1.1 	A bill for an act
1.2 	relating to human services; modifying rates for certain disability waiver services; 
1.3 	modifying rates for certain elderly waiver services; modifying rate floors for certain 
1.4 	customized living services; modifying rates for nursing facilities; establishing rate 
1.5 	floors for intermediate care facilities for persons with developmental disabilities; 
1.6 	modifying rates for intermediate care facilities for persons with developmental 
1.7 	disabilities; modifying rates for community first services and supports; modifying 
1.8 	rates for personal care assistance services; modifying rates for certain home care 
1.9 	services; modifying rates for nonemergency medical transportation services; 
1.10 	establishing a fuel cost rate adjustment for medical transportation services; 
1.11 	modifying provisions related to home and community-based services; modifying 
1.12 	provisions related to the emergency staffing pool; establishing a residential settings 
1.13 	closure prevention grant program; appropriating money;amending Minnesota 
1.14 	Statutes 2022, sections 256B.0625, subdivisions 17, 17a; 256B.0659, subdivisions 
1.15 	1, 12, 17a, 19, 24; 256B.0913, subdivisions 4, 5; 256B.4911, by adding a 
1.16 	subdivision; 256B.4912, by adding a subdivision; 256B.4914, subdivisions 3, as 
1.17 	amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by adding a subdivision; 
1.18 	256B.5012, by adding subdivisions; 256B.85, subdivisions 7, 7a, by adding a 
1.19 	subdivision; 256B.851, subdivision 5; 256E.35, subdivisions 1, 2, 4a, 6, 7; 256P.02, 
1.20 	by adding a subdivision; 256R.02, subdivisions 16, 24, 26, 29, 34, by adding 
1.21 	subdivisions; 256R.23, subdivisions 2, 3; 256R.24, subdivision 1; 256R.25; 
1.22 	256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision 
1.23 	3; 256S.205, subdivisions 3, 5; 256S.2101, subdivisions 1, 2, by adding 
1.24 	subdivisions; 256S.212; 256S.213; 256S.214; 256S.215; Laws 2022, chapter 40, 
1.25 	section 6; proposing coding for new law in Minnesota Statutes, chapter 256; 
1.26 	repealing Minnesota Statutes 2022, sections 256B.4914, subdivision 9a; 256S.19, 
1.27 	subdivision 4.
1.28 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.29 	ARTICLE 1
1.30 	CAREGIVERS STABILIZATION ACT

1.31 	Section 1. TITLE.
 1.32 	This act may be cited as the "Caregivers Stabilization Act of 2023."

2.1 	ARTICLE 2
2.2 	DISABILITY WAIVERS

2.3 	Section 1. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision 
2.4 	to read:
2.5 		Subd. 16.Rates established by the commissioner. For homemaker services eligible 
2.6 	for reimbursement under the developmental disabilities waiver, the brain injury waiver, the 
2.7 	community alternative care waiver, and the community access for disability inclusion waiver, 
2.8 	the commissioner must establish rates equal to the rates established under sections 256S.21 
2.9 	to 256S.215 for the corresponding homemaker services.

2.10 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
2.11 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
2.12 	when federal approval is obtained.

2.13 	Sec. 2. Minnesota Statutes 2022, section 256B.4914, subdivision 3, is amended to read:
2.14 		Subd. 3.Applicable services. Applicable services are those authorized under the state's 
2.15 	home and community-based services waivers under sections 256B.092 and 256B.49, 
2.16 	including the following, as defined in the federally approved home and community-based 
2.17 	services plan:
2.18 	(1) 24-hour customized living;
2.19 	(2) adult day services;
2.20 	(3) adult day services bath;
2.21 	(4) community residential services;
2.22 	(5) customized living;
2.23 	(6) day support services;
2.24 	(7) employment development services;
2.25 	(8) employment exploration services;
2.26 	(9) employment support services;
2.27 	(10) family residential services;
2.28 	(11) individualized home supports;
2.29 	(12) individualized home supports with family training;
3.1 	(13) individualized home supports with training;
3.2 	(14) integrated community supports;
3.3 	(15) night supervision;
3.4 	(16) positive support services;
3.5 	(17) prevocational services;
3.6 	(18) residential support services;
3.7 	(19) respite services;
3.8 	(20) transportation services; and
3.9 	(21) (20) other services as approved by the federal government in the state home and 
3.10 	community-based services waiver plan.

3.11 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
3.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
3.13 	when federal approval is obtained.

3.14 	Sec. 3. Minnesota Statutes 2022, section 256B.4914, subdivision 4, is amended to read:
3.15 		Subd. 4.Data collection for rate determination. (a) Rates for applicable home and 
3.16 	community-based waivered services, including customized rates under subdivision 12, are 
3.17 	set by the rates management system.
3.18 	(b) Data and information in the rates management system must be used to calculate an 
3.19 	individual's rate.
3.20 	(c) Service providers, with information from the support plan and oversight by lead 
3.21 	agencies, shall provide values and information needed to calculate an individual's rate in 
3.22 	the rates management system. The determination of service levels must be part of a discussion 
3.23 	with members of the support team as defined in section 245D.02, subdivision 34. This 
3.24 	discussion must occur prior to the final establishment of each individual's rate. The values 
3.25 	and information include:
3.26 	(1) shared staffing hours;
3.27 	(2) individual staffing hours;
3.28 	(3) direct registered nurse hours;
3.29 	(4) direct licensed practical nurse hours;
3.30 	(5) staffing ratios;
4.1 	(6) information to document variable levels of service qualification for variable levels 
4.2 	of reimbursement in each framework;
4.3 	(7) shared or individualized arrangements for unit-based services, including the staffing 
4.4 	ratio;
4.5 	(8) number of trips and miles for transportation services; and
4.6 	(9) service hours provided through monitoring technology.
4.7 	(d) Updates to individual data must include:
4.8 	(1) data for each individual that is updated annually when renewing service plans; and
4.9 	(2) requests by individuals or lead agencies to update a rate whenever there is a change 
4.10 	in an individual's service needs, with accompanying documentation.
4.11 	(e) Lead agencies shall review and approve all services reflecting each individual's needs, 
4.12 	and the values to calculate the final payment rate for services with variables under 
4.13 	subdivisions 6 to 9a 9 for each individual. Lead agencies must notify the individual and the 
4.14 	service provider of the final agreed-upon values and rate, and provide information that is 
4.15 	identical to what was entered into the rates management system. If a value used was 
4.16 	mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead 
4.17 	agencies to correct it. Lead agencies must respond to these requests. When responding to 
4.18 	the request, the lead agency must consider:
4.19 	(1) meeting the health and welfare needs of the individual or individuals receiving 
4.20 	services by service site, identified in their support plan under section 245D.02, subdivision 
4.21 	4b, and any addendum under section 245D.02, subdivision 4c;
4.22 	(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and 
4.23 	(o); and meeting or exceeding the licensing standards for staffing required under section 
4.24 	245D.09, subdivision 1; and
4.25 	(3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and 
4.26 	meeting or exceeding the licensing standards for staffing required under section 245D.31.

4.27 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
4.28 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
4.29 	when federal approval is obtained.

5.1 	Sec. 4. Minnesota Statutes 2022, section 256B.4914, subdivision 5, is amended to read:
5.2 		Subd. 5.Base wage index; establishment and updates. (a) The base wage index is 
5.3 	established to determine staffing costs associated with providing services to individuals 
5.4 	receiving home and community-based services. For purposes of calculating the base wage, 
5.5 	Minnesota-specific wages taken from job descriptions and standard occupational 
5.6 	classification (SOC) codes from the Bureau of Labor Statistics as defined in the Occupational 
5.7 	Handbook must be used.
5.8 	(b) The commissioner shall update the base wage index in subdivision 5a, publish these 
5.9 	updated values, and load them into the rate management system as follows:
5.10 	(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics 
5.11 	available as of December 31, 2019; and
5.12 	(2) on November 1, 2024, based on wage data by SOC from the Bureau of Labor Statistics 
5.13 	available as of December 31, 2021; and
5.14 	(3)(2) on July 1, 2026 January 1, 2024, and every two years thereafter, based on wage 
5.15 	data by SOC from the Bureau of Labor Statistics available 30 24 months and one day prior 
5.16 	to the scheduled update.

5.17 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
5.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
5.19 	when federal approval is obtained.

5.20 	Sec. 5. Minnesota Statutes 2022, section 256B.4914, subdivision 5a, is amended to read:
5.21 		Subd. 5a.Base wage index; calculations. The base wage index must be calculated as 
5.22 	follows:
5.23 	(1) for supervisory staff, 100 percent of the median wage for community and social 
5.24 	services specialist (SOC code 21-1099), with the exception of the supervisor of positive 
5.25 	supports professional, positive supports analyst, and positive supports specialist, which is 
5.26 	100 percent of the median wage for clinical counseling and school psychologist (SOC code 
5.27 	19-3031);
5.28 	(2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC 
5.29 	code 29-1141);
5.30 	(3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical 
5.31 	nurses (SOC code 29-2061);
6.1 	(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large 
6.2 	employers, with the exception of asleep-overnight staff for family residential services, which 
6.3 	is 36 percent of the minimum wage in Minnesota for large employers;
6.4 	(5) for residential direct care staff, the sum of:
6.5 	(i) 15 percent of the subtotal of 50 percent of the median wage for home health and 
6.6 	personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant 
6.7 	(SOC code 31-1131); and 20 percent of the median wage for social and human services 
6.8 	aide (SOC code 21-1093); and
6.9 	(ii) 85 percent of the subtotal of 40 percent of the median wage for home health and 
6.10 	personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant 
6.11 	(SOC code 31-1014 31-1131); 20 percent of the median wage for psychiatric technician 
6.12 	(SOC code 29-2053); and 20 percent of the median wage for social and human services 
6.13 	aide (SOC code 21-1093);
6.14 	(6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC 
6.15 	code 31-1131); and 30 percent of the median wage for home health and personal care aide 
6.16 	(SOC code 31-1120);
6.17 	(7) for day support services staff and prevocational services staff, 20 percent of the 
6.18 	median wage for nursing assistant (SOC code 31-1131); 20 percent of the median wage for 
6.19 	psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social 
6.20 	and human services aide (SOC code 21-1093);
6.21 	(8) for positive supports analyst staff, 100 percent of the median wage for substance 
6.22 	abuse, behavioral disorder, and mental health counselor (SOC code 21-1018);
6.23 	(9) for positive supports professional staff, 100 percent of the median wage for clinical 
6.24 	counseling and school psychologist (SOC code 19-3031);
6.25 	(10) for positive supports specialist staff, 100 percent of the median wage for psychiatric 
6.26 	technicians (SOC code 29-2053);
6.27 	(11) for individualized home supports with family training staff, 20 percent of the median 
6.28 	wage for nursing aide (SOC code 31-1131); 30 percent of the median wage for community 
6.29 	social service specialist (SOC code 21-1099); 40 percent of the median wage for social and 
6.30 	human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric 
6.31 	technician (SOC code 29-2053);
6.32 	(12) for individualized home supports with training services staff, 40 percent of the 
6.33 	median wage for community social service specialist (SOC code 21-1099); 50 percent of 
7.1 	the median wage for social and human services aide (SOC code 21-1093); and ten percent 
7.2 	of the median wage for psychiatric technician (SOC code 29-2053);
7.3 	(13) for employment support services staff, 50 percent of the median wage for 
7.4 	rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for 
7.5 	community and social services specialist (SOC code 21-1099);
7.6 	(14) for employment exploration services staff, 50 percent of the median wage for 
7.7 	rehabilitation counselor (SOC code 21-1015) education, guidance, school, and vocational 
7.8 	counselor (SOC code 21-1012); and 50 percent of the median wage for community and 
7.9 	social services specialist (SOC code 21-1099);
7.10 	(15) for employment development services staff, 50 percent of the median wage for 
7.11 	education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent 
7.12 	of the median wage for community and social services specialist (SOC code 21-1099);
7.13 	(16) for individualized home support without training staff, 50 percent of the median 
7.14 	wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the 
7.15 	median wage for nursing assistant (SOC code 31-1131); and
7.16 	(17) for night supervision staff, 40 percent of the median wage for home health and 
7.17 	personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant 
7.18 	(SOC code 31-1131); 20 percent of the median wage for psychiatric technician (SOC code 
7.19 	29-2053); and 20 percent of the median wage for social and human services aide (SOC code 
7.20 	21-1093); and.
7.21 	(18) for respite staff, 50 percent of the median wage for home health and personal care 
7.22 	aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC 
7.23 	code 31-1014).

7.24 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
7.25 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
7.26 	when federal approval is obtained.

7.27 	Sec. 6. Minnesota Statutes 2022, section 256B.4914, subdivision 5b, is amended to read:
7.28 		Subd. 5b.Standard component value adjustments. The commissioner shall update 
7.29 	the client and programming support, transportation, and program facility cost component 
7.30 	values as required in subdivisions 6 to 9a 9 for changes in the Consumer Price Index. The 
7.31 	commissioner shall adjust these values higher or lower, publish these updated values, and 
7.32 	load them into the rate management system as follows:
8.1 	(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the 
8.2 	previous update to the data available on December 31, 2019; and
8.3 	(2) on November 1, 2024, by the percentage change in the CPI-U from the date of the 
8.4 	previous update to the data available as of December 31, 2021; and
8.5 	(3) (2) on July January 1, 2026 2024, and every two years thereafter, by the percentage 
8.6 	change in the CPI-U from the date of the previous update to the data available 30 12 months 
8.7 	and one day prior to the scheduled update.

8.8 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
8.9 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
8.10 	when federal approval is obtained.

8.11 	Sec. 7. Minnesota Statutes 2022, section 256B.4914, subdivision 5c, is amended to read:
8.12 		Subd. 5c.Removal of after-framework adjustments. Any rate adjustments applied to 
8.13 	the service rates calculated under this section outside of the cost components and rate 
8.14 	methodology specified in this section shall be removed from rate calculations upon 
8.15 	implementation of the updates under subdivisions 5 and, 5b, and 5f.

8.16 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
8.17 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
8.18 	when federal approval is obtained.

8.19 	Sec. 8. Minnesota Statutes 2022, section 256B.4914, subdivision 5d, is amended to read:
8.20 		Subd. 5d.Unavailable data for updates and adjustments. If Bureau of Labor Statistics 
8.21 	occupational codes or Consumer Price Index items specified in subdivision 5 or, 5b, or 5f
8.22 	are unavailable in the future, the commissioner shall recommend to the legislature codes or 
8.23 	items to update and replace.

8.24 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
8.25 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
8.26 	when federal approval is obtained.

8.27 	Sec. 9. Minnesota Statutes 2022, section 256B.4914, subdivision 5e, is amended to read:
8.28 		Subd. 5e.Inflationary update spending requirement. (a) At least 80 percent of the 
8.29 	marginal increase in revenue from the rate adjustment applied to the service rates adjustments
8.30 	calculated under subdivisions 5 and, 5b beginning on January 1, 2022, and 5f for services 
8.31 	rendered between January 1, 2022, and March 31, 2024, on or after the day of implementation 
9.1 	of the adjustment must be used to increase compensation-related costs for employees directly 
9.2 	employed by the program on or after January 1, 2022.
9.3 	(b) For the purposes of this subdivision, compensation-related costs include:
9.4 	(1) wages and salaries;
9.5 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
9.6 	taxes, workers' compensation, and mileage reimbursement;
9.7 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
9.8 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
9.9 	employee retirement accounts; and
9.10 	(4) benefits that address direct support professional workforce needs above and beyond 
9.11 	what employees were offered prior to January 1, 2022 implementation of the applicable 
9.12 	rate adjustment, including retention and recruitment bonuses and tuition reimbursement.
9.13 	(c) Compensation-related costs for persons employed in the central office of a corporation 
9.14 	or entity that has an ownership interest in the provider or exercises control over the provider, 
9.15 	or for persons paid by the provider under a management contract, do not count toward the 
9.16 	80 percent requirement under this subdivision.
9.17 	(d) A provider agency or individual provider that receives a rate subject to the 
9.18 	requirements of this subdivision shall prepare, and upon request submit to the commissioner, 
9.19 	a distribution plan that specifies the amount of money the provider expects to receive that 
9.20 	is subject to the requirements of this subdivision, including how that money was or will be 
9.21 	distributed to increase compensation-related costs for employees. Within 60 days of final 
9.22 	implementation of a rate adjustment subject to the requirements of this subdivision, the 
9.23 	provider must post the distribution plan and leave it posted for a period of at least six months 
9.24 	in an area of the provider's operation to which all direct support professionals have access.
9.25 	The posted distribution plan must include instructions regarding how to contact the 
9.26 	commissioner or commissioner's representative if an employee believes the employee has 
9.27 	not received the compensation-related increase described in the plan.
9.28 	(e) This subdivision expires June 30, 2024.

9.29 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
9.30 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
9.31 	when federal approval is obtained.

10.1 	Sec. 10. Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision 
10.2 	to read:
10.3 		Subd. 5f.Competitive workforce factor adjustments. (a) On January 1, 2024, and 
10.4 	every two years thereafter, the commissioner shall update the competitive workforce factor 
10.5 	to equal the differential between:
10.6 	(1) the most recently available wage data by SOC code for the weighted average wage 
10.7 	for direct care staff for residential support services and direct care staff for day programs; 
10.8 	and
10.9 	(2) the most recently available wage data by SOC code of the weighted average wage 
10.10 	of comparable occupations.
10.11 	(b) For each update of the competitive workforce factor, the update must not decrease 
10.12 	the competitive workforce factor by more than 2.0. If the competitive workforce factor is 
10.13 	less than or equal to zero, then the competitive workforce factor is zero.

10.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
10.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
10.16 	when federal approval is obtained.

10.17 	Sec. 11. Minnesota Statutes 2022, section 256B.4914, subdivision 8, is amended to read:
10.18 		Subd. 8. Unit-based services with programming; component values and calculation 
10.19 	of payment rates. (a) For the purpose of this section, unit-based services with programming 
10.20 	include employment exploration services, employment development services, employment 
10.21 	support services, individualized home supports with family training, individualized home 
10.22 	supports with training, and positive support services provided to an individual outside of 
10.23 	any service plan for a day program or residential support service.
10.24 	(b) Component values for unit-based services with programming are:
10.25 	(1) competitive workforce factor: 4.7 percent;
10.26 	(2) supervisory span of control ratio: 11 percent;
10.27 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
10.28 	(4) employee-related cost ratio: 23.6 percent;
10.29 	(5) program plan support ratio: 15.5 percent;
10.30 	(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision 
10.31 	5b;
11.1 	(7) general administrative support ratio: 13.25 percent;
11.2 	(8) program-related expense ratio: 6.1 percent; and
11.3 	(9) absence and utilization factor ratio: 3.9 percent.
11.4 	(c) A unit of service for unit-based services with programming is 15 minutes.
11.5 	(d) Payments for unit-based services with programming must be calculated as follows, 
11.6 	unless the services are reimbursed separately as part of a residential support services or day 
11.7 	program payment rate:
11.8 	(1) determine the number of units of service to meet a recipient's needs;
11.9 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
11.10 	provided in subdivisions 5 and 5a;
11.11 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
11.12 	product of one plus the competitive workforce factor;
11.13 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
11.14 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
11.15 	to the result of clause (3);
11.16 	(5) multiply the number of direct staffing hours by the appropriate staff wage;
11.17 	(6) multiply the number of direct staffing hours by the product of the supervisory span 
11.18 	of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
11.19 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
11.20 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
11.21 	rate;
11.22 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
11.23 	plan support ratio;
11.24 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
11.25 	employee-related cost ratio;
11.26 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
11.27 	the client programming and support ratio;
11.28 	(11) this is the subtotal rate;
11.29 	(12) sum the standard general administrative support ratio, the program-related expense 
11.30 	ratio, and the absence and utilization factor ratio;
12.1 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
12.2 	total payment amount;
12.3 	(14) for services provided in a shared manner, divide the total payment in clause (13) 
12.4 	as follows:
12.5 	(i) for employment exploration services, divide by the number of service recipients, not 
12.6 	to exceed five;
12.7 	(ii) for employment support services, divide by the number of service recipients, not to 
12.8 	exceed six; and
12.9 	(iii) for individualized home supports with training and individualized home supports 
12.10 	with family training, divide by the number of service recipients, not to exceed two three; 
12.11 	and
12.12 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
12.13 	to adjust for regional differences in the cost of providing services.

12.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
12.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
12.16 	when federal approval is obtained.

12.17 	Sec. 12. Minnesota Statutes 2022, section 256B.4914, subdivision 9, is amended to read:
12.18 		Subd. 9. Unit-based services without programming; component values and 
12.19 	calculation of payment rates. (a) For the purposes of this section, unit-based services 
12.20 	without programming include individualized home supports without training and night 
12.21 	supervision provided to an individual outside of any service plan for a day program or 
12.22 	residential support service. Unit-based services without programming do not include respite.
12.23 	(b) Component values for unit-based services without programming are:
12.24 	(1) competitive workforce factor: 4.7 percent;
12.25 	(2) supervisory span of control ratio: 11 percent;
12.26 	(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
12.27 	(4) employee-related cost ratio: 23.6 percent;
12.28 	(5) program plan support ratio: 7.0 percent;
12.29 	(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision 
12.30 	5b;
13.1 	(7) general administrative support ratio: 13.25 percent;
13.2 	(8) program-related expense ratio: 2.9 percent; and
13.3 	(9) absence and utilization factor ratio: 3.9 percent.
13.4 	(c) A unit of service for unit-based services without programming is 15 minutes.
13.5 	(d) Payments for unit-based services without programming must be calculated as follows 
13.6 	unless the services are reimbursed separately as part of a residential support services or day 
13.7 	program payment rate:
13.8 	(1) determine the number of units of service to meet a recipient's needs;
13.9 	(2) determine the appropriate hourly staff wage rates derived by the commissioner as 
13.10 	provided in subdivisions 5 to 5a;
13.11 	(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the 
13.12 	product of one plus the competitive workforce factor;
13.13 	(4) for a recipient requiring customization for deaf and hard-of-hearing language 
13.14 	accessibility under subdivision 12, add the customization rate provided in subdivision 12 
13.15 	to the result of clause (3);
13.16 	(5) multiply the number of direct staffing hours by the appropriate staff wage;
13.17 	(6) multiply the number of direct staffing hours by the product of the supervisory span 
13.18 	of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
13.19 	(7) combine the results of clauses (5) and (6), and multiply the result by one plus the 
13.20 	employee vacation, sick, and training allowance ratio. This is defined as the direct staffing 
13.21 	rate;
13.22 	(8) for program plan support, multiply the result of clause (7) by one plus the program 
13.23 	plan support ratio;
13.24 	(9) for employee-related expenses, multiply the result of clause (8) by one plus the 
13.25 	employee-related cost ratio;
13.26 	(10) for client programming and supports, multiply the result of clause (9) by one plus 
13.27 	the client programming and support ratio;
13.28 	(11) this is the subtotal rate;
13.29 	(12) sum the standard general administrative support ratio, the program-related expense 
13.30 	ratio, and the absence and utilization factor ratio;
14.1 	(13) divide the result of clause (11) by one minus the result of clause (12). This is the 
14.2 	total payment amount;
14.3 	(14) for individualized home supports without training provided in a shared manner, 
14.4 	divide the total payment amount in clause (13) by the number of service recipients, not to 
14.5 	exceed two three; and
14.6 	(15) adjust the result of clause (14) by a factor to be determined by the commissioner 
14.7 	to adjust for regional differences in the cost of providing services.

14.8 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
14.9 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
14.10 	when federal approval is obtained.

14.11 	Sec. 13. Minnesota Statutes 2022, section 256B.4914, subdivision 10, is amended to read:
14.12 		Subd. 10.Evaluation of information and data. (a) The commissioner shall, within 
14.13 	available resources, conduct research and gather data and information from existing state 
14.14 	systems or other outside sources on the following items:
14.15 	(1) differences in the underlying cost to provide services and care across the state;
14.16 	(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and 
14.17 	units of transportation for all day services, which must be collected from providers using 
14.18 	the rate management worksheet and entered into the rates management system; and
14.19 	(3) the distinct underlying costs for services provided by a license holder under sections 
14.20 	245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided 
14.21 	by a license holder certified under section 245D.33.
14.22 	(b) The commissioner, in consultation with stakeholders, shall review and evaluate the 
14.23 	following values already in subdivisions 6 to 9a 9, or issues that impact all services, including, 
14.24 	but not limited to:
14.25 	(1) values for transportation rates;
14.26 	(2) values for services where monitoring technology replaces staff time;
14.27 	(3) values for indirect services;
14.28 	(4) values for nursing;
14.29 	(5) values for the facility use rate in day services, and the weightings used in the day 
14.30 	service ratios and adjustments to those weightings;
14.31 	(6) values for workers' compensation as part of employee-related expenses;
15.1 	(7) values for unemployment insurance as part of employee-related expenses;
15.2 	(8) direct care workforce labor market measures;
15.3 	(9) any changes in state or federal law with a direct impact on the underlying cost of 
15.4 	providing home and community-based services;
15.5 	(10) outcome measures, determined by the commissioner, for home and community-based 
15.6 	services rates determined under this section; and
15.7 	(11) different competitive workforce factors by service, as determined under subdivision 
15.8 	10b.
15.9 	(c) The commissioner shall report to the chairs and the ranking minority members of 
15.10 	the legislative committees and divisions with jurisdiction over health and human services 
15.11 	policy and finance with the information and data gathered under paragraphs (a) and (b) on 
15.12 	January 15, 2021, with a full report, and a full report once every four years thereafter.
15.13 	(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement 
15.14 	changes to the regional adjustment factors once every six years. Prior to implementation, 
15.15 	the commissioner shall consult with stakeholders on the methodology to calculate the 
15.16 	adjustment.

15.17 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
15.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
15.19 	when federal approval is obtained.

15.20 	Sec. 14. Minnesota Statutes 2022, section 256B.4914, subdivision 10a, is amended to 
15.21 	read:
15.22 		Subd. 10a.Reporting and analysis of cost data. (a) The commissioner must ensure 
15.23 	that wage values and component values in subdivisions 5 to 9a 9 reflect the cost to provide 
15.24 	the service. As determined by the commissioner, in consultation with stakeholders identified 
15.25 	in subdivision 17, a provider enrolled to provide services with rates determined under this 
15.26 	section must submit requested cost data to the commissioner to support research on the cost 
15.27 	of providing services that have rates determined by the disability waiver rates system. 
15.28 	Requested cost data may include, but is not limited to:
15.29 	(1) worker wage costs;
15.30 	(2) benefits paid;
15.31 	(3) supervisor wage costs;
16.1 	(4) executive wage costs;
16.2 	(5) vacation, sick, and training time paid;
16.3 	(6) taxes, workers' compensation, and unemployment insurance costs paid;
16.4 	(7) administrative costs paid;
16.5 	(8) program costs paid;
16.6 	(9) transportation costs paid;
16.7 	(10) vacancy rates; and
16.8 	(11) other data relating to costs required to provide services requested by the 
16.9 	commissioner.
16.10 	(b) At least once in any five-year period, a provider must submit cost data for a fiscal 
16.11 	year that ended not more than 18 months prior to the submission date. The commissioner 
16.12 	shall provide each provider a 90-day notice prior to its submission due date. If a provider 
16.13 	fails to submit required reporting data, the commissioner shall provide notice to providers 
16.14 	that have not provided required data 30 days after the required submission date, and a second 
16.15 	notice for providers who have not provided required data 60 days after the required 
16.16 	submission date. The commissioner shall temporarily suspend payments to the provider if 
16.17 	cost data is not received 90 days after the required submission date. Withheld payments 
16.18 	shall be made once data is received by the commissioner.
16.19 	(c) The commissioner shall conduct a random validation of data submitted under 
16.20 	paragraph (a) to ensure data accuracy.
16.21 	(d) The commissioner shall analyze cost data submitted under paragraph (a) and, in 
16.22 	consultation with stakeholders identified in subdivision 17, may submit recommendations 
16.23 	on component values and inflationary factor adjustments to the chairs and ranking minority 
16.24 	members of the legislative committees with jurisdiction over human services once every 
16.25 	four years beginning January 1, 2021. The commissioner shall make recommendations in 
16.26 	conjunction with reports submitted to the legislature according to subdivision 10, paragraph 
16.27 	(c).
16.28 	(e) The commissioner shall release cost data in an aggregate form, and cost data from 
16.29 	individual providers shall not be released except as provided for in current law.
16.30 	(f) The commissioner, in consultation with stakeholders identified in subdivision 17, 
16.31 	shall develop and implement a process for providing training and technical assistance 
17.1 	necessary to support provider submission of cost documentation required under paragraph 
17.2 	(a).

17.3 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
17.4 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
17.5 	when federal approval is obtained.

17.6 	Sec. 15. Minnesota Statutes 2022, section 256B.4914, subdivision 10c, is amended to 
17.7 	read:
17.8 		Subd. 10c.Reporting and analysis of competitive workforce factor. (a) Beginning 
17.9 	February 1, 2021 2025, and every two years thereafter, the commissioner shall report to the 
17.10 	chairs and ranking minority members of the legislative committees and divisions with 
17.11 	jurisdiction over health and human services policy and finance an analysis of the competitive 
17.12 	workforce factor.
17.13 	(b) The report must include recommendations to update the competitive workforce factor 
17.14 	using:
17.15 	(1) the most recently available wage data by SOC code for the weighted average wage 
17.16 	for direct care staff for residential services and direct care staff for day services;
17.17 	(2) the most recently available wage data by SOC code of the weighted average wage 
17.18 	of comparable occupations; and
17.19 	(3) workforce data as required under subdivision 10b.
17.20 	(c) The commissioner shall not recommend an increase or decrease of the competitive 
17.21 	workforce factor from the current value by more than two percentage points. If, after a 
17.22 	biennial analysis for the next report, the competitive workforce factor is less than or equal 
17.23 	to zero, the commissioner shall recommend a competitive workforce factor of zero. This 
17.24 	subdivision expires upon submission of the calendar year 2030 report.

17.25 	EFFECTIVE DATE. This section is effective July 1, 2023.

17.26 	Sec. 16. Minnesota Statutes 2022, section 256B.4914, subdivision 12, is amended to read:
17.27 		Subd. 12.Customization of rates for individuals.  (a) For persons determined to have 
17.28 	higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased 
17.29 	by an adjustment factor prior to calculating the rate under subdivisions 6 to 9a 9. The 
17.30 	customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour 
17.31 	for waiver recipients who meet the respective criteria as determined by the commissioner.
18.1 	(b) For the purposes of this section, "deaf and hard-of-hearing" means:
18.2 	(1) the person has a developmental disability and:
18.3 	(i) an assessment score which indicates a hearing impairment that is severe or that the 
18.4 	person has no useful hearing;
18.5 	(ii) an expressive communications score that indicates the person uses single signs or 
18.6 	gestures, uses an augmentative communication aid, or does not have functional 
18.7 	communication, or the person's expressive communications is unknown; and
18.8 	(iii) a communication score which indicates the person comprehends signs, gestures, 
18.9 	and modeling prompts or does not comprehend verbal, visual, or gestural communication, 
18.10 	or that the person's receptive communication score is unknown; or
18.11 	(2) the person receives long-term care services and has an assessment score that indicates 
18.12 	the person hears only very loud sounds, the person has no useful hearing, or a determination 
18.13 	cannot be made; and the person receives long-term care services and has an assessment that 
18.14 	indicates the person communicates needs with sign language, symbol board, written 
18.15 	messages, gestures, or an interpreter; communicates with inappropriate content, makes 
18.16 	garbled sounds or displays echolalia, or does not communicate needs.

18.17 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
18.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
18.19 	when federal approval is obtained.

18.20 	Sec. 17. Minnesota Statutes 2022, section 256B.4914, subdivision 14, is amended to read:
18.21 		Subd. 14.Exceptions. (a) In a format prescribed by the commissioner, lead agencies 
18.22 	must identify individuals with exceptional needs that cannot be met under the disability 
18.23 	waiver rate system. The commissioner shall use that information to evaluate and, if necessary, 
18.24 	approve an alternative payment rate for those individuals. Whether granted, denied, or 
18.25 	modified, the commissioner shall respond to all exception requests in writing. The 
18.26 	commissioner shall include in the written response the basis for the action and provide 
18.27 	notification of the right to appeal under paragraph (h).
18.28 	(b) Lead agencies must act on an exception request within 30 days and notify the initiator 
18.29 	of the request of their recommendation in writing. A lead agency shall submit all exception 
18.30 	requests along with its recommendation to the commissioner.
18.31 	(c) An application for a rate exception may be submitted for the following criteria:
18.32 	(1) an individual has service needs that cannot be met through additional units of service;
19.1 	(2) an individual's rate determined under subdivisions 6 to 9a 9 is so insufficient that it 
19.2 	has resulted in an individual receiving a notice of discharge from the individual's provider; 
19.3 	or
19.4 	(3) an individual's service needs, including behavioral changes, require a level of service 
19.5 	which necessitates a change in provider or which requires the current provider to propose 
19.6 	service changes beyond those currently authorized.
19.7 	(d) Exception requests must include the following information:
19.8 	(1) the service needs required by each individual that are not accounted for in subdivisions 
19.9 	6 to 9a 9;
19.10 	(2) the service rate requested and the difference from the rate determined in subdivisions 
19.11 	6 to 9a 9;
19.12 	(3) a basis for the underlying costs used for the rate exception and any accompanying 
19.13 	documentation; and
19.14 	(4) any contingencies for approval.
19.15 	(e) Approved rate exceptions shall be managed within lead agency allocations under 
19.16 	sections 256B.092 and 256B.49.
19.17 	(f) Individual disability waiver recipients, an interested party, or the license holder that 
19.18 	would receive the rate exception increase may request that a lead agency submit an exception 
19.19 	request. A lead agency that denies such a request shall notify the individual waiver recipient, 
19.20 	interested party, or license holder of its decision and the reasons for denying the request in 
19.21 	writing no later than 30 days after the request has been made and shall submit its denial to 
19.22 	the commissioner in accordance with paragraph (b). The reasons for the denial must be 
19.23 	based on the failure to meet the criteria in paragraph (c).
19.24 	(g) The commissioner shall determine whether to approve or deny an exception request 
19.25 	no more than 30 days after receiving the request. If the commissioner denies the request, 
19.26 	the commissioner shall notify the lead agency and the individual disability waiver recipient, 
19.27 	the interested party, and the license holder in writing of the reasons for the denial.
19.28 	(h) The individual disability waiver recipient may appeal any denial of an exception 
19.29 	request by either the lead agency or the commissioner, pursuant to sections 256.045 and 
19.30 	256.0451. When the denial of an exception request results in the proposed demission of a 
19.31 	waiver recipient from a residential or day habilitation program, the commissioner shall issue 
19.32 	a temporary stay of demission, when requested by the disability waiver recipient, consistent 
19.33 	with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary 
20.1 	stay shall remain in effect until the lead agency can provide an informed choice of 
20.2 	appropriate, alternative services to the disability waiver.
20.3 	(i) Providers may petition lead agencies to update values that were entered incorrectly 
20.4 	or erroneously into the rate management system, based on past service level discussions 
20.5 	and determination in subdivision 4, without applying for a rate exception.
20.6 	(j) The starting date for the rate exception will be the later of the date of the recipient's 
20.7 	change in support or the date of the request to the lead agency for an exception.
20.8 	(k) The commissioner shall track all exception requests received and their dispositions. 
20.9 	The commissioner shall issue quarterly public exceptions statistical reports, including the 
20.10 	number of exception requests received and the numbers granted, denied, withdrawn, and 
20.11 	pending. The report shall include the average amount of time required to process exceptions.
20.12 	(l) Approved rate exceptions remain in effect in all cases until an individual's needs 
20.13 	change as defined in paragraph (c).

20.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
20.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
20.16 	when federal approval is obtained.

20.17 	Sec. 18. Minnesota Statutes 2022, section 256S.2101, subdivision 1, is amended to read:
20.18 		Subdivision 1.Phase-in for disability waiver customized living rates. All rates and 
20.19 	rate components for community access for disability inclusion customized living and brain 
20.20 	injury customized living under section 256B.4914 shall must be the sum of ten 21.6 percent 
20.21 	of the rates calculated under sections 256S.211 to 256S.215 and 90 78.4 percent of the rates 
20.22 	calculated using the rate methodology in effect as of June 30, 2017.

20.23 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
20.24 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
20.25 	when federal approval is obtained.

20.26 	Sec. 19. DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED 
20.27 	SERVICES RATES.
 20.28 	The commissioner of human services shall establish a rate system for shared homemaker 
20.29 	services and shared chore services provided under Minnesota Statutes, sections 256B.092 
20.30 	and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed 
20.31 	1-1/2 times the rate paid for serving a single individual, and for three persons sharing 
20.32 	services, the rate paid to a provider must not exceed two times the rate paid for serving a 
21.1 	single individual. These rates apply only when all of the criteria for the shared service have 
21.2 	been met.

21.3 	Sec. 20. DIRECTION TO COMMISSIONER; SHARED SERVICES.
 21.4 	(a) By December 1, 2023, the commissioner of human services shall seek any necessary 
21.5 	changes to home and community-based services waiver plans regarding sharing services in 
21.6 	order to:
21.7 	(1) permit shared services for additional services, including chore, homemaker, and 
21.8 	night supervision;
21.9 	(2) permit existing shared services at higher ratios, including individualized home 
21.10 	supports without training, individualized home supports with training, and individualized 
21.11 	home supports with family training at a ratio of one staff person to three recipients;
21.12 	(3) ensure that individuals who are seeking to share services permitted under the waiver 
21.13 	plans in an own-home setting are not required to live in a licensed setting in order to share 
21.14 	services so long as all other requirements are met; and
21.15 	(4) issue guidance for shared services, including:
21.16 	(i) informed choice for all individuals sharing the services;
21.17 	(ii) guidance for when multiple shared services by different providers occur in one home 
21.18 	and how lead agencies and individuals shall determine that shared service is appropriate to 
21.19 	meet the needs, health, and safety of each individual for whom the lead agency provides 
21.20 	case management or care coordination; and
21.21 	(iii) guidance clarifying that an individual's decision to share services does not reduce 
21.22 	any determination of the individual's overall or assessed needs for services.
21.23 	(b) The commissioner shall develop or provide guidance outlining:
21.24 	(1) instructions for shared services support planning;
21.25 	(2) person-centered approaches and informed choice in shared services support planning; 
21.26 	and
21.27 	(3) required contents of shared services agreements.
21.28 	(c) The commissioner shall seek and utilize stakeholder input for any proposed changes 
21.29 	to waiver plans and any shared services guidance.

22.1 	Sec. 21. DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.
 22.2 		Subdivision 1.Recommendations required. The commissioner of human services shall 
22.3 	develop recommendations for establishing life sharing as a covered medical assistance 
22.4 	waiver service.
22.5 		Subd. 2.Definition. For the purposes of this section, "life sharing" means a 
22.6 	relationship-based living arrangement between an adult with a disability and an individual 
22.7 	or family in which they share their lives and experiences while the adult with a disability 
22.8 	receives support from the individual or family using person-centered practices.
22.9 		Subd. 3.Stakeholder engagement and consultation. (a) The commissioner must 
22.10 	proactively solicit participation in the development of the life-sharing medical assistance 
22.11 	service through a robust stakeholder engagement process that results in the inclusion of a 
22.12 	racially, culturally, and geographically diverse group of interested stakeholders from each 
22.13 	of the following groups:
22.14 	(1) providers currently providing or interested in providing life-sharing services;
22.15 	(2) people with disabilities accessing or interested in accessing life-sharing services;
22.16 	(3) disability advocacy organizations; and
22.17 	(4) lead agencies.
22.18 	(b) The commissioner must proactively seek input into and assistance with the 
22.19 	development of recommendations for establishing the life-sharing service from interested 
22.20 	stakeholders.
22.21 	(c) The commissioner must provide a method for the commissioner and interested 
22.22 	stakeholders to cofacilitate public meetings. The first meeting must occur before January 
22.23 	31, 2023. The commissioner must host the cofacilitated meetings at least monthly through 
22.24 	December 31, 2023. All meetings must be accessible to all interested stakeholders, recorded, 
22.25 	and posted online within one week of the meeting date.
22.26 		Subd. 4.Required topics to be discussed during development of the 
22.27 	recommendations. The commissioner and the interested stakeholders must discuss the 
22.28 	following topics:
22.29 	(1) the distinction between life sharing and adult family foster care;
22.30 	(2) successful life-sharing models used in other states;
22.31 	(3) services and supports that could be included in a life-sharing service;
23.1 	(4) potential barriers to providing or accessing life-sharing services;
23.2 	(5) solutions to remove identified barriers to providing or accessing life-sharing services;
23.3 	(6) potential medical assistance payment methodologies for life-sharing services;
23.4 	(7) expanding awareness of the life-sharing model; and
23.5 	(8) draft language for legislation necessary to define and implement life-sharing services.
23.6 		Subd. 5.Report to the legislature. By December 31, 2024, the commissioner must 
23.7 	provide to the chairs and ranking minority members of the house of representatives and 
23.8 	senate committees and divisions with jurisdiction over direct care services a report 
23.9 	summarizing the discussions between the commissioner and the interested stakeholders and 
23.10 	the commissioner's recommendations. The report must also include any draft legislation 
23.11 	necessary to define and implement life-sharing services.

23.12 	Sec. 22. REPEALER.
 23.13 	Minnesota Statutes 2022, section 256B.4914, subdivision 9a, is repealed.

23.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
23.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
23.16 	when federal approval is obtained.

23.17 	ARTICLE 3
23.18 	ELDERLY WAIVER

23.19 	Section 1. Minnesota Statutes 2022, section 256B.0913, subdivision 4, is amended to read:
23.20 		Subd. 4.Eligibility for funding for services for nonmedical assistance recipients. (a) 
23.21 	Funding for services under the alternative care program is available to persons who meet 
23.22 	the following criteria:
23.23 	(1) the person is a citizen of the United States or a United States national;
23.24 	(2) the person has been determined by a community assessment under section 256B.0911 
23.25 	to be a person who would require the level of care provided in a nursing facility, as 
23.26 	determined under section 256B.0911, subdivision 26, but for the provision of services under 
23.27 	the alternative care program;
23.28 	(3) the person is age 65 or older;
23.29 	(4) the person would be eligible for medical assistance within 135 days of admission to 
23.30 	a nursing facility;
24.1 	(5) the person is not ineligible for the payment of long-term care services by the medical 
24.2 	assistance program due to an asset transfer penalty under section 256B.0595 or equity 
24.3 	interest in the home exceeding $500,000 as stated in section 256B.056;
24.4 	(6) the person needs long-term care services that are not funded through other state or 
24.5 	federal funding, or other health insurance or other third-party insurance such as long-term 
24.6 	care insurance;
24.7 	(7) except for individuals described in clause (8), the monthly cost of the alternative 
24.8 	care services funded by the program for this person does not exceed 75 percent of the 
24.9 	monthly limit described under section 256S.18. This monthly limit does not prohibit the 
24.10 	alternative care client from payment for additional services, but in no case may the cost of 
24.11 	additional services purchased under this section exceed the difference between the client's 
24.12 	monthly service limit defined under section 256S.04, and the alternative care program 
24.13 	monthly service limit defined in this paragraph. If care-related supplies and equipment or 
24.14 	environmental modifications and adaptations are or will be purchased for an alternative 
24.15 	care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive 
24.16 	months beginning with the month of purchase. If the monthly cost of a recipient's other 
24.17 	alternative care services exceeds the monthly limit established in this paragraph, the annual 
24.18 	cost of the alternative care services shall must be determined. In this event, the annual cost 
24.19 	of alternative care services shall must not exceed 12 times the monthly limit described in 
24.20 	this paragraph;
24.21 	(8) for individuals assigned a case mix classification A as described under section 
24.22 	256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies 
24.23 	in bathing, dressing, grooming, walking, and eating when the dependency score in eating 
24.24 	is three or greater as determined by an assessment performed under section 256B.0911, the 
24.25 	monthly cost of alternative care services funded by the program cannot exceed $593 per 
24.26 	month for all new participants enrolled in the program on or after July 1, 2011. This monthly 
24.27 	limit shall be applied to all other participants who meet this criteria at reassessment. This 
24.28 	monthly limit shall must be increased annually as described in section 256S.18. This monthly 
24.29 	limit does not prohibit the alternative care client from payment for additional services, but 
24.30 	in no case may the cost of additional services purchased exceed the difference between the 
24.31 	client's monthly service limit defined in this clause and the limit described in clause (7) for 
24.32 	case mix classification A; and
24.33 	(9) the person is making timely payments of the assessed monthly fee; and
25.1 	(10) for a person participating in consumer-directed community supports, the person's 
25.2 	monthly service limit must be equal to the monthly service limits in clause (7), except that 
25.3 	a person assigned a case mix classification L must receive the monthly service limit for 
25.4 	case mix classification A.
25.5 	A person is ineligible if payment of the fee is over 60 days past due, unless the person 
25.6 	agrees to:
25.7 	(i) the appointment of a representative payee;
25.8 	(ii) automatic payment from a financial account;
25.9 	(iii) the establishment of greater family involvement in the financial management of 
25.10 	payments; or
25.11 	(iv) another method acceptable to the lead agency to ensure prompt fee payments.
25.12 	(b) The lead agency may extend the client's eligibility as necessary while making 
25.13 	arrangements to facilitate payment of past-due amounts and future premium payments. 
25.14 	Following disenrollment due to nonpayment of a monthly fee, eligibility shall must not be 
25.15 	reinstated for a period of 30 days.
25.16 	(c) Alternative care funding under this subdivision is not available for a person who is 
25.17 	a medical assistance recipient or who would be eligible for medical assistance without a 
25.18 	spenddown or waiver obligation. A person whose initial application for medical assistance 
25.19 	and the elderly waiver program is being processed may be served under the alternative care 
25.20 	program for a period up to 60 days. If the individual is found to be eligible for medical 
25.21 	assistance, medical assistance must be billed for services payable under the federally 
25.22 	approved elderly waiver plan and delivered from the date the individual was found eligible 
25.23 	for the federally approved elderly waiver plan. Notwithstanding this provision, alternative 
25.24 	care funds may not be used to pay for any service the cost of which: (i) is payable by medical 
25.25 	assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a 
25.26 	medical assistance income spenddown for a person who is eligible to participate in the 
25.27 	federally approved elderly waiver program under the special income standard provision.
25.28 	(d) Alternative care funding is not available for a person who resides in a licensed nursing 
25.29 	home, certified boarding care home, hospital, or intermediate care facility, except for case 
25.30 	management services which are provided in support of the discharge planning process for 
25.31 	a nursing home resident or certified boarding care home resident to assist with a relocation 
25.32 	process to a community-based setting.
26.1 	(e) Alternative care funding is not available for a person whose income is greater than 
26.2 	the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent 
26.3 	of the federal poverty guideline effective July 1 in the fiscal year for which alternative care 
26.4 	eligibility is determined, who would be eligible for the elderly waiver with a waiver 
26.5 	obligation.

26.6 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
26.7 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
26.8 	when federal approval is obtained.

26.9 	Sec. 2. Minnesota Statutes 2022, section 256B.0913, subdivision 5, is amended to read:
26.10 		Subd. 5.Services covered under alternative care. Alternative care funding may be 
26.11 	used for payment of costs of:
26.12 	(1) adult day services and adult day services bath;
26.13 	(2) home care;
26.14 	(3) homemaker services;
26.15 	(4) personal care;
26.16 	(5) case management and conversion case management;
26.17 	(6) respite care;
26.18 	(7) specialized supplies and equipment;
26.19 	(8) home-delivered meals;
26.20 	(9) nonmedical transportation;
26.21 	(10) nursing services;
26.22 	(11) chore services;
26.23 	(12) companion services;
26.24 	(13) nutrition services;
26.25 	(14) family caregiver training and education;
26.26 	(15) coaching and counseling;
26.27 	(16) telehome care to provide services in their own homes in conjunction with in-home 
26.28 	visits;
27.1 	(17) consumer-directed community supports under the alternative care programs which 
27.2 	are available statewide and limited to the average monthly expenditures representative of 
27.3 	all alternative care program participants for the same case mix resident class assigned in 
27.4 	the most recent fiscal year for which complete expenditure data is available;
27.5 	(18) environmental accessibility and adaptations; and
27.6 	(19) discretionary services, for which lead agencies may make payment from their 
27.7 	alternative care program allocation for services not otherwise defined in this section or 
27.8 	section 256B.0625, following approval by the commissioner.
27.9 	Total annual payments for discretionary services for all clients served by a lead agency 
27.10 	must not exceed 25 percent of that lead agency's annual alternative care program base 
27.11 	allocation, except that when alternative care services receive federal financial participation 
27.12 	under the 1115 waiver demonstration, funding shall be allocated in accordance with 
27.13 	subdivision 17.

27.14 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
27.15 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
27.16 	when federal approval is obtained.

27.17 	Sec. 3. Minnesota Statutes 2022, section 256S.15, subdivision 2, is amended to read:
27.18 		Subd. 2.Foster care limit. The elderly waiver payment for the foster care service in 
27.19 	combination with the payment for all other elderly waiver services, including case 
27.20 	management, must not exceed the monthly case mix budget cap for the participant as 
27.21 	specified in sections 256S.18, subdivision 3, and 256S.19, subdivisions subdivision 3 and 
27.22 	4.

27.23 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
27.24 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
27.25 	when federal approval is obtained.

27.26 	Sec. 4. Minnesota Statutes 2022, section 256S.18, is amended by adding a subdivision to 
27.27 	read:
27.28 		Subd. 3a.Monthly case mix budget caps for consumer-directed community 
27.29 	supports. The monthly case mix budget caps for each case mix classification for 
27.30 	consumer-directed community supports must be equal to the monthly case mix budget caps 
27.31 	in subdivision 3.

27.32 	EFFECTIVE DATE. This section is effective January 1, 2024.

28.1 	Sec. 5. Minnesota Statutes 2022, section 256S.19, subdivision 3, is amended to read:
28.2 		Subd. 3.Calculation of monthly conversion budget cap without consumer-directed 
28.3 	community supports caps. (a) The elderly waiver monthly conversion budget cap for the 
28.4 	cost of elderly waiver services without consumer-directed community supports must be 
28.5 	based on the nursing facility case mix adjusted total payment rate of the nursing facility 
28.6 	where the elderly waiver applicant currently resides for the applicant's case mix classification 
28.7 	as determined according to section 256R.17.
28.8 	(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver 
28.9 	services without consumer-directed community supports shall must be calculated by 
28.10 	multiplying the applicable nursing facility case mix adjusted total payment rate by 365, 
28.11 	dividing by 12, and subtracting the participant's maintenance needs allowance.
28.12 	(c) A participant's initially approved monthly conversion budget cap for elderly waiver 
28.13 	services without consumer-directed community supports shall must be adjusted at least 
28.14 	annually as described in section 256S.18, subdivision 5.
28.15 	(d) Conversion budget caps for individuals participating in consumer-directed community 
28.16 	supports must also be set as described in paragraphs (a) to (c).

28.17 	EFFECTIVE DATE. This section is effective January 1, 2024.

28.18 	Sec. 6. Minnesota Statutes 2022, section 256S.205, subdivision 3, is amended to read:
28.19 		Subd. 3.Rate adjustment eligibility criteria. Only facilities satisfying all of the 
28.20 	following conditions on September 1 of the application year are eligible for designation as 
28.21 	a disproportionate share facility:
28.22 	(1) at least 83.5 80 percent of the residents of the facility are customized living residents; 
28.23 	and
28.24 	(2) at least 70 50 percent of the customized living residents are elderly waiver participants.

28.25 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
28.26 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
28.27 	when federal approval is obtained.

28.28 	Sec. 7. Minnesota Statutes 2022, section 256S.205, subdivision 5, is amended to read:
28.29 		Subd. 5.Rate adjustment; rate floor. (a) Notwithstanding the 24-hour customized 
28.30 	living monthly service rate limits under section 256S.202, subdivision 2, and the component 
28.31 	service rates established under section 256S.201, subdivision 4, the commissioner must 
29.1 	establish a rate floor equal to $119 $139 per resident per day for 24-hour customized living 
29.2 	services provided to an elderly waiver participant in a designated disproportionate share 
29.3 	facility.
29.4 	(b) The commissioner must apply the rate floor to the services described in paragraph 
29.5 	(a) provided during the rate year.
29.6 	(c) The commissioner must adjust the rate floor by the same amount and at the same 
29.7 	time as any adjustment to the 24-hour customized living monthly service rate limits under 
29.8 	section 256S.202, subdivision 2.
29.9 	(d) The commissioner shall not implement the rate floor under this section if the 
29.10 	customized living rates established under sections 256S.21 to 256S.215 will be implemented 
29.11 	at 100 percent on January 1 of the year following an application year.

29.12 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
29.13 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
29.14 	when federal approval is obtained.

29.15 	Sec. 8. Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:
29.16 		Subd. 2.Phase-in for elderly waiver rates.  Except for home-delivered meals as 
29.17 	described in section 256S.215, subdivision 15 the services in subdivisions 4 and 5, all rates 
29.18 	and rate components for elderly waiver, elderly waiver customized living, and elderly waiver 
29.19 	foster care under this chapter; alternative care under section 256B.0913; and essential 
29.20 	community supports under section 256B.0922shall must be the sum of 18.8 21.6 percent 
29.21 	of the rates calculated under sections 256S.211 to 256S.215, and 81.2 78.4 percent of the 
29.22 	rates calculated using the rate methodology in effect as of June 30, 2017. The rate for 
29.23 	home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019, 
29.24 	and the increases described in section 256S.215, subdivision 15.

29.25 	EFFECTIVE DATE. This section is effective January 1, 2024.

29.26 	Sec. 9. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision 
29.27 	to read:
29.28 		Subd. 3.Spending requirements. (a) At least 80 percent of the marginal increase in 
29.29 	revenue from the implementation of any adjustments to a phase-in proportion under this 
29.30 	section, or any adjustments to the base wage indices under section 256S.212, for services 
29.31 	rendered on or after the day of implementation of the modified phase-in proportion or 
30.1 	applicable adjustment to the base wage indices must be used to increase compensation-related 
30.2 	costs for employees directly employed by the provider.
30.3 	(b) For the purposes of this subdivision, compensation-related costs include:
30.4 	(1) wages and salaries;
30.5 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
30.6 	taxes, workers' compensation, and mileage reimbursement;
30.7 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
30.8 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
30.9 	employee retirement accounts; and
30.10 	(4) benefits that address direct support professional workforce needs above and beyond 
30.11 	what employees were offered prior to the implementation of adjusted phase-in proportions 
30.12 	under this section, including any concurrent or subsequent adjustments to the base wage 
30.13 	indices.
30.14 	(c) Compensation-related costs for persons employed in the central office of a corporation 
30.15 	or entity that has an ownership interest in the provider or exercises control over the provider, 
30.16 	or for persons paid by the provider under a management contract, do not count toward the 
30.17 	80 percent requirement under this subdivision.
30.18 	(d) A provider agency or individual provider that receives additional revenue subject to 
30.19 	the requirements of this subdivision shall prepare, and upon request submit to the 
30.20 	commissioner, a distribution plan that specifies the amount of money the provider expects 
30.21 	to receive that is subject to the requirements of this subdivision, including how that money 
30.22 	was or will be distributed to increase compensation-related costs for employees. Within 60 
30.23 	days of final implementation of the new phase-in proportion or adjustment to the base wage 
30.24 	indices subject to the requirements of this subdivision, the provider must post the distribution 
30.25 	plan and leave it posted for a period of at least six months in an area of the provider's 
30.26 	operation to which all direct support professionals have access. The posted distribution plan 
30.27 	must include instructions regarding how to contact the commissioner, or the commissioner's 
30.28 	representative, if an employee has not received the compensation-related increase described 
30.29 	in the plan.

30.30 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
30.31 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
30.32 	when federal approval is obtained.

31.1 	Sec. 10. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision 
31.2 	to read:
31.3 		Subd. 4.Phase-in for home-delivered meals rate. The home-delivered meals rate for 
31.4 	the elderly waiver under this chapter; alternative care under section 256B.0913; and essential 
31.5 	community supports under section 256B.0922 must be the sum of 65 percent of the rate in 
31.6 	section 256S.215, subdivision 15, and 35 percent of the rate calculated using the rate 
31.7 	methodology in effect as of June 30, 2017.

31.8 	EFFECTIVE DATE. This section is effective January 1, 2024.

31.9 	Sec. 11. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision 
31.10 	to read:
31.11 		Subd. 5.Service rates exempt from phase-in. Subdivision 2 does not apply to rates 
31.12 	for homemaker services described in section 256S.215, subdivisions 9 to 11.

31.13 	EFFECTIVE DATE. This section is effective January 1, 2024.

31.14 	Sec. 12. Minnesota Statutes 2022, section 256S.212, is amended to read:
31.15 	256S.212 RATE SETTING; BASE WAGE INDEX.
31.16 		Subdivision 1.Updating SOC codes. If any of the SOC codes and positions used in 
31.17 	this section are no longer available, the commissioner shall, in consultation with stakeholders, 
31.18 	select a new SOC code and position that is the closest match to the previously used SOC 
31.19 	position.
31.20 		Subd. 1a.Updating base wages. (a) On January 1, 2024, and every two years thereafter, 
31.21 	the commissioner must update the base wages for the services listed in paragraph (b) based 
31.22 	on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington, 
31.23 	MN-WI MetroSA data. Any marginal increase in revenue from implementation of any 
31.24 	adjustment to base wages under this section, including any modifications to SOC codes or 
31.25 	positions, is subject to the spending requirements under section 256S.2101, subdivision 3.
31.26 	(b) This subdivision applies to:
31.27 	(1) the homemaker services and assistance with personal care base wage under subdivision 
31.28 	8;
31.29 	(2) the homemaker services and cleaning base wage under subdivision 9;
31.30 	(3) the homemaker services and home management base wage under subdivision 10; 
31.31 	and
32.1 	(4) for the purposes of calculating the unlicensed supervisor supervision wage component 
32.2 	used to calculate the homemaker services rates under section 256S.215, subdivisions 9 to 
32.3 	11, the unlicensed supervisor base wage under subdivision 15.
32.4 		Subd. 2.Home management and support services base wage. For customized living,
32.5 	and foster care, and residential care component services, the home management and support 
32.6 	services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
32.7 	MetroSA average wage for home health and personal and home care aide aides (SOC code 
32.8 	39-9021 31-1120); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA 
32.9 	average wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the 
32.10 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and 
32.11 	housekeeping cleaners (SOC code 37-2012).
32.12 		Subd. 3.Home care aide base wage. For customized living, and foster care, and 
32.13 	residential care component services, the home care aide base wage equals 50 75 percent of 
32.14 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health 
32.15 	and personal care aides (SOC code 31-1011 31-1120); and 50 25 percent of the 
32.16 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
32.17 	(SOC code 31-1014 31-1131).
32.18 		Subd. 4.Home health aide base wage. For customized living, and foster care, and 
32.19 	residential care component services, the home health aide base wage equals 20 33.33 percent 
32.20 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed 
32.21 	practical and licensed vocational nurses (SOC code 29-2061); and 80 33.33 percent of the 
32.22 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
32.23 	(SOC code 31-1014 31-1131); and 33.34 percent of the Minneapolis-St. Paul-Bloomington, 
32.24 	MN-WI MetroSA average wage for home health and personal care aides (SOC code 
32.25 	31-1120).
32.26 		Subd. 5.Medication setups by licensed nurse base wage. For customized living, and
32.27 	foster care, and residential care component services, the medication setups by licensed nurse 
32.28 	base wage equals ten 25 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA 
32.29 	average wage for licensed practical and licensed vocational nurses (SOC code 29-2061); 
32.30 	and 90 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average 
32.31 	wage for registered nurses (SOC code 29-1141).
32.32 		Subd. 6.Chore services base wage. The chore services base wage equals 100 50 percent 
32.33 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping 
32.34 	and groundskeeping workers (SOC code 37-3011); and 50 percent of the Minneapolis-St. 
33.1 	Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners 
33.2 	(SOC code 37-2012).
33.3 		Subd. 7.Companion services base wage. The companion services base wage equals 
33.4 	50 80 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage 
33.5 	for home health and personal and home care aides (SOC code 39-9021 31-1120); and 50
33.6 	20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for 
33.7 	maids and housekeeping cleaners (SOC code 37-2012).
33.8 		Subd. 8.Homemaker services and assistance with personal care base wage. The 
33.9 	homemaker services and assistance with personal care base wage equals 60 50 percent of 
33.10 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health 
33.11 	and personal and home care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of 
33.12 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
33.13 	(SOC code 31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, 
33.14 	MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
33.15 		Subd. 9.Homemaker services and cleaning base wage. The homemaker services and 
33.16 	cleaning base wage equals 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
33.17 	MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent 
33.18 	of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing 
33.19 	assistants (SOC code 31-1014); and 20 100 percent of the Minneapolis-St. Paul-Bloomington, 
33.20 	MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
33.21 		Subd. 10.Homemaker services and home management base wage. The homemaker 
33.22 	services and home management base wage equals 60 50 percent of the Minneapolis-St. 
33.23 	Paul-Bloomington, MN-WI MetroSA average wage for home health and personal and home
33.24 	care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of the Minneapolis-St. 
33.25 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code 
33.26 	31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
33.27 	MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
33.28 		Subd. 11.In-home respite care services base wage. The in-home respite care services 
33.29 	base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA 
33.30 	average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St. 
33.31 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants home health and 
33.32 	personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of the Minneapolis-St. 
33.33 	Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed 
33.34 	vocational nurses (SOC code 29-2061).
34.1 		Subd. 12.Out-of-home respite care services base wage. The out-of-home respite care 
34.2 	services base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI 
34.3 	MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the 
34.4 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
34.5 	home health and personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of 
34.6 	the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical 
34.7 	and licensed vocational nurses (SOC code 29-2061).
34.8 		Subd. 13.Individual community living support base wage. The individual community 
34.9 	living support base wage equals 20 60 percent of the Minneapolis-St. Paul-Bloomington, 
34.10 	MN-WI MetroSA average wage for licensed practical and licensed vocational nurses social 
34.11 	and human services aides (SOC code 29-2061 21-1093); and 80 40 percent of the 
34.12 	Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants 
34.13 	(SOC code 31-1014 31-1131).
34.14 		Subd. 14.Registered nurse base wage. The registered nurse base wage equals 100 
34.15 	percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for 
34.16 	registered nurses (SOC code 29-1141).
34.17 		Subd. 15.Social worker Unlicensed supervisor base wage. The social worker
34.18 	unlicensed supervisor base wage equals 100 percent of the Minneapolis-St. 
34.19 	Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
34.20 	first-line supervisors of personal service workers (SOC code 21-1022 39-1098).
34.21 		Subd. 16.Adult day services base wage. The adult day services base wage equals 75 
34.22 	percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home 
34.23 	health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St. 
34.24 	Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code 
34.25 	31-1131).

34.26 	EFFECTIVE DATE. This section is effective January 1, 2024.

34.27 	Sec. 13. Minnesota Statutes 2022, section 256S.213, is amended to read:
34.28 	256S.213 RATE SETTING; FACTORS AND SUPERVISION WAGE 
34.29 	COMPONENTS.
34.30 		Subdivision 1.Payroll taxes and benefits factor. The payroll taxes and benefits factor 
34.31 	is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing 
34.32 	facilities on the most recent and available cost report.
35.1 		Subd. 2.General and administrative factor. The general and administrative factor is 
35.2 	the difference of net general and administrative expenses and administrative salaries, divided 
35.3 	by total operating expenses for all nursing facilities on the most recent and available cost 
35.4 	report 14.4 percent.
35.5 		Subd. 3.Program plan support factor. (a) The program plan support factor is 12.8 ten
35.6 	percent for the following services to cover the cost of direct service staff needed to provide 
35.7 	support for home and community-based the service when not engaged in direct contact with 
35.8 	participants.:
35.9 	(1) adult day services;
35.10 	(2) customized living; and
35.11 	(3) foster care.
35.12 	(b) The program plan support factor is 15.5 percent for the following services to cover 
35.13 	the cost of direct service staff needed to provide support for the service when not engaged 
35.14 	in direct contact with participants:
35.15 	(1) chore services;
35.16 	(2) companion services;
35.17 	(3) homemaker services and assistance with personal care;
35.18 	(4) homemaker services and cleaning;
35.19 	(5) homemaker services and home management;
35.20 	(6) in-home respite care;
35.21 	(7) individual community living support; and
35.22 	(8) out-of-home respite care.
35.23 		Subd. 4.Registered nurse management and supervision factor wage component. The 
35.24 	registered nurse management and supervision factor wage component equals 15 percent of 
35.25 	the registered nurse adjusted base wage as defined in section 256S.214.
35.26 		Subd. 5.Social worker Unlicensed supervisor supervision factor wage 
35.27 	component. The social worker unlicensed supervisor supervision factor wage component
35.28 	equals 15 percent of the social worker unlicensed supervisor adjusted base wage as defined 
35.29 	in section 256S.214.
35.30 		Subd. 6.Facility and equipment factor. The facility and equipment factor for adult 
35.31 	day services is 16.2 percent.
36.1 		Subd. 7.Food, supplies, and transportation factor. The food, supplies, and 
36.2 	transportation factor for adult day services is 24 percent.
36.3 		Subd. 8.Supplies and transportation factor. The supplies and transportation factor 
36.4 	for the following services is 1.56 percent:
36.5 	(1) chore services;
36.6 	(2) companion services;
36.7 	(3) homemaker services and assistance with personal care;
36.8 	(4) homemaker services and cleaning;
36.9 	(5) homemaker services and home management;
36.10 	(6) in-home respite care;
36.11 	(7) individual community living support; and
36.12 	(8) out-of-home respite care.
36.13 		Subd. 9.Absence factor. The absence factor for the following services is 4.5 percent:
36.14 	(1) adult day services;
36.15 	(2) chore services;
36.16 	(3) companion services;
36.17 	(4) homemaker services and assistance with personal care;
36.18 	(5) homemaker services and cleaning;
36.19 	(6) homemaker services and home management;
36.20 	(7) in-home respite care;
36.21 	(8) individual community living support; and
36.22 	(9) out-of-home respite care.

36.23 	EFFECTIVE DATE. This section is effective January 1, 2024.

36.24 	Sec. 14. Minnesota Statutes 2022, section 256S.214, is amended to read:
36.25 	256S.214 RATE SETTING; ADJUSTED BASE WAGE.
36.26 	For the purposes of section 256S.215, the adjusted base wage for each position equals 
36.27 	the position's base wage under section 256S.212 plus:
37.1 	(1) the position's base wage multiplied by the payroll taxes and benefits factor under 
37.2 	section 256S.213, subdivision 1;
37.3 	(2) the position's base wage multiplied by the general and administrative factor under 
37.4 	section 256S.213, subdivision 2; and
37.5 	(3) (2) the position's base wage multiplied by the applicable program plan support factor 
37.6 	under section 256S.213, subdivision 3.; and
37.7 	(3) the position's base wage multiplied by the absence factor under section 256S.213, 
37.8 	subdivision 9, if applicable.

37.9 	EFFECTIVE DATE. This section is effective January 1, 2024.

37.10 	Sec. 15. Minnesota Statutes 2022, section 256S.215, is amended to read:
37.11 	256S.215 RATE SETTING; COMPONENT RATES.
37.12 		Subdivision 1.Medication setups by licensed nurse component rate. The component 
37.13 	rate for medication setups by a licensed nurse equals the medication setups by licensed 
37.14 	nurse adjusted base wage.
37.15 		Subd. 2.Home management and support services component rate. The component 
37.16 	rate for home management and support services is calculated as follows:
37.17 	(1) sum the home management and support services adjusted base wage plus and the 
37.18 	registered nurse management and supervision factor. wage component;
37.19 	(2) multiply the result of clause (1) by the general and administrative factor; and
37.20 	(3) sum the results of clauses (1) and (2).
37.21 		Subd. 3.Home care aide services component rate. The component rate for home care 
37.22 	aide services is calculated as follows:
37.23 	(1) sum the home health aide services adjusted base wage plus and the registered nurse 
37.24 	management and supervision factor. wage component;
37.25 	(2) multiply clause (1) by the general and administrative factor; and
37.26 	(3) sum the results of clauses (1) and (2).
37.27 		Subd. 4.Home health aide services component rate. The component rate for home 
37.28 	health aide services is calculated as follows:
37.29 	(1) sum the home health aide services adjusted base wage plus and the registered nurse 
37.30 	management and supervision factor. wage component;
38.1 	(2) multiply the result of clause (1) by the general and administrative factor; and
38.2 	(3) sum the results of clauses (1) and (2).
38.3 		Subd. 5.Socialization component rate. The component rate under elderly waiver 
38.4 	customized living for one-to-one socialization equals the home management and support 
38.5 	services component rate.
38.6 		Subd. 6.Transportation component rate. The component rate under elderly waiver 
38.7 	customized living for one-to-one transportation equals the home management and support 
38.8 	services component rate.
38.9 		Subd. 7.Chore services rate. The 15-minute unit rate for chore services is calculated 
38.10 	as follows:
38.11 	(1) sum the chore services adjusted base wage and the social worker unlicensed supervisor
38.12 	supervision factor wage component; and
38.13 	(2) multiply the result of clause (1) by the general and administrative factor;
38.14 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
38.15 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
38.16 		Subd. 8.Companion services rate. The 15-minute unit rate for companion services is 
38.17 	calculated as follows:
38.18 	(1) sum the companion services adjusted base wage and the social worker unlicensed 
38.19 	supervisor supervision factor wage component; and
38.20 	(2) multiply the result of clause (1) by the general and administrative factor;
38.21 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
38.22 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
38.23 		Subd. 9.Homemaker services and assistance with personal care rate. The 15-minute 
38.24 	unit rate for homemaker services and assistance with personal care is calculated as follows:
38.25 	(1) sum the homemaker services and assistance with personal care adjusted base wage 
38.26 	and the registered nurse management and unlicensed supervisor supervision factor wage 
38.27 	component; and
38.28 	(2) multiply the result of clause (1) by the general and administrative factor;
38.29 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
38.30 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
39.1 		Subd. 10.Homemaker services and cleaning rate. The 15-minute unit rate for 
39.2 	homemaker services and cleaning is calculated as follows:
39.3 	(1) sum the homemaker services and cleaning adjusted base wage and the registered 
39.4 	nurse management and unlicensed supervisor supervision factor base wage; and
39.5 	(2) multiply the result of clause (1) by the general and administrative factor;
39.6 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
39.7 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
39.8 		Subd. 11.Homemaker services and home management rate. The 15-minute unit rate 
39.9 	for homemaker services and home management is calculated as follows:
39.10 	(1) sum the homemaker services and home management adjusted base wage and the 
39.11 	registered nurse management and unlicensed supervisor supervision factor wage component; 
39.12 	and
39.13 	(2) multiply the result of clause (1) by the general and administrative factor;
39.14 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
39.15 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
39.16 		Subd. 12.In-home respite care services rates. (a) The 15-minute unit rate for in-home 
39.17 	respite care services is calculated as follows:
39.18 	(1) sum the in-home respite care services adjusted base wage and the registered nurse 
39.19 	management and supervision factor wage component; and
39.20 	(2) multiply the result of clause (1) by the general and administrative factor;
39.21 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
39.22 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
39.23 	(b) The in-home respite care services daily rate equals the in-home respite care services 
39.24 	15-minute unit rate multiplied by 18.
39.25 		Subd. 13.Out-of-home respite care services rates. (a) The 15-minute unit rate for 
39.26 	out-of-home respite care is calculated as follows:
39.27 	(1) sum the out-of-home respite care services adjusted base wage and the registered 
39.28 	nurse management and supervision factor wage component; and
39.29 	(2) multiply the result of clause (1) by the general and administrative factor;
39.30 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
40.1 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
40.2 	(b) The out-of-home respite care services daily rate equals the 15-minute unit rate for 
40.3 	out-of-home respite care services multiplied by 18.
40.4 		Subd. 14.Individual community living support rate. The individual community living 
40.5 	support rate is calculated as follows:
40.6 	(1) sum the home care aide individual community living support adjusted base wage 
40.7 	and the social worker registered nurse management and supervision factor wage component; 
40.8 	and
40.9 	(2) multiply the result of clause (1) by the general and administrative factor;
40.10 	(3) multiply the result of clause (1) by the supplies and transportation factor; and
40.11 	(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.
40.12 		Subd. 15.Home-delivered meals rate. The home-delivered meals rate equals $9.30
40.13 	$8.17. On July 1 of each year, the commissioner shall increase update the home delivered 
40.14 	meals rate every July 1 by the percent increase in the nursing facility dietary per diem using 
40.15 	the two most recent and available nursing facility cost reports.
40.16 		Subd. 16.Adult day services rate. The 15-minute unit rate for adult day services, with 
40.17 	an assumed staffing ratio of one staff person to four participants, is the sum of is calculated 
40.18 	as follows:
40.19 	(1) one-sixteenth of the home care aide divide the adult day services adjusted base wage, 
40.20 	except that the general and administrative factor used to determine the home care aide 
40.21 	services adjusted base wage is 20 percent by five to reflect an assumed staffing ratio of one 
40.22 	to five;
40.23 	(2) one-fourth of the registered nurse management and supervision factor sum the result 
40.24 	of clause (1) and the registered nurse management and supervision wage component; and
40.25 	(3) $0.63 to cover the cost of meals. multiply the result of clause (2) by the general and 
40.26 	administrative factor;
40.27 	(4) multiply the result of clause (2) by the facility and equipment factor;
40.28 	(5) multiply the result of clause (2) by the food, supplies, and transportation factor; and
40.29 	(6) sum the results of clauses (2) to (5) and divide the result by four.
40.30 		Subd. 17.Adult day services bath rate. The 15-minute unit rate for adult day services 
40.31 	bath is the sum of calculated as follows:
41.1 	(1) one-fourth of the home care aide sum the adult day services adjusted base wage, 
41.2 	except that the general and administrative factor used to determine the home care aide 
41.3 	services adjusted base wage is 20 percent and the registered nurse management and 
41.4 	supervision wage component;
41.5 	(2) one-fourth of the registered nurse management and supervision factor multiply the 
41.6 	result of clause (1) by the general and administrative factor; and
41.7 	(3) $0.63 to cover the cost of meals. multiply the result of clause (1) by the facility and 
41.8 	equipment factor;
41.9 	(4) multiply the result of clause (1) by the food, supplies, and transportation factor; and
41.10 	(5) sum the results of clauses (1) to (4) and divide the result by four.

41.11 	EFFECTIVE DATE. This section is effective the January 1, 2024.

41.12 	Sec. 16. DIRECTION TO COMMISSIONER; ESTABLISHING SHARED SERVICE 
41.13 	RATES.
 41.14 	The commissioner shall establish a rate system for shared homemaker services and 
41.15 	shared chore services based on homemaker rates for a single individual under section 
41.16 	256S.215, subdivisions 9 to 11, and the chore rate for a single individual under section 
41.17 	256S.215, subdivision 7. For two persons sharing services, the rate paid to a provider must 
41.18 	not exceed 1-1/2 times the rate paid for serving a single individual, and for three persons 
41.19 	sharing services, the rate paid to a provider must not exceed two times the rate paid for 
41.20 	serving a single individual. These rates apply only when all of the criteria for the shared 
41.21 	service have been met.

41.22 	Sec. 17. REVISOR INSTRUCTION.
 41.23 	(a) In Minnesota Statutes, chapter 256S, the revisor of statutes shall change the following 
41.24 	terms wherever the terms appear:
41.25 	(1) "homemaker services and assistance with personal care" to "homemaker assistance 
41.26 	with personal care services";
41.27 	(2) "homemaker services and cleaning" to "homemaker cleaning services"; and
41.28 	(3) "homemaker services and home management" to "homemaker home management 
41.29 	services."
41.30 	(b) The revisor shall make any necessary grammatical changes related to the changes 
41.31 	in terms under paragraph (a).

42.1 	EFFECTIVE DATE. This section is effective July 1, 2023.

42.2 	Sec. 18. REPEALER.
 42.3 	Minnesota Statutes 2022, section 256S.19, subdivision 4, is repealed.

42.4 	EFFECTIVE DATE. This section is effective January 1, 2024.

42.5 	ARTICLE 4
42.6 	HOME CARE

42.7 	Section 1. Minnesota Statutes 2022, section 256B.0659, subdivision 1, is amended to read:
42.8 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
42.9 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
42.10 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility, 
42.11 	positioning, eating, and toileting.
42.12 	(c) "Behavior," effective January 1, 2010, means a category to determine the home care 
42.13 	rating and is based on the criteria found in this section. "Level I behavior" means physical 
42.14 	aggression towards toward self, others, or destruction of property that requires the immediate 
42.15 	response of another person.
42.16 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
42.17 	determine the home care rating and is based on the criteria found in this section.
42.18 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
42.19 	mobility, eating, and toileting.
42.20 	(f) "Dependency in activities of daily living" means a person requires assistance to begin 
42.21 	and complete one or more of the activities of daily living.
42.22 	(g) "Extended personal care assistance service" means personal care assistance services 
42.23 	included in a service plan under one of the home and community-based services waivers 
42.24 	authorized under chapter 256S and sections 256B.092, subdivision 5, and 256B.49, which 
42.25 	exceed the amount, duration, and frequency of the state plan personal care assistance services 
42.26 	for participants who:
42.27 	(1) need assistance provided periodically during a week, but less than daily will not be 
42.28 	able to remain in their homes without the assistance, and other replacement services are 
42.29 	more expensive or are not available when personal care assistance services are to be reduced; 
42.30 	or
43.1 	(2) need additional personal care assistance services beyond the amount authorized by 
43.2 	the state plan personal care assistance assessment in order to ensure that their safety, health, 
43.3 	and welfare are provided for in their homes.
43.4 	(h) "Health-related procedures and tasks" means procedures and tasks that can be 
43.5 	delegated or assigned by a licensed health care professional under state law to be performed 
43.6 	by a personal care assistant.
43.7 	(i) "Instrumental activities of daily living" means activities to include meal planning and 
43.8 	preparation; basic assistance with paying bills; shopping for food, clothing, and other 
43.9 	essential items; performing household tasks integral to the personal care assistance services; 
43.10 	communication by telephone and other media; and traveling, including to medical 
43.11 	appointments and to participate in the community. For purposes of this paragraph, traveling 
43.12 	includes driving and accompanying the recipient in the recipient's chosen mode of 
43.13 	transportation and according to the recipient's personal care assistance care plan.
43.14 	(j) "Managing employee" has the same definition as Code of Federal Regulations, title 
43.15 	42, section 455.
43.16 	(k) "Qualified professional" means a professional providing supervision of personal care 
43.17 	assistance services and staff as defined in section 256B.0625, subdivision 19c.
43.18 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
43.19 	provider that provides or assists with providing personal care assistance services and includes 
43.20 	a personal care assistance provider organization, personal care assistance choice agency, 
43.21 	class A licensed nursing agency, and Medicare-certified home health agency.
43.22 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
43.23 	care assistance agency who provides personal care assistance services.
43.24 	(n) "Personal care assistance care plan" means a written description of personal care 
43.25 	assistance services developed by the personal care assistance provider according to the 
43.26 	service plan.
43.27 	(o) "Responsible party" means an individual who is capable of providing the support 
43.28 	necessary to assist the recipient to live in the community.
43.29 	(p) "Self-administered medication" means medication taken orally, by injection, nebulizer, 
43.30 	or insertion, or applied topically without the need for assistance.
43.31 	(q) "Service plan" means a written summary of the assessment and description of the 
43.32 	services needed by the recipient.
44.1 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes, 
44.2 	Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage 
44.3 	reimbursement, health and dental insurance, life insurance, disability insurance, long-term 
44.4 	care insurance, uniform allowance, and contributions to employee retirement accounts.

44.5 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
44.6 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
44.7 	when federal approval is obtained.

44.8 	Sec. 2. Minnesota Statutes 2022, section 256B.0659, subdivision 12, is amended to read:
44.9 		Subd. 12.Documentation of personal care assistance services provided. (a) Personal 
44.10 	care assistance services for a recipient must be documented daily by each personal care 
44.11 	assistant, on a time sheet form approved by the commissioner. All documentation may be 
44.12 	web-based, electronic, or paper documentation. The completed form must be submitted on 
44.13 	a monthly basis to the provider and kept in the recipient's health record.
44.14 	(b) The activity documentation must correspond to the personal care assistance care plan 
44.15 	and be reviewed by the qualified professional.
44.16 	(c) The personal care assistant time sheet must be on a form approved by the 
44.17 	commissioner documenting time the personal care assistant provides services in the home. 
44.18 	The following criteria must be included in the time sheet:
44.19 	(1) full name of personal care assistant and individual provider number;
44.20 	(2) provider name and telephone numbers;
44.21 	(3) full name of recipient and either the recipient's medical assistance identification 
44.22 	number or date of birth;
44.23 	(4) consecutive dates, including month, day, and year, and arrival and departure times 
44.24 	with a.m. or p.m. notations;
44.25 	(5) signatures of recipient or the responsible party;
44.26 	(6) personal signature of the personal care assistant;
44.27 	(7) any shared care provided, if applicable;
44.28 	(8) a statement that it is a federal crime to provide false information on personal care 
44.29 	service billings for medical assistance payments; and
44.30 	(9) dates and location of recipient stays in a hospital, care facility, or incarceration; and
45.1 	(10) any time spent traveling, as described in subdivision 1, paragraph (i), including 
45.2 	start and stop times with a.m. and p.m. designations, the origination site, and the destination 
45.3 	site.

45.4 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
45.5 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
45.6 	when federal approval is obtained.

45.7 	Sec. 3. Minnesota Statutes 2022, section 256B.0659, subdivision 17a, is amended to read:
45.8 		Subd. 17a.Enhanced rate. An enhanced rate of 107.5 143 percent of the rate paid for 
45.9 	personal care assistance services shall be paid for services provided to persons who qualify 
45.10 	for ten or more hours of personal care assistance services per day when provided by a 
45.11 	personal care assistant who meets the requirements of subdivision 11, paragraph (d). Any 
45.12 	change in the eligibility criteria for the enhanced rate for personal care assistance services 
45.13 	as described in this subdivision and referenced in subdivision 11, paragraph (d), does not 
45.14 	constitute a change in a term or condition for individual providers as defined in section 
45.15 	256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter 
45.16 	179A.

45.17 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
45.18 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
45.19 	when federal approval is obtained.

45.20 	Sec. 4. Minnesota Statutes 2022, section 256B.0659, subdivision 19, is amended to read:
45.21 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) Under 
45.22 	personal care assistance choice, the recipient or responsible party shall:
45.23 	(1) recruit, hire, schedule, and terminate personal care assistants according to the terms 
45.24 	of the written agreement required under subdivision 20, paragraph (a);
45.25 	(2) develop a personal care assistance care plan based on the assessed needs and 
45.26 	addressing the health and safety of the recipient with the assistance of a qualified professional 
45.27 	as needed;
45.28 	(3) orient and train the personal care assistant with assistance as needed from the qualified 
45.29 	professional;
45.30 	(4) supervise and evaluate the personal care assistant with the qualified professional, 
45.31 	who is required to visit the recipient at least every 180 days;
46.1 	(5) monitor and verify in writing and report to the personal care assistance choice agency 
46.2 	the number of hours worked by the personal care assistant and the qualified professional;
46.3 	(6) engage in an annual reassessment as required in subdivision 3a to determine 
46.4 	continuing eligibility and service authorization; and
46.5 	(7) use the same personal care assistance choice provider agency if shared personal 
46.6 	assistance care is being used; and
46.7 	(8) ensure that a personal care assistant driving the recipient under subdivision 1, 
46.8 	paragraph (i), has a valid driver's license and the vehicle used is registered and insured 
46.9 	according to Minnesota law.
46.10 	(b) The personal care assistance choice provider agency shall:
46.11 	(1) meet all personal care assistance provider agency standards;
46.12 	(2) enter into a written agreement with the recipient, responsible party, and personal 
46.13 	care assistants;
46.14 	(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal 
46.15 	care assistant; and
46.16 	(4) ensure arm's-length transactions without undue influence or coercion with the recipient 
46.17 	and personal care assistant.
46.18 	(c) The duties of the personal care assistance choice provider agency are to:
46.19 	(1) be the employer of the personal care assistant and the qualified professional for 
46.20 	employment law and related regulations including but not limited to purchasing and 
46.21 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
46.22 	and liability insurance, and submit any or all necessary documentation including but not 
46.23 	limited to workers' compensation, unemployment insurance, and labor market data required 
46.24 	under section 256B.4912, subdivision 1a;
46.25 	(2) bill the medical assistance program for personal care assistance services and qualified 
46.26 	professional services;
46.27 	(3) request and complete background studies that comply with the requirements for 
46.28 	personal care assistants and qualified professionals;
46.29 	(4) pay the personal care assistant and qualified professional based on actual hours of 
46.30 	services provided;
46.31 	(5) withhold and pay all applicable federal and state taxes;
47.1 	(6) verify and keep records of hours worked by the personal care assistant and qualified 
47.2 	professional;
47.3 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
47.4 	any legal requirements for a Minnesota employer;
47.5 	(8) enroll in the medical assistance program as a personal care assistance choice agency; 
47.6 	and
47.7 	(9) enter into a written agreement as specified in subdivision 20 before services are 
47.8 	provided.

47.9 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
47.10 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
47.11 	when federal approval is obtained.

47.12 	Sec. 5. Minnesota Statutes 2022, section 256B.0659, subdivision 24, is amended to read:
47.13 		Subd. 24.Personal care assistance provider agency; general duties. A personal care 
47.14 	assistance provider agency shall:
47.15 	(1) enroll as a Medicaid provider meeting all provider standards, including completion 
47.16 	of the required provider training;
47.17 	(2) comply with general medical assistance coverage requirements;
47.18 	(3) demonstrate compliance with law and policies of the personal care assistance program 
47.19 	to be determined by the commissioner;
47.20 	(4) comply with background study requirements;
47.21 	(5) verify and keep records of hours worked by the personal care assistant and qualified 
47.22 	professional;
47.23 	(6) not engage in any agency-initiated direct contact or marketing in person, by phone, 
47.24 	or other electronic means to potential recipients, guardians, or family members;
47.25 	(7) pay the personal care assistant and qualified professional based on actual hours of 
47.26 	services provided;
47.27 	(8) withhold and pay all applicable federal and state taxes;
47.28 	(9) document that the agency uses a minimum of 72.5 percent of the revenue generated 
47.29 	by the medical assistance rate for personal care assistance services for employee personal 
47.30 	care assistant wages and benefits. The revenue generated by the qualified professional and 
48.1 	the reasonable costs associated with the qualified professional shall not be used in making 
48.2 	this calculation;
48.3 	(10) make the arrangements and pay unemployment insurance, taxes, workers' 
48.4 	compensation, liability insurance, and other benefits, if any;
48.5 	(11) enter into a written agreement under subdivision 20 before services are provided;
48.6 	(12) report suspected neglect and abuse to the common entry point according to section 
48.7 	256B.0651;
48.8 	(13) provide the recipient with a copy of the home care bill of rights at start of service;
48.9 	(14) request reassessments at least 60 days prior to the end of the current authorization 
48.10 	for personal care assistance services, on forms provided by the commissioner;
48.11 	(15) comply with the labor market reporting requirements described in section 256B.4912, 
48.12 	subdivision 1a; and
48.13 	(16) document that the agency uses the additional revenue due to the enhanced rate under 
48.14 	subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements 
48.15 	under subdivision 11, paragraph (d); and
48.16 	(17) ensure that a personal care assistant driving a recipient under subdivision 1, 
48.17 	paragraph (i), has a valid driver's license and the vehicle used is registered and insured 
48.18 	according to Minnesota law.

48.19 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
48.20 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
48.21 	when federal approval is obtained.

48.22 	Sec. 6. Minnesota Statutes 2022, section 256B.4911, is amended by adding a subdivision 
48.23 	to read:
48.24 		Subd. 6.Services provided by parents and spouses. (a) This subdivision limits medical 
48.25 	assistance payments under the consumer-directed community supports option for personal 
48.26 	assistance services provided by a parent to the parent's minor child or by a participant's 
48.27 	spouse. This subdivision applies to the consumer-directed community supports option 
48.28 	available under all of the following:
48.29 	(1) alternative care program;
48.30 	(2) brain injury waiver;
48.31 	(3) community alternative care waiver;
49.1 	(4) community access for disability inclusion waiver;
49.2 	(5) developmental disabilities waiver;
49.3 	(6) elderly waiver; and
49.4 	(7) Minnesota senior health option.
49.5 	(b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal 
49.6 	guardian of a minor.
49.7 	(c) If multiple parents are providing personal assistance services to their minor child or 
49.8 	children, each parent may provide up to 40 hours of personal assistance services in any 
49.9 	seven-day period regardless of the number of children served. The total number of hours 
49.10 	of personal assistance services provided by all of the parents must not exceed 80 hours in 
49.11 	a seven-day period regardless of the number of children served.
49.12 	(d) If only one parent is providing personal assistance services to a minor child or 
49.13 	children, the parent may provide up to 60 hours of personal assistance services in a seven-day 
49.14 	period regardless of the number of children served.
49.15 	(e) If a participant's spouse is providing personal assistance services, the spouse may 
49.16 	provide up to 60 hours of personal assistance services in a seven-day period.
49.17 	(f) This subdivision must not be construed to permit an increase in the total authorized 
49.18 	consumer-directed community supports budget for an individual.

49.19 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
49.20 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
49.21 	when federal approval is obtained.

49.22 	Sec. 7. Minnesota Statutes 2022, section 256B.85, subdivision 7, is amended to read:
49.23 		Subd. 7.Community first services and supports; covered services.  Services and 
49.24 	supports covered under CFSS include:
49.25 	(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of 
49.26 	daily living (IADLs), and health-related procedures and tasks through hands-on assistance 
49.27 	to accomplish the task or constant supervision and cueing to accomplish the task;
49.28 	(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to 
49.29 	accomplish activities of daily living, instrumental activities of daily living, or health-related 
49.30 	tasks;
50.1 	(3) expenditures for items, services, supports, environmental modifications, or goods, 
50.2 	including assistive technology. These expenditures must:
50.3 	(i) relate to a need identified in a participant's CFSS service delivery plan; and
50.4 	(ii) increase independence or substitute for human assistance, to the extent that 
50.5 	expenditures would otherwise be made for human assistance for the participant's assessed 
50.6 	needs;
50.7 	(4) observation and redirection for behavior or symptoms where there is a need for 
50.8 	assistance;
50.9 	(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices, 
50.10 	to ensure continuity of the participant's services and supports;
50.11 	(6) services provided by a consultation services provider as defined under subdivision 
50.12 	17, that is under contract with the department and enrolled as a Minnesota health care 
50.13 	program provider;
50.14 	(7) services provided by an FMS provider as defined under subdivision 13a, that is an 
50.15 	enrolled provider with the department;
50.16 	(8) CFSS services provided by a support worker who is a parent, stepparent, or legal 
50.17 	guardian of a participant under age 18, or who is the participant's spouse. These support 
50.18 	workers shall not: Covered services under this clause are subject to the limitations described 
50.19 	in subdivision 7b; and
50.20 	(i) provide any medical assistance home and community-based services in excess of 40 
50.21 	hours per seven-day period regardless of the number of parents providing services, 
50.22 	combination of parents and spouses providing services, or number of children who receive 
50.23 	medical assistance services; and
50.24 	(ii) have a wage that exceeds the current rate for a CFSS support worker including the 
50.25 	wage, benefits, and payroll taxes; and
50.26 	(9) worker training and development services as described in subdivision 18a.

50.27 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
50.28 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
50.29 	when federal approval is obtained.

51.1 	Sec. 8. Minnesota Statutes 2022, section 256B.85, subdivision 7a, is amended to read:
51.2 		Subd. 7a.Enhanced rate. An enhanced rate of 107.5 143 percent of the rate paid for 
51.3 	CFSS must be paid for services provided to persons who qualify for ten or more hours of 
51.4 	CFSS per day when provided by a support worker who meets the requirements of subdivision 
51.5 	16, paragraph (e). Any change in the eligibility criteria for the enhanced rate for CFSS as 
51.6 	described in this subdivision and referenced in subdivision 16, paragraph (e), does not 
51.7 	constitute a change in a term or condition for individual providers as defined in section 
51.8 	256B.0711, and is not subject to the state's obligation to meet and negotiate under chapter 
51.9 	179A.

51.10 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
51.11 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
51.12 	when federal approval is obtained.

51.13 	Sec. 9. Minnesota Statutes 2022, section 256B.85, is amended by adding a subdivision to 
51.14 	read:
51.15 		Subd. 7b.Services provided by parents and spouses. (a) This subdivision applies to 
51.16 	services and supports described in subdivision 7, clause (8).
51.17 	(b) If multiple parents are support workers providing CFSS services to their minor child 
51.18 	or children, each parent may provide up to 40 hours of medical assistance home and 
51.19 	community-based services in any seven-day period regardless of the number of children 
51.20 	served. The total number of hours of medical assistance home and community-based services 
51.21 	provided by all of the parents must not exceed 80 hours in a seven-day period regardless of 
51.22 	the number of children served.
51.23 	(c) If only one parent is a support worker providing CFSS services to the parent's minor 
51.24 	child or children, the parent may provide up to 60 hours of medical assistance home and 
51.25 	community-based services in a seven-day period regardless of the number of children served.
51.26 	(d) If a participant's spouse is a support worker providing CFSS services, the spouse 
51.27 	may provide up to 60 hours of medical assistance home and community-based services in 
51.28 	a seven-day period.
51.29 	(e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total 
51.30 	authorized service budget for an individual or the total number of authorized service units.
51.31 	(f) A parent or participant's spouse must not receive a wage that exceeds the current rate 
51.32 	for a CFSS support worker, including wages, benefits, and payroll taxes.

52.1 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
52.2 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
52.3 	when federal approval is obtained.

52.4 	Sec. 10. Minnesota Statutes 2022, section 256B.851, subdivision 5, is amended to read:
52.5 		Subd. 5.Payment rates; component values. (a) The commissioner must use the 
52.6 	following component values:
52.7 	(1) employee vacation, sick, and training factor, 8.71 percent;
52.8 	(2) employer taxes and workers' compensation factor, 11.56 percent;
52.9 	(3) employee benefits factor, 12.04 percent;
52.10 	(4) client programming and supports factor, 2.30 percent;
52.11 	(5) program plan support factor, 7.00 percent;
52.12 	(6) general business and administrative expenses factor, 13.25 percent;
52.13 	(7) program administration expenses factor, 2.90 percent; and
52.14 	(8) absence and utilization factor, 3.90 percent.
52.15 	(b) For purposes of implementation, the commissioner shall use the following 
52.16 	implementation components:
52.17 	(1) personal care assistance services and CFSS: 75.45 ... percent;
52.18 	(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45 ...
52.19 	percent; and
52.20 	(3) qualified professional services and CFSS worker training and development: 75.45
52.21 	... percent.

52.22 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
52.23 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
52.24 	when federal approval is obtained.

52.25 	Sec. 11. PERSONAL CARE ASSISTANCE ENHANCED RATE FOR PERSONS 
52.26 	USING CONSUMER-DIRECTED COMMUNITY SUPPORTS.
 52.27 	The commissioner of human services shall increase the annual budgets for participants 
52.28 	who use consumer-directed community supports under Minnesota Statutes, sections 
52.29 	256B.0913, subdivision 5, clause (17); 256B.092, subdivision 1b, paragraph (a), clause (4); 
53.1 	and 256B.49, subdivision 16, paragraph (c); and chapter 256S, by 43 percent for participants 
53.2 	who: (1) are determined by assessment to be eligible for ten or more hours of personal care 
53.3 	assistance services or community first services and supports per day; and (2) use direct 
53.4 	support services provided by a worker employed by the participant who has completed 
53.5 	training identified in Minnesota Statutes, section 256B.0659, subdivision 11, paragraph (d), 
53.6 	or 256B.85, subdivision 16, paragraph (e).

53.7 	EFFECTIVE DATE. This section is effective January 1, 2024, or upon federal approval, 
53.8 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
53.9 	when federal approval is obtained.

53.10 	Sec. 12. RATE INCREASE FOR CERTAIN HOME CARE SERVICES.
 53.11 		Subdivision 1.Rate increases. (a) Effective January 1, 2024, or upon federal approval, 
53.12 	whichever is later, the commissioner of human services shall increase payment rates for 
53.13 	home health aide visits by 14 percent from the rates in effect on December 31, 2023. The 
53.14 	commissioner must apply the annual rate increases under Minnesota Statutes, section 
53.15 	256B.0653, subdivision 8, to the rates resulting from the application of the rate increases 
53.16 	under this paragraph.
53.17 	(b) Effective January 1, 2024, or upon federal approval, whichever is later, the 
53.18 	commissioner shall increase payment rates for respiratory therapy under Minnesota Rules, 
53.19 	part 9505.0295, subpart 2, item E, and for home health services and home care nursing 
53.20 	services, except home health aide visits, under Minnesota Statutes, section 256B.0651, 
53.21 	subdivision 2, clauses (1) to (3), by 38.8 percent from the rates in effect on December 31, 
53.22 	2023. The commissioner must apply the annual rate increases under Minnesota Statutes, 
53.23 	sections 256B.0653, subdivision 8, and 256B.0654, subdivision 5, to the rates resulting 
53.24 	from the application of the rate increase under this paragraph.
53.25 		Subd. 2.Spending requirements. (a) At least 80 percent of the marginal increase in 
53.26 	revenue for home care services resulting from implementation of the rate increases under 
53.27 	this section for services rendered on or after the day of implementation of the increase must 
53.28 	be used to increase compensation-related costs for employees directly employed by the 
53.29 	provider to provide the services.
53.30 	(b) For the purposes of this subdivision, compensation-related costs include:
53.31 	(1) wages and salaries;
53.32 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
53.33 	taxes, workers' compensation, and mileage reimbursement;
54.1 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
54.2 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
54.3 	employee retirement accounts; and
54.4 	(4) benefits that address direct support professional workforce needs above and beyond 
54.5 	what employees were offered prior to implementation of the rate increases.
54.6 	(c) Compensation-related costs for persons employed in the central office of a corporation 
54.7 	or entity that has an ownership interest in the provider or exercises control over the provider, 
54.8 	or for persons paid by the provider under a management contract, do not count toward the 
54.9 	80 percent requirement under this subdivision.
54.10 	(d) A provider agency or individual provider that receives additional revenue subject to 
54.11 	the requirements of this subdivision shall prepare, and upon request submit to the 
54.12 	commissioner, a distribution plan that specifies the amount of money the provider expects 
54.13 	to receive that is subject to the requirements of this subdivision, including how that money 
54.14 	was or will be distributed to increase compensation-related costs for employees. Within 60 
54.15 	days of final implementation of the new rate methodology or any rate adjustment subject 
54.16 	to the requirements of this subdivision, the provider must post the distribution plan and 
54.17 	leave it posted for a period of at least six months in an area of the provider's operation to 
54.18 	which all direct support professionals have access. The posted distribution plan must include 
54.19 	instructions regarding how to contact the commissioner, or the commissioner's representative, 
54.20 	if an employee has not received the compensation-related increase described in the plan.

54.21 	ARTICLE 5
54.22 	NURSING FACILITIES

54.23 	Section 1. Minnesota Statutes 2022, section 256R.02, subdivision 16, is amended to read:
54.24 		Subd. 16.Dietary costs. "Dietary costs" means the costs for the salaries and wages of 
54.25 	the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other employees assigned 
54.26 	to the kitchen and dining room, and associated fringe benefits and payroll taxes. Dietary 
54.27 	costs also includes the salaries or fees of dietary consultants, dietary supplies, and food 
54.28 	preparation and serving.

54.29 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
54.30 	2025, or upon federal approval, whichever is later. The commissioner of human services 
54.31 	shall notify the revisor of statutes when federal approval is obtained.

55.1 	Sec. 2. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to 
55.2 	read:
55.3 		Subd. 16a.Dietary labor costs. "Dietary labor costs" means the costs for the salaries 
55.4 	and wages of the dietary supervisor, dietitians, chefs, cooks, dishwashers, and other 
55.5 	employees assigned to the kitchen and dining room, and associated fringe benefits and 
55.6 	payroll taxes.

55.7 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
55.8 	2025, or upon federal approval, whichever is later. The commissioner of human services 
55.9 	shall notify the revisor of statutes when federal approval is obtained.

55.10 	Sec. 3. Minnesota Statutes 2022, section 256R.02, subdivision 24, is amended to read:
55.11 		Subd. 24.Housekeeping costs. "Housekeeping costs" means the costs for the salaries 
55.12 	and wages of the housekeeping supervisor, housekeepers, and other cleaning employees 
55.13 	and associated fringe benefits and payroll taxes. It also includes the cost of housekeeping 
55.14 	supplies, including, but not limited to, cleaning and lavatory supplies and contract services.

55.15 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
55.16 	2025, or upon federal approval, whichever is later. The commissioner of human services 
55.17 	shall notify the revisor of statutes when federal approval is obtained.

55.18 	Sec. 4. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to 
55.19 	read:
55.20 		Subd. 24a.Housekeeping labor costs. "Housekeeping labor costs" means the costs for 
55.21 	the salaries and wages of the housekeeping supervisor, housekeepers, and other cleaning 
55.22 	employees, and associated fringe benefits and payroll taxes.

55.23 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
55.24 	2025, or upon federal approval, whichever is later. The commissioner of human services 
55.25 	shall notify the revisor of statutes when federal approval is obtained.

55.26 	Sec. 5. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to 
55.27 	read:
55.28 		Subd. 25b.Known cost change factor. "Known cost change factor" means 1.00 plus 
55.29 	the forecasted percentage change in the CPI-U index from July 1 of the reporting period to 
55.30 	July 1 of the rate year as determined by the national economic consultant used by the 
55.31 	commissioner of management and budget.

56.1 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
56.2 	2025, or upon federal approval, whichever is later. The commissioner of human services 
56.3 	shall notify the revisor of statutes when federal approval is obtained.

56.4 	Sec. 6. Minnesota Statutes 2022, section 256R.02, subdivision 26, is amended to read:
56.5 		Subd. 26.Laundry costs. "Laundry costs" means the costs for the salaries and wages 
56.6 	of the laundry supervisor and other laundry employees, associated fringe benefits, and 
56.7 	payroll taxes. It also includes the costs of linen and bedding, the laundering of resident 
56.8 	clothing, laundry supplies, and contract services.

56.9 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
56.10 	2025, or upon federal approval, whichever is later. The commissioner of human services 
56.11 	shall notify the revisor of statutes when federal approval is obtained.

56.12 	Sec. 7. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to 
56.13 	read:
56.14 		Subd. 26a.Laundry labor costs. "Laundry labor costs" means the costs for the salaries 
56.15 	and wages of the laundry supervisor and other laundry employees, and associated fringe 
56.16 	benefits and payroll taxes.

56.17 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
56.18 	2025, or upon federal approval, whichever is later. The commissioner of human services 
56.19 	shall notify the revisor of statutes when federal approval is obtained.

56.20 	Sec. 8. Minnesota Statutes 2022, section 256R.02, subdivision 29, is amended to read:
56.21 		Subd. 29.Maintenance and plant operations costs. "Maintenance and plant operations 
56.22 	costs" means the costs for the salaries and wages of the maintenance supervisor, engineers, 
56.23 	heating-plant employees, and other maintenance employees and associated fringe benefits 
56.24 	and payroll taxes. It also includes identifiable costs for maintenance and operation of the 
56.25 	building and grounds, including, but not limited to, fuel, electricity, plastic waste bags, 
56.26 	medical waste and garbage removal, water, sewer, supplies, tools, repairs, and minor 
56.27 	equipment not requiring capitalization under Medicare guidelines.

56.28 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
56.29 	2025, or upon federal approval, whichever is later. The commissioner of human services 
56.30 	shall notify the revisor of statutes when federal approval is obtained.

57.1 	Sec. 9. Minnesota Statutes 2022, section 256R.02, is amended by adding a subdivision to 
57.2 	read:
57.3 		Subd. 29a.Maintenance and plant operations labor costs. "Maintenance and plant 
57.4 	operations labor costs" means the costs for the salaries and wages of the maintenance 
57.5 	supervisor, engineers, heating-plant employees, and other maintenance employees, and 
57.6 	associated fringe benefits and payroll taxes.

57.7 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
57.8 	2025, or upon federal approval, whichever is later. The commissioner of human services 
57.9 	shall notify the revisor of statutes when federal approval is obtained.

57.10 	Sec. 10. Minnesota Statutes 2022, section 256R.02, subdivision 34, is amended to read:
57.11 		Subd. 34.Other care-related costs. "Other care-related costs" means the sum of activities 
57.12 	costs, other direct care costs, raw food costs, dietary labor costs, housekeeping labor costs, 
57.13 	laundry labor costs, maintenance and plant operations labor costs, therapy costs, and social 
57.14 	services costs.

57.15 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
57.16 	2025, or upon federal approval, whichever is later. The commissioner of human services 
57.17 	shall notify the revisor of statutes when federal approval is obtained.

57.18 	Sec. 11. Minnesota Statutes 2022, section 256R.23, subdivision 2, is amended to read:
57.19 		Subd. 2.Calculation of direct care cost per standardized day. Each facility's direct 
57.20 	care cost per standardized day is (1) the product of the facility's direct care costs and the 
57.21 	known cost change factor, (2) divided by the sum of the facility's standardized days. A 
57.22 	facility's direct care cost per standardized day is the facility's cost per day for direct care 
57.23 	services associated with a case mix index of 1.00.

57.24 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
57.25 	2025, or upon federal approval, whichever is later. The commissioner of human services 
57.26 	shall notify the revisor of statutes when federal approval is obtained.

57.27 	Sec. 12. Minnesota Statutes 2022, section 256R.23, subdivision 3, is amended to read:
57.28 		Subd. 3.Calculation of other care-related cost per resident day. Each facility's other 
57.29 	care-related cost per resident day is (1) the product of its other care-related costs and the 
57.30 	known cost change factor, (2) divided by the sum of the facility's resident days.

58.1 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
58.2 	2025, or upon federal approval, whichever is later. The commissioner of human services 
58.3 	shall notify the revisor of statutes when federal approval is obtained.

58.4 	Sec. 13. Minnesota Statutes 2022, section 256R.24, subdivision 1, is amended to read:
58.5 		Subdivision 1.Determination of other operating cost per day. Each facility's other 
58.6 	operating cost per day is (1) the product of its other operating costs and the known cost 
58.7 	change factor, (2) divided by the sum of the facility's resident days.

58.8 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
58.9 	2025, or upon federal approval, whichever is later. The commissioner of human services 
58.10 	shall notify the revisor of statutes when federal approval is obtained.

58.11 	Sec. 14. Minnesota Statutes 2022, section 256R.25, is amended to read:
58.12 	256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.
58.13 	(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs 
58.14 	(b) to (o).
58.15 	(b) For a facility licensed as a nursing home, the portion related to the provider surcharge 
58.16 	under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a 
58.17 	nursing home and a boarding care home, the portion related to the provider surcharge under 
58.18 	section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number 
58.19 	of nursing home beds divided by its total number of licensed beds.
58.20 	(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the 
58.21 	amount of the fee divided by the sum of the facility's resident days.
58.22 	(d) The portion related to development and education of resident and family advisory 
58.23 	councils under section 144A.33 is $5 per resident day divided by 365.
58.24 	(e) The portion related to scholarships is determined under section 256R.37.
58.25 	(f) The portion related to planned closure rate adjustments is as determined under section 
58.26 	256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.
58.27 	(g) The portion related to consolidation rate adjustments shall be as determined under 
58.28 	section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
58.29 	(h) The portion related to single-bed room incentives is as determined under section 
58.30 	256R.41.
59.1 	(i) The portions related to real estate taxes, special assessments, and payments made in 
59.2 	lieu of real estate taxes directly identified or allocated to the nursing facility are the allowable 
59.3 	amounts divided by the sum of the facility's resident days. Allowable costs under this 
59.4 	paragraph for payments made by a nonprofit nursing facility that are in lieu of real estate 
59.5 	taxes shall not exceed the amount which the nursing facility would have paid to a city or 
59.6 	township and county for fire, police, sanitation services, and road maintenance costs had 
59.7 	real estate taxes been levied on that property for those purposes.
59.8 	(j) The portion related to employer health insurance costs is (1) the product of the 
59.9 	allowable costs and the known cost change factor, (2) divided by the sum of the facility's 
59.10 	resident days.
59.11 	(k) The portion related to the Public Employees Retirement Association is the allowable 
59.12 	costs divided by the sum of the facility's resident days.
59.13 	(l) The portion related to quality improvement incentive payment rate adjustments is 
59.14 	the amount determined under section 256R.39.
59.15 	(m) The portion related to performance-based incentive payments is the amount 
59.16 	determined under section 256R.38.
59.17 	(n) The portion related to special dietary needs is the amount determined under section 
59.18 	256R.51.
59.19 	(o) The portion related to the rate adjustments for border city facilities is the amount 
59.20 	determined under section 256R.481.

59.21 	EFFECTIVE DATE. This section is effective for the rate year beginning January 1, 
59.22 	2025, or upon federal approval, whichever is later. The commissioner of human services 
59.23 	shall notify the revisor of statutes when federal approval is obtained.

59.24 	Sec. 15. NURSING FACILITY FUNDING.
 59.25 	(a) Effective July 1, 2023, through December 31, 2025, the total payment rate for all 
59.26 	facilities reimbursed under Minnesota Statutes, chapter 256R, must be increased by $28.65 
59.27 	per resident day.
59.28 	(b) To be eligible to receive a payment under this section, a nursing facility must attest 
59.29 	to the commissioner of human services that the additional revenue will be used exclusively 
59.30 	to increase compensation-related costs for employees directly employed by the facility on 
59.31 	or after July 1, 2023, excluding:
59.32 	(1) owners of the building and operation;
60.1 	(2) persons employed in the central office of an entity that has any ownership interest 
60.2 	in the nursing facility or exercises control over the nursing facility;
60.3 	(3) persons paid by the nursing facility under a management contract; and
60.4 	(4) persons providing separately billable services.
60.5 	(c) Contracted housekeeping, dietary, and laundry employees providing services on site 
60.6 	at the nursing facility are eligible for compensation-related cost increases under this section, 
60.7 	provided the agency that employs them submits to the nursing facility proof of the costs of 
60.8 	the increases provided to those employees.
60.9 	(d) For purposes of this section, compensation-related costs include:
60.10 	(1) permanent new increases to wages and salaries implemented on or after July 1, 2023, 
60.11 	and before September 1, 2023, for nursing facility employees;
60.12 	(2) permanent new increases to wages and salaries implemented on or after July 1, 2023, 
60.13 	and before September 1, 2023, for employees in the organization's shared services 
60.14 	departments of hospital-attached nursing facilities for the nursing facility allocated share 
60.15 	of wages; and
60.16 	(3) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
60.17 	taxes, PERA, workers' compensation, and pension and employee retirement accounts directly 
60.18 	associated with the wage and salary increases in clauses (1) and (2) incurred no later than 
60.19 	December 31, 2025, and paid for no later than June 30, 2026.
60.20 	(e) A facility that receives a rate increase under this section must complete a distribution 
60.21 	plan in the form and manner determined by the commissioner. This plan must specify the 
60.22 	total amount of money the facility is estimated to receive from this rate increase and how 
60.23 	that money will be distributed to increase the allowable compensation-related costs described 
60.24 	in paragraph (d) for employees described in paragraphs (b) and (c). This estimate must be 
60.25 	computed by multiplying $28.65 by the sum of the medical assistance and private pay 
60.26 	resident days as defined in Minnesota Statutes, section 256R.02, subdivision 45, for the 
60.27 	period beginning October 1, 2021, through September 30, 2022, dividing this sum by 365 
60.28 	and multiplying the result by 915. A facility must submit its distribution plan to the 
60.29 	commissioner by October 1, 2023. The commissioner may review the distribution plan to 
60.30 	ensure that the payment rate adjustment per resident day is used in accordance with this 
60.31 	section. The commissioner may allow for a distribution plan amendment under exceptional 
60.32 	circumstances to be determined at the sole discretion of the commissioner.
61.1 	(f) By September 1, 2023, a facility must post the distribution plan summary and leave 
61.2 	it posted for a period of at least six months in an area of the facility to which all employees 
61.3 	have access. The posted distribution plan summary must be in the form and manner 
61.4 	determined by the commissioner. The distribution plan summary must include instructions 
61.5 	regarding how to contact the commissioner, or the commissioner's representative, if an 
61.6 	employee believes the employee is covered by paragraph (b) or (c) and has not received the 
61.7 	compensation-related increases described in paragraph (d). The instruction to such employees 
61.8 	must include the e-mail address and telephone number that may be used by the employee 
61.9 	to contact the commissioner's representative. The posted distribution plan summary must 
61.10 	demonstrate how the increase in paragraph (a) received by the nursing facility from July 1, 
61.11 	2023, through December 1, 2025, will be used in full to pay the compensation-related costs 
61.12 	in paragraph (d) for employees described in paragraphs (b) and (c).
61.13 	(g) If the nursing facility expends less on new compensation-related costs than the amount 
61.14 	that was made available by the rate increase in this section for that purpose, the amount of 
61.15 	this rate adjustment must be reduced to equal the amount utilized by the facility for purposes 
61.16 	authorized under this section. If the facility fails to post the distribution plan summary in 
61.17 	its facility as required, fails to submit its distribution plan to the commissioner by the due 
61.18 	date, or uses these funds for unauthorized purposes, these rate increases must be treated as 
61.19 	an overpayment and subsequently recovered.
61.20 	(h) The commissioner shall not treat payments received under this section as an applicable 
61.21 	credit for purposes of setting total payment rates under Minnesota Statutes, chapter 256R.

61.22 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
61.23 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
61.24 	when federal approval is obtained.

61.25 	ARTICLE 6
61.26 	INTERMEDIATE CARE FACILITIES

61.27 	Section 1. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
61.28 	to read:
61.29 		Subd. 19.ICF/DD rate increase effective July 1, 2023. (a) Effective July 1, 2023, the 
61.30 	daily operating payment rate for a class A intermediate care facility for persons with 
61.31 	developmental disabilities is increased by $50.
61.32 	(b) Effective July 1, 2023, the daily operating payment rate for a class B intermediate 
61.33 	care facility for persons with developmental disabilities is increased by $50.

62.1 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
62.2 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
62.3 	when federal approval is obtained.

62.4 	Sec. 2. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
62.5 	to read:
62.6 		Subd. 20.ICF/DD minimum daily operating payment rates. (a) The minimum daily 
62.7 	operating payment rate for a class A intermediate care facility for persons with developmental 
62.8 	disabilities is $300.
62.9 	(b) The minimum daily operating payment rate for a class B intermediate care facility 
62.10 	for persons with developmental disabilities is $400.

62.11 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
62.12 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
62.13 	when federal approval is obtained.

62.14 	Sec. 3. Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision 
62.15 	to read:
62.16 		Subd. 21.Spending requirements. (a) At least 80 percent of the marginal increase in 
62.17 	revenue resulting from implementation of the rate increases under subdivisions 19 and 20 
62.18 	for services rendered on or after the day of implementation of the increases must be used 
62.19 	to increase compensation-related costs for employees directly employed by the facility.
62.20 	(b) For the purposes of this subdivision, compensation-related costs include:
62.21 	(1) wages and salaries;
62.22 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
62.23 	taxes, workers' compensation, and mileage reimbursement;
62.24 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
62.25 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
62.26 	employee retirement accounts; and
62.27 	(4) benefits that address direct support professional workforce needs above and beyond 
62.28 	what employees were offered prior to implementation of the rate increases.
62.29 	(c) Compensation-related costs for persons employed in the central office of a corporation 
62.30 	or entity that has an ownership interest in the provider or exercises control over the provider, 
63.1 	or for persons paid by the provider under a management contract, do not count toward the 
63.2 	80 percent requirement under this subdivision.
63.3 	(d) A provider agency or individual provider that receives additional revenue subject to 
63.4 	the requirements of this subdivision shall prepare, and upon request submit to the 
63.5 	commissioner, a distribution plan that specifies the amount of money the provider expects 
63.6 	to receive that is subject to the requirements of this subdivision, including how that money 
63.7 	was or will be distributed to increase compensation-related costs for employees. Within 60 
63.8 	days of final implementation of the new rate methodology or any rate adjustment subject 
63.9 	to the requirements of this subdivision, the provider must post the distribution plan and 
63.10 	leave it posted for a period of at least six months in an area of the provider's operation to 
63.11 	which all direct support professionals have access. The posted distribution plan must include 
63.12 	instructions regarding how to contact the commissioner, or the commissioner's representative, 
63.13 	if an employee has not received the compensation-related increase described in the plan.

63.14 	Sec. 4. DIRECTION TO COMMISSIONER; APPLICATION OF INTERMEDIATE 
63.15 	CARE FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES 
63.16 	RATE INCREASES.
 63.17 	The commissioner of human services shall apply the rate increases under Minnesota 
63.18 	Statutes, section 256B.5012, subdivisions 19 and 20, as follows:
63.19 	(1) apply Minnesota Statutes, section 256B.5012, subdivision 19; and
63.20 	(2) apply any required rate increase as required under Minnesota Statutes, section 
63.21 	256B.5012, subdivision 20, to the results of clause (1).

63.22 	ARTICLE 7
63.23 	EMERGENCY AND NONEMERGENCY MEDICAL TRANSPORTATION

63.24 	Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to 
63.25 	read:
63.26 		Subd. 17.Transportation costs. (a) "Nonemergency medical transportation service" 
63.27 	means motor vehicle transportation provided by a public or private person that serves 
63.28 	Minnesota health care program beneficiaries who do not require emergency ambulance 
63.29 	service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
63.30 	(b) Medical assistance covers medical transportation costs incurred solely for obtaining 
63.31 	emergency medical care or transportation costs incurred by eligible persons in obtaining 
63.32 	emergency or nonemergency medical care when paid directly to an ambulance company, 
64.1 	nonemergency medical transportation company, or other recognized providers of 
64.2 	transportation services. Medical transportation must be provided by:
64.3 	(1) nonemergency medical transportation providers who meet the requirements of this 
64.4 	subdivision;
64.5 	(2) ambulances, as defined in section 144E.001, subdivision 2;
64.6 	(3) taxicabs that meet the requirements of this subdivision;
64.7 	(4) public transit, as defined in section 174.22, subdivision 7; or
64.8 	(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472, 
64.9 	subdivision 1, paragraph (h).
64.10 	(c) Medical assistance covers nonemergency medical transportation provided by 
64.11 	nonemergency medical transportation providers enrolled in the Minnesota health care 
64.12 	programs. All nonemergency medical transportation providers must comply with the 
64.13 	operating standards for special transportation service as defined in sections 174.29 to 174.30 
64.14 	and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the 
64.15 	commissioner and reported on the claim as the individual who provided the service. All 
64.16 	nonemergency medical transportation providers shall bill for nonemergency medical 
64.17 	transportation services in accordance with Minnesota health care programs criteria. Publicly 
64.18 	operated transit systems, volunteers, and not-for-hire vehicles are exempt from the 
64.19 	requirements outlined in this paragraph.
64.20 	(d) An organization may be terminated, denied, or suspended from enrollment if:
64.21 	(1) the provider has not initiated background studies on the individuals specified in 
64.22 	section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
64.23 	(2) the provider has initiated background studies on the individuals specified in section 
64.24 	174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
64.25 	(i) the commissioner has sent the provider a notice that the individual has been 
64.26 	disqualified under section 245C.14; and
64.27 	(ii) the individual has not received a disqualification set-aside specific to the special 
64.28 	transportation services provider under sections 245C.22 and 245C.23.
64.29 	(e) The administrative agency of nonemergency medical transportation must:
64.30 	(1) adhere to the policies defined by the commissioner;
65.1 	(2) pay nonemergency medical transportation providers for services provided to 
65.2 	Minnesota health care programs beneficiaries to obtain covered medical services;
65.3 	(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled 
65.4 	trips, and number of trips by mode; and
65.5 	(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single 
65.6 	administrative structure assessment tool that meets the technical requirements established 
65.7 	by the commissioner, reconciles trip information with claims being submitted by providers, 
65.8 	and ensures prompt payment for nonemergency medical transportation services.
65.9 	(f) Until the commissioner implements the single administrative structure and delivery 
65.10 	system under subdivision 18e, clients shall obtain their level-of-service certificate from the 
65.11 	commissioner or an entity approved by the commissioner that does not dispatch rides for 
65.12 	clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
65.13 	(g) The commissioner may use an order by the recipient's attending physician, advanced 
65.14 	practice registered nurse, physician assistant, or a medical or mental health professional to 
65.15 	certify that the recipient requires nonemergency medical transportation services. 
65.16 	Nonemergency medical transportation providers shall perform driver-assisted services for 
65.17 	eligible individuals, when appropriate. Driver-assisted service includes passenger pickup 
65.18 	at and return to the individual's residence or place of business, assistance with admittance 
65.19 	of the individual to the medical facility, and assistance in passenger securement or in securing 
65.20 	of wheelchairs, child seats, or stretchers in the vehicle.
65.21 	Nonemergency medical transportation providers must take clients to the health care 
65.22 	provider using the most direct route, and must not exceed 30 miles for a trip to a primary 
65.23 	care provider or 60 miles for a trip to a specialty care provider, unless the client receives 
65.24 	authorization from the local agency.
65.25 	Nonemergency medical transportation providers may not bill for separate base rates for 
65.26 	the continuation of a trip beyond the original destination. Nonemergency medical 
65.27 	transportation providers must maintain trip logs, which include pickup and drop-off times, 
65.28 	signed by the medical provider or client, whichever is deemed most appropriate, attesting 
65.29 	to mileage traveled to obtain covered medical services. Clients requesting client mileage 
65.30 	reimbursement must sign the trip log attesting mileage traveled to obtain covered medical 
65.31 	services.
65.32 	(h) The administrative agency shall use the level of service process established by the 
65.33 	commissioner to determine the client's most appropriate mode of transportation. If public 
66.1 	transit or a certified transportation provider is not available to provide the appropriate service 
66.2 	mode for the client, the client may receive a onetime service upgrade.
66.3 	(i) The covered modes of transportation are:
66.4 	(1) client reimbursement, which includes client mileage reimbursement provided to 
66.5 	clients who have their own transportation, or to family or an acquaintance who provides 
66.6 	transportation to the client;
66.7 	(2) volunteer transport, which includes transportation by volunteers using their own 
66.8 	vehicle;
66.9 	(3) unassisted transport, which includes transportation provided to a client by a taxicab 
66.10 	or public transit. If a taxicab or public transit is not available, the client can receive 
66.11 	transportation from another nonemergency medical transportation provider;
66.12 	(4) assisted transport, which includes transport provided to clients who require assistance 
66.13 	by a nonemergency medical transportation provider;
66.14 	(5) lift-equipped/ramp transport, which includes transport provided to a client who is 
66.15 	dependent on a device and requires a nonemergency medical transportation provider with 
66.16 	a vehicle containing a lift or ramp;
66.17 	(6) protected transport, which includes transport provided to a client who has received 
66.18 	a prescreening that has deemed other forms of transportation inappropriate and who requires 
66.19 	a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety 
66.20 	locks, a video recorder, and a transparent thermoplastic partition between the passenger and 
66.21 	the vehicle driver; and (ii) who is certified as a protected transport provider; and
66.22 	(7) stretcher transport, which includes transport for a client in a prone or supine position 
66.23 	and requires a nonemergency medical transportation provider with a vehicle that can transport 
66.24 	a client in a prone or supine position.
66.25 	(j) The local agency shall be the single administrative agency and shall administer and 
66.26 	reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the 
66.27 	commissioner has developed, made available, and funded the web-based single administrative 
66.28 	structure, assessment tool, and level of need assessment under subdivision 18e. The local 
66.29 	agency's financial obligation is limited to funds provided by the state or federal government.
66.30 	(k) The commissioner shall:
66.31 	(1) verify that the mode and use of nonemergency medical transportation is appropriate;
66.32 	(2) verify that the client is going to an approved medical appointment; and
67.1 	(3) investigate all complaints and appeals.
67.2 	(l) The administrative agency shall pay for the services provided in this subdivision and 
67.3 	seek reimbursement from the commissioner, if appropriate. As vendors of medical care, 
67.4 	local agencies are subject to the provisions in section 256B.041, the sanctions and monetary 
67.5 	recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
67.6 	(m) Payments for nonemergency medical transportation must be paid based on the client's 
67.7 	assessed mode under paragraph (h), not the type of vehicle used to provide the service. The 
67.8 	medical assistance reimbursement rates for nonemergency medical transportation services 
67.9 	that are payable by or on behalf of the commissioner for nonemergency medical 
67.10 	transportation services are:
67.11 	(1) $0.22 per mile for client reimbursement;
67.12 	(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer 
67.13 	transport;
67.14 	(3) equivalent to the standard fare for unassisted transport when provided by public 
67.15 	transit, and $11 $12.93 for the base rate and $1.30 $1.53 per mile when provided by a 
67.16 	nonemergency medical transportation provider;
67.17 	(4) $13 $15.28 for the base rate and $1.30 $1.53 per mile for assisted transport;
67.18 	(5) $18 $21.15 for the base rate and $1.55 $1.82 per mile for lift-equipped/ramp transport;
67.19 	(6) $75 for the base rate and $2.40 per mile for protected transport; and
67.20 	(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for 
67.21 	an additional attendant if deemed medically necessary.
67.22 	(n) The base rate for nonemergency medical transportation services in areas defined 
67.23 	under RUCA to be super rural is equal to 111.3 percent of the respective base rate in 
67.24 	paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation 
67.25 	services in areas defined under RUCA to be rural or super rural areas is:
67.26 	(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage 
67.27 	rate in paragraph (m), clauses (1) to (7); and
67.28 	(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage 
67.29 	rate in paragraph (m), clauses (1) to (7).
67.30 	(o) For purposes of reimbursement rates for nonemergency medical transportation 
67.31 	services under paragraphs (m) and (n), the zip code of the recipient's place of residence 
67.32 	shall determine whether the urban, rural, or super rural reimbursement rate applies.
68.1 	(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means 
68.2 	a census-tract based classification system under which a geographical area is determined 
68.3 	to be urban, rural, or super rural.
68.4 	(q) The commissioner, when determining reimbursement rates for nonemergency medical 
68.5 	transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed 
68.6 	under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
68.7 	(r) Effective for the first day of each calendar quarter in which the price of gasoline as 
68.8 	posted publicly by the United States Energy Information Administration exceeds $3.00 per 
68.9 	gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent 
68.10 	up or down for every increase or decrease of ten cents for the price of gasoline. The increase 
68.11 	or decrease must be calculated using a base gasoline price of $3.00. The percentage increase 
68.12 	or decrease must be calculated using the average of the most recently available price of all 
68.13 	grades of gasoline for Minnesota as posted publicly by the United States Energy Information 
68.14 	Administration.

68.15 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
68.16 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
68.17 	when federal approval is obtained.

68.18 	Sec. 2. Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read:
68.19 		Subd. 17a.Payment for ambulance services. (a) Medical assistance covers ambulance 
68.20 	services. Providers shall bill ambulance services according to Medicare criteria. 
68.21 	Nonemergency ambulance services shall not be paid as emergencies. Effective for services 
68.22 	rendered on or after July 1, 2001, medical assistance payments for ambulance services shall 
68.23 	be paid at the Medicare reimbursement rate or at the medical assistance payment rate in 
68.24 	effect on July 1, 2000, whichever is greater.
68.25 	(b) Effective for services provided on or after July 1, 2016, medical assistance payment 
68.26 	rates for ambulance services identified in this paragraph are increased by five percent. 
68.27 	Capitation payments made to managed care plans and county-based purchasing plans for 
68.28 	ambulance services provided on or after January 1, 2017, shall be increased to reflect this 
68.29 	rate increase. The increased rate described in this paragraph applies to ambulance service 
68.30 	providers whose base of operations as defined in section 144E.10 is located:
68.31 	(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside 
68.32 	the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or
68.33 	(2) within a municipality with a population of less than 1,000.
69.1 	(c) Effective for the first day of each calendar quarter in which the price of gasoline as 
69.2 	posted publicly by the United States Energy Information Administration exceeds $3.00 per 
69.3 	gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one 
69.4 	percent up or down for every increase or decrease of ten cents for the price of gasoline. The 
69.5 	increase or decrease must be calculated using a base gasoline price of $3.00. The percentage 
69.6 	increase or decrease must be calculated using the average of the most recently available 
69.7 	price of all grades of gasoline for Minnesota as posted publicly by the United States Energy 
69.8 	Information Administration.

69.9 	EFFECTIVE DATE. This section is effective July 1, 2023, or upon federal approval, 
69.10 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
69.11 	when federal approval is obtained.

69.12 	Sec. 3. NONEMERGENCY MEDICAL TRANSPORTATION SPENDING 
69.13 	REQUIREMENTS.
 69.14 	(a) At least 80 percent of the marginal increase in revenue from the implementation of 
69.15 	rate increases in this act under Minnesota Statutes, section 256B.0625, subdivision 17, 
69.16 	paragraph (m), clauses (3) to (5), for services rendered on or after the day of implementation 
69.17 	of the rate increases must be used to increase compensation-related costs for drivers.
69.18 	(b) For the purposes of this subdivision, compensation-related costs include:
69.19 	(1) wages and salaries;
69.20 	(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment 
69.21 	taxes, workers' compensation, and mileage reimbursement;
69.22 	(3) the employer's paid share of health and dental insurance, life insurance, disability 
69.23 	insurance, long-term care insurance, uniform allowance, pensions, and contributions to 
69.24 	employee retirement accounts; and
69.25 	(4) benefits that address direct support professional workforce needs above and beyond 
69.26 	what employees were offered prior to the implementation of the rate increases.
69.27 	(c) Compensation-related costs for persons employed in the central office of a corporation 
69.28 	or entity that has an ownership interest in the provider or exercises control over the provider, 
69.29 	or for persons paid by the provider under a management contract, do not count toward the 
69.30 	80 percent requirement under this subdivision.
69.31 	(d) A provider agency or individual provider that receives additional revenue subject to 
69.32 	the requirements of this subdivision shall prepare, and upon request submit to the 
70.1 	commissioner, a distribution plan that specifies the amount of money the provider expects 
70.2 	to receive that is subject to the requirements of this section, including how that money was 
70.3 	or will be distributed to increase compensation-related costs for drivers. Within 60 days of 
70.4 	final implementation of the new phase-in proportion or adjustment to the base wage indices 
70.5 	subject to the requirements of this subdivision, the provider must post the distribution plan 
70.6 	and leave it posted for a period of at least six months in an area of the provider's operation 
70.7 	to which all drivers have access. The posted distribution plan must include instructions 
70.8 	regarding how to contact the commissioner, or the commissioner's representative, if a driver 
70.9 	has not received the compensation-related increase described in the plan.

70.10 	ARTICLE 8
70.11 	RESIDENTIAL SETTING CLOSURE PREVENTION GRANTS

70.12 	Section 1. [256.4795] RESIDENTIAL SETTING CLOSURE PREVENTION 
70.13 	GRANTS.
70.14 		Subdivision 1.Residential setting closure prevention grants established. The 
70.15 	commissioner of human services shall establish a grant program to reduce the risk of 
70.16 	residential settings in financial distress from closing. The commissioner shall limit 
70.17 	expenditures under this subdivision to the amount appropriated for this purpose.
70.18 		Subd. 2.Definitions. (a) For the purposes of this section, the terms in this subdivision 
70.19 	have the meanings given them.
70.20 	(b) "At risk of closure" or "at risk of closing" means a residential setting is in significant 
70.21 	financial distress, and, in the judgment of the commissioner, the setting will close without 
70.22 	additional funding from the commissioner.
70.23 	(c) "Residential setting" means any of the following: (1) a nursing facility; (2) an assisted 
70.24 	living facility with a majority of residents receiving services funded by medical assistance; 
70.25 	(3) a setting exempt from assisted living facility licensure under section 144G.08, subdivision 
70.26 	7, clauses (10) to (13), with a majority of residents receiving services funded by medical 
70.27 	assistance; (4) an intermediate care facility for persons with developmental disabilities; or 
70.28 	(5) an adult foster care setting, a community residential setting, or an integrated community 
70.29 	supports setting.
70.30 		Subd. 3.Eligibility. (a) A license holder operating a residential setting in significant 
70.31 	financial distress may apply to the commissioner for a grant under this section to relieve its 
70.32 	immediate financial distress.
71.1 	(b) Lead agencies that suspect a residential setting is in significant financial distress may 
71.2 	refer the license holder to the commissioner for consideration by the commissioner for grant 
71.3 	funding under this section. Upon a referral from a lead agency under this section, the 
71.4 	commissioner shall immediately solicit an application from the license holder, providing 
71.5 	individualized technical assistance to the license holder regarding the application process.
71.6 	(c) The commissioner must give priority for closure prevention grants to residential 
71.7 	settings that are the most significantly at risk of closing in violation of the applicable notice 
71.8 	requirements prior to the termination of services.
71.9 		Subd. 4.Criteria and limitations. (a) Within available appropriations for this purpose, 
71.10 	the commissioner must award sufficient funding to a residential setting at risk of closure to 
71.11 	ensure that the residential setting remains open long enough to comply with the applicable 
71.12 	termination of services notification requirements.
71.13 	(b) The commissioner may award additional funding to a residential setting at risk of 
71.14 	closure if, in the judgment of the commissioner, the residential setting is likely to remain 
71.15 	open and financially viable after receiving time-limited additional funding from the 
71.16 	commissioner.
71.17 	(c) Before receiving any additional funding under paragraph (b), grantees must work 
71.18 	with the commissioner to develop a business plan and corrective action plan to reduce the 
71.19 	risk of future financial distress. No residential setting may receive additional funding under 
71.20 	paragraph (b) more than once.
71.21 		Subd. 5.Interagency coordination. The commissioner must coordinate the grant 
71.22 	activities under this section with any other impacted state agencies and lead agencies.
71.23 		Subd. 6.Administrative funding. The commissioner may use up to 6.5 percent of the 
71.24 	grant money appropriated for the commissioner's costs related to administration of this 
71.25 	program.

71.26 	EFFECTIVE DATE. This section is effective July 1, 2023.

72.1 	ARTICLE 9
72.2 	EXPANSION OF EMERGENCY STAFFING POOL

72.3 	Section 1. Laws 2022, chapter 40, section 6, is amended to read:
72.4 	Sec. 6. COMMISSIONER OF HUMAN SERVICES; TEMPORARY STAFFING 
72.5 	POOL; APPROPRIATION.
 72.6 	(a) The commissioner of human services shall establish a temporary emergency staffing 
72.7 	pool for congregate settings and for providers or recipients of home- and community-based 
72.8 	services experiencing staffing crises. Vendor contracts may include retention bonuses, 
72.9 	sign-on bonuses, and payment for hours on call. The commissioner may pay for necessary 
72.10 	training, travel, and lodging expenses of the temporary staff. Contracts for temporary staffing 
72.11 	executed under this section: (1) should minimize the recruitment away from providers' 
72.12 	current workforces; and (2) may not be executed with an individual until at least 30 days 
72.13 	since the individual was last employed in Minnesota by one of the types of facilities, 
72.14 	providers, or individuals listed in paragraph (g).
72.15 	(b) Temporary staff, at the request of the commissioner, may be deployed to providers 
72.16 	of home- and community-based services, individual recipients of home- and 
72.17 	community-based services, and long-term care facilities and other congregate care residential 
72.18 	facilities and programs experiencing an emergency staffing crisis on or after the effective 
72.19 	date of this section. Temporary staff must be provided at no cost to the provider, individual 
72.20 	recipient, facility, or program receiving the temporary staff.
72.21 	(c) Members of the temporary staffing pool under this section are not state employees.
72.22 	(d) The commissioner must coordinate the activities under this section with any other 
72.23 	impacted state agencies, to appropriately prioritize locations to deploy contracted temporary 
72.24 	staff.
72.25 	(e) The commissioner must give priority for deploying staff to providers, individual 
72.26 	recipients, facilities, and programs with the most significant staffing crises and where, but 
72.27 	for this assistance, residents or service recipients would be at significant risk of injury due 
72.28 	to the need to transfer to another a facility or a hospital for adequately staffed care.
72.29 	(f) A provider, individual recipient, facility, or program may seek onetime assistance 
72.30 	per setting or individual service recipient from the temporary staffing pool only after the
72.31 	provider, individual recipient, facility, or program has used all resources available to obtain 
72.32 	temporary staff but is unable to meet the provider's, individual's, facility's, or program's 
72.33 	temporary staffing needs. A provider, individual, facility, or program may apply for 
73.1 	temporary staff for up to 21 days. Applicants must submit a proposed plan for ensuring 
73.2 	resident safety at the end of that time period.
73.3 	(g) Providers, individuals, facilities, and programs eligible to obtain temporary staff 
73.4 	from the temporary staffing pool include:
73.5 	(1) nursing facilities;
73.6 	(2) assisted living facilities;
73.7 	(3) intermediate care facilities for persons with developmental disabilities;
73.8 	(4) adult foster care or , community residential settings, or integrated community supports 
73.9 	settings;
73.10 	(5) licensed substance use disorder treatment facilities;
73.11 	(6) unlicensed county-based substance use disorder treatment facilities;
73.12 	(7) licensed facilities for adults with mental illness;
73.13 	(8) licensed detoxification programs;
73.14 	(9) licensed withdrawal management programs;
73.15 	(10) licensed children's residential facilities;
73.16 	(11) licensed child foster residence settings;
73.17 	(12) unlicensed, Tribal-certified facilities that perform functions similar to the licensed 
73.18 	facilities listed in this paragraph;
73.19 	(13) boarding care homes;
73.20 	(14) board and lodging establishments serving people with disabilities or disabling 
73.21 	conditions;
73.22 	(15) board and lodging establishments with special services;
73.23 	(16) supervised living facilities;
73.24 	(17) supportive housing;
73.25 	(18) sober homes;
73.26 	(19) community-based halfway houses for people exiting the correctional system;
73.27 	(20) shelters serving people experiencing homelessness;
73.28 	(21) drop-in centers for people experiencing homelessness;
74.1 	(22) homeless outreach services for unsheltered individuals;
74.2 	(23) shelters for people experiencing domestic violence; and
74.3 	(24) temporary isolation spaces for people who test positive for COVID-19;
74.4 	(25) individuals who use consumer-directed community supports;
74.5 	(26) individuals who use the personal care assistance choice program;
74.6 	(27) personal care assistance provider agencies;
74.7 	(28) individuals who use the community first services and supports budget model;
74.8 	(29) agency-providers of community first services and supports; and
74.9 	(30) providers of individualized home supports.
74.10 	(h) Notwithstanding Minnesota Statutes, chapter 16C, the commissioner may maintain, 
74.11 	extend, or renew contracts for temporary staffing entered into on or after September 1, 2020. 
74.12 	The commissioner may also enter into new contracts with eligible entities for temporary 
74.13 	staff deployed in the temporary staffing pool. The commissioner may use up to 6.5 percent 
74.14 	of this funding for the commissioner's costs related to administration of this program.
74.15 	(i) The commissioner shall seek all allowable FEMA reimbursement for the costs of this 
74.16 	activity.

74.17 	ARTICLE 10
74.18 	FAMILY ASSETS FOR INDEPENDENCE

74.19 	Section 1. Minnesota Statutes 2022, section 256E.35, subdivision 1, is amended to read:
74.20 		Subdivision 1.Establishment. The Minnesota family assets for independence initiative 
74.21 	is established to provide incentives for low-income families to accrue assets for education, 
74.22 	housing, vehicles, emergencies, and economic development purposes.

74.23 	Sec. 2. Minnesota Statutes 2022, section 256E.35, subdivision 2, is amended to read:
74.24 		Subd. 2.Definitions. (a) The definitions in this subdivision apply to this section.
74.25 	(b) "Eligible educational institution" means the following:
74.26 	(1) an institution of higher education described in section 101 or 102 of the Higher 
74.27 	Education Act of 1965; or
74.28 	(2) an area vocational education school, as defined in subparagraph (C) or (D) of United 
74.29 	States Code, title 20, chapter 44, section 2302 (3) (the Carl D. Perkins Vocational and 
75.1 	Applied Technology Education Act), which is located within any state, as defined in United 
75.2 	States Code, title 20, chapter 44, section 2302 (30). This clause is applicable only to the 
75.3 	extent section 2302 is in effect on August 1, 2008.
75.4 	(c) "Family asset account" means a savings account opened by a household participating 
75.5 	in the Minnesota family assets for independence initiative.
75.6 	(d) "Fiduciary organization" means:
75.7 	(1) a community action agency that has obtained recognition under section 256E.31;
75.8 	(2) a federal community development credit union serving the seven-county metropolitan 
75.9 	area; or
75.10 	(3) a women-oriented economic development agency serving the seven-county 
75.11 	metropolitan area.;
75.12 	(4) a federally recognized Tribal nation; or
75.13 	(5) a nonprofit organization, as defined under section 501(c)(3) of the Internal Revenue 
75.14 	Code.
75.15 	(e) "Financial coach" means a person who:
75.16 	(1) has completed an intensive financial literacy training workshop that includes 
75.17 	curriculum on budgeting to increase savings, debt reduction and asset building, building a 
75.18 	good credit rating, and consumer protection;
75.19 	(2) participates in ongoing statewide family assets for independence in Minnesota (FAIM) 
75.20 	network training meetings under FAIM program supervision; and
75.21 	(3) provides financial coaching to program participants under subdivision 4a.
75.22 	(f) "Financial institution" means a bank, bank and trust, savings bank, savings association, 
75.23 	or credit union, the deposits of which are insured by the Federal Deposit Insurance 
75.24 	Corporation or the National Credit Union Administration.
75.25 	(g) "Household" means all individuals who share use of a dwelling unit as primary 
75.26 	quarters for living and eating separate from other individuals.
75.27 	(h) "Permissible use" means:
75.28 	(1) postsecondary educational expenses at an eligible educational institution as defined 
75.29 	in paragraph (b), including books, supplies, and equipment required for courses of instruction;
75.30 	(2) acquisition costs of acquiring, constructing, or reconstructing a residence, including 
75.31 	any usual or reasonable settlement, financing, or other closing costs;
76.1 	(3) business capitalization expenses for expenditures on capital, plant, equipment, working 
76.2 	capital, and inventory expenses of a legitimate business pursuant to a business plan approved 
76.3 	by the fiduciary organization;
76.4 	(4) acquisition costs of a principal residence within the meaning of section 1034 of the 
76.5 	Internal Revenue Code of 1986 which do not exceed 100 percent of the average area purchase 
76.6 	price applicable to the residence determined according to section 143(e)(2) and (3) of the 
76.7 	Internal Revenue Code of 1986; and
76.8 	(5) acquisition costs of a personal vehicle only if approved by the fiduciary organization.;
76.9 	(6) contribution to an emergency savings account; and
76.10 	(7) contribution to a Minnesota 529 savings plan.

76.11 	Sec. 3. Minnesota Statutes 2022, section 256E.35, subdivision 4a, is amended to read:
76.12 		Subd. 4a.Financial coaching. A financial coach shall provide the following to program 
76.13 	participants:
76.14 	(1) financial education relating to budgeting, debt reduction, asset-specific training, 
76.15 	credit building, and financial stability activities;
76.16 	(2) asset-specific training related to buying a home or vehicle, acquiring postsecondary 
76.17 	education, or starting or expanding a small business, saving for emergencies, or saving for 
76.18 	a child's education; and
76.19 	(3) financial stability education and training to improve and sustain financial security.

76.20 	Sec. 4. Minnesota Statutes 2022, section 256E.35, subdivision 6, is amended to read:
76.21 		Subd. 6.Withdrawal; matching; permissible uses. (a) To receive a match, a 
76.22 	participating household must transfer funds withdrawn from a family asset account to its 
76.23 	matching fund custodial account held by the fiscal agent, according to the family asset 
76.24 	agreement. The fiscal agent must determine if the match request is for a permissible use 
76.25 	consistent with the household's family asset agreement.
76.26 	(b) The fiscal agent must ensure the household's custodial account contains the applicable 
76.27 	matching funds to match the balance in the household's account, including interest, on at 
76.28 	least a quarterly basis and at the time of an approved withdrawal. Matches must be a 
76.29 	contribution of $3 from state grant or TANF funds for every $1 of funds withdrawn from 
76.30 	the family asset account not to exceed a $6,000 $9,000 lifetime limit.
77.1 	(c) Notwithstanding paragraph (b), if funds are appropriated for the Federal Assets for 
77.2 	Independence Act of 1998, and a participating fiduciary organization is awarded a grant 
77.3 	under that act, participating households with that fiduciary organization must be provided 
77.4 	matches as follows:
77.5 	(1) from state grant and TANF funds, a matching contribution of $1.50 for every $1 of 
77.6 	funds withdrawn from the family asset account not to exceed a $3,000 $4,500 lifetime limit; 
77.7 	and
77.8 	(2) from nonstate funds, a matching contribution of not less than $1.50 for every $1 of 
77.9 	funds withdrawn from the family asset account not to exceed a $3,000 $4,500 lifetime limit.
77.10 	(d) Upon receipt of transferred custodial account funds, the fiscal agent must make a 
77.11 	direct payment to the vendor of the goods or services for the permissible use.

77.12 	Sec. 5. Minnesota Statutes 2022, section 256E.35, subdivision 7, is amended to read:
77.13 		Subd. 7.Program reporting. The fiscal agent on behalf of each fiduciary organization 
77.14 	participating in a family assets for independence initiative must report quarterly to the 
77.15 	commissioner of human services identifying the participants with accounts, the number of 
77.16 	accounts, the amount of savings and matches for each participant's account, the uses of the 
77.17 	account, and the number of businesses, homes, vehicles, and educational services paid for 
77.18 	with money from the account, and the amount of contributions to Minnesota 529 savings 
77.19 	plans and emergency savings accounts, as well as other information that may be required 
77.20 	for the commissioner to administer the program and meet federal TANF reporting 
77.21 	requirements.

77.22 	Sec. 6. Minnesota Statutes 2022, section 256P.02, is amended by adding a subdivision to 
77.23 	read:
77.24 		Subd. 4.Account exception. Family asset accounts under section 256E.35 and individual 
77.25 	development accounts authorized under the Assets for Independence Act, Title IV of the 
77.26 	Community Opportunities, Accountability, and Training and Educational Services Human 
77.27 	Services Reauthorization Act of 1998, Public Law 105-285, must be excluded when 
77.28 	determining the equity value of personal property.

78.1 	ARTICLE 11
78.2 	APPROPRIATIONS

78.3 	Section 1. APPROPRIATION; FAMILY ASSETS FOR INDEPENDENCE.
 78.4 	$100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the 
78.5 	general fund to the commissioner of human services for the purposes of the family assets 
78.6 	for independence program in Minnesota Statutes, section 256E.35.

78.7 	Sec. 2. APPROPRIATION; LIFESHARING SERVICE DEVELOPMENT.
 78.8 	$184,000 in fiscal year 2024 is appropriated from the general fund to the commissioner 
78.9 	of human services for engaging stakeholders and developing a lifesharing service under the 
78.10 	state's medical assistance disability waivers and elderly waiver. This is a onetime 
78.11 	appropriation and is available until June 30, 2025.

78.12 	Sec. 3. APPROPRIATION; RESIDENTIAL SETTING CLOSURE PREVENTION 
78.13 	GRANTS.
 78.14 	$6,671,000 in fiscal year 2024 and $6,671,000 in fiscal year 2025 are appropriated from 
78.15 	the general fund to the commissioner of human services for residential setting closure 
78.16 	prevention grants under Minnesota Statutes, section 256.4795.

78.17 	Sec. 4. APPROPRIATION; WELLNESS IN THE WOODS.
 78.18 	$100,000 in fiscal year 2024 and $100,000 in fiscal year 2025 are appropriated from the 
78.19 	general fund to the commissioner of human services for a grant to Wellness in the Woods 
78.20 	for daily peer support and special sessions for individuals who are in substance use disorder 
78.21 	recovery, are transitioning out of incarceration, or have experienced trauma.

APPENDIX 

Repealed Minnesota Statutes: 23-01278 

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.Subd. 9a.Respite services; component values and calculation of payment rates. 
(a) For the purposes of this section, respite services include respite services provided to an individual outside of any service plan for a day program or residential support service. 

(b) Component values for respite services are: 

(1) competitive workforce factor: 4.7 percent; 

(2) supervisory span of control ratio: 11 percent; 

(3) employee vacation, sick, and training allowance ratio: 8.71 percent; 

(4) employee-related cost ratio: 23.6 percent; 

(5) general administrative support ratio: 13.25 percent; 

(6) program-related expense ratio: 2.9 percent; and 

(7) absence and utilization factor ratio: 3.9 percent. 

(c) A unit of service for respite services is 15 minutes. 

(d) Payments for respite services must be calculated as follows unless the service is reimbursed separately as part of a residential support services or day program payment rate: 

(1) determine the number of units of service to meet an individual's needs; 

(2) determine the appropriate hourly staff wage rates derived by the commissioner as provided in subdivisions 5 and 5a; 

(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the product of one plus the competitive workforce factor; 

(4) for a recipient requiring deaf and hard-of-hearing customization under subdivision 12, add the customization rate provided in subdivision 12 to the result of clause (3); 

(5) multiply the number of direct staffing hours by the appropriate staff wage; 

(6) multiply the number of direct staffing hours by the product of the supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1); 

(7) combine the results of clauses (5) and (6), and multiply the result by one plus the employee vacation, sick, and training allowance ratio. This is defined as the direct staffing rate; 

(8) for employee-related expenses, multiply the result of clause (7) by one plus the employee-related cost ratio; 

(9) this is the subtotal rate; 

(10) sum the standard general administrative support ratio, the program-related expense ratio, and the absence and utilization factor ratio; 

(11) divide the result of clause (9) by one minus the result of clause (10). This is the total payment amount; 

(12) for respite services provided in a shared manner, divide the total payment amount in clause (11) by the number of service recipients, not to exceed three; and 

(13) adjust the result of clause (12) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. 

256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS.Subd. 4.Calculation of monthly conversion budget cap with consumer-directed community supports. 
For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent.