HF 651

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to medical assistance; changing the 
  1.3             geographic designation of certain counties for 
  1.4             purposes of ICF/MR reimbursement; amending Minnesota 
  1.5             Statutes 1996, section 256B.501, subdivision 5b. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1996, section 256B.501, 
  1.8   subdivision 5b, is amended to read: 
  1.9      Subd. 5b.  [ICF/MR OPERATING COST LIMITATION AFTER 
  1.10  SEPTEMBER 30, 1995.] (a) For the rate year beginning on October 
  1.11  1, 1995, and for rate years beginning on or after October 1, 
  1.12  1997, the commissioner shall limit the allowable operating cost 
  1.13  per diems, as determined under this subdivision and the 
  1.14  reimbursement rules, for high cost ICF's/MR.  Prior to indexing 
  1.15  each facility's operating cost per diems for inflation, the 
  1.16  commissioner shall group the facilities into eight groups.  The 
  1.17  commissioner shall then array all facilities within each 
  1.18  grouping by their general operating cost per service unit per 
  1.19  diems. 
  1.20     (b) The commissioner shall annually review and adjust the 
  1.21  general operating costs incurred by the facility during the 
  1.22  reporting year preceding the rate year to determine the 
  1.23  facility's allowable historical general operating costs.  For 
  1.24  this purpose, the term general operating costs means the 
  1.25  facility's allowable operating costs included in the program, 
  2.1   maintenance, and administrative operating costs categories, as 
  2.2   well as the facility's related payroll taxes and fringe 
  2.3   benefits, real estate insurance, and professional liability 
  2.4   insurance.  A facility's total operating cost payment rate shall 
  2.5   be limited according to paragraphs (c) and (d) as follows: 
  2.6      (c) A facility's total operating cost payment rate shall be 
  2.7   equal to its allowable historical operating cost per diems for 
  2.8   program, maintenance, and administrative cost categories 
  2.9   multiplied by the forecasted inflation index in subdivision 3c, 
  2.10  clause (1), subject to the limitations in paragraph (d). 
  2.11     (d) For the rate years beginning on or after October 1, 
  2.12  1995, the commissioner shall establish maximum overall general 
  2.13  operating cost per service unit limits for facilities according 
  2.14  to clauses (1) to (8).  Each facility's allowable historical 
  2.15  general operating costs and client assessment information 
  2.16  obtained from client assessments completed under subdivision 3g 
  2.17  for the reporting year ending December 31, 1994 (the base year), 
  2.18  shall be used for establishing the overall limits.  If a 
  2.19  facility's proportion of temporary care resident days to total 
  2.20  resident days exceeds 80 percent, the commissioner must exempt 
  2.21  that facility from the overall general operating cost per 
  2.22  service unit limits in clauses (1) to (8).  For this purpose, 
  2.23  "temporary care" means care provided by a facility to a client 
  2.24  for less than 30 consecutive resident days. 
  2.25     (1) The commissioner shall determine each facility's 
  2.26  weighted service units for the reporting year by multiplying its 
  2.27  resident days in each client classification level as established 
  2.28  in subdivision 3g, paragraph (d), by the corresponding weights 
  2.29  for that classification level, as established in subdivision 3g, 
  2.30  paragraph (i), and summing the results.  For the reporting year 
  2.31  ending December 31, 1994, the commissioner shall use the service 
  2.32  unit score computed from the client classifications determined 
  2.33  by the Minnesota department of health's annual review, including 
  2.34  those of clients admitted during that year. 
  2.35     (2) The facility's service unit score is equal to its 
  2.36  weighted service units as computed in clause (1), divided by the 
  3.1   facility's total resident days excluding temporary care resident 
  3.2   days, for the reporting year. 
  3.3      (3) For each facility, the commissioner shall determine the 
  3.4   facility's cost per service unit by dividing its allowable 
  3.5   historical general operating costs for the reporting year by the 
  3.6   facility's service unit score in clause (2) multiplied by its 
  3.7   total resident days, or 85 percent of the facility's capacity 
  3.8   days times its service unit score in clause (2), if the 
  3.9   facility's occupancy is less than 85 percent of licensed 
  3.10  capacity.  If a facility reports temporary care resident days, 
  3.11  the temporary care resident days shall be multiplied by the 
  3.12  service unit score in clause (2), and the resulting weighted 
  3.13  resident days shall be added to the facility's weighted service 
  3.14  units in clause (1) prior to computing the facility's cost per 
  3.15  service unit under this clause. 
  3.16     (4) The commissioner shall group facilities based on class 
  3.17  A or class B licensure designation, number of licensed beds, and 
  3.18  geographic location.  For purposes of this grouping, facilities 
  3.19  with six beds or less shall be designated as small facilities 
  3.20  and facilities with more than six beds shall be designated as 
  3.21  large facilities.  If a facility has both class A and class B 
  3.22  licensed beds, the facility shall be considered a class A 
  3.23  facility for this purpose if the number of class A beds is more 
  3.24  than half its total number of ICF/MR beds; otherwise the 
  3.25  facility shall be considered a class B facility.  The 
  3.26  metropolitan geographic designation shall include Anoka, Carver, 
  3.27  Dakota, Hennepin, Olmsted, Ramsey, St. Louis, Scott, and 
  3.28  Washington counties.  All other Minnesota counties shall be 
  3.29  designated as the nonmetropolitan geographic group.  These 
  3.30  characteristics result in the following eight groupings: 
  3.31     (i) small class A metropolitan; 
  3.32     (ii) large class A metropolitan; 
  3.33     (iii) small class B metropolitan; 
  3.34     (iv) large class B metropolitan; 
  3.35     (v) small class A nonmetropolitan; 
  3.36     (vi) large class A nonmetropolitan; 
  4.1      (vii) small class B nonmetropolitan; and 
  4.2      (viii) large class B nonmetropolitan. 
  4.3      (5) The commissioner shall array facilities within each 
  4.4   grouping in clause (4) by each facility's cost per service unit 
  4.5   as determined in clause (3). 
  4.6      (6) In each array established under clause (5), facilities 
  4.7   with a cost per service unit at or above the median shall be 
  4.8   limited to the lesser of:  (i) the current reporting year's cost 
  4.9   per service unit; or (ii) the prior reporting year's allowable 
  4.10  historical general operating cost per service unit plus the 
  4.11  inflation factor as established in subdivision 3c, clause (2), 
  4.12  increased by three percentage points. 
  4.13     (7) The overall operating cost per service unit limit for 
  4.14  each group shall be established as follows: 
  4.15     (i) each array established under clause (5) shall be 
  4.16  arrayed again after the application of clause (6); 
  4.17     (ii) in each array established in clause (5), two general 
  4.18  operating cost limits shall be determined.  The first cost per 
  4.19  service unit limit shall be established at 0.5 and less than or 
  4.20  equal to 1.0 standard deviation above the median of that array.  
  4.21  The second cost per service unit limit shall be established at 
  4.22  1.0 standard deviation above the median of the array; and 
  4.23     (iii) the overall operating cost per service unit limits 
  4.24  shall be indexed for inflation annually beginning with the 
  4.25  reporting year ending December 31, 1995, using the forecasted 
  4.26  inflation index in subdivision 3c, clause (2). 
  4.27     (8) Annually, facilities shall be arrayed using the method 
  4.28  described in clauses (5) and (7).  Each facility with a cost per 
  4.29  service unit at or above its group's first cost per service unit 
  4.30  limit, but less than the second cost per service unit limit for 
  4.31  that group, shall be limited to 98 percent of its total 
  4.32  operating cost per diems then add the forecasted inflation index 
  4.33  in subdivision 3c, clause (1).  Each facility with a cost per 
  4.34  service unit at or above the second cost per service unit limit 
  4.35  will be limited to 97 percent of its total operating cost per 
  4.36  diems, then add the forecasted inflation index in subdivision 
  5.1   3c, clause (1).  Facilities that have undergone a class A to 
  5.2   class B conversion since January 1, 1990, are exempt from the 
  5.3   limitations in this clause for six years after the completion of 
  5.4   the conversion process. 
  5.5      (9) The commissioner may rebase these overall limits, using 
  5.6   the method described in this subdivision but no more frequently 
  5.7   than once every three years. 
  5.8      (e) For rate years beginning on or after October 1, 1995, 
  5.9   the facility's efficiency incentive shall be determined as 
  5.10  provided in the reimbursement rule. 
  5.11     (f) The total operating cost payment rate shall be the sum 
  5.12  of paragraphs (c) and (e). 
  5.13     (g) For the rate year beginning on October 1, 1996, the 
  5.14  commissioner shall exempt a facility from the reductions in this 
  5.15  subdivision if the facility is involved in a bed relocation 
  5.16  project where more than 25 percent of the facility's beds are 
  5.17  transferred to another facility, the relocated beds are six or 
  5.18  fewer, there is no change in the total number of ICF/MR beds for 
  5.19  the parent organization of the facility, and the relocation is 
  5.20  not part of an interim or settle-up rate.