1.1.................... moves to amend H.F. No. 1233, the delete everything amendment
1.2(A13-0408), as follows:
1.3Page 109, delete article 3 and insert:


1.6    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
1.7read:
1.8    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
1.9under section 256B.4914, statewide payment methodologies that meet federal waiver
1.10requirements for home and community-based waiver services for individuals with
1.11disabilities. The payment methodologies must abide by the principles of transparency
1.12and equitability across the state. The methodologies must involve a uniform process of
1.13structuring rates for each service and must promote quality and participant choice.
1.14    (b) As of January 1, 2012, counties shall not implement changes to established
1.15processes for rate-setting methodologies for individuals using components of or data
1.16from research rates.

1.17    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
1.18    Subd. 3. Payment requirements. The payment methodologies established under
1.19this section shall accommodate:
1.20(1) supervision costs;
1.21(2) staffing patterns staff compensation;
1.22(3) staffing and supervisory patterns;
1.23(3) (4) program-related expenses;
1.24(4) (5) general and administrative expenses; and
1.25(5) (6) consideration of recipient intensity.

2.1    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended by adding a
2.2subdivision to read:
2.3    Subd. 4a. Rate stabilization adjustment. (a) The commissioner of human services
2.4shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
2.5January 1, 2014. Rates must be adjusted using the new payment methodology so that
2.6the unit rate varies no more than 1.0 percent per year from the rate effective December
2.71 of the prior calendar year. This adjustment is made annually for three calendar years
2.8from the date of implementation.
2.9(b) Rate stabilization adjustment applies to services that are authorized in a
2.10recipient's service plan prior to January 1, 2014.
2.11(c) Exemptions shall be made only when there is a significant change in the
2.12recipient's assessed needs which results in a service authorization change. Exemption
2.13adjustments shall be limited to the difference in the authorized framework rate specific to
2.14change in assessed need. Exemptions shall be managed within lead agencies' budgets per
2.15existing allocation procedures.
2.16(d) This subdivision expires January 1, 2017.

2.17    Sec. 4. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:
2.18    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
2.19on regular intervals with the existing stakeholder group established as part of the
2.20rate-setting methodology process and others, to gather input, concerns, and data, and
2.21exchange ideas for the legislative proposals for to assist in the full implementation of
2.22 the new rate payment system and to make pertinent information available to the public
2.23through the department's Web site.

2.24    Sec. 5. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:
2.25    Subd. 6. Implementation. (a) The commissioner may shall implement changes
2.26no sooner than on January 1, 2014, to payment rates for individuals receiving home and
2.27community-based waivered services after the enactment of legislation that establishes
2.28specific payment methodology frameworks, processes for rate calculations, and specific
2.29values to populate the payment methodology frameworks disability waiver rates system.
2.30(b) On January 1, 2014, all new service authorizations must use the disability waiver
2.31rates system. Beginning January 1, 2014, all renewing individual service plans must use the
2.32disability waiver rates system as reassessment and reauthorization occurs. By December
2.3331, 2014, data for all recipients must be entered into the disability waiver rates system.

3.1    Sec. 6. [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS;
3.2RATE SETTING.
3.3    Subdivision 1. Application. The payment methodologies in this section apply to
3.4home and community-based services waivers under sections 256B.092 and 256B.49. This
3.5section does not change existing waiver policies and procedures.
3.6    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
3.7meanings given them, unless the context clearly indicates otherwise.
3.8(b) "Commissioner" means the commissioner of human services.
3.9(c) "Component value" means underlying factors that are part of the cost of providing
3.10services that are built into the waiver rates methodology to calculate service rates.
3.11(d) "Customized living tool" means a methodology for setting service rates which
3.12delineates and documents the amount of each component service included in a recipient's
3.13customized living service plan.
3.14(e) "Disability Waiver Rates System" means a statewide system which establishes
3.15rates that are based on uniform processes and captures the individualized nature of waiver
3.16services and recipient needs.
3.17(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
3.18with administering waivered services under sections 256B.092 and 256B.49.
3.19(g) "Median" means the amount that divides distribution into two equal groups, half
3.20above the median and half below the median.
3.21(h) "Payment or rate" means reimbursement to an eligible provider for services
3.22provided to a qualified individual based on an approved service authorization.
3.23(i) "Rates management system" means a web-based software application that uses
3.24a framework and component values, as determined by the commissioner, to establish
3.25service rates.
3.26(j) "Recipient" means a person receiving home and community- based services
3.27funded under any of the disability waivers.
3.28    Subd. 3. Applicable services. Applicable services are those authorized under the
3.29state's home and community-based services waivers under sections 256B.092 and 256B.49
3.30including, as defined in the federally approved home and community-based services plan:
3.31(1) 24 hour customized living;
3.32(2) adult day care;
3.33(3) adult day care bath;
3.34(4) behavioral programming;
3.35(5) companion services;
3.36(6) customized living;
4.1(7) day training and habilitation;
4.2(8) housing access coordination;
4.3(9) independent living skills;
4.4(10) in-home family support;
4.5(11) night supervision;
4.6(12) personal support;
4.7(13) prevocational services;
4.8(14) residential care services;
4.9(15) residential support services;
4.10(16) respite services;
4.11(17) structured day services;
4.12(18) supported employment services;
4.13(19) supported living services;
4.14(20) transportation services; and
4.15(21) other services as approved by the federal government in the state home and
4.16community-based services plan.
4.17    Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
4.18and community-based waivered services, including rate exceptions under subdivision 12
4.19are set via the rates management system.
4.20(b) Only data and information in the rates management system may be used to
4.21calculate an individual's rate.
4.22(c) Service providers, with information from the community support plan, shall enter
4.23values and information needed to calculate an individual's rate into the rates management
4.24system. These values and information include:
4.25(1) shared staffing hours;
4.26(2) individual staffing hours;
4.27(3) staffing ratios;
4.28(4) information to document variable levels of service qualification for variable
4.29levels of reimbursement in each framework;
4.30(5) shared or individualized arrangements for unit-based services, including the
4.31staffing ratio; and;
4.32(6) number of trips and miles for transportation services.
4.33(d) Updates to individual data shall include:
4.34(1) data for each individual that is updated annually when renewing service plans; and
4.35(2) requests by individuals or lead agencies to update a rate whenever there is a
4.36change in an individual's service needs, with accompanying documentation.
5.1(e) Lead agencies shall review and approve values to calculate the final payment rate
5.2for each individual. Lead agencies must notify the individual and the service provider
5.3of the final agreed upon values and rate. If a value used was mistakenly or erroneously
5.4entered and used to calculate a rate, a provider may petition lead agencies to correct it.
5.5Lead agencies must respond to these requests.
5.6    Subd. 5. Base wage index and standard component values. (a) The base wage
5.7index is established to determine staffing costs associated with providing services to
5.8individuals receiving home and community-based services. For purposes of developing
5.9and calculating the proposed base wage, Minnesota-specific wages taken from job
5.10descriptions and standard occupational classification (SOC) codes from the Bureau of
5.11Labor Statistics, as defined in the most recent edition of the Occupational Handbook shall
5.12be used. The base wage index shall be calculated as follows:
5.13(1) for residential direct care basic staff, 50 percent of the median wage for personal
5.14and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
5.15aide (SOC code 31-1012); and 20 percent of the median wage for social and human
5.16services aide (SOC code 21-1093);
5.17(2) for residential direct care intensive staff, 20 percent of the median wage for home
5.18health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
5.19health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
5.2021-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
5.21and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
5.22(3) for day services, 20 percent of the median wage for nursing aide (SOC Code
5.2331-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
5.24and 60 percent of the median wage for social and human services code (SOC Code
5.2521-1093);
5.26(4) for residential asleep overnight staff, the wage will be $7.66 per hour, except
5.27in a family foster care setting the wage is $2.80 per hour;
5.28(5) for behavior program analyst staff: 100 percent of the median wage for mental
5.29health counselors (SOC code 21-1014);
5.30(6) for behavior program professional staff: 100 percent of the median wage for
5.31clinical counseling and school psychologist (SOC code 19-3031);
5.32(7) for behavior program specialist staff: 100 percent of the median wage for
5.33psychiatric technicians (SOC code 29-2053);
5.34(8) for supportive living services staff: 20 percent of the median wage for nursing
5.35aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
6.1code 29-2053); and 60 percent of the median wage for social and human services aide
6.2(SOC code 21-1093);
6.3(9) for housing access coordination staff: 50 percent of the median wage for
6.4community and social services specialist (SOC code 21-1099); and 50 percent of the
6.5median wage for social and human services aide (SOC code 21-1093);
6.6(10) for in-home family support staff: 20 percent of the median wage for nursing
6.7aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
6.821-1099); 40 percent of the median wage for social and human services aide (SOC code
6.921-1093); and 10 percent of the median wage for psychiatric technician (SOC code
6.1029-2053);
6.11(11) for independent living skills staff: 40 percent of the median wage for
6.12community social service specialist (SOC code 21-1099); 50 percent of the median wage
6.13for social and human services aide (SOC code 21-1093); and 10 percent of the median
6.14wage for psychiatric technician (SOC code 29-2053);
6.15(12) for supported employment staff: 20 percent of the median wage for nursing
6.16aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
6.17code 29-2053); and 60 percent of the median wage for social and human services aide
6.18(SOC code 21-1093);
6.19(13) for adult companion staff: 50 percent of the median wage for personal and
6.20home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
6.21orderlies, and attendants (SOC code 31-1012);
6.22(14) for night supervision staff: 20 percent of the median wage for home health aide
6.23(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
6.24(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
6.2520 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
6.26percent of the median wage for social and human services aide (SOC code 21-1093);
6.27(15) for respite staff: 50 percent of the median wage for personal and home care aide
6.28(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
6.29attendants (SOC code 31-1012);
6.30(16) for personal support staff: 50 percent of the median wage for personal and
6.31home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
6.32aides, orderlies, and attendants (SOC code 31-1012); and
6.33(17) For supervisory staff: the basic wage is $17.43 per hour with exception of the
6.34supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
6.35(b) Component values for residential support services, excluding family foster
6.36care, are:
7.1(1) supervisory span of control ratio: 11 percent;
7.2(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
7.3(3) employee-related cost ratio: 23.6 percent;
7.4(4) general administrative support ratio: 13.25 percent;
7.5(5) program-related expense ratio: 1.3 percent; and
7.6(6) absence and utilization factor ratio: 3.9 percent.
7.7(c) Component values for family foster care are:
7.8(1) supervisory span of control ratio: 11 percent;
7.9(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
7.10(3) employee-related cost ratio: 23.6 percent;
7.11(4) general administrative support ratio: 3.3 percent; and
7.12(5) program-related expense ratio: 1.3 percent.
7.13(d) Component values for day services for all services are:
7.14(1) supervisory span of control ratio: 11 percent;
7.15(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
7.16(3) employee-related cost ratio: 23.6 percent;
7.17(4) program plan support ratio: 5.6 percent;
7.18(5) client programming and support ratio: 10 percent;
7.19(6) general administrative support ratio: 13.25 percent;
7.20(7) program-related expense ratio: 1.8 percent; and
7.21(8) absence and utilization factor ratio: 3.9 percent.
7.22(e) Component values for unit-based with program services are:
7.23(1) supervisory span of control ratio: 11 percent;
7.24(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
7.25(3) employee-related cost ratio: 23.6 percent;
7.26(4) program plan supports ratio: 3.1 percent;
7.27(5) client programming and supports ratio: 8.6 percent;
7.28(6) general administrative support ratio: 13.25 percent;
7.29(7) program-related expense ratio: 6.1 percent; and
7.30(8) absence and utilization factor ratio: 3.9 percent.
7.31(f) Component values for unit-based services without programming except respite
7.32are:
7.33(1) supervisory span of control ratio: 11 percent;
7.34(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
7.35(3) employee-related cost ratio: 23.6 percent;
7.36(4) program plan support ratio: 3.1 percent;
8.1(5) client programming and support ratio: 8.6 percent;
8.2(6) general administrative support ratio: 13.25 percent;
8.3(7) program-related expense ratio: 6.1 percent; and
8.4(8) absence and utilization factor ratio: 3.9 percent.
8.5(g) Component values for unit-based services without programming for respite are:
8.6(1) supervisory span of control ratio: 11 percent;
8.7(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
8.8(3) employee-related cost ratio: 23.6 percent;
8.9(4) general administrative support ratio: 13.25 percent;
8.10(5) program-related expense ratio: 6.1 percent; and
8.11(6) absence and utilization factor ratio: 3.9 percent.
8.12(h) The commissioner shall revise the wage rates in the manner provided in
8.13subdivision 10.
8.14    Subd. 6. Payments for residential support services. (a) Payments for residential
8.15support services, as defined in 256B.092, subdivision 11, and 256B.49 subdivision 22,
8.16must be calculated as follows:
8.17(1) determine the number of units of service to meet a recipient's needs;
8.18(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
8.19national and Minnesota-specific rates or rates derived by the commissioner as provided in
8.20subdivision 5. This is defined as the direct care rate;
8.21(3) for a recipient requiring customization for deaf and hard-of-hearing language
8.22accessibility under subdivision 12, add the customization rate provided in subdivision 12
8.23to the result of clause (2). This is defined as the customized direct care rate;
8.24(4) multiply the number of residential services direct staff hours by the appropriate
8.25staff wage in subdivision 5, paragraph (a) or the customized direct care rate;
8.26(5) multiply the number of direct staff hours by the product of the supervision span
8.27of control ratio in subdivision 5, paragraph (b) clause (1), and the appropriate supervision
8.28wage in subdivision 5 paragraph (a) clause (17);
8.29(6) combine the results of clauses (4) and (5), and multiply the result by one plus
8.30the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
8.31clause (2). This is defined as the direct staffing cost;
8.32(7) for employee-related expenses, multiply the direct staffing cost by one plus the
8.33employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
8.34(8) for client programming and supports, the commissioner shall add $2,179; and
8.35(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
8.36customized for adapted transport per year.
9.1(b) The total rate shall be calculated using the following steps:
9.2(1) subtotal paragraph (a), clauses (7) to (9);
9.3(2) sum the standard general and administrative rate, the program-related expense
9.4ratio, and the absence and utilization ratio; and
9.5(3) divide the result of clause (1) by one minus the result of clause (2). This is
9.6the total payment amount.
9.7    Subd. 7. Payments for day programs. Payments for services with day programs
9.8including adult day care, day treatment and habilitation, prevocational services, and
9.9structured day services must be calculated as follows:
9.10(1) determine the number of units of service to meet a recipient's needs;
9.11(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
9.12Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
9.13(3) for a recipient requiring customization for deaf and hard-of-hearing language
9.14accessibility under subdivision 12, add the customization rate provided in subdivision 12
9.15to the result of clause (2). This is defined as the customized direct care rate;
9.16(4) multiply the number of day program direct staff hours by the appropriate staff
9.17wage in subdivision 5 paragraph (a) or the customized direct care rate;
9.18(5) multiply the number of day direct staff hours by the product of the supervision
9.19span of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate
9.20supervision wage in paragraph subdivision 5 paragraph (a) clause (17);
9.21(6) combine the results of clauses (4) and (5), and multiply the result by one plus
9.22the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
9.23clause (2). This is defined as the direct staffing rate;
9.24(7) for program plan support, multiply the result of clause (6) by one plus the
9.25program plan support ratio in subdivision 5, paragraph (d), clause (4);
9.26(8) for employee-related expenses, multiply the result of clause (7) by one plus the
9.27employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
9.28(9) for client programming and supports, multiply the result of clause (8) by one plus
9.29the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
9.30(10) for program facility costs, add $8.30 per week with consideration of staffing
9.31ratios to meet individual needs;
9.32(11) for adult day bath services, add $7.01 per 15 minute unit;
9.33(12) this is the subtotal rate;
9.34(13) sum the standard general and administrative rate, the program-related expense
9.35ratio, and the absence and utilization factor ratio;
10.1(14) divide the result of clause (12) by one minus the result of clause (13). This is
10.2the total payment amount;
10.3(15) for transportation provided as part of day training and habilitation for an
10.4individual who does not require a lift, add:
10.5(i) $10.50 for a trip between zero and ten miles for a non-shared ride in a vehicle
10.6without a lift, $8.83 for a shared ride in a vehicle without a lift and $9.25 for a shared
10.7ride in a vehicle with a lift;
10.8(ii) $15.75 for a trip between 11 and 20 miles for a non-shared ride in a vehicle
10.9without a lift, $10.58 for a shared ride in a vehicle without a lift and $11.88 for a shared
10.10ride in a vehicle with a lift;
10.11(iii) $25.75 for a trip between 21and 50 miles for a non-shared ride in a vehicle
10.12without a lift, $13.92 for a shared ride in a vehicle without a lift and $16.88 for a shared
10.13ride in a vehicle with a lift; or
10.14(iv) $33.50 for a trip of 51 miles or more for a non-shared ride in a vehicle without
10.15a lift, $16.50 for a shared ride in a vehicle without a lift and $20.75 for a shared ride
10.16in a vehicle with a lift.;
10.17(16) for transportation provide as part of day training and habilitation for an
10.18individual who does require a lift, add:
10.19(i) $19.05 for a trip between zero and ten miles for a non-shared ride in a vehicle
10.20with a lift, and $15.05 for a shared ride in a vehicle with a lift;
10.21(ii) $32.16 for a trip between 11 and 20 miles for a non-shared ride in a vehicle with
10.22a lift, and $28.16 for a shared ride in a vehicle with a lift;
10.23(iii) $58.76 for a trip between 21 and 50 miles for a non-shared ride in a vehicle with
10.24a lift, and $58.76 for a shared ride in a vehicle with a lift; or
10.25(iv) $80.93 for a trip of 51 miles or more for a non-shared ride in a vehicle with a
10.26lift, and $80.93 for a shared ride in a vehicle with a lift.
10.27    Subd. 8. Payments for unit-based services with programming. Payments for
10.28unit-based with program services, including behavior programming, housing access
10.29coordination, in-home family support, independent living skills training, hourly supported
10.30living services, and supported employment provided to an individual outside of any day or
10.31residential service plan must be calculated as follows, unless the services are authorized
10.32separately under subdivision 6 or subdivision 7:
10.33(1) determine the number of units of service to meet a recipient's needs;
10.34(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
10.35Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
11.1(3) for a recipient requiring customization for deaf and hard-of-hearing language
11.2accessibility under subdivision 12, add the customization rate provided in subdivision 12
11.3to the result of clause (2). This is defined as the customized direct care rate;
11.4(4) multiply the number of direct staff hours by the appropriate staff wage in
11.5subdivision 5 paragraph (a) or the customized direct care rate;
11.6(5) multiply the number of direct staff hours by the product of the supervision span
11.7of control ratio in subdivision 5 paragraph (e) clause (1) and the appropriate supervision
11.8wage in subdivision 5 paragraph (a), clause (17);
11.9(6) combine the results of clauses (4) and (5), and multiply the result by one plus
11.10the employee vacation, sick, and training allowance ratio in subdivision 5 paragraph (e)
11.11clause (2). This is defined as the direct staffing rate;
11.12(7) for program plan support, multiply the result of clause (6) by one plus the
11.13program plan supports ratio in subdivision 5 paragraph (e) clause (4);
11.14(8) for employee-related expenses, multiply the result of clause (7) by one plus the
11.15employee-related cost ratio in subdivision 5 paragraph (e) clause (3);
11.16(9) for client programming and supports, multiply the result of clause (8) by one plus
11.17the client programming and supports ratio in subdivision 5 paragraph (e) clause (5);
11.18(10) this is the subtotal rate;
11.19(11) sum the standard general and administrative rate, the program-related expense
11.20ratio, and the absence and utilization factor ratio; and
11.21(12) divide the result of clause (10) by one minus the result of clause (11). This is
11.22the total payment amount.
11.23    Subd. 9. Payments for unit-based services without programming. Payments
11.24for unit-based without program services including night supervision, personal support,
11.25respite, and companion care provided to an individual outside of any day or residential
11.26service plan must be calculated as follows unless the services are authorized separately
11.27under subdivision 6 or subdivision 7:
11.28(1) for all services except respite, determine the number of units of service to meet
11.29a recipient's needs;
11.30(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
11.31Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
11.32(3) for a recipient requiring customization for deaf and hard-of-hearing language
11.33accessibility under subdivision 12, add the customization rate provided in subdivision 12
11.34to the result of clause (2). This is defined as the customized direct care rate;
11.35(4) multiply the number of direct staff hours by the appropriate staff wage in
11.36subdivision 5 or the customized direct care rate;
12.1(5) multiply the number of direct staff hours by the product of the supervision span
12.2of control ratio in subdivision 5 paragraph (f) clause (1) and the appropriate supervision
12.3wage in subdivision 5 paragraph (a) clause (17);
12.4(6) combine the results of clauses (4) and (5) and multiply the result by one plus
12.5the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
12.6clause (2). This is defined as the direct staffing rate;
12.7(7) for program plan support, multiply the result of clause (6) by one plus the
12.8program plan support ratio in subdivision 5 paragraph (f) clause (4);
12.9(8) for employee-related expenses, multiply the result of clause (7) by one plus the
12.10employee-related cost ratio in subdivision 5 paragraph (f) clause (3);
12.11(9) For client programming and supports, multiply the result of clause (8) by one
12.12plus the client programming and support ratio in subdivision 5 paragraph (f) clause (5);
12.13(10) this is the subtotal rate;
12.14(11) sum the standard general and administrative rate, the program-related expense
12.15ratio, and the absence and utilization factor ratio;
12.16(12) divide the result of clause (10) by one minus the result of clause (11). This is
12.17the total payment amount;
12.18(13) for respite services, determine the number of daily units of service to meet an
12.19individual's needs;
12.20(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
12.21Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
12.22(15) for a recipient requiring deaf and hard-of-hearing customization under
12.23subdivision 12, add the customization rate provided in subdivision 12 to the result of
12.24clause (14). This is defined as the customized direct care rate;
12.25(16) multiply the number of direct staff hours by the appropriate staff wage in
12.26subdivision 5 paragraph (a);
12.27(17) multiply the number of direct staff hours by the product of the supervisory span
12.28of control ratio in subdivision 5 paragraph (g) clause (1) and the appropriate supervision
12.29wage in subdivision 5 paragraph (a) clause (17);
12.30(18) combine the results of clauses (16) and (17) and multiply the result by one plus
12.31the employee vacation, sick, and training allowance ratio in subdivision 5 paragraph (g)
12.32clause (2). This is defined as the direct staffing rate;
12.33(19) for employee-related expenses, multiply the result of clause (18) by one plus
12.34the employee-related cost ratio in subdivision 5 paragraph (g) clause (3).
12.35(20) this is the subtotal rate;
13.1(21) sum the standard general and administrative rate, the program-related expense
13.2ratio, and the absence and utilization factor ratio; and
13.3(22) divide the result of clause (20) by one minus the result of clause (21). This is
13.4the total payment amount.
13.5    Subd. 10. Updating payment values and additional information. (a) The
13.6commissioner shall develop and implement uniform procedures to refine terms and update
13.7or adjust values used to calculate payment rates in this section. For calendar year 2014,
13.8the commissioner shall use the values, terms, and procedures provided in this section.
13.9(b) The commissioner shall work with stakeholders to assess efficacy of values
13.10and payment rates. The commissioner shall report back to the legislature with proposed
13.11changes for component values and recommendations for revisions on the schedule
13.12provided in paragraphs (c) and (d).
13.13(c) The commissioner shall work with stakeholders to continue refining a
13.14subset of component values, which are to be referred to as interim values, and report
13.15recommendations to the legislature by February 15, 2014. Interim component values are:
13.16transportation rates for day training and habilitation; transportation for adult day, structured
13.17day, and prevocational services; geographic difference factor; day program facility rate;
13.18services where monitoring technology replaces staff time; shared services for independent
13.19living skills training; and supported employment and billing for indirect services.
13.20(d) The commissioner shall report and make recommendations to the legislature on:
13.21February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
13.222021, reports shall be provided on a four-year cycle.
13.23(e) The commissioner shall provide a public notice via list serve in October of each
13.24year beginning October 1, 2014. The notice shall contain information detailing legislatively
13.25approved changes in: calculation values including derived wage rates and related employee
13.26and administrative factors; services utilization; county and tribal allocation changes
13.27and; information on adjustments to be made to calculation values and timing of those
13.28adjustments. Information in this notice shall be effective January 1 of the following year.
13.29    Subd. 11. Payment implementation. Upon implementation of the payment
13.30methodologies under this section, those payment rates supersede rates established in county
13.31contracts for recipients receiving waiver services under sections 256B.092 or 256B.49.
13.32    Subd. 12. Customization of rates for individuals. (a) For persons determined
13.33to have higher needs based on being deaf/hard-of-hearing, the direct care costs must
13.34be increased by an adjustment factor prior to calculating the rate under subdivisions 6,
13.357, 8 and 9. The customization rate with respect to deaf/hard-of-hearing persons shall be
14.1$2.50 per hour for waiver recipients who meet the respective criteria as determined by the
14.2commissioner. (b) For the purposes of this section, "Deaf or Hard of Hearing" means:
14.3(1)(i) the person has a developmental disability and an assessment score which
14.4indicates a hearing impairment that is severe or that the person has no useful hearing;
14.5(ii) the person has a developmental disability and an expressive communications
14.6score that indicates the person uses single signs or gestures, uses an augmentative
14.7communication aid, or does not have functional communication, or the person's expressive
14.8communications is unknown; and
14.9(iii) the person has a developmental disability and a communication score which
14.10indicates the person comprehends signs, gestures and modeling prompts or does not
14.11comprehend verbal, visual or gestural communication or that the person's receptive
14.12communication score is unknown; or
14.13(2)(i) the person receives long-term care services and has an assessment score which
14.14indicates they hear only very loud sounds, have no useful hearing or a determination
14.15cannot be made; and
14.16(ii) the person receives long-term care services and has an assessment which
14.17indicates the person communicates needs with sign language, symbol board, written
14.18messages, gestures or an interpreter; communicates with inappropriate content, makes
14.19garbled sounds or displays echolalia or does not communicate needs.
14.20    Subd. 13. Transportation. The commissioner shall require that the purchase
14.21of transportation services be cost-effective and be limited to market rates where the
14.22transportation mode is generally available and accessible.
14.23    Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
14.24agencies must identify individuals with exceptional needs that cannot be met under the
14.25disability waiver rate system. The commissioner shall use that information to evaluate
14.26and, if necessary, approve an alternative payment rate for those individuals.
14.27(b) Lead agencies must submit exceptions requests to the state.
14.28(c) An application for a rate exception may be submitted for the following criteria:
14.29(1) an individual has service needs that cannot be met through additional units
14.30of service; or
14.31(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
14.32individual being discharged.
14.33(d) Exception requests will include the following information:
14.34(1) the service needs required by each individual that are not accounted for in
14.35subdivisions 6, 7, 8, and 9;
15.1(2) the service rate requested and the difference from the rate determined in
15.2subdivisions 6, 7, 8, and 9;
15.3(3) a basis for the underlying costs used for the rate exception and any accompanying
15.4documentation;
15.5(4) the duration of the rate exception; and
15.6(5) any contingencies for approval.
15.7(e) Approved rate exceptions shall be managed within lead agency allocations under
15.8sections 256B.092 and 256B.49.
15.9(f) Individual disability waiver recipients may request that a lead agency submit an
15.10exceptions request. A lead agency that denies such a request shall notify the individual
15.11waiver recipient of its decision and the reasons for denying the request in writing no later
15.12than 30 days after the individual's request has been made.
15.13(g) The commissioner shall determine whether to approve or deny an exception
15.14request no more than 30 days after receiving the request. If the commissioner denies the
15.15request, the commissioner shall notify the lead agency and the individual disability waiver
15.16recipient in writing of the reasons for the denial.
15.17(h) The individual disability waiver recipient may appeal any denial of an exception
15.18request by either the lead agency or the commissioner, pursuant to Minnesota Statutes,
15.19sections 256.045 and 256.0451. When the denial of an exception request results in the
15.20proposed demission of a waiver recipient from a residential or day habilitation program, the
15.21commissioner shall issue a temporary stay of demission, when requested by the disability
15.22waiver recipient, consistent with the provisions of Minnesota Statutes, section 256.045,
15.23subdivisions 4a and 6(c). The temporary stay shall remain in effect until the lead agency
15.24can provide an informed choice of appropriate, alternative services to the disability waiver.
15.25(i) Providers may petition lead agencies to update values that were entered
15.26incorrectly or erroneously into the rate management system, based on past service level
15.27discussions and determination in subdivision 4, without applying for a rate exception.
15.28    Subd. 15. County or tribal allocations. (a) Upon implementation of the Disability
15.29Waiver Rates Management System on January 1, 2014, the commissioner shall establish
15.30a method of tracking and reporting the fiscal impact of the Disability Waiver Rates
15.31Management System on individual lead agencies.
15.32(b) Beginning January 1, 2014, and continuing through full implementation on
15.33December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
15.34home and community-based waivered service budget allocations to adjust for rate
15.35differences and the resulting impact on county allocations upon implementation of the
15.36disability waiver rates system.
16.1    Subd. 16. Budget neutrality adjustment. The commissioner shall calculate the
16.2total spending for all home and community-based waiver services under the payments as
16.3defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
16.4spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
16.5for services in one particular subdivision differs, there will be a percentage adjustment
16.6to increase or decrease individual rates for the services defined in each subdivision so
16.7aggregate spending matches projections under current law.

16.8    Sec. 7. REPEALER.
16.9Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, is repealed."