policies

CADI customized living providers bear the brunt of unfriendly & restrictive DHS policies 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 18, 29, 30, 43 & 64 HHS omnibus bill Effective: Various

Short description More restrictions and disincentives to providing customized living (CL) to Community Access for Disability Inclusion (CADI) waiver recipients were added to statute.

Summary The 2021 legislature modified CADI customized living by doing the following: • Directing the DHS to develop and implement residential support services criteria that limit eligibility for community residential services, customized living services, and 24-hour customized living services • Establishing a moratorium on enrolling after June 30, 2021, certain new customized living settings serving in a single-family home four or fewer participants in the Brain Injury (BI) or CADI waivers • Clarifies that the customized living rate floor under section 256S.205 does not apply to customized living services reimbursed by CADI and BI • Prohibiting the authorization of more than 24-hours of support in a daily unit of customized living services • Directing DHS to establish an acuity-based input limit for service rate calculations • Excludes CADI CL from the rate increases provided to Elderly Waiver and Alternative Care

Implications DHS continues to make the provision of customized living to the under 65 population more difficult. Taken together with the recent state transition plan tiers, the states near intransigence on exceptions to assisted living licensure, and these legislative changes, the implications are that: 1. DHS is not supportive of CADI CL; and 2. DHS is forcing providers of CADI CL into the provision of Integrated Community Support (ICS) services, even though it is not clear if ICS works for this population

Bill language Chapter 7: https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

Sec. 18. Minnesota Statutes 2020, section 256B.092, is amended by adding a subdivision to read:

Subd. 11a. Residential support services criteria. (a) For the purposes of this subdivision, "residential support services" means the following residential support services reimbursed under section 256B.4914: community residential services, customized living services, and 24-hour customized living services. (b)In order to increase independent living options for people with disabilities and in accordance with section 256B.4905, subdivisions 3 and 4, and consistent with section 245A.03, subdivision 7, the commissioner must establish and implement criteria to access residential support services. The criteria for accessing residential support services must prohibit the commissioner from authorizing residential support services unless at least all of the following conditions are met: (1) the individual has complex behavioral health or complex medical needs; and (2)the individual's service planning team has considered all other available residential service options and determined that those options are inappropriate to meet the individual's support needs. Nothing in this subdivision shall be construed as permitting the commissioner to establish criteria prohibiting the authorization of residential support services for individuals described in the statewide priorities established in subdivision 12, the transition populations in subdivision 13, and the licensing moratorium exception criteria under section 245A.03, subdivision 7, paragraph (a). (c)Individuals with active service agreements for residential support services on the date that the criteria for accessing residential support services become effective are exempt from the requirements of this subdivision, and the exemption from the criteria for accessing residential support services continues to apply for renewals of those service agreements. EFFECTIVE DATE. This section is effective 90 days following federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 29. Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision to read:

Subd. 28. Customized living moratorium for brain injury and community access for disability inclusion waivers. (a) Notwithstanding section 245A.03, subdivision 2, paragraph (a), clause (23), to prevent new development of customized living settings that otherwise meet the residential program definition under section 245A.02, subdivision 14, the commissioner shall not enroll new customized living settings serving four or fewer people in a single-family home to deliver customized living services as defined under the brain injury or community access for disability inclusion waiver plans under this section. (b) The commissioner may approve an exception to paragraph (a) when an existing customized living setting changes ownership at the same address.

(c) Customized living settings operational on or before June 30, 2021, are considered existing customized living settings. (d)For any new customized living settings serving four or fewer people in a singlefamily home to deliver customized living services as defined in paragraph (a) and that was not operational on or before June 30, 2021, the authorizing lead agency is financially responsible for all home and community-based service payments in the setting. (e)For purposes of this subdivision, "operational" means customized living services are authorized and delivered to a person in the customized living setting. EFFECTIVE DATE. This section is effective July 1, 2021. This section applies only to customized living services as defined under the brain injury or community access for disability inclusion waiver plans under Minnesota Statutes, section 256B.49.

Sec. 30. Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision to read:

Subd. 29. Residential support services criteria. (a) For the purposes of this subdivision, "residential support services" means the following residential support services reimbursed under section 256B.4914: community residential services, customized living services, and 24-hour customized living services. (b)In order to increase independent living options for people with disabilities and in accordance with section 256B.4905, subdivisions 3 and 4, and consistent with section 245A.03, subdivision 7, the commissioner must establish and implement criteria to access residential support services. The criteria for accessing residential support services must prohibit the commissioner from authorizing residential support services unless at least all of the following conditions are met: (1) the individual has complex behavioral health or complex medical needs; and (2)the individual's service planning team has considered all other available residential service options and determined that those options are inappropriate to meet the individual's support needs. Nothing in this subdivision shall be construed as permitting the commissioner to establish criteria prohibiting the authorization of residential support services for individuals described in the statewide priorities established in subdivision 12, the transition populations in subdivision 13, and the licensing moratorium exception criteria under section 245A.03, subdivision 7, paragraph (a). (c)Individuals with active service agreements for residential support services on the date that the criteria for accessing residential support services become effective are exempt from the requirements of this subdivision, and the exemption from the criteria for accessing residential support services continues to apply for renewals of those service agreements.

EFFECTIVE DATE. This section is effective 90 days following federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

read: Sec. 43. Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to

Subd. 6. Payments for residential support services. (a) For purposes of this subdivision, residential support services includes 24-hour customized living services, community residential services, customized living services, family residential services, foster care services, integrated community supports, and supportive living services daily. (b) Payments for community residential services, corporate foster care services, corporate supportive living services daily, family residential services, and family foster care services must be calculated as follows:

(1)determine the number of shared staffing and individual direct staff hours to meet a recipient's needs provided on site or through monitoring technology; (2)personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5; (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the result of clause (2) by the product of one plus the competitive workforce factor in subdivision 5, paragraph (b), clause (1); (4)for a recipient requiring customization for deaf and hard-of-hearing language accessibility under subdivision 12, add the customization rate provided in subdivision 12 to the result of clause (3); (5) multiply the number of shared and individual direct staff hours provided on site or through monitoring technology and nursing hours by the appropriate staff wages; (6) multiply the number of shared and individual direct staff hours provided on site or through monitoring technology and nursing hours by the product of the supervision span of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision wage in subdivision 5, paragraph (a), clause (21); (7) combine the results of clauses (5) and (6), excluding any shared and individual direct staff hours provided through monitoring technology, and multiply the result by one plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause (3). This is defined as the direct staffing cost; (8) for employee-related expenses, multiply the direct staffing cost, excluding any shared and individual direct staff hours provided through monitoring technology, by one plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (4);

(9)for client programming and supports, the commissioner shall add $2,179; and (10)for transportation, if provided, the commissioner shall add $1,680, or $3,000 if customized for adapted transport, based on the resident with the highest assessed need.

(c) The total rate must be calculated using the following steps: (1)subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared and individual direct staff hours provided through monitoring technology that was excluded in clause (8); (2)sum the standard general and administrative rate, the program-related expense ratio, and the absence and utilization ratio; (3) divide the result of clause (1) by one minus the result of clause (2). This is the total payment amount; and (4) adjust the result of clause (3) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. (d) The payment methodology for customized living, and 24-hour customized living, and residential care services must be the customized living tool. Revisions to The commissioner shall revise the customized living tool must be made to reflect the services and activities unique to disability-related recipient needs., and adjust for regional differences in the cost of providing services. The rate adjustments described in section 256S.205 do not apply to rates paid under this section. Customized living and 24-hour customized living rates determined under this section shall not include more than 24 hours of support in a daily unit. The commissioner shall establish the following acuitybased customized living tool input limits, based on case mix, for customized living and 24hour customized living rates determined under this section: (1) no more than two hours of mental health management per day for people assessed for case mixes A, D, and G; (2)no more than four hours of activities of daily living assistance per day for people assessed for case mix B; and (3)no more than six hours of activities of daily living assistance per day for people assessed for case mix D.

(e)Payments for integrated community support services must be calculated as follows:

(1) the base shared staffing shall must be eight hours divided by the number of people receiving support in the integrated community support setting; (2) the individual staffing hours shall must be the average number of direct support hours provided directly to the service recipient;

(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5; (4)except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the result of clause (3) by the product of one plus the competitive workforce factor in subdivision 5, paragraph (b), clause (1); (5)for a recipient requiring customization for deaf and hard-of-hearing language accessibility under subdivision 12, add the customization rate provided in subdivision 12 to the result of clause (4); (6)multiply the number of shared and individual direct staff hours in clauses (1) and (2) by the appropriate staff wages; (7)multiply the number of shared and individual direct staff hours in clauses (1) and (2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause (21);

(8) combine the results of clauses (6) and (7) and multiply the result by one plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause (3). This is defined as the direct staffing cost; (9)for employee-related expenses, multiply the direct staffing cost by one plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and (10)for client programming and supports, the commissioner shall add $2,260.21 divided by 365. (f)The total rate must be calculated as follows: (1)add the results of paragraph (e), clauses (9) and (10); (2)add the standard general and administrative rate, the program-related expense ratio, and the absence and utilization factor ratio; (3) divide the result of clause (1) by one minus the result of clause (2). This is the total payment amount; and (4) adjust the result of clause (3) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. (g) The payment methodology for customized living and 24-hour customized living services must be the customized living tool. The commissioner shall revise the customized living tool to reflect the services and activities unique to disability-related recipient needs and adjust for regional differences in the cost of providing services. (h) (g) The number of days authorized for all individuals enrolling in residential services must include every day that services start and end.

EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later, except the fifth sentence in paragraph (d) is effective January 1, 2022. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 64. Minnesota Statutes 2020, section 256S.2101, is amended to read: 256S.2101 RATE SETTING; PHASE-IN. Subdivision 1. Phase-in for disability waiver customized living rates. All rates and rate components for services listed in section 256S.21 community access for disability inclusion customized living and brain injury customized living under section 256B.4914 shall be the sum of ten percent of the rates calculated under sections 256S.211 to 256S.215 and 90 percent of the rates calculated using the rate methodology in effect as of June 30, 2017. Subd. 2. Phase-in for elderly waiver rates. Except for home-delivered meals as described in section 256S.215, subdivision 15, all rates and rate components for elderly waiver, elderly waiver customized living, and elderly waiver foster care under this chapter; alternative care under section 256B.0913; and essential community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019, and the increases described in section 256S.215, subdivision 15. EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later. The commissioner of human services shall inform the revisor of statutes when federal approval is obtained.