SF 1032

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions 
  1.3             relating to ancillary services on long-term care 
  1.4             facilities; amending Minnesota Statutes 1994, section 
  1.5             256B.433, subdivision 3. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1994, section 256B.433, 
  1.8   subdivision 3, is amended to read: 
  1.9      Subd. 3.  [SEPARATE BILLINGS FOR THERAPY SERVICES.] Until 
  1.10  new procedures are developed under subdivision 4, payment for 
  1.11  therapy services provided to nursing facility residents that are 
  1.12  billed separate from nursing facility's payment rate or 
  1.13  according to Minnesota Rules, parts 9505.0170 to 9505.0475, 
  1.14  shall be subject to the following requirements:  
  1.15     (a) The practitioner invoice must include, in a format 
  1.16  specified by the commissioner, the provider number of the 
  1.17  nursing facility where the medical assistance recipient resides 
  1.18  regardless of the service setting.  
  1.19     (b) Nursing facilities that are related by ownership, 
  1.20  control, affiliation, or employment status to the vendor of 
  1.21  therapy services shall report, in a format specified by the 
  1.22  commissioner, the revenues received during the reporting year 
  1.23  for therapy services provided to medical assistance and private 
  1.24  paying residents of the nursing facility.  For rate years 
  1.25  beginning on or after July 1, 1988 1995, the commissioner shall 
  2.1   offset the medical assistance and private pay revenues received 
  2.2   during the reporting year for therapy services provided to 
  2.3   residents of the nursing facility to the total payment rate of 
  2.4   the nursing facility by dividing the amount of offset by the 
  2.5   nursing facility's actual resident days.  Medicare and other 
  2.6   third party payor costs and revenues are exempt from the 
  2.7   reporting requirements in this clause and (d).  Except as 
  2.8   specified in paragraphs clauses (d) and (f), the amount of 
  2.9   offset shall be the revenue in excess of 108 percent of the cost 
  2.10  removed from the cost report resulting from the requirement of 
  2.11  the commissioner to ensure the avoidance of double payments as 
  2.12  determined by section 256B.47.  Therapy revenues that are 
  2.13  specific to mental health services shall be subject to this 
  2.14  paragraph for rate years beginning after June 30, 1993.  In 
  2.15  establishing a new base period for the purpose of setting 
  2.16  operating cost payment rate limits and rates, the commissioner 
  2.17  shall not include the revenues offset in accordance with this 
  2.18  section.  
  2.19     (c) For rate years beginning on or after July 1, 1987, 
  2.20  nursing facilities shall limit charges in total to vendors of 
  2.21  therapy services for renting space, equipment, or obtaining 
  2.22  other services during the rate year to 108 percent of the 
  2.23  annualized cost removed from the reporting year cost report 
  2.24  resulting from the requirement of the commissioner to ensure the 
  2.25  avoidance of double payments as determined by section 256B.47.  
  2.26  If the arrangement for therapy services is changed so that a 
  2.27  nursing facility is subject to this paragraph instead of 
  2.28  paragraph clause (b), the cost that is used to determine rent 
  2.29  must be adjusted to exclude the annualized costs for therapy 
  2.30  services that are not provided in the rate year.  The maximum 
  2.31  charges to the vendors shall be based on the commissioner's 
  2.32  determination of annualized cost and may be subsequently 
  2.33  adjusted upon resolution of appeals.  Mental health services 
  2.34  shall be subject to this paragraph clause for rate years 
  2.35  beginning after June 30, 1993. 
  2.36     (d) The commissioner shall require reporting of all 
  3.1   revenues relating to the provision of therapy services and shall 
  3.2   establish a therapy cost, as determined by section 256B.47, to 
  3.3   revenue ratio for the reporting year ending in 1986.  For 
  3.4   subsequent reporting years, the ratio may increase five 
  3.5   percentage points in total until a new base year is established 
  3.6   under paragraph clause (e).  Increases in excess of five 
  3.7   percentage points may be allowed if adequate justification is 
  3.8   provided to and accepted by the commissioner.  Unless an 
  3.9   exception is allowed by the commissioner, the amount of offset 
  3.10  in paragraph clause (b) is the greater of the amount determined 
  3.11  in paragraph clause (b) or the amount of offset that is imputed 
  3.12  based on one minus the lesser of (1) the actual reporting year 
  3.13  ratio or (2) the base reporting year ratio increased by five 
  3.14  percentage points, multiplied by the revenues. 
  3.15     (e) The commissioner may establish a new reporting year 
  3.16  base for determining the cost to revenue ratio. 
  3.17     (f) If the arrangement for therapy services is changed so 
  3.18  that a nursing facility is subject to the provisions of 
  3.19  paragraph clause (b) instead of paragraph clause (c), an average 
  3.20  cost to revenue ratio based on the ratios of nursing facilities 
  3.21  that are subject to the provisions of paragraph (b) shall be 
  3.22  imputed for paragraph clause (d). 
  3.23     (g) This section does not allow unrelated nursing 
  3.24  facilities to reorganize related organization therapy services 
  3.25  and provide services among themselves to avoid offsetting 
  3.26  revenues.  Nursing facilities that are found to be in violation 
  3.27  of this provision shall be subject to the penalty requirements 
  3.28  of section 256B.48, subdivision 1, paragraph (f).