Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 2002, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 276-S.F.No. 3124
An act relating to health; modifying resident
reimbursement classifications; clarifying minimum
nursing staff requirements; amending Minnesota
Statutes 2000, section 144A.04, subdivision 7;
Minnesota Statutes 2001 Supplement, section 144.0724,
subdivisions 3, 5, 7, 9.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2001 Supplement, section
144.0724, subdivision 3, is amended to read:
Subd. 3. [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a)
Resident reimbursement classifications shall be based on the
minimum data set, version 2.0 assessment instrument, or its
successor version mandated by the Health Care Financing
Administration that nursing facilities are required to complete
for all residents. The commissioner of health shall establish
resident classes according to the 34 group, resource utilization
groups, version III or RUG-III model. Resident classes must be
established based on the individual items on the minimum data
set and must be completed according to the facility manual for
case mix classification issued by the Minnesota department of
health. The facility manual for case mix classification shall
be drafted by the Minnesota department of health and presented
to the chairs of health and human services legislative
committees by December 31, 2001.
(b) Each resident must be classified based on the
information from the minimum data set according to general
domains in clauses (1) to (7):
(1) extensive services where a resident requires
intravenous feeding or medications, suctioning, or tracheostomy
care, or is on a ventilator or respirator;
(2) rehabilitation where a resident requires physical,
occupational, or speech therapy;
(3) special care where a resident has cerebral palsy;
quadriplegia; multiple sclerosis; pressure ulcers; ulcers; fever
with vomiting, weight loss, pneumonia, or dehydration; surgical
wounds with treatment; or tube feeding and aphasia; or is
receiving radiation therapy;
(4) clinically complex status where a resident has tube
feeding, burns, coma, septicemia, pneumonia, internal bleeding,
chemotherapy, wounds, kidney failure, urinary tract
infections dialysis, oxygen, or transfusions, foot infections or
lesions with treatment, heiplegia/hemiparesis, physician visits
or order changes, or diabetes with injections and order changes;
(5) impaired cognition where a resident has poor cognitive
performance;
(6) behavior problems where a resident exhibits
wandering or socially inappropriate or disruptive behavior, has
hallucinations or delusions, or is physically or verbally
abusive toward others, or resists care, unless the resident's
other condition would place the resident in other categories;
and
(7) reduced physical functioning where a resident has no
special clinical conditions.
(c) The commissioner of health shall establish resident
classification according to a 34 group model based on the
information on the minimum data set and within the general
domains listed in paragraph (b), clauses (1) to (7). Detailed
descriptions of each resource utilization group shall be defined
in the facility manual for case mix classification issued by the
Minnesota department of health. The 34 groups are described as
follows:
(1) SE3: requires four or five extensive services;
(2) SE2: requires two or three extensive services;
(3) SE1: requires one extensive service;
(4) RAD: requires rehabilitation services and is dependent
in activity of daily living (ADL) at a count of 17 or 18;
(5) RAC: requires rehabilitation services and ADL count is
14 to 16;
(6) RAB: requires rehabilitation services and ADL count is
ten to 13;
(7) RAA: requires rehabilitation services and ADL count is
four to nine;
(8) SSC: requires special care and ADL count is 17 or 18;
(9) SSB: requires special care and ADL count is 15 or 16;
(10) SSA: requires special care and ADL count is seven to
14;
(11) CC2: clinically complex with depression and ADL count
is 17 or 18;
(12) CC1: clinically complex with no depression and ADL
count is 17 or 18;
(13) CB2: clinically complex with depression and ADL count
is 12 to 16;
(14) CB1: clinically complex with no depression and ADL
count is 12 to 16;
(15) CA2: clinically complex with depression and ADL count
is four to 11;
(16) CA1: clinically complex with no depression and ADL
count is four to 11;
(17) IB2: impaired cognition with nursing rehabilitation
and ADL count is six to ten;
(18) IB1: impaired cognition with no nursing
rehabilitation and ADL count is six to ten;
(19) IA2: impaired cognition with nursing rehabilitation
and ADL count is four or five;
(20) IA1: impaired cognition with no nursing
rehabilitation and ADL count is four or five;
(21) BB2: behavior problems with nursing rehabilitation
and ADL count is six to ten;
(22) BB1: behavior problems with no nursing rehabilitation
and ADL count is six to ten;
(23) BA2: behavior problems with nursing rehabilitation
and ADL count is four to five;
(24) BA1: behavior problems with no nursing rehabilitation
and ADL count is four to five;
(25) PE2: reduced physical functioning with nursing
rehabilitation and ADL count is 16 to 18;
(26) PE1: reduced physical functioning with no nursing
rehabilitation and ADL count is 16 to 18;
(27) PD2: reduced physical functioning with nursing
rehabilitation and ADL count is 11 to 15;
(28) PD1: reduced physical functioning with no nursing
rehabilitation and ADL count is 11 to 15;
(29) PC2: reduced physical functioning with nursing
rehabilitation and ADL count is nine or ten;
(30) PC1: reduced physical functioning with no nursing
rehabilitation and ADL count is nine or ten;
(31) PB2: reduced physical functioning with nursing
rehabilitation and ADL count is six to eight;
(32) PB1: reduced physical functioning with no nursing
rehabilitation and ADL count is six to eight;
(33) PA2: reduced physical functioning with nursing
rehabilitation and ADL count is four or five; and
(34) PA1: reduced physical functioning with no nursing
rehabilitation and ADL count is four or five.
Sec. 2. Minnesota Statutes 2001 Supplement, section
144.0724, subdivision 5, is amended to read:
Subd. 5. [SHORT STAYS.] (a) A facility must submit to the
commissioner of health an initial admission assessment for all
residents who stay in the facility less than 14 days.
(b) Notwithstanding the admission assessment requirements
of paragraph (a), a facility may elect to accept a default rate
with a case mix index of 1.0 for all facility residents who stay
less than 14 days in lieu of submitting an initial assessment.
Facilities may make this election to be effective on the day of
implementation of the revised case mix system.
(c) After implementation of the revised case mix system,
nursing facilities must elect one of the options described in
paragraphs (a) and (b) on the annual report by reporting to the
commissioner of human services filed for each report year ending
September 30 health, as prescribed by the commissioner. The
election shall be is effective on the following July 1.
(d) For residents who are admitted or readmitted and leave
the facility on a frequent basis and for whom readmission is
expected, the resident may be discharged on an extended leave
status. This status does not require reassessment each time the
resident returns to the facility unless a significant change in
the resident's status has occurred since the last assessment.
The case mix classification for these residents is determined by
the facility election made in paragraphs (a) and (b).
Sec. 3. Minnesota Statutes 2001 Supplement, section
144.0724, subdivision 7, is amended to read:
Subd. 7. [NOTICE OF RESIDENT REIMBURSEMENT
CLASSIFICATION.] (a) A facility must elect between the options
in clauses (1) and (2) to provide notice to a resident of the
resident's case mix classification.
(1) The commissioner of health shall provide to a nursing
facility a notice for each resident of the reimbursement
classification established under subdivision 1. The notice must
inform the resident of the classification that was assigned, the
opportunity to review the documentation supporting the
classification, the opportunity to obtain clarification from the
commissioner, and the opportunity to request a reconsideration
of the classification. The commissioner must send notice of
resident classification by first class mail. A nursing facility
is responsible for the distribution of the notice to each
resident, to the person responsible for the payment of the
resident's nursing home expenses, or to another person
designated by the resident. This notice must be distributed
within three working days after the facility's receipt of the
notice from the commissioner of health.
(2) A facility may choose to provide a classification
notice, as prescribed by the commissioner of health, to a
resident upon receipt of the confirmation of the case mix
classification calculated by a facility or a corrected case mix
classification as indicated on the final validation report from
the commissioner. A nursing facility is responsible for the
distribution of the notice to each resident, to the person
responsible for the payment of the resident's nursing home
expenses, or to another person designated by the resident. This
notice must be distributed within three working days after the
facility's receipt of the validation report from the
commissioner. If a facility elects this option, the
commissioner of health shall provide the facility with a list of
residents and their case mix classifications as determined by
the commissioner. A nursing facility may make this election to
be effective on the day of implementation of the revised case
mix system.
(3) After implementation of the revised case mix system, a
nursing facility shall elect a notice of resident reimbursement
classification procedure as described in clause (1) or (2) on
the annual report by reporting to the commissioner of human
services filed for each report year ending September 30 health,
as prescribed by the commissioner. The election will be is
effective the following July 1.
(b) If a facility submits a correction to an the most
recent assessment used to establish a case mix classification
conducted under subdivision 3 that results in a change in case
mix classification, the facility shall give written notice to
the resident or the resident's representative about the item
that was corrected and the reason for the correction. The
notice of corrected assessment may be provided at the same time
that the resident or resident's representative is provided the
resident's corrected notice of classification.
Sec. 4. Minnesota Statutes 2001 Supplement, section
144.0724, subdivision 9, is amended to read:
Subd. 9. [AUDIT AUTHORITY.] (a) The commissioner shall
audit the accuracy of resident assessments performed under
section 256B.438 through desk audits, on-site review of
residents and their records, and interviews with staff and
families. The commissioner shall reclassify a resident if the
commissioner determines that the resident was incorrectly
classified.
(b) The commissioner is authorized to conduct on-site
audits on an unannounced basis.
(c) A facility must grant the commissioner access to
examine the medical records relating to the resident assessments
selected for audit under this subdivision. The commissioner may
also observe and speak to facility staff and residents.
(d) The commissioner shall consider documentation under the
time frames for coding items on the minimum data set as set out
in the Resident Assessment Instrument Manual published by the
Health Care Financing Administration.
(e) The commissioner shall develop an audit selection
procedure that includes the following factors:
(1) The commissioner may target facilities that demonstrate
an atypical pattern of scoring minimum data set items,
nonsubmission of assessments, late submission of assessments, or
a previous history of audit changes of greater than 35 percent.
The commissioner shall select at least 20 percent, with a
minimum of ten assessments, of the most current assessments
submitted to the state for audit. Audits of assessments
selected in the targeted facilities must focus on the factors
leading to the audit. If the number of targeted assessments
selected does not meet the threshold of 20 percent of the
facility residents, then a stratified sample of the remainder of
assessments shall be drawn to meet the quota. If the total
change exceeds 35 percent, the commissioner may conduct an
expanded audit up to 100 percent of the remaining current
assessments.
(2) Facilities that are not a part of the targeted group
shall be placed in a general pool from which facilities will be
selected on a random basis for audit. Every facility shall be
audited annually. If a facility has two successive audits in
which the percentage of change is five percent or less and the
facility has not been the subject of a targeted audit in the
past 36 months, the facility may be audited biannually. A
stratified sample of 15 percent, with a minimum of ten
assessments, of the most current assessments shall be selected
for audit. If more than 20 percent of the RUGS-III
classifications after the audit are changed, the audit shall be
expanded to a second 15 percent sample, with a minimum of ten
assessments. If the total change between the first and second
samples exceed 35 percent, the commissioner may expand the audit
to all of the remaining assessments.
(3) If a facility qualifies for an expanded audit, the
commissioner may audit the facility again within six months. If
a facility has two expanded audits within a 24-month period,
that facility will be audited at least every six months for the
next 18 months.
(4) The commissioner may conduct special audits if the
commissioner determines that circumstances exist that could
alter or affect the validity of case mix classifications of
residents. These circumstances include, but are not limited to,
the following:
(i) frequent changes in the administration or management of
the facility;
(ii) an unusually high percentage of residents in a
specific case mix classification;
(iii) a high frequency in the number of reconsideration
requests received from a facility;
(iv) frequent adjustments of case mix classifications as
the result of reconsiderations or audits;
(v) a criminal indictment alleging provider fraud; or
(vi) other similar factors that relate to a facility's
ability to conduct accurate assessments.
(f) Within 15 working days of completing the audit process,
the commissioner shall mail the written results of the audit to
the facility, along with a written notice for each resident
affected to be forwarded by the facility. The notice must
contain the resident's classification and a statement informing
the resident, the resident's authorized representative, and the
facility of their right to review the commissioner's documents
supporting the classification and to request a reconsideration
of the classification. This notice must also include the
address and telephone number of the area nursing home ombudsman.
Sec. 5. Minnesota Statutes 2000, section 144A.04,
subdivision 7, is amended to read:
Subd. 7. [MINIMUM NURSING STAFF REQUIREMENT.]
Notwithstanding the provisions of Minnesota Rules, part
4655.5600, the minimum staffing standard for nursing personnel
in certified nursing homes is as follows:
(a) The minimum number of hours of nursing personnel to be
provided in a nursing home is the greater of two hours per
resident per 24 hours or 0.95 hours per standardized resident
day. Upon transition to the 34 group, RUG-III resident
classification system, the 0.95 hours per standardized resident
day shall no longer apply.
(b) For purposes of this subdivision, "hours of nursing
personnel" means the paid, on-duty, productive nursing hours of
all nurses and nursing assistants, calculated on the basis of
any given 24-hour period. "Productive nursing hours" means all
on-duty hours during which nurses and nursing assistants are
engaged in nursing duties. Examples of nursing duties may be
found in Minnesota Rules, parts 4655.5900, 4655.6100, and
4655.6400. Not included are vacations, holidays, sick leave,
in-service classroom training, or lunches. Also not included
are the nonproductive nursing hours of the in-service training
director. In homes with more than 60 licensed beds, the hours
of the director of nursing are excluded. "Standardized resident
day" means the sum of the number of residents in each case mix
class multiplied by the case mix weight for that resident class,
as found in Minnesota Rules, part 9549.0059, subpart 2,
calculated on the basis of a facility's census for any given
day. For the purpose of determining a facility's census, the
commissioner of health shall exclude the resident days claimed
by the facility for resident therapeutic leave or bed hold days.
(c) Calculation of nursing hours per standardized resident
day is performed by dividing total hours of nursing personnel
for a given period by the total of standardized resident days
for that same period.
(d) A nursing home that is issued a notice of noncompliance
under section 144A.10, subdivision 5, for a violation of this
subdivision, shall be assessed a civil fine of $300 for each day
of noncompliance, subject to section 144A.10, subdivisions 7 and
8.
Presented to the governor March 22, 2002
Signed by the governor March 25, 2002, 2:14 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes