144.0722 RESIDENT REIMBURSEMENT CLASSIFICATIONS.
Subdivision 1. Resident reimbursement classifications.
The commissioner of health
shall establish resident reimbursement classifications based upon the assessments of residents
of nursing homes and boarding care homes conducted under sections
or under rules established by the commissioner of human services under sections
. The reimbursement classifications established by the commissioner must conform to
the rules established by the commissioner of human services.
Subd. 2. Notice of resident reimbursement classification.
The commissioner of health shall
notify each resident, and the nursing home or boarding care home in which the resident resides,
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 notice of resident
classification must be sent by first-class mail. The individual resident notices may be sent to the
resident's nursing home or boarding care home for distribution to the resident. The nursing home
or boarding care home 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 notices from the department.
Subd. 2a. Semiannual assessment by nursing facilities.
Notwithstanding Minnesota Rules,
, subpart 2, item B, the individual dependencies items 21 to 24 and 28 are required
to be completed in accordance with the Facility Manual for Completing Case Mix Requests for
Classification, July 1987, issued by the Minnesota Department of Health.
Subd. 3. Request for reconsideration.
The resident or the nursing home or boarding care
home may request that the commissioner reconsider the assigned reimbursement classification.
The request for reconsideration must be submitted in writing to the commissioner within 30 days
of the receipt of the notice of resident classification. For reconsideration requests submitted by
or on behalf of the resident, the time period for submission of the request begins as of the date
the resident or the resident's representative receives the 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, the requested classification changes,
and documentation supporting the requested classification. The documentation accompanying the
reconsideration request is limited to documentation establishing that the needs of the resident at
the time of the assessment resulting in the disputed classification justify a change of classification.
Subd. 3a. Access to information.
Upon written request, the nursing home or boarding care
home must give the resident or the resident's representative a copy of the assessment form and the
other documentation that was given to the department to support the assessment findings. The
nursing home or boarding care home 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. If a facility fails to provide the
material within this time, it is subject to the issuance of a correction order and penalty assessment
. Notwithstanding those sections, any correction order
issued under this subdivision must require that the 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 the first day of noncompliance, and an increase in the $100 fine
by $50 increments for each day the noncompliance continues. For the purposes of this section,
"representative" includes the resident's guardian or conservator, the person authorized to pay the
nursing home expenses of the resident, a representative of the nursing home ombudsman's office
whose assistance has been requested, or any other individual designated by the resident.
Subd. 3b. Facility's request for reconsideration.
In addition to the information required
in subdivision 3, a reconsideration request from a nursing home or boarding care home
must contain the following information: the date the resident reimbursement classification
notices were received by the facility; the date the classification notices were distributed to the
resident or the resident's representative; and a copy of a notice sent to the resident or to the
resident's representative. This notice must tell 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 department and 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
this information with the reconsideration request, the request must be denied, and the facility may
not make further reconsideration requests on that specific reimbursement classification.
Subd. 4. Reconsideration.
The commissioner's reconsideration must be made by individuals
not involved in reviewing the assessment that established the disputed classification. The
reconsideration must be based upon the initial assessment and upon the information provided to
the commissioner under subdivision 3. If necessary for evaluating the reconsideration request,
the commissioner may conduct on-site reviews. In its discretion, the commissioner may review
the reimbursement classifications assigned to all residents in the facility. 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 the needs of
the resident at the time of the assessment. The resident and the nursing home or boarding care
home shall be notified within five working days after the decision is made. The commissioner's
decision under this subdivision is the final administrative decision of the agency.
Subd. 5. Audit authority.
The Department of Health may audit assessments of nursing home
and boarding care home residents. These audits may be in addition to the assessments completed
by the department under section
. The audits may be conducted at the facility, and the
department may conduct the audits on an unannounced basis.
History: 1Sp1985 c 3 s 1; 1987 c 209 s 2; 1996 c 451 art 5 s 3