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S.F. No. 894 - Health Care Facilities Resident Case Mix Classification Provisions Modifications
 
Author: Senator Melissa H. Wiklund
 
Prepared By:
 
Date: March 4, 2013



 

S.F. No. 894 is a Minnesota Department of Health (MDH) bill that updates and clarifies changes to the Case Mix Classification system (Section 144.0724), which sets nursing home reimbursement rates based on assessments of residents’ health and level of functionality. Through this assessment process (called the Minimum Data Set, or MDS), nursing home residents are placed into one of 48 Resource Utilization Groups (RUG). The RUG structure was updated in 2011 to comply with federal law; this bill removes language related to the old RUG structure.

This bill also combines the targeted audits conducted by MDH into the special audit category.

Subdivision 1 renames the headnote “Resident reimbursement case mix classifications” and deletes outdated language.

Subdivision 2 redefines “assessment reference date” (ARD) and MDS, updates a reference to the Office of Ombudsman for Long-Term Care, and removes an obsolete reference to RUG-III classification.

Subdivision 3 removes language related to the case mix classification in place prior to January 1, 2012, by striking the entire subdivision.

Subdivision 3a updates language related to the new case mix classification by citing the RUG-IV classification, and replaces the language stricken in subdivision 3 by referencing the MDH Case Mix Classification Manual for Nursing Facilities.

Subdivision 4  removes the requirement that new assessments be completed within two weeks of nursing home admission; clarifies the timing of quarterly assessments performed in conjunction with yearly assessments; and adds language allowing significant corrections to annual or quarterly assessments to be used to redetermine case mix classification.

Subdivision 5 clarifies that short-stay provisions apply to residents staying 14 days or less (instead of less than 14 days), and removes language exempting reassessments for residents previously discharged on an extended leave status.

Subdivision 6 removes obsolete references to RUG-III classification, updates references to the new RUG-IV classification and Long-Term Care Facility Resident Assessment Instrument User’s Manual.  Also provides for a reduced rate beginning on the ARD to any nursing home failing to submit a significant change in assessment status within seven days of the time requirements in the Long-Term Care Facility Resident Assessment Instrument User's Manual.

Subdivision 7 modifies the information provided by MDH to a nursing home on each resident’s case mix classification by including the address and telephone number of the Office of Ombudsman for Long-Term Care, and replaces “correction” with “modification” in regards to case mix classification assessments.

Subdivision 8 modifies the documentation used to reconsider a resident classification assignment, limiting the documents to the MDS and other documents supporting or changing the MDS findings; restricts nursing homes from charging a fee for providing copies of the documentation; and provides that a reconsideration request must be denied if documentation is not provided by the facility.

Subdivision 9 removes provisions allowing MDH to target facilities for audits if they have an atypical MDS score, late submissions or no submissions of assessments, or a previous history of audit changes; these provisions are consolidated into special audit provisions found within the subdivision.  An obsolete reference to RUG-III classification is removed.

No changes made to subdivisions 10 through 12.

 
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