Section 1 (245A.11, subdivision 8) creates support teams for individuals receiving services under the community residential setting license. Support teams consist of:  the person; a case manager or services coordinator; the person’s legal representative; the person’s advocate, if any; and others chosen by the person.

The support team has access to all data and information in the person’s assessment, is included in all evaluations of service quality, and has the final say in plans to mitigate indentified risks.

Section 2 (256B.0911, subdivision 10) adds a subdivision instructing the Department of Human Services (DHS) to establish an assessment methodology to determine reimbursement classifications. The assessment methodology is to be completed prior to payment rate change implementation under Minnesota Statutes, section 256B.4913, allows for an appeal of assessment results, and grants DHS rulemaking authority to implement the methodology.

“High medical needs,” “high behavioral needs,” “high mental health needs,” and “deaf or hard-of-hearing” are defined.

Section 3 (256B.0916, subdivision 2) instructs DHS to adjust allocations to local agencies for home and community-based service (HCBS) waivers to reflect the total amount of spending for all recipients with disabilities in need of the level of care provided in an intermediate care facility for individuals with developmental disabilities (ICF/DD), nursing facility, or hospital under the payment methodology in section 256B.4913.

Section 4 (256B.092, subdivision 4) states that HCBS waiver resources and payment rates as of January 1, 2012, remain in place until the changes to the payment methodology in section 256B.4913 are implemented.

Section 5 (256B.49, subdivision 17) instructs DHS to adjust allocations to local agencies for HCBS waivers to reflect the total amount of spending for all recipients with disabilities in need of the level of care provided in an intermediate care facility for individuals with developmental disabilities (ICF/DD), nursing facility, or hospital under the payment methodology in section 256B.4913. It also instructs DHS on how to allocate funds to the counties and deletes unnecessary language.

Section 6 (256B.4912) terminates existing county and tribal contracts once the new payment rate methodology is implemented, and requires waiver service providers to reenroll with the state. It also specifies that no changes in existing provider rates are effective until the assessment process from section 2 of the bill is implemented.

A new subdivision is created, providing guidance and criteria used for the development of the new payment structures and methodologies, and lists the services not be reimbursed.

 Section 7 (256B.4913) creates a new section.

Subdivision 1 lists the applicable services under HCBS waivers, specified in subdivisions 3, 4, and 5.

Subdivision 2 establishes the base wage index, calculated by using data from the Bureau of Labor Statistics, for the following services: day services; residential direct care staff; residential awake overnight staff; residential asleep overnight staff; behavior programming aide staff; behavioral programming professional staff; supported employment job coach staff; supported employment job developer staff; in-home family support; housing access coordination staff; night supervision staff; respite staff; personal support staff; transportation staff; independent living skills staff; and supervisory staff.

The base wage index is updated annually, as are payment rates.

Subdivision 3 sets the methodology for calculating payments for residential settings, including supported living service, foster care, residential care, customized living, and 24-hour customized living.

The separate components for each individual’s payment are: direct supervision, including direct staff cost and supervision technology cost; employee-related expenses; transportation; client programming and supports; support costs; and administrative overhead. How each component is used in the daily rate calculation is established.

Subdivision 4 sets the methodology for calculating payments for day program services, including adult day care, family adult day care, day training and habilitation, prevocational services, and structured day services.

The separate components for each individual’s payment are: direct staffing; employee-related expenses; transportation; program plan and supports; client programming and supports; support costs; and administrative overhead. How each component is used in the daily rate calculation is established.

Subdivision 5 sets the methodology for calculating payments for individualized services, including supported employment, behavioral programming, housing access coordination, independent living services, in-home family supports, night supervision, personal supports, and respite services.

The separate components for each individual’s payment are: direct staffing; employee-related expenses; program plan and supports; client programming and supports; support costs; and administrative overhead. How each component is used in the 15-minute rate calculation is established.

Subdivision 6 creates a customization add-on in the rate calculations in subdivisions 3, 4, and 5 for people assessed to have higher needs, as defined in section 2.

Subdivision 7 creates a rate exemption process.

Subdivision 8 creates a cost neutrality adjustment, allowing DHS to apply across-the-board rate adjustments within groups of service found in subdivisions 3, 4, and 5, if spending for each group does not match spending under current law.

Subdivision 9 creates a budget neutrality adjustment, allowing DHS to make percentage adjustments to maintain aggregate spending at current levels.

Subdivision 10 makes available, upon request, the rate calculation for each individual prior to any cost or budget neutrality adjustments.

Subdivision 11 grants DHS the rulemaking authority to implement this payment methodology.

Subdivision 12 provides for rate reviews and adjustments if individuals’ needs or existing services change.

Subdivision 13 requires DHS, 12 months prior to implementation, to generate and publish provider rates calculated under the new methodology and provide an analysis to the Legislature of the impact of the rate methodology.

Section 8 makes sections 1 to 7 effective the day following final enactment, except the rate-setting provisions in section 7 apply on January 1, 2013, after the assessment methodology in section 2 is implemented.

DL/rdr