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HF 2607

2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 06/02/2016 10:28am

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 01/29/2016
1st Engrossment Posted on 03/21/2016
2nd Engrossment Posted on 05/13/2016

Current Version - 2nd Engrossment

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A bill for an act
relating to human services; modifying certain nursing facilities requirements;
amending Minnesota Statutes 2014, section 144A.071, subdivisions 4c, 4d;
Minnesota Statutes 2015 Supplement, section 256B.441, subdivisions 13, 53.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 144A.071, subdivision 4c, is amended to
read:


Subd. 4c.

Exceptions for replacement beds after June 30, 2003.

(a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the renovation, replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:

(1) to license and certify an 80-bed city-owned facility in Nicollet County to be
constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
attached to a hospital that is also being replaced. The threshold allowed for this project
under section 144A.073 shall be the maximum amount available to pay the additional
medical assistance costs of the new facility;

(2) to license and certify 29 beds to be added to an existing 69-bed facility in St.
Louis County, provided that the 29 beds must be transferred from active or layaway status
at an existing facility in St. Louis County that had 235 beds on April 1, 2003.

The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
rate at that facility shall not be adjusted as a result of this transfer. The operating payment
rate of the facility adding beds after completion of this project shall be the same as it was
on the day prior to the day the beds are licensed and certified. This project shall not
proceed unless it is approved and financed under the provisions of section 144A.073;

(3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of
the new beds are transferred from a 45-bed facility in Austin under common ownership
that is closed and 15 of the new beds are transferred from a 182-bed facility in Albert Lea
under common ownership; (ii) the commissioner of human services is authorized by the
2004 legislature to negotiate budget-neutral planned nursing facility closures; and (iii)
money is available from planned closures of facilities under common ownership to make
implementation of this clause budget-neutral to the state. The bed capacity of the Albert
Lea facility shall be reduced to 167 beds following the transfer. Of the 60 beds at the
new facility, 20 beds shall be used for a special care unit for persons with Alzheimer's
disease or related dementias;

(4) to license and certify up to 80 beds transferred from an existing state-owned
nursing facility in Cass County to a new facility located on the grounds of the
Ah-Gwah-Ching campus. The operating cost payment rates for the new facility shall be
determined based on the interim and settle-up payment provisions of Minnesota Rules,
part 9549.0057, and the reimbursement provisions of section 256B.431. The property
payment rate for the first three years of operation shall be $35 per day. For subsequent
years, the property payment rate of $35 per day shall be adjusted for inflation as provided
in section 256B.434, subdivision 4, paragraph (c), as long as the facility has a contract
under section 256B.434;

(5) to initiate a pilot program to license and certify up to 80 beds transferred from
an existing county-owned nursing facility in Steele County relocated to the site of a new
acute care facility as part of the county's Communities for a Lifetime comprehensive plan
to create innovative responses to the aging of its population. Upon relocation to the new
site, the nursing facility shall delicense 28 beds. The deleted text beginpropertydeleted text end payment rate for deleted text beginthe first
three years of operation of
deleted text endnew text begin external fixed costs fornew text end the new facility shall be increased by an
amount as calculated according to items (i) to (v):

(i) compute the estimated decrease in medical assistance residents served by the
nursing facility by multiplying the decrease in licensed beds by the historical percentage
of medical assistance resident days;

(ii) compute the annual savings to the medical assistance program from the
delicensure of 28 beds by multiplying the anticipated decrease in medical assistance
residents, determined in item (i), by the existing facility's weighted average payment rate
multiplied by 365;

(iii) compute the anticipated annual costs for community-based services by
multiplying the anticipated decrease in medical assistance residents served by the nursing
facility, determined in item (i), by the average monthly elderly waiver service costs for
individuals in Steele County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) divide the amount in item (iv) by an amount equal to the relocated nursing
facility's occupancy factor under section 256B.431, subdivision 3f, paragraph (c),
multiplied by the historical percentage of medical assistance resident daysdeleted text begin.deleted text endnew text begin; and
new text end

deleted text begin For subsequent years, the adjusted property payment rate shall be adjusted for
inflation as provided in section 256B.434, subdivision 4, paragraph (c), as long as the
facility has a contract under section 256B.434; and
deleted text end

(6) to consolidate and relocate nursing facility beds to a new site in Goodhue County
and to integrate these services with other community-based programs and services under a
communities for a lifetime pilot program and comprehensive plan to create innovative
responses to the aging of its population. deleted text beginEighty beds in the city of Red Wing shall be
transferred from the downsizing and relocation of an existing 84-bed, hospital-owned
nursing facility and the entire closure or downsizing of beds from a 65-bed nonprofit
nursing facility in the community resulting in the delicensure of 69 beds in the two
existing facilities
deleted text endnew text begin Two nursing facilities, one for 84 beds and one for 65 beds, in the city of
Red Wing licensed on July 1, 2015, shall be consolidated into a newly renovated 64-bed
nursing facility resulting in the delicensure of 85 beds
new text end. Notwithstanding the carryforward
of the approval authority in section 144A.073, subdivision 11, the funding approved in
April 2009 by the commissioner of health for a project in Goodhue County shall not carry
forward. The closure of the deleted text begin69deleted text endnew text begin 85new text end beds shall not be eligible for a planned closure rate
adjustment under section 256B.437. The construction project permitted in this clause shall
not be eligible for a threshold project rate adjustment under section 256B.434, subdivision
4f
. The deleted text beginpropertydeleted text end payment rate for deleted text beginthe first three years of operation ofdeleted text end new text beginexternal fixed costs for
new text endthe new facility shall be increased by an amount as calculated according to items (i) to (vi):

(i) compute the estimated decrease in medical assistance residents served by both
nursing facilities by multiplying the difference between the occupied beds of the two
nursing facilities for the reporting year ending September 30, 2009, and the projected
occupancy of the facility at 95 percent occupancy by the historical percentage of medical
assistance resident days;

(ii) compute the annual savings to the medical assistance program from the
delicensure by multiplying the anticipated decrease in the medical assistance residents,
determined in item (i), by the hospital-owned nursing facility weighted average payment
rate multiplied by 365;

(iii) compute the anticipated annual costs for community-based services by
multiplying the anticipated decrease in medical assistance residents served by the
facilities, determined in item (i), by the average monthly elderly waiver service costs for
individuals in Goodhue County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) multiply the amount in item (iv) by deleted text begin48.5deleted text endnew text begin 57.2new text end percent; and

(vi) divide the difference of the amount in item (iv) and the amount in item (v) by an
amount equal to the relocated nursing facility's occupancy factor under section 256B.431,
subdivision 3f, paragraph (c), multiplied by the historical percentage of medical assistance
resident days.

deleted text begin For subsequent years, the adjusted property payment rate shall be adjusted for
inflation as provided in section 256B.434, subdivision 4, paragraph (c), as long as the
facility has a contract under section 256B.434.
deleted text end

(b) Projects approved under this subdivision shall be treated in a manner equivalent
to projects approved under subdivision 4a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2017, except that the amendment to paragraph (a), clause (6), transferring the
rate adjustment in items (i) to (vi) from the property payment rate to the payment rate for
external fixed costs, is effective for rate years beginning on or after January 1, 2017, or
upon completion of the closure and new construction authorized in paragraph (a), clause
(6), whichever is later. The commissioner of human services shall notify the revisor
of statutes when the section is effective.
new text end

Sec. 2.

Minnesota Statutes 2014, section 144A.071, subdivision 4d, is amended to read:


Subd. 4d.

Consolidation of nursing facilities.

(a) The commissioner of health,
in consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities
and the upgrading of the physical plant of the remaining nursing facility or facilities,
the costs of which exceed the threshold project limit under subdivision 2, clause (a).
The commissioners shall consider the criteria in this section, section 144A.073, and
section 256B.437, in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate deleted text begina
property
deleted text endnew text begin an external fixed costsnew text end rate adjustment according to clauses (1) to (3):

(1) the closure of beds shall not be eligible for a planned closure rate adjustment
under section 256B.437, subdivision 6;

(2) the construction project permitted in this clause shall not be eligible for a
threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium
exception adjustment under section 144A.073; and

(3) the deleted text beginpropertydeleted text end payment rate new text beginfor external fixed costs new text endfor a remaining facility or
facilities shall be increased by an amount equal to 65 percent of the projected net cost
savings to the state calculated in paragraph (b), divided by the state's medical assistance
percentage of medical assistance dollars, and then divided by estimated medical assistance
resident days, as determined in paragraph (c), of the remaining nursing facility or facilities
in the request in this paragraph. The rate adjustment is effective on the later of the first
day of the month following completion of the construction upgrades in the consolidation
plan or the first day of the month following the complete closure of a facility designated
for closure in the consolidation plan. If more than one facility is receiving upgrades in
the consolidation plan, each facility's date of construction completion must be evaluated
separately.

(b) For purposes of calculating the net cost savings to the state, the commissioner
shall consider clauses (1) to (7):

(1) the annual savings from estimated medical assistance payments from the net
number of beds closed taking into consideration only beds that are in active service on the
date of the request and that have been in active service for at least three years;

(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;

(3) the estimated annual cost of elderly waiver recipients receiving support under
group residential housing;

(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;

(5) the annual loss of license surcharge payments on closed beds;

(6) the savings from not paying planned closure rate adjustments that the facilities
would otherwise be eligible for under section 256B.437; and

(7) the savings from not paying deleted text beginpropertydeleted text endnew text begin external fixed costsnew text end payment rate
adjustments from submission of renovation costs that would otherwise be eligible as
threshold projects under section 256B.434, subdivision 4f.

(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance
resident days of the remaining facility or facilities, as reported on the facility's or facilities'
most recent nursing facility statistical and cost report filed before the plan of closure
is submitted, multiplied by 365.

(d) For purposes of net cost of savings to the state in paragraph (b), the average
occupancy percentages will be those reported on the facility's or facilities' most recent
nursing facility statistical and cost report filed before the plan of closure is submitted, and
the average payment rates shall be calculated based on the approved payment rates in
effect at the time the consolidation request is submitted.

(e) To qualify for the deleted text beginpropertydeleted text endnew text begin external fixed costsnew text end payment rate adjustment under
this deleted text beginprovisiondeleted text endnew text begin subdivisionnew text end, the closing facilities shall:

(1) submit an application for closure according to section 256B.437, subdivision
3; and

(2) follow the resident relocation provisions of section 144A.161.

(f) The county or counties in which a facility or facilities are closed under this
subdivision shall not be eligible for designation as a hardship area under section 144A.071,
subdivision 3, for five years from the date of the approval of the proposed consolidation.
The applicant shall notify the county of this limitation and the county shall acknowledge
this in a letter of support.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2017.
new text end

Sec. 3.

Minnesota Statutes 2015 Supplement, section 256B.441, subdivision 13,
is amended to read:


Subd. 13.

External fixed costs.

"External fixed costs" means costs related to the
nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
section 144.122; family advisory council fee under section 144A.33; scholarships under
section 256B.431, subdivision 36; planned closure rate adjustments under section
256B.437;new text begin consolidation rate adjustments under section 144A.071, subdivisions 4c,
paragraph (a), clauses (5) and (6), and 4d;
new text end single bed room incentives under section
256B.431, subdivision 42; property taxes, assessments, and payments in lieu of taxes;
employer health insurance costs; quality improvement incentive payment rate adjustments
under subdivision 46c; performance-based incentive payments under subdivision 46d;
special dietary needs under subdivision 51b; and PERA.

Sec. 4.

Minnesota Statutes 2015 Supplement, section 256B.441, subdivision 53,
is amended to read:


Subd. 53.

Calculation of payment rate for external fixed costs.

The commissioner
shall calculate a payment rate for external fixed costs.

(a) For a facility licensed as a nursing home, the portion related to section 256.9657
shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
result of its number of nursing home beds divided by its total number of licensed beds.

(b) The portion related to the licensure fee under section 144.122, paragraph (d),
shall be the amount of the fee divided by actual resident days.

(c) The portion related to development and education of resident and family advisory
councils under section 144A.33 shall be $5 divided by 365.

(d) The portion related to scholarships shall be determined under section 256B.431,
subdivision 36.

(e) The portion related to planned closure rate adjustments shall be as determined
under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.

new text begin (f) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
new text end

deleted text begin (f)deleted text endnew text begin (g)new text end The single bed room incentives shall be as determined under section
256B.431, subdivision 42.

deleted text begin (g)deleted text endnew text begin (h)new text end The portions related to real estate taxes, special assessments, and payments
made in lieu of real estate taxes directly identified or allocated to the nursing facility shall
be the actual amounts divided by actual resident days.

deleted text begin (h)deleted text endnew text begin (i)new text end The portion related to employer health insurance costs shall be the allowable
costs divided by resident days.

deleted text begin (i)deleted text endnew text begin (j)new text end The portion related to the Public Employees Retirement Association shall
be actual costs divided by resident days.

deleted text begin (j)deleted text endnew text begin (k)new text end The portion related to quality improvement incentive payment rate
adjustments shall be as determined under subdivision 46c.

deleted text begin (k)deleted text endnew text begin (l)new text end The portion related to performance-based incentive payments shall be as
determined under subdivision 46d.

deleted text begin (l)deleted text endnew text begin (m)new text end The portion related to special dietary needs shall be the per diem amount
determined under subdivision 51b.

deleted text begin (m)deleted text endnew text begin (n)new text end The payment rate for external fixed costs shall be the sum of the amounts in
paragraphs (a) to deleted text begin(l)deleted text endnew text begin (m)new text end.