Data collection for rate determination.

(a) Rates for applicable home and community-based waivered services, including rate exceptions under subdivision 12, are set by the rates management system.

deleted text begin (b) Data for services under section 256B.4913, subdivision 4a , shall be collected in a manner prescribed by the commissioner. deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Data and information in the rates management system may be used to calculate an individual's rate.

deleted text begin (d) deleted text end new text begin (c) new text end Service providers, with information from the community support plan and oversight by lead agencies, shall provide values and information needed to calculate an individual's rate into the rates management system. The determination of service levels must be part of a discussion with members of the support team as defined in section 245D.02, subdivision 34 . This discussion must occur prior to the final establishment of each individual's rate. The values and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

(6) information to document variable levels of service qualification for variable levels of reimbursement in each framework;

(7) shared or individualized arrangements for unit-based services, including the staffing ratio;

(8) number of trips and miles for transportation services; and

(9) service hours provided through monitoring technology.

deleted text begin (e) deleted text end new text begin (d) new text end Updates to individual data must include:

(1) data for each individual that is updated annually when renewing service plans; and

(2) requests by individuals or lead agencies to update a rate whenever there is a change in an individual's service needs, with accompanying documentation.

deleted text begin (f) deleted text end new text begin (e) new text end Lead agencies shall review and approve all services reflecting each individual's needs, and the values to calculate the final payment rate for services with variables under subdivisions 6, 7, 8, and 9 for each individual. Lead agencies must notify the individual and the service provider of the final agreed-upon values and rate, and provide information that is identical to what was entered into the rates management system. If a value used was mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead agencies to correct it. Lead agencies must respond to these requests. When responding to the request, the lead agency must consider:

(1) meeting the health and welfare needs of the individual or individuals receiving services by service site, identified in their coordinated service and support plan under section 245D.02, subdivision 4b , and any addendum under section 245D.02, subdivision 4c;

(2) meeting the requirements for staffing under subdivision 2, paragraphs deleted text begin (f) deleted text end new text begin (h) new text end , deleted text begin (i) deleted text end new text begin (n) new text end , and deleted text begin (m) deleted text end new text begin (o) new text end ; and meeting or exceeding the licensing standards for staffing required under section 245D.09, subdivision 1 ; and

(3) meeting the staffing ratio requirements under subdivision 2, paragraph deleted text begin (n) deleted text end new text begin (o) new text end , and meeting or exceeding the licensing standards for staffing required under section 245D.31 .