relating to BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

485.21    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
485.22read:
485.23    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
485.24under section 256B.4914, statewide payment methodologies that meet federal waiver
485.25requirements for home and community-based waiver services for individuals with
485.26disabilities. The payment methodologies must abide by the principles of transparency
485.27and equitability across the state. The methodologies must involve a uniform process of
485.28structuring rates for each service and must promote quality and participant choice.
485.29    (b) As of January 1, 2012, counties shall not implement changes to established
485.30processes for rate-setting methodologies for individuals using components of or data
485.31from research rates.

485.32    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
486.1    Subd. 3. Payment requirements. The payment methodologies established under
486.2this section shall accommodate:
486.3(1) supervision costs;
486.4(2) staffing patterns staff compensation;
486.5(3) staffing and supervisory patterns;
486.6(3) (4) program-related expenses;
486.7(4) (5) general and administrative expenses; and
486.8(5) (6) consideration of recipient intensity.

486.9    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended by adding a
486.10subdivision to read:
486.11    Subd. 4a. Rate stabilization adjustment. (a) The commissioner of human services
486.12shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
486.13January 1, 2016. Rates determined under section 256B.4914 must be adjusted so that
486.14the unit rate varies no more than 1.0 percent per year from the rate effective December
486.151 of the prior calendar year. This adjustment is made annually for three calendar years
486.16from the date of implementation.
486.17(b) Rate stabilization adjustment applies to services that are authorized in a
486.18recipient's service plan prior to January 1, 2016.
486.19(c) Exemptions shall be made only when there is a significant change in the
486.20recipient's assessed needs that results in a service authorization change. Exemption
486.21adjustments shall be limited to the difference in the authorized framework rate specific to
486.22change in assessed need. Exemptions shall be managed within lead agencies' budgets per
486.23existing allocation procedures.
486.24(d) This subdivision expires January 1, 2019.

486.25    Sec. 4. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:
486.26    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
486.27on regular intervals with the existing stakeholder group established as part of the
486.28rate-setting methodology process and others, to gather input, concerns, and data, and
486.29exchange ideas for the legislative proposals for to assist in the full implementation of
486.30 the new rate payment system and to make pertinent information available to the public
486.31through the department's Web site.

486.32    Sec. 5. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:
487.1    Subd. 6. Implementation. (a) The commissioner may shall implement changes
487.2no sooner than on January 1, 2014, to payment rates for individuals receiving home and
487.3community-based waivered services after the enactment of legislation that establishes
487.4specific payment methodology frameworks, processes for rate calculations, and specific
487.5values to populate the payment methodology frameworks disability waiver rates system.
487.6(b) On January 1, 2014, all new service authorizations must use the disability waiver
487.7rates system. Beginning January 1, 2014, all renewing individual service plans must use the
487.8disability waiver rates system as reassessment and reauthorization occurs. By December
487.931, 2014, data for all recipients must be entered into the disability waiver rates system.

487.10    Sec. 6. [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS;
487.11RATE SETTING.
487.12    Subdivision 1. Application. The payment methodologies in this section apply to
487.13home and community-based services waivers under sections 256B.092 and 256B.49. This
487.14section does not change existing waiver policies and procedures.
487.15    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
487.16meanings given them, unless the context clearly indicates otherwise.
487.17(b) "Commissioner" means the commissioner of human services.
487.18(c) "Component value" means underlying factors that are part of the cost of providing
487.19services that are built into the waiver rates methodology to calculate service rates.
487.20(d) "Customized living tool" means a methodology for setting service rates that
487.21delineates and documents the amount of each component service included in a recipient's
487.22customized living service plan.
487.23(e) "Disability waiver rates system" means a statewide system that establishes rates
487.24that are based on uniform processes and captures the individualized nature of waiver
487.25services and recipient needs.
487.26(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
487.27with administering waivered services under sections 256B.092 and 256B.49.
487.28(g) "Median" means the amount that divides distribution into two equal groups, half
487.29above the median and half below the median.
487.30(h) "Payment or rate" means reimbursement to an eligible provider for services
487.31provided to a qualified individual based on an approved service authorization.
487.32(i) "Rates management system" means a Web-based software application that uses
487.33a framework and component values, as determined by the commissioner, to establish
487.34service rates.
488.1(j) "Recipient" means a person receiving home and community- based services
488.2funded under any of the disability waivers.
488.3    Subd. 3. Applicable services. Applicable services are those authorized under
488.4the state's home and community-based services waivers under sections 256B.092 and
488.5256B.49, including the following, as defined in the federally approved home and
488.6community-based services plan:
488.7(1) 24 hour customized living;
488.8(2) adult day care;
488.9(3) adult day care bath;
488.10(4) behavioral programming;
488.11(5) companion services;
488.12(6) customized living;
488.13(7) day training and habilitation;
488.14(8) housing access coordination;
488.15(9) independent living skills;
488.16(10) in-home family support;
488.17(11) night supervision;
488.18(12) personal support;
488.19(13) prevocational services;
488.20(14) residential care services;
488.21(15) residential support services;
488.22(16) respite services;
488.23(17) structured day services;
488.24(18) supported employment services;
488.25(19) supported living services;
488.26(20) transportation services; and
488.27(21) other services as approved by the federal government in the state home and
488.28community-based services plan.
488.29    Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
488.30and community-based waivered services, including rate exceptions under subdivision 12,
488.31are set via the rates management system.
488.32(b) Only data and information in the rates management system may be used to
488.33calculate an individual's rate.
488.34(c) Service providers, with information from the community support plan, shall enter
488.35values and information needed to calculate an individual's rate into the rates management
488.36system. These values and information include:
489.1(1) shared staffing hours;
489.2(2) individual staffing hours;
489.3(3) staffing ratios;
489.4(4) information to document variable levels of service qualification for variable
489.5levels of reimbursement in each framework;
489.6(5) shared or individualized arrangements for unit-based services, including the
489.7staffing ratio; and
489.8(6) number of trips and miles for transportation services.
489.9(d) Updates to individual data shall include:
489.10(1) data for each individual that is updated annually when renewing service plans; and
489.11(2) requests by individuals or lead agencies to update a rate whenever there is a
489.12change in an individual's service needs, with accompanying documentation.
489.13(e) Lead agencies shall review and approve values to calculate the final payment rate
489.14for each individual. Lead agencies must notify the individual and the service provider
489.15of the final agreed-upon values and rate. If a value used was mistakenly or erroneously
489.16entered and used to calculate a rate, a provider may petition lead agencies to correct it.
489.17Lead agencies must respond to these requests.
489.18    Subd. 5. Base wage index and standard component values. (a) The base wage
489.19index is established to determine staffing costs associated with providing services to
489.20individuals receiving home and community-based services. For purposes of developing
489.21and calculating the proposed base wage, Minnesota-specific wages taken from job
489.22descriptions and standard occupational classification (SOC) codes from the Bureau of
489.23Labor Statistics as defined in the most recent edition of the Occupational Handbook shall
489.24be used. The base wage index shall be calculated as follows:
489.25(1) for residential direct-care basic staff, 50 percent of the median wage for personal
489.26and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
489.27aide (SOC code 31-1012); and 20 percent of the median wage for social and human
489.28services aide (SOC code 21-1093);
489.29(2) for residential direct-care intensive staff, 20 percent of the median wage for home
489.30health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
489.31health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
489.3221-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
489.33and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
489.34(3) for day services, 20 percent of the median wage for nursing aide (SOC Code
489.3531-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
490.1and 60 percent of the median wage for social and human services code (SOC Code
490.221-1093);
490.3(4) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in
490.4a family foster care setting, the wage is $2.80 per hour;
490.5(5) for behavior program analyst staff, 100 percent of the median wage for mental
490.6health counselors (SOC code 21-1014);
490.7(6) for behavior program professional staff, 100 percent of the median wage for
490.8clinical counseling and school psychologist (SOC code 19-3031);
490.9(7) for behavior program specialist staff, 100 percent of the median wage for
490.10psychiatric technicians (SOC code 29-2053);
490.11(8) for supportive living services staff, 20 percent of the median wage for nursing
490.12aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
490.13code 29-2053); and 60 percent of the median wage for social and human services aide
490.14(SOC code 21-1093);
490.15(9) for housing access coordination staff, 50 percent of the median wage for
490.16community and social services specialist (SOC code 21-1099); and 50 percent of the
490.17median wage for social and human services aide (SOC code 21-1093);
490.18(10) for in-home family support staff, 20 percent of the median wage for nursing
490.19aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
490.2021-1099); 40 percent of the median wage for social and human services aide (SOC code
490.2121-1093); and ten percent of the median wage for psychiatric technician (SOC code
490.2229-2053);
490.23(11) for independent living skills staff, 40 percent of the median wage for community
490.24social service specialist (SOC code 21-1099); 50 percent of the median wage for social
490.25and human services aide (SOC code 21-1093); and ten percent of the median wage for
490.26psychiatric technician (SOC code 29-2053);
490.27(12) for supported employment staff, 20 percent of the median wage for nursing aide
490.28(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
490.29code 29-2053); and 60 percent of the median wage for social and human services aide
490.30(SOC code 21-1093);
490.31(13) for adult companion staff, 50 percent of the median wage for personal and home
490.32care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
490.33orderlies, and attendants (SOC code 31-1012);
490.34(14) for night supervision staff, 20 percent of the median wage for home health aide
490.35(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
490.36(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
491.120 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
491.2percent of the median wage for social and human services aide (SOC code 21-1093);
491.3(15) for respite staff, 50 percent of the median wage for personal and home care aide
491.4(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
491.5attendants (SOC code 31-1012);
491.6(16) for personal support staff, 50 percent of the median wage for personal and home
491.7care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
491.8orderlies, and attendants (SOC code 31-1012); and
491.9(17) for supervisory staff, the basic wage is $17.43 per hour with exception of the
491.10supervisor of behavior analyst and behavior specialists, which shall be $30.75 per hour.
491.11(b) Component values for residential support services, excluding family foster
491.12care, are:
491.13(1) supervisory span of control ratio: 11 percent;
491.14(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
491.15(3) employee-related cost ratio: 23.6 percent;
491.16(4) general administrative support ratio: 13.25 percent;
491.17(5) program-related expense ratio: 1.3 percent; and
491.18(6) absence and utilization factor ratio: 3.9 percent.
491.19(c) Component values for family foster care are:
491.20(1) supervisory span of control ratio: 11 percent;
491.21(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
491.22(3) employee-related cost ratio: 23.6 percent;
491.23(4) general administrative support ratio: 3.3 percent; and
491.24(5) program-related expense ratio: 1.3 percent.
491.25(d) Component values for day services for all services are:
491.26(1) supervisory span of control ratio: 11 percent;
491.27(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
491.28(3) employee-related cost ratio: 23.6 percent;
491.29(4) program plan support ratio: 5.6 percent;
491.30(5) client programming and support ratio: ten percent;
491.31(6) general administrative support ratio: 13.25 percent;
491.32(7) program-related expense ratio: 1.8 percent; and
491.33(8) absence and utilization factor ratio: 3.9 percent.
491.34(e) Component values for unit-based with program services are:
491.35(1) supervisory span of control ratio: 11 percent;
491.36(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
492.1(3) employee-related cost ratio: 23.6 percent;
492.2(4) program plan supports ratio: 3.1 percent;
492.3(5) client programming and supports ratio: 8.6 percent;
492.4(6) general administrative support ratio: 13.25 percent;
492.5(7) program-related expense ratio: 6.1 percent; and
492.6(8) absence and utilization factor ratio: 3.9 percent.
492.7(f) Component values for unit-based services without programming except respite
492.8are:
492.9(1) supervisory span of control ratio: 11 percent;
492.10(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
492.11(3) employee-related cost ratio: 23.6 percent;
492.12(4) program plan support ratio: 3.1 percent;
492.13(5) client programming and support ratio: 8.6 percent;
492.14(6) general administrative support ratio: 13.25 percent;
492.15(7) program-related expense ratio: 6.1 percent; and
492.16(8) absence and utilization factor ratio: 3.9 percent.
492.17(g) Component values for unit-based services without programming for respite are:
492.18(1) supervisory span of control ratio: 11 percent;
492.19(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
492.20(3) employee-related cost ratio: 23.6 percent;
492.21(4) general administrative support ratio: 13.25 percent;
492.22(5) program-related expense ratio: 6.1 percent; and
492.23(6) absence and utilization factor ratio: 3.9 percent.
492.24(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
492.25(b) based on the wage data by standard occupational code (SOC) from the Bureau of
492.26Labor Statistics available on December 31, 2016. The commissioner shall publish these
492.27updated values and load them into the rate management system. This adjustment occurs
492.28every five years. For adjustments in 2021 and beyond, the commissioner shall use the data
492.29available on December 31 of the calendar year five years prior.
492.30(i) On July 1, 2017, the commissioner shall update the framework components in
492.31paragraph (c) for changes in the Consumer Price Index. The commissioner will adjust
492.32these values higher or lower by the percentage change in the Consumer Price Index-All
492.33Items, United States city average (CPI-U) from January 1, 2014, to January 1, 2017. The
492.34commissioner shall publish these updated values and load them into the rate management
492.35system. This adjustment occurs every five years. For adjustments in 2021 and beyond, the
493.1commissioner shall use the data available on January 1 of the calendar year four years
493.2prior and January 1 of the current calendar year.
493.3    Subd. 6. Payments for residential support services. (a) Payments for residential
493.4support services, as defined in section 256B.092, subdivision 11, and section 256B.49,
493.5subdivision 22, must be calculated as follows:
493.6(1) determine the number of units of service to meet a recipient's needs;
493.7(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
493.8national and Minnesota-specific rates or rates derived by the commissioner as provided
493.9in subdivision 5. This is defined as the direct-care rate;
493.10(3) for a recipient requiring customization for deaf and hard-of-hearing language
493.11accessibility under subdivision 12, add the customization rate provided in subdivision 12
493.12to the result of clause (2). This is defined as the customized direct-care rate;
493.13(4) multiply the number of residential services direct staff hours by the appropriate
493.14staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;
493.15(5) multiply the number of direct staff hours by the product of the supervision span
493.16of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
493.17wage in subdivision 5, paragraph (a), clause (17);
493.18(6) combine the results of clauses (4) and (5), and multiply the result by one plus
493.19the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
493.20clause (2). This is defined as the direct staffing cost;
493.21(7) for employee-related expenses, multiply the direct staffing cost by one plus the
493.22employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
493.23(8) for client programming and supports, the commissioner shall add $2,179; and
493.24(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
493.25customized for adapted transport, per year.
493.26(b) The total rate shall be calculated using the following steps:
493.27(1) subtotal paragraph (a), clauses (7) to (9);
493.28(2) sum the standard general and administrative rate, the program-related expense
493.29ratio, and the absence and utilization ratio; and
493.30(3) divide the result of clause (1) by one minus the result of clause (2). This is
493.31the total payment amount.
493.32    Subd. 7. Payments for day programs. Payments for services with day programs
493.33including adult day care, day treatment and habilitation, prevocational services, and
493.34structured day services must be calculated as follows:
493.35(1) determine the number of units of service to meet a recipient's needs;
494.1(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
494.2Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
494.3(3) for a recipient requiring customization for deaf and hard-of-hearing language
494.4accessibility under subdivision 12, add the customization rate provided in subdivision 12
494.5to the result of clause (2). This is defined as the customized direct-care rate;
494.6(4) multiply the number of day program direct staff hours by the appropriate staff
494.7wage in subdivision 5. paragraph (a). or the customized direct-care rate;
494.8(5) multiply the number of day direct staff hours by the product of the supervision
494.9span of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate
494.10supervision wage in subdivision 5, paragraph (a), clause (17);
494.11(6) combine the results of clauses (4) and (5), and multiply the result by one plus
494.12the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
494.13clause (2). This is defined as the direct staffing rate;
494.14(7) for program plan support, multiply the result of clause (6) by one plus the
494.15program plan support ratio in subdivision 5, paragraph (d), clause (4);
494.16(8) for employee-related expenses, multiply the result of clause (7) by one plus the
494.17employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
494.18(9) for client programming and supports, multiply the result of clause (8) by one plus
494.19the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
494.20(10) for program facility costs, add $8.30 per week with consideration of staffing
494.21ratios to meet individual needs;
494.22(11) for adult day bath services, add $7.01 per 15 minute unit;
494.23(12) this is the subtotal rate;
494.24(13) sum the standard general and administrative rate, the program-related expense
494.25ratio, and the absence and utilization factor ratio;
494.26(14) divide the result of clause (12) by one minus the result of clause (13). This is
494.27the total payment amount;
494.28(15) for transportation provided as part of day training and habilitation for an
494.29individual who does not require a lift, add:
494.30(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
494.31without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
494.32ride in a vehicle with a lift;
494.33(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
494.34without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
494.35ride in a vehicle with a lift;
495.1(iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
495.2without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
495.3ride in a vehicle with a lift; or
495.4(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
495.5lift, $16.50 for a shared ride in a vehicle without a lift. and $20.75 for a shared ride in a
495.6vehicle with a lift;
495.7(16) for transportation provide as part of day training and habilitation for an
495.8individual who does require a lift, add:
495.9(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
495.10a lift, and $15.05 for a shared ride in a vehicle with a lift;
495.11(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
495.12lift, and $28.16 for a shared ride in a vehicle with a lift;
495.13(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
495.14a lift, and $58.76 for a shared ride in a vehicle with a lift; or
495.15(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
495.16lift, and $80.93 for a shared ride in a vehicle with a lift.
495.17    Subd. 8. Payments for unit-based services with programming. Payments for
495.18unit-based with program services, including behavior programming, housing access
495.19coordination, in-home family support, independent living skills training, hourly supported
495.20living services, and supported employment provided to an individual outside of any day or
495.21residential service plan must be calculated as follows, unless the services are authorized
495.22separately under subdivision 6 or subdivision 7:
495.23(1) determine the number of units of service to meet a recipient's needs;
495.24(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
495.25Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
495.26(3) for a recipient requiring customization for deaf and hard-of-hearing language
495.27accessibility under subdivision 12, add the customization rate provided in subdivision 12
495.28to the result of clause (2). This is defined as the customized direct-care rate;
495.29(4) multiply the number of direct staff hours by the appropriate staff wage in
495.30subdivision 5, paragraph (a), or the customized direct care rate;
495.31(5) multiply the number of direct staff hours by the product of the supervision span
495.32of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
495.33wage in subdivision 5, paragraph (a), clause (17);
495.34(6) combine the results of clauses (4) and (5), and multiply the result by one plus
495.35the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
495.36clause (2). This is defined as the direct staffing rate;
496.1(7) for program plan support, multiply the result of clause (6) by one plus the
496.2program plan supports ratio in subdivision 5, paragraph (e), clause (4);
496.3(8) for employee-related expenses, multiply the result of clause (7) by one plus the
496.4employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
496.5(9) for client programming and supports, multiply the result of clause (8) by one plus
496.6the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
496.7(10) this is the subtotal rate;
496.8(11) sum the standard general and administrative rate, the program-related expense
496.9ratio, and the absence and utilization factor ratio; and
496.10(12) divide the result of clause (10) by one minus the result of clause (11). This is
496.11the total payment amount.
496.12    Subd. 9. Payments for unit-based services without programming. Payments
496.13for unit-based without program services, including night supervision, personal support,
496.14respite, and companion care provided to an individual outside of any day or residential
496.15service plan must be calculated as follows unless the services are authorized separately
496.16under subdivision 6 or subdivision 7:
496.17(1) for all services except respite, determine the number of units of service to meet
496.18a recipient's needs;
496.19(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
496.20Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
496.21(3) for a recipient requiring customization for deaf and hard-of-hearing language
496.22accessibility under subdivision 12, add the customization rate provided in subdivision 12
496.23to the result of clause (2). This is defined as the customized direct care rate;
496.24(4) multiply the number of direct staff hours by the appropriate staff wage in
496.25subdivision 5 or the customized direct care rate;
496.26(5) multiply the number of direct staff hours by the product of the supervision span
496.27of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
496.28wage in subdivision 5, paragraph (a), clause (17);
496.29(6) combine the results of clauses (4) and (5), and multiply the result by one plus
496.30the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
496.31clause (2). This is defined as the direct staffing rate;
496.32(7) for program plan support, multiply the result of clause (6) by one plus the
496.33program plan support ratio in subdivision 5, paragraph (f), clause (4);
496.34(8) for employee-related expenses, multiply the result of clause (7) by one plus the
496.35employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
497.1(9) for client programming and supports, multiply the result of clause (8) by one plus
497.2the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
497.3(10) this is the subtotal rate;
497.4(11) sum the standard general and administrative rate, the program-related expense
497.5ratio, and the absence and utilization factor ratio;
497.6(12) divide the result of clause (10) by one minus the result of clause (11). This is
497.7the total payment amount;
497.8(13) for respite services, determine the number of daily units of service to meet an
497.9individual's needs;
497.10(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
497.11Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
497.12(15) for a recipient requiring deaf and hard-of-hearing customization under
497.13subdivision 12, add the customization rate provided in subdivision 12 to the result of
497.14clause (14). This is defined as the customized direct care rate;
497.15(16) multiply the number of direct staff hours by the appropriate staff wage in
497.16subdivision 5, paragraph (a);
497.17(17) multiply the number of direct staff hours by the product of the supervisory span
497.18of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
497.19wage in subdivision 5, paragraph (a), clause (17);
497.20(18) combine the results of clauses (16) and (17), and multiply the result by one plus
497.21the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
497.22clause (2). This is defined as the direct staffing rate;
497.23(19) for employee-related expenses, multiply the result of clause (18) by one plus
497.24the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
497.25(20) this is the subtotal rate;
497.26(21) sum the standard general and administrative rate, the program-related expense
497.27ratio, and the absence and utilization factor ratio; and
497.28(22) divide the result of clause (20) by one minus the result of clause (21). This is
497.29the total payment amount.
497.30    Subd. 10. Updating payment values and additional information. (a) The
497.31commissioner shall develop and implement uniform procedures to refine terms and update
497.32or adjust values used to calculate payment rates in this section. For calendar year 2014,
497.33the commissioner shall use the values, terms, and procedures provided in this section.
497.34(b) The commissioner shall work with stakeholders to assess efficacy of values
497.35and payment rates. The commissioner shall report back to the legislature with proposed
498.1changes for component values and recommendations for revisions on the schedule
498.2provided in paragraphs (c) and (d).
498.3(c) The commissioner shall work with stakeholders to continue refining a
498.4subset of component values, which are to be referred to as interim values, and report
498.5recommendations to the legislature by February 15, 2014. Interim component values are:
498.6transportation rates for day training and habilitation; transportation for adult day, structured
498.7day, and prevocational services; geographic difference factor; day program facility rate;
498.8services where monitoring technology replaces staff time; shared services for independent
498.9living skills training; and supported employment and billing for indirect services.
498.10(d) The commissioner shall report and make recommendations to the legislature on:
498.11February 15, 2015; February 15, 2017; February 15, 2019; and February 15, 2021. After
498.122021, reports shall be provided on a four-year cycle.
498.13(e) The commissioner shall provide a public notice via LISTSERV in October of
498.14each year beginning October 1, 2014. The notice shall contain information detailing
498.15legislatively approved changes in: calculation values, including derived wage rates
498.16and related employee and administrative factors; services utilization; county and tribal
498.17allocation changes; and information on adjustments to be made to calculation values
498.18and timing of those adjustments. Information in this notice shall be effective January
498.191 of the following year.
498.20    Subd. 11. Payment implementation. Upon implementation of the payment
498.21methodologies under this section, those payment rates supersede rates established in county
498.22contracts for recipients receiving waiver services under section 256B.092 or 256B.49.
498.23    Subd. 12. Customization of rates for individuals. (a) For persons determined to
498.24have higher needs based on being deaf or hard-of-hearing, the direct-care costs must be
498.25increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
498.26and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
498.27$2.50 per hour for waiver recipients who meet the respective criteria as determined by
498.28the commissioner.
498.29(b) For the purposes of this section, "deaf or hard-of-hearing" means:
498.30(1) the person has a developmental disability and an assessment score which
498.31indicates a hearing impairment that is severe or that the person has no useful hearing;
498.32(2) the person has a developmental disability and an expressive communications
498.33score that indicates the person uses single signs or gestures, uses an augmentative
498.34communication aid, or does not have functional communication, or the person's expressive
498.35communications is unknown; and
499.1(3) the person has a developmental disability and a communication score which
499.2indicates the person comprehends signs, gestures and modeling prompts or does not
499.3comprehend verbal, visual or gestural communication or that the person's receptive
499.4communication score is unknown; or
499.5(4) the person receives long-term care services and has an assessment score that
499.6indicates they hear only very loud sounds, have no useful hearing, or a determination
499.7cannot be made; and the person receives long-term care services and has an assessment
499.8that indicates the person communicates needs with sign language, symbol board, written
499.9messages, gestures or an interpreter; communicates with inappropriate content, makes
499.10garbled sounds or displays echolalia, or does not communicate needs.
499.11    Subd. 13. Transportation. The commissioner shall require that the purchase
499.12of transportation services be cost-effective and be limited to market rates where the
499.13transportation mode is generally available and accessible.
499.14    Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
499.15agencies must identify individuals with exceptional needs that cannot be met under the
499.16disability waiver rate system. The commissioner shall use that information to evaluate
499.17and, if necessary, approve an alternative payment rate for those individuals.
499.18(b) Lead agencies must submit exceptions requests to the state.
499.19(c) An application for a rate exception may be submitted for the following criteria:
499.20(1) an individual has service needs that cannot be met through additional units
499.21of service; or
499.22(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
499.23individual being discharged.
499.24(d) Exception requests will include the following information:
499.25(1) the service needs required by each individual that are not accounted for in
499.26subdivisions 6, 7, 8, and 9;
499.27(2) the service rate requested and the difference from the rate determined in
499.28subdivisions 6, 7, 8, and 9;
499.29(3) a basis for the underlying costs used for the rate exception and any accompanying
499.30documentation;
499.31(4) the duration of the rate exception; and
499.32(5) any contingencies for approval.
499.33(e) Approved rate exceptions shall be managed within lead agency allocations under
499.34sections 256B.092 and 256B.49.
499.35(f) Individual disability waiver recipients may request that a lead agency submit an
499.36exceptions request. A lead agency that denies such a request shall notify the individual
500.1waiver recipient of its decision and the reasons for denying the request in writing no later
500.2than 30 days after the individual's request has been made.
500.3(g) The commissioner shall determine whether to approve or deny an exception
500.4request no more than 30 days after receiving the request. If the commissioner denies the
500.5request, the commissioner shall notify the lead agency and the individual disability waiver
500.6recipient in writing of the reasons for the denial.
500.7(h) The individual disability waiver recipient may appeal any denial of an exception
500.8request by either the lead agency or the commissioner, pursuant to sections 256.045 and
500.9256.0451. When the denial of an exception request results in the proposed demission of a
500.10waiver recipient from a residential or day habilitation program, the commissioner shall
500.11issue a temporary stay of demission, when requested by the disability waiver recipient,
500.12consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
500.13The temporary stay shall remain in effect until the lead agency can provide an informed
500.14choice of appropriate, alternative services to the disability waiver.
500.15(i) Providers may petition lead agencies to update values that were entered
500.16incorrectly or erroneously into the rate management system, based on past service level
500.17discussions and determination in subdivision 4, without applying for a rate exception.
500.18    Subd. 15. County or tribal allocations. (a) Upon implementation of the disability
500.19waiver rates management system on January 1, 2014, the commissioner shall establish
500.20a method of tracking and reporting the fiscal impact of the disability waiver rates
500.21management system on individual lead agencies.
500.22(b) Beginning January 1, 2014, and continuing through full implementation on
500.23December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
500.24home and community-based waivered service budget allocations to adjust for rate
500.25differences and the resulting impact on county allocations upon implementation of the
500.26disability waiver rates system.
500.27    Subd. 16. Budget neutrality adjustment. The commissioner shall calculate the
500.28total spending for all home and community-based waiver services under the payments as
500.29defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
500.30spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
500.31for services in one particular subdivision differs, there will be a percentage adjustment
500.32to increase or decrease individual rates for the services defined in each subdivision so
500.33aggregate spending matches projections under current law.
500.34    Subd. 17. Implementation. (a) On January 1, 2014, the commissioner shall fully
500.35implement the calculation of rates for waivered services under section 256B.092 and
500.36section 256B.49 without additional legislative approval.
501.1(b) The commissioner shall phase in the application of rates determined in
501.2subdivisions 6 to 9 for two years.
501.3(c) The commissioner shall preserve rates in effect on December 31, 2013, for
501.4the two-year period.
501.5(d) The commissioner shall calculate and measure the difference in cost per
501.6individual using the historical rate and the rates under subdivisions 6 to 9 for all existing
501.7individuals. This measurement shall occur statewide, and for individuals in every county.
501.8The commissioner shall provide the results of this analysis by county for calendar year
501.92014 to the legislative committees and divisions with jurisdiction over health and human
501.10service finance by February 15, 2015.
501.11(e) The commissioner shall calculate the average rate per unit for each service by
501.12county. For individuals enrolled after January 1, 2014, individuals will receive the higher
501.13of the rate produced under subdivisions 6 to 9, or the by-county average rate.
501.14(f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.

501.15    Sec. 7. REPEALER.
501.16Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, is repealed.