Purpose

• This bill changes how rates are set for home and community-based waiver services (HCBS) and increases room and board rates for certain individuals receiving HCBS.

Main provisions

• Rates are determined through a rates management system
  • All rates for applicable HCBS, including customized rates, are set by a central rates management system.
  • The data and information in this system are used to calculate each individual's rate.
• Data collection and inputs
  • Service providers must supply data from the support plan and other information to calculate rates, with oversight from lead agencies.
  • Lead agencies use forms provided by the commissioner to collect needed information.
  • Required data includes:
  • Shared staffing hours and individual staffing hours
  • Direct registered nurse hours and direct licensed practical nurse hours
  • Staffing ratios
  • Information documenting variable levels of service and reimbursement in each framework
  • Shared or individualized arrangements for unit-based services, including staffing ratio
  • Number of trips and miles for transportation services
  • Service hours provided through monitoring technology
• Process and timing for rate decisions
  • Updates to individual data must occur annually during service plan renewal and when requested due to changes in service needs, with accompanying documentation.
  • Lead agencies have 30 business days to review and approve all services and the final rate calculations.
  • If the lead agency does not approve a final rate within 30 days, a late payment penalty applies, equal to 10% of the total final payment rate (pro-rated as needed).
  • After final values are agreed, lead agencies must notify the individual and the service provider and provide the same information that was entered into the rates management system.
• Corrections and protections
  • If a value used to calculate a rate was entered erroneously, a provider may petition the lead agency to correct it.
  • When responding to correction requests, the lead agency must consider:
  • Meeting the health and welfare needs of the individual(s) and the specified service site
  • Meeting staffing requirements and licensing standards
  • Meeting or exceeding staffing ratio requirements
• Compliance and standards
  • Rate determinations must align with health and welfare needs, appropriate staffing standards, and applicable licensing requirements.
  • The provisions reference existing requirements in Minnesota statutes related to supports and staffing (e.g., sections in 245D-series) to ensure proper staffing and oversight.
• Scope and terminology
  • The policy covers rates for HCBS and may include adjustments related to room and board for eligible individuals receiving HCBS.

Significant changes to existing law

• Establishes a centralized rates management system as the basis for calculating HCBS rates.
• Codifies a structured data collection process from providers and lead agencies to determine individual rates.
• Introduces a formal 30-day deadline for lead agencies to approve final rates, with a 10% late payment penalty if missed.
• Requires explicit annual data updates and responses to rate correction requests.
• Ties rate decisions to defined staffing, licensing, and health/welfare standards, using specified statutory references to ensure consistency with existing caregiving and support requirements.

Relevant notes - The bill emphasizes data-driven rate setting, transparency in final rates, and accountability for timely payment and accurate rate calculations. - It expands how room and board adjustments may be applied within the HCBS rate framework.

Relevant Terms - home and community-based waiver services (HCBS) - rates management system - rate determination / final payment rate - lead agencies - support plan - support team - shared staffing hours - individual staffing hours - direct registered nurse hours - direct licensed practical nurse hours - staffing ratios - variable levels of service - unit-based services - transportation trips and miles - monitoring technology - annual data update - health and welfare needs - licensing standards - Minnesota Statutes (245D-series references) - customized rates - service authorization - service site - rate correction petition - late payment penalty