as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
Engrossments | ||
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Introduction | Posted on 08/14/1998 |
1.1 A bill for an act 1.2 relating to health; eliminating certain provisions 1.3 reducing nursing facility reimbursement; amending 1.4 Minnesota Statutes 1994, section 256B.431, by adding a 1.5 subdivision; Minnesota Statutes 1995 Supplement, 1.6 section 256B.431, subdivision 25. 1.7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.8 Section 1. Minnesota Statutes 1995 Supplement, section 1.9 256B.431, subdivision 25, is amended to read: 1.10 Subd. 25. [CHANGES TO NURSING FACILITY REIMBURSEMENT 1.11 BEGINNING JULY 1, 1995.] The nursing facility reimbursement 1.12 changes in paragraphs (a) to(g)(f) shall apply in the sequence 1.13 specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and 1.14 this section, beginning July 1, 1995. 1.15 (a) The eight-cent adjustment to care-related rates in 1.16 subdivision 22, paragraph (e), shall no longer apply. 1.17 (b) For the rateyearsyear beginning onor afterJuly 1, 1.18 1995, the commissioner shall limit a nursing facility's 1.19 allowable operating per diem for each case mix category foreach1.20 the rate year asin clauses (1) to (3)provided in this 1.21 paragraph. 1.22(1)For the rate year beginning July 1, 1995, the 1.23 commissioner shall group nursing facilities into two groups, 1.24 freestanding and nonfreestanding, within each geographic group, 1.25 using their operating cost per diem for the case mix A 1.26 classification. A nonfreestanding nursing facility is a nursing 2.1 facility whose other operating cost per diem is subject to the 2.2 hospital attached, short length of stay, or the rule 80 limits. 2.3 All other nursing facilities shall be considered freestanding 2.4 nursing facilities. The commissioner shall then array all 2.5 nursing facilities in each grouping by their allowable case mix 2.6 A operating cost per diem. In calculating a nursing facility's 2.7 operating cost per diem for this purpose, the commissioner shall 2.8 exclude the raw food cost per diem related to providing special 2.9 diets that are based on religious beliefs, as determined in 2.10 subdivision 2b, paragraph (h). For those nursing facilities in 2.11 each grouping whose case mix A operating cost per diem: 2.12(i)(1) is at or below the median minus 1.0 standard 2.13 deviation of the array, the commissioner shall limit the nursing 2.14 facility's allowable operating cost per diem for each case mix 2.15 category to the lesser of the prior reporting year's allowable 2.16 operating cost per diems plus the inflation factor as 2.17 established in paragraph(f)(e), clause (2), increased by six 2.18 percentage points, or the current reporting year's corresponding 2.19 allowable operating cost per diem; 2.20(ii)(2) is between minus .5 standard deviation and minus 2.21 1.0 standard deviation below the median of the array, the 2.22 commissioner shall limit the nursing facility's allowable 2.23 operating cost per diem for each case mix category to the lesser 2.24 of the prior reporting year's allowable operating cost per diems 2.25 plus the inflation factor as established in paragraph(f)(e), 2.26 clause (2), increased by four percentage points, or the current 2.27 reporting year's corresponding allowable operating cost per 2.28 diem; or 2.29(iii)(3) is equal to or above minus .5 standard deviation 2.30 below the median of the array, the commissioner shall limit the 2.31 nursing facility's allowable operating cost per diem for each 2.32 case mix category to the lesser of the prior reporting year's 2.33 allowable operating cost per diems plus the inflation factor as 2.34 established in paragraph(f)(e), clause (2), increased by three 2.35 percentage points, or the current reporting year's corresponding 2.36 allowable operating cost per diem. 3.1(2) For the rate year beginning on July 1, 1996, the3.2commissioner shall limit the nursing facility's allowable3.3operating cost per diem for each case mix category to the lesser3.4of the prior reporting year's allowable operating cost per diems3.5plus the inflation factor as established in paragraph (f),3.6clause (2), increased by one percentage point or the current3.7reporting year's corresponding allowable operating cost per3.8diems; and3.9(3) For rate years beginning on or after July 1, 1997, the3.10commissioner shall limit the nursing facility's allowable3.11operating cost per diem for each case mix category to the lesser3.12of the reporting year prior to the current reporting year's3.13allowable operating cost per diems plus the inflation factor as3.14established in paragraph (f), clause (2), or the current3.15reporting year's corresponding allowable operating cost per3.16diems.3.17 (c) For rate years beginning on July 1, 1995, the 3.18 commissioner shall limit the allowable operating cost per diems 3.19 for high cost nursing facilities. After application of the 3.20 limits in paragraph (b) to each nursing facility's operating 3.21 cost per diems, the commissioner shall group nursing facilities 3.22 into two groups, freestanding or nonfreestanding, within each 3.23 geographic group. A nonfreestanding nursing facility is a 3.24 nursing facility whose other operating cost per diems are 3.25 subject to hospital attached, short length of stay, or rule 80 3.26 limits. All other nursing facilities shall be considered 3.27 freestanding nursing facilities. The commissioner shall then 3.28 array all nursing facilities within each grouping by their 3.29 allowable case mix A operating cost per diems. In calculating a 3.30 nursing facility's operating cost per diem for this purpose, the 3.31 commissioner shall exclude the raw food cost per diem related to 3.32 providing special diets that are based on religious beliefs, as 3.33 determined in subdivision 2b, paragraph (h). For those nursing 3.34 facilities in each grouping whose case mix A operating cost per 3.35 diem exceeds 1.0 standard deviation above the median, the 3.36 commissioner shall reduce their allowable operating cost per 4.1 diems by two percent. For those nursing facilities in each 4.2 grouping whose case mix A operating cost per diem exceeds 0.5 4.3 standard deviation above the median but is less than or equal to 4.4 1.0 standard deviation above the median, the commissioner shall 4.5 reduce their allowable operating cost per diems by one percent. 4.6 (d)For rate years beginning on or after July 1, 1996, the4.7commissioner shall limit the allowable operating cost per diems4.8for high cost nursing facilities. After application of the4.9limits in paragraph (b) to each nursing facility's operating4.10cost per diems, the commissioner shall group nursing facilities4.11into two groups, freestanding or nonfreestanding, within each4.12geographic group. A nonfreestanding nursing facility is a4.13nursing facility whose other operating cost per diems are4.14subject to hospital attached, short length of stay, or rule 804.15limits. All other nursing facilities shall be considered4.16freestanding nursing facilities. The commissioner shall then4.17array all nursing facilities within each grouping by their4.18allowable case mix A operating cost per diems. In calculating a4.19nursing facility's operating cost per diem for this purpose, the4.20commissioner shall exclude the raw food cost per diem related to4.21providing special diets that are based on religious beliefs, as4.22determined in subdivision 2b, paragraph (h). In those nursing4.23facilities in each grouping whose case mix A operating cost per4.24diem exceeds 1.0 standard deviation above the median, the4.25commissioner shall reduce their allowable operating cost per4.26diems by three percent. For those nursing facilities in each4.27grouping whose case mix A operating cost per diem exceeds 0.54.28standard deviation above the median but is less than or equal to4.291.0 standard deviation above the median, the commissioner shall4.30reduce their allowable operating cost per diems by two percent.4.31(e)For rate years beginning on or after July 1, 1995, the 4.32 commissioner shall determine a nursing facility's efficiency 4.33 incentive by first computing the allowable difference, which is 4.34 the lesser of $4.50 or the amount by which the facility's other 4.35 operating cost limit exceeds its nonadjusted other operating 4.36 cost per diem for that rate year. The commissioner shall 5.1 compute the efficiency incentive by: 5.2 (1) subtracting the allowable difference from $4.50 and 5.3 dividing the result by $4.50; 5.4 (2) multiplying 0.20 by the ratio resulting from clause 5.5 (1), and then; 5.6 (3) adding 0.50 to the result from clause (2); and 5.7 (4) multiplying the result from clause (3) times the 5.8 allowable difference. 5.9 The nursing facility's efficiency incentive payment shall 5.10 be the lesser of $2.25 or the product obtained in clause (4). 5.11(f)(e) For the rateyearsyear beginning onor after5.12 July 1, 1995, the forecasted price index for a nursing 5.13 facility's allowable operating cost per diems shall be 5.14 determined under clauses (1)to (3)and (2) using the change in 5.15 the Consumer Price Index-All Items (United States city average) 5.16 (CPI-U) or the change in the Nursing Home Market Basket, both as 5.17 forecasted by Data Resources Inc., whichever is applicable. The 5.18 commissioner shall use the indices as forecasted in the fourth 5.19 quarter of the calendar year preceding the rate year, subject to 5.20 subdivision 2l, paragraph (c).If, as a result of federal5.21legislative or administrative action, the methodology used to5.22calculate the Consumer Price Index-All Items (United States city5.23average) (CPI-U) changes, the commissioner shall develop a5.24conversion factor or other methodology to convert the CPI-U5.25index factor that results from the new methodology to an index5.26factor that approximates, as closely as possible, the index5.27factor that would have resulted from application of the original5.28CPI-U methodology prior to any changes in methodology. The5.29commissioner shall use the conversion factor or other5.30methodology to calculate an adjusted inflation index. The5.31adjusted inflation index must be used to calculate payment rates5.32under this section instead of the CPI-U index specified in5.33paragraph (d). If the commissioner is required to develop an5.34adjusted inflation index, the commissioner shall report to the5.35legislature as part of the next budget submission the fiscal5.36impact of applying this index.6.1 (1) The CPI-U forecasted index for allowable operating cost 6.2 per diems shall be based on the 21-month period from the 6.3 midpoint of the nursing facility's reporting year to the 6.4 midpoint of the rate year following the reporting year. 6.5 (2) The Nursing Home Market Basket forecasted index for 6.6 allowable operating costs and per diem limits shall be based on 6.7 the 12-month period between the midpoints of the two reporting 6.8 years preceding the rate year. 6.9(3) For rate years beginning on or after July 1, 1996, the6.10forecasted index for operating cost limits referred to in6.11subdivision 21, paragraph (b), shall be based on the CPI-U for6.12the 12-month period between the midpoints of the two reporting6.13years preceding the rate year.6.14(g)(f) After applying these provisions for therespective6.15 rateyearsyear beginning on July 1, 1995, the commissioner 6.16 shall index these allowable operating costs per diems by the 6.17 inflation factor provided for in paragraph(f)(e), clause (1), 6.18 and add the nursing facility's efficiency incentive as computed 6.19 in paragraph(e)(d). 6.20 Sec. 2. Minnesota Statutes 1994, section 256B.431, is 6.21 amended by adding a subdivision to read: 6.22 Subd. 26. [CHANGES TO NURSING FACILITY REIMBURSEMENT 6.23 BEGINNING JULY 1, 1996.] For rate years beginning on or after 6.24 July 1, 1996, the commissioner shall reimburse nursing 6.25 facilities using the provisions for reimbursement that were in 6.26 effect on July 30, 1995, except as provided in subdivision 25.