S.F. No. 2679 makes changes to the disability waiver rates system (DWRS), enacted during the 2013 Legislative Session and implemented beginning January 1, 2014. The DWRS is the statewide system for setting rates for residential support services, day programs, unit-based services with programming, and unit-based services without programming  (“applicable services”) under the Developmental Disability (DD), Community Alternative Care (CAC), Community Alternatives for Disabled Individuals (CADI), and Brain Injury (BI) waiver services.

Section 1 (256B.4913, subdivision 4a) makes changes to the rate stabilization adjustment provisions in the DWRS.

Paragraph (a) adds cross-references to the DD, CAC, CADI, and BI waiver services, and defines "banding period."

Paragraph (b) changes the term “banding value,” used to describe that rates will not go up or down by more than 0.5 percent in each of the first two years of the DWRS, or up or down by more than one percent for each of the next three years, to “historical rate.” Adds units of service to the historical rate calculation, and outlines how the historical rate is calculated for recipients of applicable services who were not authorized to receive the services prior to, or changed services on or after, January 1, 2014 (the implementation date of the DWRS).

Paragraph (c) makes a conforming language change.

Paragraph (d) requires the Department of Human Services (DHS) to review the rates and units in effect on December 1, 2013, to verify that counties reviewed the service agreements and that they continue to meet requirements in Minnesota Rules, and that the rates, units, and types of services authorized are equivalent to the those in effect on October 31, 2013.

Paragraph (e) requires DHS to complete the review in paragraph (d) by August 1, 2014, and if applicable, adjust the units or rates to provide an equivalent level of spending or authorized services and a lump-sum payment if the values in effect on November 1, 2013, would have resulted in a greater payment to the provider.

Paragraph (f) requires the historical rate to be adjusted if an individual’s need changes during the banding period.

Paragraph (g) prohibits lead agencies from recalculating historical rates if an individual relocates to another county or terminates services.

Paragraph (i) requires personal support services providers that previously operated as fiscal support entities be treated as new providers as of January 1, 2014.

Section 2 (256B.4914, subdivision 2) adds “individual staffing,” “nursing hours,” “shared staffing,” “staffing ratio,” and “unit of service” to the list of definitions.

Section 3 (256B.4914, subdivision 4) makes changes to the data collection process used to determine rates under the DWRS.

Paragraph (d) allows service providers to submit to DHS values up to two decimals, specifies that the values are determined by an interdisciplinary team, and makes language changes.

Paragraph (f) clarifies that lead agencies must review and approve values to calculate a payment rate for residential support services, day services, and unit-based services with and without programming, based on individuals’ needs. Requires lead agencies to provide individuals and service providers with the final values and rates using information as entered into the rate management system; requires that the values meet the health and safety needs of the individuals and staffing ratio requirements, and exceed licensing standards in Minnesota Statutes, chapter 245D.

Paragraph (g) requires DHS to complete a rate management system manual, with references to the existing Community-Based Services Manual, and provide a 30-day public notice allowing for public input before substantial changes are made to the manual.

Section 4 (256B.4914, subdivision 5) requires adjustments, through cross-reference changes, to the component values listed in paragraphs (b) through (g), the client programming and transportation add-ons under the residential support services rate calculation in subdivision 6, and the transportation values under the day program rate calculation in subdivision 7, according to the Consumer Price Index, every five years beginning July 1, 2017.

Section 5 (256B.4914, subdivision 6) modifies how residential support services rates are calculated under the DWRS.

Paragraph (a) specifies how shared staffing and overnight staffing hours are used to calculate the rates for residential support services, and changes the transportation add-on from $1,680 per person to $7,500 per site, or from $3,000 per person to $12,000 per site if adaptive transport is used, based on the resident with the highest assessed need.

Paragraph (e) requires, for individuals enrolled prior to January 1, 2014, the number of service days authorized to meet or exceed the days of service used to convert service agreements effective December 1, 2013, in order to prevent a reduction in spending or service utilization during the implementation period. Also requires an individual to be authorized for 365 days of service if the historical rate is equal to the new rate calculated under the rate management system.

Paragraph (f) sets the standard for the number of days authorized at 365 days for individuals enrolling in residential support services after January 1, 2014, and requires the number of days authorized to include every day that services start and end.

Paragraph (g) requires DHS to use annual average values when comparing the values used to set an individual’s residential support services rate under the Surveillance and Integrity Review Program.

Section 6 (256B.4914, subdivision 7) requires the determination of staffing ratios in the rate calculation process for day services; requires DHS to consult with service providers on developing a uniform staffing ratio worksheet; modifies transportation rates by applying the existing rates for roundtrips to one-way trips; and requires DHS to use annual average values when comparing the values used to set an individual’s day services rate under the Surveillance and Integrity Review Program.

Section 7 (256B.4914, subdivision 8) requires DHS to use annual average values when comparing the values used to set an individual’s unit-based services with programming rate under the Surveillance and Integrity Review Program.

Section 8 (256B.4914, subdivision 9) requires lead agencies to authorize units of service that are equal to or greater than the units of service authorized on October 31, 2013, for those receiving personal support services prior to January 1, 2014, unless needs have decreased; requires lead agencies to authorize units of service that exceed the average number of units authorized in each county on October 1, 2013, for individuals authorized for personal support services on or after January 1, 2014; and requires DHS to use annual average values when comparing the values used to set an individual’s unit-based services without programming rate under the Surveillance and Integrity Review Program.

Section 9 (256B.4914, subdivision 10) modifies provisions regarding updating and adjusting payment values in the DWRS.

Paragraph (b) specifies that DHS must begin conducting research and gathering data no later than July 1, 2014, and adds additional transportation-related data and the underlying cost of caring for recipients with a primary diagnosis of mental illness to the list of data DHS is required to collect and analyze.

Paragraph (c) requires DHS to issue monthly reports to stakeholders on the difference in rates, by service and county, for individuals after removing identifying information, with the first report covering January 1, 2014, through June 30, 2014, and issued at the July 2014 stakeholder meeting.

Paragraph (d) specifies that DHS, in consultation with stakeholders, must begin reviewing and evaluating the values  entered into the DWRS from January 1, 2014 to June 30, 2014 no later than July 1, 2014, including a review and evaluation of values to account for employer-provided health insurance and electronic medical record requirements.

Paragraph (f) requires DHS to make recommendations to the Legislature by January 15, 2015, to address issues identified during the DWRS’s first year of implementation, and allows DHS to make recommendations on potential issues to the Legislature after January 15, 2015.

Section 10 (256B.4914, subdivision 14) adds to the list of exceptions used by DHS to approve an alternative payment rate under the DWRS values used to calculate rates that do not reflect the underlying cost of providing any of the applicable services.

Section 11 (256B.4914, subdivision 15) allows lead agencies to be liable for excess spending in their home and community-based waivered service budget allocations due to adjustments for rate differences only after a reallocation by DHS, and requires DHS to notify lead agencies of this process by July 1, 2014.

Section 12 (256B.4914, subdivision 16) modifies budget neutrality adjustment provisions.

Paragraph (b) changes when DHS is required to compare the spending under the DWRS to the spending prior to the DWRS to be in conjunction with the November 2014 budget forecast (instead of within 12 months of January 1, 2014).

Paragraph (c) requires DHS to provide Minnesota Management and Budget (MMB) with the total level of spending under the DWRS for each applicable service; requires MMB to preserve the total spending level for these services, in the aggregate, prior to the DWRS if aggregate spending is lower.

Paragraph (d) requires DHS to assure aggregate spending in each applicable service meets the total in the November 2014 forecast if the total level of spending prior to the implementation of the DWRS is used.

Section 13 (246B.4914, subdivision 17) adds a new subdivision providing for an appeals process for providers.

Paragraph (a) lists the actions of a lead agency that may be appealed by a provider or group of providers.

Paragraph (b) lists the appeal criteria.

Paragraph (c) requires an appeal to be heard under the contested case provisions in sections 14.57 to 14.62 and Minnesota Rules, and allows for any informal dispute resolution method when both parties come to an agreement.

Paragraph (d) requires any reimbursement as a result of an appeal be paid via a lump sum directly to the provider.

Section 14 (256B.4914, subdivision 18) adds a new subdivision providing a disability waiver recipient appeals process under existing DHS procedures for values used to calculate applicable service rates.  

Section 15 requires DHS to adjust the historical rate, and the applicable service rates, in the DWRS for the one percent long-term care rate increase effective April 1, 2014, and any additional rate increases enacted during the 2014 Legislative Session.

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