SF 301

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

A bill for an act
relating to human services; changing the rate a
nursing facility may charge a private pay resident;
amending Minnesota Statutes 2004, section 256B.48,
subdivision 1.

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

Section 1.

Minnesota Statutes 2004, section 256B.48,
subdivision 1, is amended to read:

Subdivision 1.

Prohibited practices.

A nursing facility
is not eligible to receive medical assistance payments unless it
refrains from all of the following:

(a) Charging private paying residents rates for similar
services which exceed those which are approved by the state
agency for medical assistance recipients as determined by the
prospective desk audit rate, except under the following
circumstances: new text begin (1) new text end the nursing facility may deleted text begin (1) deleted text end new text begin (i) new text end charge
private paying residents a higher rate for a private room deleted text begin , deleted text end new text begin ; new text end and
deleted text begin (2) deleted text end new text begin (ii) new text end charge for special services which are not included in
the daily rate if medical assistance residents are charged
separately at the same rate for the same services in addition to
the daily rate paid by the commissioner deleted text begin . deleted text end new text begin ; (2) effective July 1,
2005, nursing facilities may charge private paying residents
rates up to two percent higher than the allowable payment rate
in effect on June 30, 2004, plus an adjustment equal to any
other rate increase provided in law, for the RUGs group
currently assigned to the resident; (3) effective July 1, 2006,
nursing facilities may charge private paying residents rates up
to four percent higher than the allowable payment rate in effect
on June 30, 2004, plus an adjustment equal to any other rate
increase provided in law, for the RUGs group currently assigned
to the resident; (4) effective July 1, 2007, nursing facilities
may charge private paying residents rates up to six percent
higher than the allowable payment rate in effect on June 30,
2004, plus an adjustment equal to any other rate increase
provided in law, for the RUGs group currently assigned to the
resident; and (5) effective July 1, 2008, nursing facilities may
charge private paying residents rates up to eight percent higher
than the allowable payment rate in effect on June 30, 2004, plus
an adjustment equal to any other rate increase provided in law,
for the RUGs group currently assigned to the resident. For
purposes of this subdivision, the allowable payment rate under
section 256B.431 or 256B.434, including adjustments for enhanced
rates during the first 30 days under section 256B.431,
subdivision 32, and private room differentials under clause
(1)(i) and Minnesota Rules, part 9549.0060, subpart 11, item C.
Nothing in this section precludes a nursing facility from
charging a rate allowable under the facility's single room
election option under Minnesota Rules, part 9549.0060, subpart
11. new text end Services covered by the payment rate must be the same
regardless of payment source. Special services, if offered,
must be available to all residents in all areas of the nursing
facility and charged separately at the same rate. Residents are
free to select or decline special services. Special services
must not include services which must be provided by the nursing
facility in order to comply with licensure or certification
standards and that if not provided would result in a deficiency
or violation by the nursing facility. Services beyond those
required to comply with licensure or certification standards
must not be charged separately as a special service if they were
included in the payment rate for the previous reporting year. A
nursing facility that charges a private paying resident a rate
in violation of this clause is subject to an action by the state
of Minnesota or any of its subdivisions or agencies for civil
damages. A private paying resident or the resident's legal
representative has a cause of action for civil damages against a
nursing facility that charges the resident rates in violation of
this clause. The damages awarded shall include three times the
payments that result from the violation, together with costs and
disbursements, including reasonable attorneys' fees or their
equivalent. A private paying resident or the resident's legal
representative, the state, subdivision or agency, or a nursing
facility may request a hearing to determine the allowed rate or
rates at issue in the cause of action. Within 15 calendar days
after receiving a request for such a hearing, the commissioner
shall request assignment of an administrative law judge under
sections 14.48 to 14.56 to conduct the hearing as soon as
possible or according to agreement by the parties. The
administrative law judge shall issue a report within 15 calendar
days following the close of the hearing. The prohibition set
forth in this clause shall not apply to facilities licensed as
boarding care facilities which are not certified as skilled or
intermediate care facilities level I or II for reimbursement
through medical assistance.

(b) new text begin Effective July 1, 2009, paragraph (a) no longer
applies, except that special services, if offered, must be
available to all residents of the nursing facility and charged
separately at the same rate. Residents are free to select or
decline special services. Special services must not include
services which must be provided by the nursing facility in order
to comply with licensure or certification standards and that if
not provided would result in a deficiency or violation by the
nursing facility.
new text end

new text begin (c) new text end (1) Charging, soliciting, accepting, or receiving from
an applicant for admission to the facility, or from anyone
acting in behalf of the applicant, as a condition of admission,
expediting the admission, or as a requirement for the
individual's continued stay, any fee, deposit, gift, money,
donation, or other consideration not otherwise required as
payment under the state plan new text begin . For residents on medical
assistance, medical assistance payment according to the state
plan must be accepted as payment in full for continued stay,
except where otherwise provided for under statute new text end ;

(2) requiring an individual, or anyone acting in behalf of
the individual, to loan any money to the nursing facility;

(3) requiring an individual, or anyone acting in behalf of
the individual, to promise to leave all or part of the
individual's estate to the facility; or

(4) requiring a third-party guarantee of payment to the
facility as a condition of admission, expedited admission, or
continued stay in the facility.

Nothing in this paragraph would prohibit discharge for
nonpayment of services in accordance with state and federal
regulations.

deleted text begin (c) deleted text end new text begin (d) new text end Requiring any resident of the nursing facility to
utilize a vendor of health care services chosen by the nursing
facility. A nursing facility may require a resident to use
pharmacies that utilize unit dose packing systems approved by
the Minnesota Board of Pharmacy, and may require a resident to
use pharmacies that are able to meet the federal regulations for
safe and timely administration of medications such as systems
with specific number of doses, prompt delivery of medications,
or access to medications on a 24-hour basis. Notwithstanding
the provisions of this paragraph, nursing facilities shall not
restrict a resident's choice of pharmacy because the pharmacy
utilizes a specific system of unit dose drug packing.

deleted text begin (d) deleted text end new text begin (e) new text end Providing differential treatment on the basis of
status with regard to public assistance.

deleted text begin (e) deleted text end new text begin (f) new text end Discriminating in admissions, services offered, or
room assignment on the basis of status with regard to public
assistance deleted text begin or refusal to purchase special
services deleted text end . new text begin Discrimination in new text end admissions deleted text begin discrimination deleted text end new text begin , services
offered, or room assignment new text end shall include, but is not limited to deleted text begin :
deleted text end

deleted text begin (1) deleted text end new text begin , new text end basing admissions decisions upon deleted text begin assurance by the
applicant to the nursing facility, or the applicant's guardian
or conservator, that the applicant is neither eligible for nor
will seek deleted text end new text begin information or assurances regarding current or future
eligibility for new text end public assistance for payment of nursing
facility care deleted text begin costs; and deleted text end new text begin .
new text end

deleted text begin (2) engaging in preferential selection from waiting lists
based on an applicant's ability to pay privately or an
applicant's refusal to pay for a special service.
deleted text end

The collection and use by a nursing facility of financial
information of any applicant pursuant to a preadmission
screening program established by law shall not raise an
inference that the nursing facility is utilizing that
information for any purpose prohibited by this paragraph.

deleted text begin (f) deleted text end new text begin (g) new text end Requiring any vendor of medical care as defined by
section 256B.02, subdivision 7, who is reimbursed by medical
assistance under a separate fee schedule, to pay any amount
based on utilization or service levels or any portion of the
vendor's fee to the nursing facility except as payment for
renting or leasing space or equipment or purchasing support
services from the nursing facility as limited by section
256B.433. All agreements must be disclosed to the commissioner
upon request of the commissioner. Nursing facilities and
vendors of ancillary services that are found to be in violation
of this provision shall each be subject to an action by the
state of Minnesota or any of its subdivisions or agencies for
treble civil damages on the portion of the fee in excess of that
allowed by this provision and section 256B.433. Damages awarded
must include three times the excess payments together with costs
and disbursements including reasonable attorney's fees or their
equivalent.

deleted text begin (g) deleted text end new text begin (h) new text end Refusing, for more than 24 hours, to accept a
resident returning to the same bed or a bed certified for the
same level of care, in accordance with a physician's order
authorizing transfer, after receiving inpatient hospital
services.

new text begin (i) new text end For a period not to exceed 180 days, the commissioner
may continue to make medical assistance payments to a nursing
facility or boarding care home which is in violation of this
section if extreme hardship to the residents would result. In
these cases the commissioner shall issue an order requiring the
nursing facility to correct the violation. The nursing facility
shall have 20 days from its receipt of the order to correct the
violation. If the violation is not corrected within the 20-day
period the commissioner may reduce the payment rate to the
nursing facility by up to 20 percent. The amount of the payment
rate reduction shall be related to the severity of the violation
and shall remain in effect until the violation is corrected.
The nursing facility or boarding care home may appeal the
commissioner's action pursuant to the provisions of chapter 14
pertaining to contested cases. An appeal shall be considered
timely if written notice of appeal is received by the
commissioner within 20 days of notice of the commissioner's
proposed action.

In the event that the commissioner determines that a
nursing facility is not eligible for reimbursement for a
resident who is eligible for medical assistance, the
commissioner may authorize the nursing facility to receive
reimbursement on a temporary basis until the resident can be
relocated to a participating nursing facility.

Certified beds in facilities which do not allow medical
assistance intake on July 1, 1984, or after shall be deemed to
be decertified for purposes of section 144A.071 only.