Purpose of the Bill

This bill aims to update and modify the case mix reimbursement system for nursing facilities in Minnesota. It seeks to align state practices with federal regulations, ensuring conformity with Medicare and Medicaid Services guidelines.

Main Provisions

• Definitions Updates: The bill clarifies terminology related to the case mix reimbursement process, including the assessment reference date (ARD), the Minimum Data Set (MDS), and new systems such as the Patient-Driven Payment Model (PDPM).
• Resident Assessment: Establishes a schedule for resident assessments in nursing facilities, incorporating updated guidelines from the Centers for Medicare and Medicaid Services (CMS). Assessments will include screening and clinical evaluations impacting reimbursement classifications.
• Audit Authority: Provides the commissioner with the authority to audit facilities to ensure accurate resident assessments and correct classification. Facilities may undergo regular or special audits based on compliance and history.
• Case Mix Classifications: Specifies procedures for determining resident reimbursement classifications based on clinical assessments, particularly for significant changes in resident status or upon the cessation of therapy treatments.
• Notification Requirements: Requires facilities to provide prompt notification to residents concerning their case mix classification, any changes, and their rights regarding the classification.

Significant Changes to Existing Law

• Assessment Frequency: Introduces new timelines and conditions for when significant change assessments must be carried out, particularly relating to isolation for infectious diseases.
• Auditing Process: Establishes more stringent auditing processes and criteria for the frequency and scope of audits, including expanded audits under specific conditions.
• Implementation of Optional State Assessments: Prior to October 1, 2025, an optional state assessment must accompany all OBRA assessments and is used when speech, occupational, and physical therapies end.

Relevant Terms

• Case Mix Reimbursement
• Minimum Data Set (MDS)
• Patient-Driven Payment Model (PDPM)
• Resident Classification
• Audit Authority
• Centers for Medicare and Medicaid Services (CMS)
• OBRA Assessment