2001 Minnesota Statutes

     256B.5013 Payment rate adjustments. 

    Subdivision 1.    Variable rate adjustments.  For rate 
 years beginning on or after October 1, 2000, when there is a 
 documented increase in the resource needs of a current ICF/MR 
 recipient or recipients, or a person is admitted to a facility 
 who requires additional resources, the county of financial 
 responsibility may recommend approval of a variable rate to 
 enable the facility to meet the individual's increased needs.  
 Variable rate adjustments made under this subdivision replace 
 payments for persons with special needs under section 256B.501, 
 subdivision 8, and payments for persons with special needs for 
 crisis intervention services under section 256B.501, subdivision 
 8a.  Resource needs directly attributable to an individual that 
 may be considered under the variable rate adjustment include 
 increased direct staff hours, other specialized services, and 
 equipment.  The guidelines in paragraphs (a) to (d) apply for 
 the payment rate adjustments under this section. 

    (a) All persons must be screened according to section 
 256B.092, subdivisions 7 and 8, prior to implementation of the 
 new payment system, and annually thereafter, and when a variable 
 rate is being requested due to changes in the needs of the 
 recipient.  Screening data shall be used to monitor changes as 
 follows: 

    (1) the functional ability of a recipient to care for and 
 maintain the recipient's own basic needs; 

    (2) the intensity of any aggressive or destructive 
 behavior; and 

    (3) any history of obstructive behavior in combination with 
 a diagnosis of psychosis or neurosis. 

    (b) A variable rate may be recommended for increased 
 service needs such as: 

    (1) a need for resources due to a change in resident day 
 program participation because the resident:  (i) has reached the 
 age of 65 or has a change in health condition that makes it 
 difficult for the person to participate in day training and 
 habilitation services over an extended period of time because it 
 is medically contraindicated; and (ii) has expressed a desire 
 for change through the mental retardation and related conditions 
 screening process under section 256B.092; and 

    (2) a need for additional resources for intensive 
 short-term programming which is necessary prior to a recipient's 
 discharge to a less restrictive, more integrated setting. 

    Recommendations for a variable rate shall be used to link 
 resource needs to funding.  The variable rate must be applied to 
 expenses related to increased direct staff hours, other 
 specialized services, and equipment.  

    (c) A recipient must be screened by the county of financial 
 responsibility using the developmental disabilities screening 
 document completed immediately prior to approval of a variable 
 rate by the county.  A comparison of the updated screening and 
 the previous screening must demonstrate an increase in resource 
 needs. 

    (d) Rate adjustments projected to exceed the authorized 
 funding level associated with the person's profile must be 
 submitted to the commissioner. 

    (e) The county of financial responsibility must indicate 
 the projected length of time that the additional funding may be 
 needed for the individual.  The need to continue an individual 
 variable rate must be reviewed at the end of the anticipated 
 duration of need but at least annually through the completion of 
 the developmental disabilities screening document. 

    Subd. 2.    Other payment rate adjustments.  Facility 
 total payment rates may be adjusted by the host county, with 
 authorization from a statewide advisory committee, if, through 
 the local system needs planning process, it is determined that a 
 need exists to amend the package of purchased services with a 
 resulting increase or decrease in costs.  Except as provided in 
 section 252.292, subdivision 4, if a provider demonstrates that 
 the loss of revenues caused by the downsizing or closure of a 
 facility cannot be absorbed by the facility based on current 
 operations, the host county or the provider may submit a request 
 to the statewide advisory committee for a facility base rate 
 adjustment. 

    Subd. 3.    Relocation.  (a) Property rates for all 
 facilities relocated after December 31, 1997, and up to and 
 including October 1, 2000, shall have the full annual costs of 
 relocation included in their October 1, 2000, property rate.  
 The property rate for the relocated home is subject to the costs 
 that were allowable under Minnesota Rules, chapter 9553, and the 
 investment per bed limitation for newly constructed or newly 
 established class B facilities.  

    (b) In ensuing years, all relocated homes shall be subject 
 to the investment per bed limit for newly constructed or newly 
 established class B facilities under section 256B.501, 
 subdivision 11.  The limits shall be adjusted on January 1 of 
 each year by the percentage increase in the construction index 
 published by the Bureau of Economic Analysis of the United 
 States Department of Commerce in the Survey of Current Business 
 Statistics in October of the previous two years.  Facilities 
 that are relocated within the investment per bed limit may be 
 approved by the statewide advisory committee.  Costs for 
 relocation of a facility that exceed the investment per bed 
 limit must be absorbed by the facility. 

    (c) The payment rate shall take effect when the new 
 facility is licensed and certified by the commissioner of 
 health.  Rates for facilities that are relocated after December 
 31, 1997, through October 1, 2000, shall be adjusted to reflect 
 the full inclusion of the relocation costs, subject to the 
 investment per bed limit in paragraph (b).  The investment per 
 bed limit calculated rate for the year in which the facility was 
 relocated shall be the investment per bed limit used. 

    Subd. 4.    Temporary rate adjustments to address 
 occupancy and access.  If a facility is operating at less than 
 100 percent occupancy on September 30, 2000, or if a recipient 
 is discharged from a facility, the commissioner shall adjust the 
 total payment rate for up to 90 days for the remaining 
 recipients.  This mechanism shall not be used to pay for 
 hospital or therapeutic leave days beyond the maximums allowed.  
 Facility payment adjustments exceeding 90 days to address a 
 demonstrated need for access must be submitted to the statewide 
 advisory committee with a local system needs assessment, plan, 
 and budget for review and recommendation. 

    Subd. 5.    Required data; payment adjustments.  
 Facilities shall maintain and submit monthly bed use data in the 
 form of resident days and variable rate information.  When a 
 variable rate is reported by a facility, monthly bed use data 
 shall be used to track the amount and time span of the rate 
 adjustment.  The total payments made to a facility may be 
 adjusted based on concurrent changes in the needs of recipients 
 that are covered by a variable rate adjustment.  Any adjustment 
 for multiple resident changes shall not result in a decrease to 
 the facility base rate. 

    Subd. 6.    Commissioner review.  During the initial 
 contracting period, the commissioner shall review the process of 
 variable rate adjustments to determine if the variable rate 
 process is being effectively implemented and whether the 
 variable rate process minimizes unnecessary detailed 
 recordkeeping and meets recipient needs.  

    HIST: 1999 c 245 art 3 s 34; 2000 c 474 s 14-16; 2001 c 203 s 
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