Skip to main content Skip to office menu Skip to footer
Capital IconMinnesota Legislature

SF 4253

as introduced - 91st Legislature (2019 - 2020) Posted on 03/11/2020 03:54pm

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

Current Version - as introduced

Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8
1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25
2.26 2.27 2.28 2.29 2.30 2.31 2.32 3.1 3.2 3.3 3.4 3.5
3.6
3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34
5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20
6.21
6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9
8.10 8.11
8.12 8.13 8.14 8.15 8.16

A bill for an act
relating to human services; modifying resident assessments and classifications
provisions; requiring certain related party disclosures; establishing interim and
settle-up payment rates for new owners and operators; appropriating money for
improved financial integrity of nursing facility payments; amending Minnesota
Statutes 2018, sections 144.0724, subdivisions 4, 5, 8; 256R.08, subdivision 1;
proposing coding for new law in Minnesota Statutes, chapter 256R.

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

Section 1.

Minnesota Statutes 2018, 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 MDS 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
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
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;

(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;

(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessmentnew text begin. Effective for
rehabilitation therapy completed on or after January 1, 2021, a facility must complete a
significant change in status assessment if for any reason all speech, occupational, and
physical therapies have ended. The ARD of the significant change in status assessment must
be the eighth day after all speech, occupational, and physical therapies have ended. The last
day on which rehabilitation therapy was furnished is considered day zero when determining
the ARD for the significant change in status assessment
new text end;

(4) all quarterly assessments must have an deleted text beginassessment reference date (ARD)deleted text endnew text begin ARDnew text end within
92 days of the ARD of the previous assessment;

(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; deleted text beginand
deleted text end

(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classificationdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (7) modifications to the most recent assessment in clauses (1) to (6).
new text end

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and

(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e
, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2018, section 144.0724, subdivision 5, is amended to read:


Subd. 5.

Short stays.

(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or less.

(b) Notwithstanding the admission assessment requirements of paragraph (a), a facility
may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents
who stay 14 days or less in lieu of submitting an admission assessment. Facilities shall make
this election annually.

(c) Nursing facilities must elect one of the options described in paragraphs (a) and (b)
by reporting to the commissioner of health, as prescribed by the commissioner. The election
is effective on July 1 each year.

new text begin (d) An admission assessment is not required regardless of the facility's election status
when a resident is admitted to and discharged from the facility on the same day.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for admissions on or after July 1, 2020.
new text end

Sec. 3.

Minnesota Statutes 2018, section 144.0724, subdivision 8, is amended to read:


Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident, or
resident's representative, or the nursing facility or boarding care home may request that the
commissioner of health reconsider the assigned reimbursement classificationnew text begin, including any
items changed during the audit process
new text end. The request for reconsideration must be submitted
in writing to the commissioner within 30 days of the day the resident or the resident's
representative receives the resident classification notice. The request for reconsideration
must include the name of the resident, the name and address of the facility in which the
resident resides, the reasons for the reconsideration, and documentation supporting the
request. The documentation accompanying the reconsideration request is limited to deleted text begina copy
of the MDS that determined the classification and other
deleted text end documents that would support or
change the MDS findings.

(b) Upon request, the nursing facility must give the resident or the resident's representative
a copy of the assessment form and the other documentation that was given to the
commissioner of health to support the assessment findings. The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information. Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the material within this time, it is subject to the issuance of a correction order
and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections,
any correction order issued under this subdivision must require that the nursing facility
immediately comply with the request for information and that as of the date of the issuance
of the correction order, the facility shall forfeit to the state a $100 fine for the first day of
noncompliance, and an increase in the $100 fine by $50 increments for each day the
noncompliance continues.

(c) In addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
classification notices were distributed to the resident or the resident's representative; and
(iii) a copy of a notice sent to the resident or to the resident's representative. This notice
must inform the resident or the resident's representative that a reconsideration of the resident's
classification is being requested, the reason for the request, that the resident's rate will change
if the request is approved by the commissioner, the extent of the change, that copies of the
facility's request and supporting documentation are available for review, and that the resident
also has the right to request a reconsideration. If the facility fails to provide the required
information listed in item (iii) with the reconsideration request, the commissioner may
request that the facility provide the information within 14 calendar days. The reconsideration
request must be denied if the information is then not provided, and the facility may not
make further reconsideration requests on that specific reimbursement classification.

(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner under paragraphs (a) and (b). If
necessary for evaluating the reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of receiving the request for reconsideration, the
commissioner shall affirm or modify the original resident classification. The original
classification must be modified if the commissioner determines that the assessment resulting
in the classification did not accurately reflect characteristics of the resident at the time of
the assessment. The resident and the nursing facility or boarding care home shall be notified
within five working days after the decision is made. A decision by the commissioner under
this subdivision is the final administrative decision of the agency for the party requesting
reconsideration.

(e) The resident classification established by the commissioner shall be the classification
that applies to the resident while the request for reconsideration is pending. If a request for
reconsideration applies to an assessment used to determine nursing facility level of care
under subdivision 4, paragraph (c), the resident shall continue to be eligible for nursing
facility level of care while the request for reconsideration is pending.

(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.

Sec. 4.

Minnesota Statutes 2018, section 256R.08, subdivision 1, is amended to read:


Subdivision 1.

Reporting of financial statements.

new text begin (a) For purposes of this subdivision,
the following terms have the meanings given:
new text end

new text begin (1) "profit and loss statement" means the most recent annual statement on profits and
losses finalized by a related party for the most recent year available; and
new text end

new text begin (2) "related party" means an organization related to the licensee provider or that is under
common ownership or control, as defined in Code of Federal Regulations, title 42, section
413.17(b).
new text end

deleted text begin (a)deleted text endnew text begin (b)new text end No later than February 1 of each year, a nursing facility shall:

(1) provide the state agency with a copy of its audited financial statements or its working
trial balance;

(2) provide the state agency with a statement of ownership for the facility;

(3) provide the state agency with separate, audited financial statements or working trial
balances for every other facility owned in whole or in part by an individual or entity that
has an ownership interest in the facility;

new text begin (4) provide the state agency with information regarding whether the licensee, or a general
partner, director, or officer of the licensee, has an ownership or control interest of five
percent or more in a related party or related organization that provides a service to the skilled
nursing facility. If the licensee, or the general partner, director, or officer of the licensee,
has such an interest, the licensee shall disclose all services provided to the skilled nursing
facility, the number of individuals who provide that service at the skilled nursing facility,
and any other information requested by the state agency. If goods, fees, and services
collectively worth $10,000 or more per year are delivered to the skilled nursing facility, the
disclosure required under this subdivision shall include the related party and related
organization profit and loss statement and the payroll-based journal public use data;
new text end

deleted text begin (4)deleted text endnew text begin (5)new text end upon request, provide the state agency with separate, audited financial statements
or working trial balances for every organization with which the facility conducts business
and which is owned in whole or in part by an individual or entity which has an ownership
interest in the facility;

deleted text begin (5)deleted text endnew text begin (6)new text end provide the state agency with copies of leases, purchase agreements, and other
documents related to the lease or purchase of the nursing facility; and

deleted text begin (6)deleted text endnew text begin (7)new text end upon request, provide the state agency with copies of leases, purchase agreements,
and other documents related to the acquisition of equipment, goods, and services which are
claimed as allowable costs.

deleted text begin (b)deleted text endnew text begin (c)new text end Audited financial statements submitted under paragraph deleted text begin(a)deleted text endnew text begin (b)new text end must include a
balance sheet, income statement, statement of the rate or rates charged to private paying
residents, statement of retained earnings, statement of cash flows, notes to the financial
statements, audited applicable supplemental information, and the public accountant's report.
Public accountants must conduct audits in accordance with chapter 326A. The cost of an
audit shall not be an allowable cost unless the nursing facility submits its audited financial
statements in the manner otherwise specified in this subdivision. A nursing facility must
permit access by the state agency to the public accountant's audit work papers that support
the audited financial statements submitted under paragraph deleted text begin(a)deleted text endnew text begin (b)new text end.

deleted text begin (c)deleted text endnew text begin (d)new text end Documents or information provided to the state agency pursuant to this subdivision
shall be public.

deleted text begin (d)deleted text endnew text begin (e)new text end If the requirements of paragraphs deleted text begin(a)deleted text endnew text begin (b)new text end and deleted text begin(b)deleted text endnew text begin (c)new text end are not met, the reimbursement
rate may be reduced to 80 percent of the rate in effect on the first day of the fourth calendar
month after the close of the reporting period and the reduction shall continue until the
requirements are met.

new text begin (f) Licensees shall provide the information required in this section to the commissioner
in a manner prescribed by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2020.
new text end

Sec. 5.

new text begin [256R.28] INTERIM AND SETTLE-UP PAYMENT RATES FOR NEW
OWNERS AND OPERATORS.
new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) A nursing facility that undergoes a change of ownership
or operator resulting in a change of licensee, as determined by the commissioner of health
under chapter 144A, must receive interim payment rates and settle-up payment rates
according to this section.
new text end

new text begin (b) The effective date of the interim rates is the effective date of the new license. The
interim payment rates must not be in effect for more than 26 months.
new text end

new text begin (c) The nursing facility must continue to receive the interim payment rates until the
settle-up payment rates are determined under subdivision 3.
new text end

new text begin (d) The settle-up payment rates are effective retroactively from the effective date of the
new license and remain effective until the end of the interim rate period.
new text end

new text begin (e) For the 15-month period following the settle-up payment, rates must be determined
according to subdivision 3, paragraph (c).
new text end

new text begin (f) The total operating and external fixed costs payment rates for the rate year beginning
January 1 following the 15-month period in paragraph (e) must be determined under section
256R.21.
new text end

new text begin Subd. 2. new text end

new text begin Determination of interim payment rates. new text end

new text begin The interim total payment rates
must be the rates established under section 256R.21.
new text end

new text begin Subd. 3. new text end

new text begin Determination of settle-up payment rates. new text end

new text begin (a) When the effective date of the
new license is between May 1 and September 30, the nursing facility shall file a settle-up
cost report for the period from the beginning of the interim payment rates through September
30 of the following year.
new text end

new text begin (b) When the effective date of the new license is between October 1 and April 30, the
nursing facility shall file a settle-up cost report for the period from the beginning of the
interim payment rates to the first September 30 following the beginning of the interim
payment rates.
new text end

new text begin (c) The settle-up payment rates are determined according to sections 256R.21 to 256R.25,
except that:
new text end

new text begin (1) the allowable costs and resident days reported on the settle-up cost report and the
standardized days as defined by section 256R.02, subdivision 50, must be used for the
interim and settle-up period;
new text end

new text begin (2) the commissioner shall use the allowable costs and standardized days in clause (1)
to determine the allowable historical direct care cost per standardized day as determined
under section 256R.23, subdivision 2;
new text end

new text begin (3) the commissioner shall use the allowable costs and the allowable resident days to
determine both the allowable historical other care-related cost per resident day as determined
under section 256R.23, subdivision 3;
new text end

new text begin (4) the commissioner shall use the allowable costs and the allowable resident days to
determine the allowable historical external fixed costs per day under section 256R.25,
paragraphs (b) to (e), (j), (k), (n), and (o);
new text end

new text begin (5) the commissioner shall allow the new licensee to assume the previous licensee's
external fixed per day rate components that the new licensee qualifies for under section
256R.25, paragraphs (f) to (i) and (l). The new licensee may be permitted to assume the
previous licensee rate component from section 256R.25, paragraph (m), at the commissioner's
discretion;
new text end

new text begin (6) the total care-related payment limits established in section 256R.23, subdivision 5,
are the limits for the settle-up reporting periods; and
new text end

new text begin (7) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for changes of ownership or operator
that occur on or after January 1, 2021.
new text end

Sec. 6. new text beginAPPROPRIATION; IMPROVED FINANCIAL INTEGRITY OF NURSING
FACILITY RATES AND PAYMENTS.
new text end

new text begin $600,000 in fiscal year 2021 is appropriated from the general fund to the commissioner
of human services to hire additional auditing staff to improve financial integrity of nursing
facility rates and payments, for auditor travel to conduct audits, and for investigative software.
new text end