HF5130

Purpose

Clarifies how border-city nursing facilities’ rate adjustments are calculated and added to their payment rates. Specifically, it sets rules for nonprofit nursing facilities in Breckenridge and Moorhead to receive an annual addon to their external fixed costs payment rate, based on cross-border rate differences with an adjacent state.

Main provisions

• Eligible facilities: nonprofit nursing facilities located within the city boundaries of Breckenridge or Moorhead before January 1, 2015.
• Annual addon opportunity: Each eligible facility may apply once per year to receive a rate addon to its external fixed costs payment rate. Applications must be submitted within 60 calendar days of the effective date of any addon; the commissioner can waive this deadline in extraordinary circumstances.
• Addon eligibility and payout: The commissioner must provide the addon to every eligible facility that applies by the deadline.
• How the addon is calculated: The addon equals the difference, on January 1, between:
  • The median total payment rate for case mix classification PA1 (the lowest PA1 classification) for nonprofit facilities in the adjacent city in the neighboring state (and in cities contiguous to that adjacent city), and
  • The eligible facility’s total payment rate for PA1 (the lowest PA1 classification) in effect, as determined under Minnesota Statutes §256R.22, subdivision 4.
• Payment context: The addon is added to the facility’s existing external fixed costs payment rate.

Key terms and concepts

• External fixed costs payment rate: the base rate to which the addon is applied.
• Rate addon: the additional funding amount determined by the cross-border comparison.
• PA1: the lowest case mix classification used for calculation.
• Adjacent city in another state and cities contiguous to that city: the reference points for the cross-border rate comparison.
• 256R.22 subdivision 4: the statutory method used to determine the local PA1 rate for the facility.

Administrative details

• The commissioner administers the addon process, including approving applications, calculating the addon, and disbursing the adjustment.
• Deadline flexibility via waiver allows consideration of extraordinary circumstances.

Significance

• Establishes a specific, codified method for border-city rate adjustments, ensuring facilities in Breckenridge and Moorhead receive a defined addon based on cross-border rate comparisons rather than broader or variable schemes.

Relevant Terms

border city facilities; border city nursing facility rate adjustments; external fixed costs payment rate; rate addon; PA1; median total payment rate; adjacent city in another state; cities contiguous to the adjacent city; Minnesota Statutes 2024 section 256R.481; 256R.22 subdivision 4; nonprofit nursing facility; Breckenridge; Moorhead; application deadline; extraordinary circumstances waiver; commissioner.