HF 3153

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; requiring quarterly resident assessments; modifying
case mix indices for nursing facility reimbursement; providing certain facilities
with rate adjustments; amending Minnesota Statutes 2004, sections 144.0724,
subdivision 4; 256B.438, subdivision 4, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2004, section 144.0724, subdivision 4, is amended to
read:

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made
in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0,
August 1996. The commissioner of health may substitute successor manuals or question
and answer documents published by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, to replace or supplement the
current version of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment must be completed by day 14 following admission;

(2) an annual assessment must be completed within 366 days of the last
comprehensive assessment;

(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and

(4) deleted text begin the second quarterly assessment following either a new admission assessment, an
annual assessment, or a significant change assessment deleted text end new text begin all quarterly assessments following
a new admission assessment, a quarterly assessment, an annual assessment, or a significant
change assessment new text end . Each quarterly assessment must be completed within 92 days of
the previous assessment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2006.
new text end

Sec. 2.

Minnesota Statutes 2004, section 256B.438, subdivision 4, is amended to read:

Subd. 4.

Resident assessment schedule.

(a) Nursing facilities shall conduct and
submit case mix assessments according to the schedule established by the commissioner
of health under section 144.0724, subdivisions 4 and 5.

(b) The resident reimbursement classifications established under section 144.0724,
subdivision 3, shall be effective the day of admission for new admission assessments. The
effective date for significant change assessments shall be the assessment reference date.
The effective date for annual and deleted text begin second deleted text end new text begin all new text end quarterly assessments shall be the first day of
the month following assessment reference date.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2006.
new text end

Sec. 3.

Minnesota Statutes 2004, section 256B.438, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin New case mix indices. new text end

new text begin (a) Effective with rates for the rate year beginning
October 1, 2006, the commissioner shall implement the case mix indices recommended
by the time study conducted under Laws 2001, First Special Session chapter 9, article 5,
section 35, paragraph (e). The commissioner shall implement the new case mix indices
as follows:
new text end

new text begin (1) The September 30, 2005, case mix component of the nursing facility operating
payment rate shall be multiplied by the new case mix indices to create 36 case mix
adjusted rates.
new text end

new text begin (2) The 36 case mix adjusted rates determined in clause (1), plus the noncase mix
component, shall be the 36 nursing facility operating payment rates.
new text end

new text begin (3) The rate increases authorized by sections 256B.431, subdivision 41, and
256B.441, subdivision 46, shall be applied to the rates determined under clause (2).
new text end

new text begin (b) The commissioner shall adjust the October 1, 2006, operating rates in paragraph
(a) for nursing facilities estimated to receive a decrease in operating revenue. The rate
interim adjustment is established as follows:
new text end

new text begin (1) The commissioner shall use the minimum data set to classify private and medical
assistance patient days by RUG classification for the rate year ending June 30, 2006,
according to both the case mix indices and resident assessment schedule to be used on
September 30, 2006, and the case mix indices and resident assessment schedule to be
used on October 1, 2006.
new text end

new text begin (2) The commissioner shall use the resident days in clause (1) and the nursing
facility's October 1, 2006, unadjusted operating payment rate to estimate operating
revenue according to both the case mix indices and resident assessment schedule to be
used on September 30, 2006, and the case mix indices and resident assessment schedule
to be used on October 1, 2006.
new text end

new text begin (3) The estimated operating revenue determined with the case mix indices and
resident assessment schedule to be used on September 30, 2006, minus the operating
revenue determined with the case mix indices and resident assessment schedule to be
used on October 1, 2006, shall equal the decrease in medical assistance and private pay
operating revenue.
new text end

new text begin (4) Facilities with an estimated decrease in clause (3) shall receive an interim rate
adjustment equal to the value determined in clause (3) divided by the medical assistance
and private pay resident days in clause (1).
new text end

new text begin (5) The interim rate adjustment shall be in effect from October 1, 2006, through
June 30, 2007, and shall not be part of a facility's operating payment rate after June 30,
2007. The interim rate adjustment shall be applied to the case mix portion of the facility
operating rate.
new text end

new text begin (6) The commissioner, by August 15, 2006, shall provide nursing facilities which
the commissioner has estimated will experience a decrease in operating revenue, with
written notice that specifies the amount of the estimated decrease in operating revenue
and the amount of the interim rate adjustment. Nursing facilities shall have 30 days to
decline the interim rate adjustment.
new text end

new text begin (c) The commissioner shall adjust the July 1, 2007, operating rates of facilities
receiving the interim rate adjustments in paragraph (b) and facilities that demonstrate a
decrease in operating revenue from the implementation of the case mix indices and use of
all quarterly assessments. The adjustment is calculated as follows:
new text end

new text begin (1) Facilities that received the interim rate adjustment in paragraph (b) shall report
to the commissioner the number of medical assistance and private pay resident days
by RUG classification for the six-month period October 1, 2006, through March 31,
2007, according to both the case mix indices and resident assessment schedule used on
September 30, 2006, and the case mix indices and resident assessment schedule used on
October 1, 2006. A facility not receiving the rate adjustment in paragraph (b) that had a
decrease in operating revenue resulting from implementation of the new case mix indices
and the use of quarterly assessments may report to the commissioner the number of
medical assistance and private pay resident days by RUG classification for the six-month
period October 1, 2006, through March 31, 2007, according to both the case mix indices
and resident assessment schedule used on September 30, 2006, and the case mix indices
and resident assessment schedule used on October 1, 2006. Nursing facilities shall submit
the required information to the commissioner by May 15, 2007, in the manner specified by
the commissioner.
new text end

new text begin (2) The commissioner shall use the resident days reported in clause (1) and the
nursing facility's October 1, 2006, unadjusted operating payment rate to determine
operating revenue under both the case mix indices and resident assessment schedule
used on September 30, 2006, and the case mix indices and resident assessment schedule
used on October 1, 2006.
new text end

new text begin (3) The operating revenue determined using the case mix indices and resident
assessment schedule used on September 30, 2006, minus the operating revenue determined
using the case mix indices and resident assessment schedule used on October 1, 2006,
shall equal the decrease in operating revenue.
new text end

new text begin (4) The July 1, 2007, operating payment rate adjustment shall be the decrease in
operating revenue determined in clause (3) divided by the total medical assistance and
private pay days reported in clause (1) for the six-month period October 1, 2006, through
March 31, 2007. The operating payment rate adjustment shall be applied to the case
mix portion of the facility operating rate.
new text end

new text begin (5) If the amount determined in clause (4) is greater than the amount determined
under paragraph (b), clause (4), the commissioner shall retroactively pay to nursing
facilities the difference between the two amounts for all paid medical assistance days
between October 1, 2006, to June 30, 2007.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end