | | 3.7 Sec. 2. Minnesota Statutes 2024, section 256B.4914, subdivision 14, is amended to read: |
|---|
| 72 | 72 | | 3.8 Subd. 14.Exceptions.(a) In a format prescribed by the commissioner, lead agencies |
|---|
| 73 | 73 | | 3.9must identify individuals with exceptional needs that cannot be met under the disability |
|---|
| 74 | 74 | | 3.10waiver rate system. The commissioner shall use that information to evaluate and, if necessary, |
|---|
| 75 | 75 | | 3.11approve an alternative payment rate for those individuals. Whether granted, denied, or |
|---|
| 76 | 76 | | 3.12modified, the commissioner shall respond to all exception requests in writing. The |
|---|
| 77 | 77 | | 3.13commissioner shall include in the written response the basis for the action and provide |
|---|
| 78 | 78 | | 3.14notification of the right to appeal under paragraph (h). |
|---|
| 79 | 79 | | 3.15 (b) Lead agencies must act on an exception request within 30 days and notify the initiator |
|---|
| 80 | 80 | | 3.16of the request of their recommendation in writing. A lead agency shall submit all exception |
|---|
| 81 | 81 | | 3.17requests along with its recommendation to the commissioner. |
|---|
| 82 | 82 | | 3.18 (c) An application for a rate exception may be submitted for the following criteria: |
|---|
| 83 | 83 | | 3.19 (1) an individual has service needs that cannot be met through additional units of service; |
|---|
| 84 | 84 | | 3.20 (2) an individual's rate determined under subdivisions 6 to 9 is so insufficient that it has |
|---|
| 85 | 85 | | 3.21resulted in an individual receiving a notice of discharge from the individual's provider; or |
|---|
| 86 | 86 | | 3.22 (3) an individual's service needs, including behavioral changes, require a level of service |
|---|
| 87 | 87 | | 3.23which necessitates a change in provider or which requires the current provider to propose |
|---|
| 88 | 88 | | 3.24service changes beyond those currently authorized. |
|---|
| 89 | 89 | | 3.25 (d) Exception requests must include the following information: |
|---|
| 90 | 90 | | 3.26 (1) the service needs required by each individual that are not accounted for in subdivisions |
|---|
| 91 | 91 | | 3.276 to 9; |
|---|
| 92 | 92 | | 3.28 (2) the service rate requested and the difference from the rate determined in subdivisions |
|---|
| 93 | 93 | | 3.296 to 9; |
|---|
| 94 | 94 | | 3.30 (3) a basis for the underlying costs used for the rate exception and any accompanying |
|---|
| 95 | 95 | | 3.31documentation; and |
|---|
| 96 | 96 | | 3Sec. 2. |
|---|
| 97 | 97 | | REVISOR AGW/NS 25-0064811/21/24 4.1 (4) any contingencies for approval. |
|---|
| 98 | 98 | | 4.2 (e) Approved rate exceptions shall be managed within lead agency allocations under |
|---|
| 99 | 99 | | 4.3sections 256B.092 and 256B.49. |
|---|
| 100 | 100 | | 4.4 (f) Individual disability waiver recipients, an interested party, or the license holder that |
|---|
| 101 | 101 | | 4.5would receive the rate exception increase may request that a lead agency submit an exception |
|---|
| 102 | 102 | | 4.6request. A lead agency that denies such a request shall notify the individual waiver recipient, |
|---|
| 103 | 103 | | 4.7interested party, or license holder of its decision and the reasons for denying the request in |
|---|
| 104 | 104 | | 4.8writing no later than 30 days after the request has been made and shall submit its denial to |
|---|
| 105 | 105 | | 4.9the commissioner in accordance with paragraph (b). The reasons for the denial must be |
|---|
| 106 | 106 | | 4.10based on the failure to meet the criteria in paragraph (c). |
|---|
| 107 | 107 | | 4.11 (g) The commissioner shall determine whether to approve or deny an exception request |
|---|
| 108 | 108 | | 4.12no more than 30 days after receiving the request. If the commissioner denies the request, |
|---|
| 109 | 109 | | 4.13the commissioner shall notify the lead agency and the individual disability waiver recipient, |
|---|
| 110 | 110 | | 4.14the interested party, and the license holder in writing of the reasons for the denial. |
|---|
| 111 | 111 | | 4.15 (h) The individual disability waiver recipient may appeal any denial of an exception |
|---|
| 112 | 112 | | 4.16request by either the lead agency or the commissioner, pursuant to sections 256.045 and |
|---|
| 113 | 113 | | 4.17256.0451. When the denial of an exception request results in the proposed demission of a |
|---|
| 114 | 114 | | 4.18waiver recipient from a residential or day habilitation program, the commissioner shall issue |
|---|
| 115 | 115 | | 4.19a temporary stay of demission, when requested by the disability waiver recipient, consistent |
|---|
| 116 | 116 | | 4.20with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary |
|---|
| 117 | 117 | | 4.21stay shall remain in effect until the lead agency can provide an informed choice of |
|---|
| 118 | 118 | | 4.22appropriate, alternative services to the disability waiver. |
|---|
| 119 | 119 | | 4.23 (i) Providers may petition lead agencies to update values that were entered incorrectly |
|---|
| 120 | 120 | | 4.24or erroneously into the rate management system, based on past service level discussions |
|---|
| 121 | 121 | | 4.25and determination in subdivision 4, without applying for a rate exception. |
|---|
| 122 | 122 | | 4.26 (j) The starting date for the rate exception will be the later of the date of the recipient's |
|---|
| 123 | 123 | | 4.27change in support or the date of the request to the lead agency for an exception. |
|---|
| 124 | 124 | | 4.28 (k) The commissioner shall track all exception requests received and their dispositions. |
|---|
| 125 | 125 | | 4.29The commissioner shall issue quarterly public exceptions statistical reports, including the |
|---|
| 126 | 126 | | 4.30number of exception requests received and the numbers granted, denied, withdrawn, and |
|---|
| 127 | 127 | | 4.31pending. The report shall include the average amount of time required to process exceptions. |
|---|
| 128 | 128 | | 4.32 (l) Approved rate exceptions remain in effect in all cases until an individual's needs |
|---|
| 129 | 129 | | 4.33change as defined in paragraph (c). Notwithstanding a change in an individual's service |
|---|
| 130 | 130 | | 4Sec. 2. |
|---|
| 131 | 131 | | REVISOR AGW/NS 25-0064811/21/24 5.1needs, an approved rate exception must remain in effect in all cases if the individual's |
|---|
| 132 | 132 | | 5.2interdisciplinary team as defined in Minnesota Rules, part 9525.0004, subpart 14, determines |
|---|
| 133 | 133 | | 5.3that removing the rate exception would have a negative impact on the individual's well-being. |
|---|
| 134 | 134 | | 5.4 (m) Rates determined under subdivision 19 are ineligible for rate exceptions. |
|---|
| 135 | 135 | | 5.5 EFFECTIVE DATE.This section is effective July 1, 2025, or upon federal approval, |
|---|
| 136 | 136 | | 5.6whichever is later. The commissioner of human services shall inform the revisor of statutes |
|---|
| 137 | 137 | | 5.7when federal approval is obtained. |
|---|
| 138 | 138 | | 5.8 Sec. 3. Minnesota Statutes 2024, section 256B.4914, subdivision 17, is amended to read: |
|---|
| 139 | 139 | | 5.9 Subd. 17.Stakeholder consultation and county training.(a) The commissioner shall |
|---|
| 140 | 140 | | 5.10continue consultation at regular intervals with the existing stakeholder group established |
|---|
| 141 | 141 | | 5.11as part of the rate-setting methodology process and others, to gather input, concerns, and |
|---|
| 142 | 142 | | 5.12data, to assist in the implementation of the rate payment system, and to make pertinent |
|---|
| 143 | 143 | | 5.13information available to the public through the department's website. |
|---|
| 144 | 144 | | 5.14 (b) The commissioner shall offer training at least annually for county personnel |
|---|
| 145 | 145 | | 5.15responsible for administering the rate-setting framework in a manner consistent with this |
|---|
| 146 | 146 | | 5.16section. |
|---|
| 147 | 147 | | 5.17 (c) The commissioner shall maintain an online instruction manual explaining the |
|---|
| 148 | 148 | | 5.18rate-setting framework. The manual shall be consistent with this section, and shall be |
|---|
| 149 | 149 | | 5.19accessible to all stakeholders including recipients, representatives of recipients, county or |
|---|
| 150 | 150 | | 5.20Tribal agencies, and license holders. |
|---|
| 151 | 151 | | 5.21 (d) The commissioner shall not defer to the county or Tribal agency on matters of |
|---|
| 152 | 152 | | 5.22technical application of the rate-setting framework, and a county or Tribal agency shall not |
|---|
| 153 | 153 | | 5.23set rates in a manner that conflicts with this section. |
|---|
| 154 | 154 | | 5.24 (e) The commissioner must consult with existing stakeholder groups as required under |
|---|
| 155 | 155 | | 5.25this subdivision to periodically review, update, and revise the format by which initiators of |
|---|
| 156 | 156 | | 5.26rate exception requests and lead agencies collect and submit information about individuals |
|---|
| 157 | 157 | | 5.27with exceptional needs under subdivision 14. |
|---|
| 158 | 158 | | 5.28 EFFECTIVE DATE.This section is effective July 1, 2025. |
|---|
| 159 | 159 | | 5Sec. 3. |
|---|
| 160 | 160 | | REVISOR AGW/NS 25-0064811/21/24 6.1 Sec. 4. Minnesota Statutes 2024, section 256I.05, subdivision 1c, is amended to read: |
|---|
| 161 | 161 | | 6.2 Subd. 1c.Rate increases.An agency may not increase the rates negotiated for housing |
|---|
| 162 | 162 | | 6.3support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f) |
|---|
| 163 | 163 | | 6.4(g). |
|---|
| 164 | 164 | | 6.5 (a) An agency may increase the rates for room and board to the MSA equivalent rate |
|---|
| 165 | 165 | | 6.6for those settings whose current rate is below the MSA equivalent rate. |
|---|
| 166 | 166 | | 6.7 (b) An agency may increase the rates for residents in adult foster care whose difficulty |
|---|
| 167 | 167 | | 6.8of care has increased. The total housing support rate for these residents must not exceed the |
|---|
| 168 | 168 | | 6.9maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase |
|---|
| 169 | 169 | | 6.10difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding |
|---|
| 170 | 170 | | 6.11by home and community-based waiver programs under title XIX of the Social Security Act. |
|---|
| 171 | 171 | | 6.12 (c) An agency must increase the room and board rates each year when the MSA equivalent |
|---|
| 172 | 172 | | 6.13rate is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, |
|---|
| 173 | 173 | | 6.14less the amount of the increase in the medical assistance personal needs allowance under |
|---|
| 174 | 174 | | 6.15section 256B.35. |
|---|
| 175 | 175 | | 6.16 (d) An agency may increase the rates for residents in facilities meeting substantial change |
|---|
| 176 | 176 | | 6.17criteria within the prior year. Substantial change criteria exist if the establishment experiences |
|---|
| 177 | 177 | | 6.18a 25 percent increase or decrease in the total number of its beds, if the net cost of capital |
|---|
| 178 | 178 | | 6.19additions or improvements is in excess of 15 percent of the current market value of the |
|---|
| 179 | 179 | | 6.20residence, or if the residence physically moves, or changes its licensure, and incurs a resulting |
|---|
| 180 | 180 | | 6.21increase in operation and property costs. |
|---|
| 181 | 181 | | 6.22 (e) Until June 30, 1994, an agency may increase by up to five percent the total rate paid |
|---|
| 182 | 182 | | 6.23for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who |
|---|
| 183 | 183 | | 6.24reside in residences that are licensed by the commissioner of health as a boarding care home, |
|---|
| 184 | 184 | | 6.25but are not certified for the purposes of the medical assistance program. However, an increase |
|---|
| 185 | 185 | | 6.26under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical |
|---|
| 186 | 186 | | 6.27assistance reimbursement rate for nursing home resident class A, in the geographic grouping |
|---|
| 187 | 187 | | 6.28in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to |
|---|
| 188 | 188 | | 6.299549.0058. |
|---|
| 189 | 189 | | 6.30 (f) Notwithstanding the provisions of subdivision 1, an agency may increase the monthly |
|---|
| 190 | 190 | | 6.31room and board rates by $50 per month for residents in settings under section 256I.04, |
|---|
| 191 | 191 | | 6.32subdivision 2a, paragraph (b), clause (2). Participants in the Minnesota supportive housing |
|---|
| 192 | 192 | | 6.33demonstration program under section 256I.04, subdivision 3, paragraph (a), clause (3), may |
|---|
| 193 | 193 | | 6.34not receive the increase under this paragraph. |
|---|
| 194 | 194 | | 6Sec. 4. |
|---|
| 195 | 195 | | REVISOR AGW/NS 25-0064811/21/24 7.1 (g) Notwithstanding subdivision 1, an agency must negotiate a single-occupancy monthly |
|---|
| 196 | 196 | | 7.2room and board rate add-on for any recipient of housing support who cannot live with others |
|---|
| 197 | 197 | | 7.3and is residing in a facility licensed under chapter 245A as a community residential setting. |
|---|
| 198 | 198 | | 7.4A single-occupancy monthly room and board rate add-on is in addition to the monthly room |
|---|
| 199 | 199 | | 7.5and board rate under subdivision 1. The single-occupancy monthly room and board rate |
|---|
| 200 | 200 | | 7.6add-on must not exceed $1,000 per month plus an annual percentage adjustment to the |
|---|
| 201 | 201 | | 7.7allowable monthly add-on equal to the percentage change in the MSA equivalent rate |
|---|
| 202 | 202 | | 7.8resulting from the adjustment to the MSA equivalent rate specified under section 256I.03, |
|---|
| 203 | 203 | | 7.9subdivision 11a. To be eligible for a single-occupancy monthly room and board rate add-on, |
|---|
| 204 | 204 | | 7.10the determination that a recipient of housing support cannot live with others must be |
|---|
| 205 | 205 | | 7.11documented in the individual's support plan. For the purposes of this paragraph, "community |
|---|
| 206 | 206 | | 7.12residential setting" and "support plan" have the meanings giving in section 245D.02. |
|---|
| 207 | 207 | | 7.13 EFFECTIVE DATE.This section is effective July 1, 2025. |
|---|
| 208 | 208 | | 7.14 Sec. 5. DIRECTION TO COMMISSIONER; ENVIRONMENT AL ACCESSIBILITY |
|---|
| 209 | 209 | | 7.15ADAPTATIONS COVERED SERVICE MODIFICATIONS. |
|---|
| 210 | 210 | | 7.16 By December 1, 2025, the commissioner of human services must submit to the federal |
|---|
| 211 | 211 | | 7.17Centers for Medicare and Medicaid Services all necessary amendments to home and |
|---|
| 212 | 212 | | 7.18community-based services waiver plans to include as a covered service under environmental |
|---|
| 213 | 213 | | 7.19accessibility adaptations the repair of property damage caused by an individual receiving |
|---|
| 214 | 214 | | 7.20services under the waivers. |
|---|
| 215 | 215 | | 7.21 EFFECTIVE DATE.This section is effective July 1, 2025. |
|---|
| 216 | 216 | | 7Sec. 5. |
|---|
| 217 | 217 | | REVISOR AGW/NS 25-0064811/21/24 |
|---|