Minnesota Administrative Rules

9050.0400 UTILIZATION REVIEW COMMITTEE.

Subpart 1.

Appointment and duties.

The administrator of a facility shall appoint a utilization review committee composed of persons as specified in subpart 2 who are employed by or under contract to the facility operated by the commissioner of veterans affairs or the commissioner. The committee shall have the duties specified in subpart 3.

Subp. 2.

Composition.

The utilization review committee consists of one physician and at least one of each of the following professionals: a registered nurse, the administrator or the administrator's designee, a social worker, and a medical records technician, who shall not participate in a voting capacity. Additional committee members may include any of the following staff members as indicated by the diagnosis or diagnoses of the resident to be reviewed: a chemical dependency counselor, a mental health practitioner or mental health professional, or a dietitian. The administrator or the administrator's designee, one other committee member, and at least one physician must be in attendance to hold a meeting and to take action.

Subp. 3.

Duties.

The duties of the utilization review committee are to:

A.

review the necessity and appropriateness of admissions, bed holds, transfers, and the need for discharge of all residents according to the United States Department of Veterans Affairs, this chapter, and Department of Health nursing and boarding care criteria specified in parts 4655.0400, 4655.0500, 4655.0700, 4658.0030, and 4658.0140;

B.

recommend to the administrator of the facility operated by the commissioner of veterans affairs criteria for use in admitting residents for care plan reviews and discharge;

C.

perform medical care evaluation studies at the request of the commissioner of veterans affairs and review assessments of residents;

D.

provide reports and recommendations to the administrators and the commissioner of veterans affairs;

E.

provide information as required to appropriate state and federal agencies and fiscal agents, including the United States Department of Veterans Affairs, Minnesota Department of Veterans Affairs, Minnesota Department of Health, Minnesota Department of Human Services, Minnesota Department of Administration, and legislative auditor;

F.

periodically evaluate the Minnesota veterans homes utilization review procedures and recommend ways to correct deficiencies in the review procedures; and

G.

review each resident's case record annually to:

(1)

determine the facility's ability to meet the resident's care needs;

(2)

assess the resident's willingness to cooperate with an individual care plan and obey facility rules in chapter 9050;

(3)

assess the appropriateness of the resident's stay; and

(4)

develop and update the discharge component of the individual care plan for each resident, as appropriate.

Subp. 4.

Decisions.

Decisions must be by majority vote of the members of the utilization review committee following review at a committee meeting. Decisions about residents must be based on the facility's ability to meet the care needs of the resident or applicant according to part 9050.0070, subpart 3 or 4.

Statutory Authority:

MS s 198.003

History:

14 SR 2355; 14 SR 2533; 20 SR 2095; 28 SR 1251; L 2008 c 297 art 2 s 29

Published Electronically:

October 15, 2008