Minnesota Legislature
SF 2728
as introduced - 86th Legislature (2009 - 2010) Posted on 02/18/2010 03:22pm
Current Version - as introduced
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A bill for an act
relating to human services; increasing the nursing home surcharge; authorizing
negotiated rate increases for certain nursing facilities; increasing reimbursement
for nursing facility fixed costs; reducing the reimbursement rates for nursing
facilities with high operating rates; limiting growth in medical assistance waiver
slots; amending Minnesota Statutes 2008, sections 256.9657, subdivision 1;
256B.441, subdivisions 51a, 53, by adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2008, section 256.9657, subdivision 1, is amended to
read:
Subdivision 1.
Nursing home license surcharge.
(a) Effective July 1, 1993,
each non-state-operated nursing home licensed under chapter 144A shall pay to the
commissioner an annual surcharge according to the schedule in subdivision 4. The
surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds
is deleted text begin reduceddeleted text end new text begin changednew text end , the surcharge shall be based on the number of remaining licensed
beds the second month following the receipt of timely notice by the commissioner of
human services that new text begin the number of new text end beds deleted text begin have been delicenseddeleted text end new text begin has been changednew text end . The
nursing home must notify the commissioner of health in writing when new text begin the number of new text end beds
deleted text begin are delicenseddeleted text end new text begin is changednew text end . The commissioner of health must notify the commissioner
of human services within ten working days after receiving written notification. If the
notification is received by the commissioner of human services by the deleted text begin 15thdeleted text end new text begin thirdnew text end of the
month, the invoice for the second following month must be deleted text begin reduceddeleted text end new text begin changednew text end to recognize
the deleted text begin delicensingdeleted text end new text begin change in the numbernew text end of beds. deleted text begin Beds on layaway status continue to be
subject to the surcharge.deleted text end The commissioner of human services must acknowledge a
medical care surcharge appeal within 30 days of receipt of the written appeal from the
provider.
(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
to $990.
(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
to $2,815.
(e) new text begin Effective July 15, 2010, the surcharge under paragraph (d) shall be increased
to $3,300.
new text end
new text begin (f) new text end The commissioner may reduce, and may subsequently restore, the surcharge under
paragraph deleted text begin (d)deleted text end new text begin (e)new text end based on the commissioner's determination of a permissible surcharge.
deleted text begin (f)deleted text end new text begin (g)new text end Between deleted text begin April 1, 2002, and August 15, 2004deleted text end new text begin July 1, 2010, and June 30,
2011new text end , a facility governed by this subdivision may elect to assume full participation in
the medical assistance program by agreeing to comply with all of the requirements of
the medical assistance program, including the rate equalization law in section 256B.48,
subdivision 1, paragraph (a), and all other requirements established in law or rule, and
to begin intake of new medical assistance recipients. Rates will be determined under
Minnesota Rules, parts 9549.0010 to 9549.0080. Notwithstanding section 256B.431,
subdivision 27, paragraph (i), rate calculations will be subject to limits as prescribed
in rule and law. Other than the adjustments in sections 256B.431, subdivisions 30 and
32; 256B.437, subdivision 3, paragraph (b), Minnesota Rules, part 9549.0057, and any
other applicable legislation enacted prior to the finalization of rates, facilities assuming
full participation in medical assistance under this paragraph are not eligible for any rate
adjustments until the July 1 following their settle-up period.
Sec. 2.
Minnesota Statutes 2008, section 256B.441, subdivision 51a, is amended to
read:
Subd. 51a.
Exception allowing contracting for specialized care.
(a) new text begin For rate years
beginning on or after October 1, 2010, and prior to October 1, 2016, the commissioner
may negotiate rate adjustments for nursing facilities that provide specialized care and that
receive rate adjustments under subdivision 60. These rate adjustments may restore to
these facilities a portion of the amount of the rate reduction resulting from subdivision
60. The commissioner shall publish a request for proposals and may negotiate these
rate adjustments according to paragraph (c), at a cost to the general fund not to exceed
a total of $300,000 per year plus the value of the rate reductions these facilities receive
under subdivision 60.
new text end
new text begin (b) new text end For rate years beginning on or after October 1, 2016, the commissioner may
negotiate increases to the care-related limit for nursing facilities that provide specialized
care, at a cost to the general fund not to exceed $600,000 per year. The commissioner
shall publish a request for proposals annually, and may negotiate increases to the limits
that shall apply for either one or two years before the increase shall be subject to a new
proposal and negotiation. The care-related limit may be increased by up to 50 percent.
deleted text begin (b)deleted text end new text begin (c)new text end In selecting facilities with which to negotiate, the commissioner shall
consider:
(1) the diagnoses or other circumstances of residents in the specialized program that
require care that costs substantially more than the RUG's rates associated with those
residents;
(2) the nature of the specialized program or programs offered to meet the needs
of these individuals; and
(3) outcomes achieved by the specialized program.
Sec. 3.
Minnesota Statutes 2008, 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 deleted text begin $8.86deleted text end new text begin $10.52new text end . 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 deleted text begin $8.86deleted text end new text begin $10.52new text end
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 scholarships shall be determined under section 256B.431,
subdivision 36.
(d) The portion related to long-term care consultation shall be determined according
to section 256B.0911, subdivision 6.
(e) The portion related to development and education of resident and family advisory
councils under section 144A.33 shall be $5 divided by 365.
(f) The portion related to planned closure rate adjustments shall be as determined
under sections 256B.436 and 256B.437, subdivision 6. Planned closure rate adjustments
that take effect before October 1, 2014, shall no longer be included in the payment rate
for external fixed costs beginning October 1, 2016. Planned closure rate adjustments that
take effect on or after October 1, 2014, shall no longer be included in the payment rate
for external fixed costs beginning on October 1 of the first year not less than two years
after their effective date.
(g) The portions related to property insurance, 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.
(h) The portion related to the Public Employees Retirement Association shall be
actual costs divided by resident days.
(i) The single bed room incentives shall be as determined under section 256B.431,
subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
no longer be included in the payment rate for external fixed costs beginning October 1,
2016. Single bed room incentives that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.
(j) The payment rate for external fixed costs shall be the sum of the amounts in
paragraphs (a) to (i).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2010.
new text end
Sec. 4.
Minnesota Statutes 2008, section 256B.441, is amended by adding a
subdivision to read:
new text begin Subd. 60. new text end
new text begin Rate adjustments effective October 1, 2010. new text end
new text begin
(a) For the rate year
beginning October 1, 2010, nursing facility operating payment rates shall be reduced
for facilities that have the highest operating payment rates within their peer group. The
commissioner shall calculate the rate reductions in accordance with paragraphs (b) to (d).
new text end
new text begin
(b) Within each peer group determine the operating payment rate at the 60th
percentile at a resource utilization group (RUGs) weight of 1.00.
new text end
new text begin
(c) Each nursing facility with an operating payment rate greater than the 60th
percentile at a RUGs weight of 1.00 shall have the difference between its rates at a RUGs
weight of 1.00 and the 60th percentile amount determined in paragraph (b) reduced by
an amount equal to the sum of:
new text end
new text begin
(1) 25 percent of the amount that is less than or equal to $5;
new text end
new text begin
(2) 37.5 percent of the amount of the difference that exceeds $5 but is less than or
equal to $10;
new text end
new text begin
(3) 50 percent of the amount of the difference that exceeds $10 but is less than or
equal to $15;
new text end
new text begin
(4) 62.5 percent of the amount of the difference that exceeds $15 but is less than
or equal to $20; and
new text end
new text begin
(5) 75 percent of the amount of the difference that exceeds $20.
new text end
new text begin
(d) The reductions computed in paragraph (c), clauses (1) to (5), shall be apportioned
to the direct care per diem, the other care-related per diem, the other operating per diem,
and the efficiency incentive in accordance with clauses (1) to (3):
new text end
new text begin
(1) the commissioner shall determine the percentage of the operating payment rate
determined in subdivisions 55 and 56, at a RUGs weight of 1.00 for October 1, 2010, that
is for the direct care per diem, the other care-related per diem, the other operating per
diem, and the efficiency incentive;
new text end
new text begin
(2) the percentages determined in clause (1) shall be multiplied by the operating
payment rate reduction determined in paragraph (c); and
new text end
new text begin
(3) for each RUGs level, the operating payment rate shall be reduced in accordance
with items (i) and (ii):
new text end
new text begin
(i) the direct care rate reduction determined for a RUGs weight of 1.00 determined
in clause (2) multiplied by the corresponding weight in subdivision 14; and
new text end
new text begin
(ii) the other care-related per diem, the other operating per diem, and the efficiency
incentive rate reduction determined for a RUGs weight of 1.00 determined in clause (2).
new text end
Sec. 5. new text begin GROWTH IN DEVELOPMENTAL DISABILITIES, TRAUMATIC
BRAIN INJURY, AND COMMUNITY ALTERNATIVES FOR DISABLED
INDIVIDUALS WAIVERS.
new text end
new text begin
Notwithstanding the provisions of Laws 2009, chapter 79, article 13, section 3,
subdivision 8, the commissioner of human services shall implement the following
limitations on caseload growth in the developmental disabilities, traumatic brain injury,
and community alternatives for disabled individuals waivers:
new text end
new text begin
(1) the commissioner shall manage the growth in the developmental disabilities
waiver by limiting the allocations included in the February 2009 forecast to five additional
diversion allocations each month for the period from January 1, 2011, to December 31,
2011. Additional allocations must be made available for transfers authorized by the
commissioner from the personal care assistance program of individuals having a home
care rating of CS, MT, or HL; and
new text end
new text begin
(2) during the fiscal year beginning on July 1, 2010, the commissioner shall allocate
money for home and community-based waiver programs under Minnesota Statutes,
section 256B.49, to ensure a reduction in state spending that is equivalent to limiting the
caseload growth of the traumatic brain injury waiver to three allocations per month each
year of the biennium and the community alternatives for disabled individuals waiver to 75
allocations per month each year of the biennium. Limits do not apply:
new text end
new text begin
(i) when there is an approved plan for nursing facility bed closures for individuals
under age 65 who require relocation due to the bed closure; or
new text end
new text begin
(ii) to transfers authorized by the commissioner from the personal care assistance
program of individuals having a home care rating of CS, MT, or HL.
new text end
new text begin
Priorities for the allocation of funds must be for individuals anticipated to be discharged
from institutional settings or who are at imminent risk of a placement in an institutional
setting.
new text end