1.1.................... moves to amend H.F. No. 2150, the delete everything amendment
1.2(A14-0976), as follows:
1.3Page 82, after line 31, insert:

1.4    "Sec. .... Minnesota Statutes 2012, section 144.0724, as amended by Laws 2014,
1.5chapter 147, section 1, is amended to read:
1.6144.0724 RESIDENT REIMBURSEMENT CLASSIFICATION.
1.7    Subdivision 1. Resident reimbursement case mix classifications. The
1.8commissioner of health shall establish resident reimbursement classifications based upon
1.9the assessments of residents of nursing homes and boarding care homes conducted under
1.10this section and according to section 256B.438.
1.11    Subd. 2. Definitions. For purposes of this section, the following terms have the
1.12meanings given.
1.13(a) "Assessment reference date" or "ARD" means the specific end point for
1.14look-back periods in the MDS assessment process. This look-back period is also called
1.15the observation or assessment period.
1.16(b) "Case mix index" means the weighting factors assigned to the RUG-IV
1.17classifications.
1.18(c) "Index maximization" means classifying a resident who could be assigned to
1.19more than one category, to the category with the highest case mix index.
1.20(d) "Minimum data set" or "MDS" means a core set of screening, clinical assessment,
1.21and functional status elements, that include common definitions and coding categories
1.22specified by the Centers for Medicare and Medicaid Services and designated by the
1.23Minnesota Department of Health.
1.24(e) "Representative" means a person who is the resident's guardian or conservator,
1.25the person authorized to pay the nursing home expenses of the resident, a representative of
1.26the Office of Ombudsman for Long-Term Care whose assistance has been requested, or
1.27any other individual designated by the resident.
2.1(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
2.2facility's residents according to their clinical and functional status identified in data
2.3supplied by the facility's minimum data set.
2.4(g) "Activities of daily living" means grooming, dressing, bathing, transferring,
2.5mobility, positioning, eating, and toileting.
2.6(h) "Nursing facility level of care determination" means the assessment process
2.7that results in a determination of a resident's or prospective resident's need for nursing
2.8facility level of care as established in subdivision 11 for purposes of medical assistance
2.9payment of long-term care services for:
2.10(1) nursing facility services under section 256B.434 or 256B.441;
2.11(2) elderly waiver services under section 256B.0915;
2.12(3) CADI and BI waiver services under section 256B.49; and
2.13(4) state payment of alternative care services under section 256B.0913.
2.14    Subd. 3a. Resident reimbursement classifications beginning January 1, 2012.
2.15(a) Beginning January 1, 2012, resident reimbursement classifications shall be based
2.16on the minimum data set, version 3.0 assessment instrument, or its successor version
2.17mandated by the Centers for Medicare and Medicaid Services that nursing facilities are
2.18required to complete for all residents. The commissioner of health shall establish resident
2.19classifications according to the RUG-IV, 48 group, resource utilization groups. Resident
2.20classification must be established based on the individual items on the minimum data set,
2.21which must be completed according to the Long Term Care Facility Resident Assessment
2.22Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare
2.23and Medicaid Services.
2.24(b) Each resident must be classified based on the information from the minimum
2.25data set according to general categories as defined in the Case Mix Classification Manual
2.26for Nursing Facilities issued by the Minnesota Department of Health.
2.27    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
2.28electronically submit to the commissioner of health MDS assessments that conform with
2.29the assessment schedule defined by Code of Federal Regulations, title 42, section 483.20,
2.30and published by the United States Department of Health and Human Services, Centers for
2.31Medicare and Medicaid Services, in the Long Term Care Assessment Instrument User's
2.32Manual, version 3.0, and subsequent updates when issued by the Centers for Medicare
2.33and Medicaid Services. The commissioner of health may substitute successor manuals or
2.34question and answer documents published by the United States Department of Health and
2.35Human Services, Centers for Medicare and Medicaid Services, to replace or supplement
2.36the current version of the manual or document.
3.1(b) The assessments used to determine a case mix classification for reimbursement
3.2include the following:
3.3(1) a new admission assessment;
3.4(2) an annual assessment which must have an assessment reference date (ARD)
3.5within 92 days of the previous assessment and within 366 days of the ARD of the previous
3.6comprehensive assessment;
3.7(3) a significant change in status assessment must be completed within 14 days of
3.8the identification of a significant change;
3.9(4) all quarterly assessments must have an assessment reference date (ARD) within
3.1092 days of the ARD of the previous assessment;
3.11(5) any significant correction to a prior comprehensive assessment, if the assessment
3.12being corrected is the current one being used for RUG classification; and
3.13(6) any significant correction to a prior quarterly assessment, if the assessment being
3.14corrected is the current one being used for RUG classification.
3.15(c) In addition to the assessments listed in paragraph (b), the assessments used to
3.16determine nursing facility level of care include the following:
3.17(1) preadmission screening completed under section 256B.0911, subdivision 4a,
3.18by a county, tribe, or managed care organization under contract with the Department
3.19of Human Services; and
3.20(2) a face-to-face long-term care consultation assessment completed under section
3.21256B.0911, subdivision 3a , 3b, or 4d, by a county, tribe, or managed care organization
3.22under contract with the Department of Human Services.
3.23    Subd. 5. Short stays. (a) A facility must submit to the commissioner of health an
3.24admission assessment for all residents who stay in the facility 14 days or less.
3.25(b) Notwithstanding the admission assessment requirements of paragraph (a), a
3.26facility may elect to accept a short stay rate with a case mix index of 1.0 for all facility
3.27residents who stay 14 days or less in lieu of submitting an admission assessment. Facilities
3.28shall make this election annually.
3.29(c) Nursing facilities must elect one of the options described in paragraphs (a) and
3.30(b) by reporting to the commissioner of health, as prescribed by the commissioner. The
3.31election is effective on July 1 each year.
3.32    Subd. 6. Penalties for late or nonsubmission. (a) A facility that fails to complete
3.33or submit an assessment according to subdivisions 4 and 5 for a RUG-IV classification
3.34within seven days of the time requirements listed in the Long-Term Care Facility Resident
3.35Assessment Instrument User's Manual is subject to a reduced rate for that resident. The
3.36reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the
4.1day of admission for new admission assessments, on the ARD for significant change in
4.2status assessments, or on the day that the assessment was due for all other assessments and
4.3continues in effect until the first day of the month following the date of submission and
4.4acceptance of the resident's assessment.
4.5    (b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
4.6are equal to or greater than 1.0 percent of the total operating costs on the facility's most
4.7recent annual statistical and cost report, a facility may apply to the commissioner of
4.8human services for a reduction in the total penalty amount. The commissioner of human
4.9services, in consultation with the commissioner of health, may, at the sole discretion of
4.10the commissioner of human services, limit the penalty for residents covered by medical
4.11assistance to 15 days.
4.12    Subd. 7. Notice of resident reimbursement classification. (a) The commissioner
4.13of health shall provide to a nursing facility a notice for each resident of the reimbursement
4.14classification established under subdivision 1. The notice must inform the resident of the
4.15classification that was assigned, the opportunity to review the documentation supporting
4.16the classification, the opportunity to obtain clarification from the commissioner, and the
4.17opportunity to request a reconsideration of the classification and the address and telephone
4.18number of the Office of Ombudsman for Long-Term Care. The commissioner must
4.19transmit the notice of resident classification by electronic means to the nursing facility.
4.20A nursing facility is responsible for the distribution of the notice to each resident, to the
4.21person responsible for the payment of the resident's nursing home expenses, or to another
4.22person designated by the resident. This notice must be distributed within three working
4.23days after the facility's receipt of the electronic file of notice of case mix classifications
4.24from the commissioner of health.
4.25    (b) If a facility submits a modification to the most recent assessment used to establish
4.26a case mix classification conducted under subdivision 3 that results in a change in case
4.27mix classification, the facility shall give written notice to the resident or the resident's
4.28representative about the item that was modified and the reason for the modification. The
4.29notice of modified assessment may be provided at the same time that the resident or
4.30resident's representative is provided the resident's modified notice of classification.
4.31    Subd. 8. Request for reconsideration of resident classifications. (a) The resident,
4.32or resident's representative, or the nursing facility or boarding care home may request that
4.33the commissioner of health reconsider the assigned reimbursement classification. The
4.34request for reconsideration must be submitted in writing to the commissioner within
4.3530 days of the day the resident or the resident's representative receives the resident
4.36classification notice. The request for reconsideration must include the name of the
5.1resident, the name and address of the facility in which the resident resides, the reasons
5.2for the reconsideration, and documentation supporting the request. The documentation
5.3accompanying the reconsideration request is limited to a copy of the MDS that determined
5.4the classification and other documents that would support or change the MDS findings.
5.5(b) Upon request, the nursing facility must give the resident or the resident's
5.6representative a copy of the assessment form and the other documentation that was given
5.7to the commissioner of health to support the assessment findings. The nursing facility
5.8shall also provide access to and a copy of other information from the resident's record that
5.9has been requested by or on behalf of the resident to support a resident's reconsideration
5.10request. A copy of any requested material must be provided within three working days of
5.11receipt of a written request for the information. Notwithstanding any law to the contrary,
5.12the facility may not charge a fee for providing copies of the requested documentation.
5.13If a facility fails to provide the material within this time, it is subject to the issuance
5.14of a correction order and penalty assessment under sections 144.653 and 144A.10.
5.15Notwithstanding those sections, any correction order issued under this subdivision must
5.16require that the nursing facility immediately comply with the request for information and
5.17that as of the date of the issuance of the correction order, the facility shall forfeit to the
5.18state a $100 fine for the first day of noncompliance, and an increase in the $100 fine by
5.19$50 increments for each day the noncompliance continues.
5.20(c) In addition to the information required under paragraphs (a) and (b), a
5.21reconsideration request from a nursing facility must contain the following information: (i)
5.22the date the reimbursement classification notices were received by the facility; (ii) the date
5.23the classification notices were distributed to the resident or the resident's representative;
5.24and (iii) a copy of a notice sent to the resident or to the resident's representative. This
5.25notice must inform the resident or the resident's representative that a reconsideration
5.26of the resident's classification is being requested, the reason for the request, that the
5.27resident's rate will change if the request is approved by the commissioner, the extent of the
5.28change, that copies of the facility's request and supporting documentation are available
5.29for review, and that the resident also has the right to request a reconsideration. If the
5.30facility fails to provide the required information listed in item (iii) with the reconsideration
5.31request, the commissioner may request that the facility provide the information within 14
5.32calendar days. The reconsideration request must be denied if the information is then not
5.33provided, and the facility may not make further reconsideration requests on that specific
5.34reimbursement classification.
5.35(d) Reconsideration by the commissioner must be made by individuals not
5.36involved in reviewing the assessment, audit, or reconsideration that established the
6.1disputed classification. The reconsideration must be based upon the assessment that
6.2determined the classification and upon the information provided to the commissioner
6.3under paragraphs (a) and (b). If necessary for evaluating the reconsideration request, the
6.4commissioner may conduct on-site reviews. Within 15 working days of receiving the
6.5request for reconsideration, the commissioner shall affirm or modify the original resident
6.6classification. The original classification must be modified if the commissioner determines
6.7that the assessment resulting in the classification did not accurately reflect characteristics
6.8of the resident at the time of the assessment. The resident and the nursing facility or
6.9boarding care home shall be notified within five working days after the decision is made.
6.10A decision by the commissioner under this subdivision is the final administrative decision
6.11of the agency for the party requesting reconsideration.
6.12(e) The resident classification established by the commissioner shall be the
6.13classification that applies to the resident while the request for reconsideration is pending.
6.14If a request for reconsideration applies to an assessment used to determine nursing facility
6.15level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible
6.16for nursing facility level of care while the request for reconsideration is pending.
6.17(f) The commissioner may request additional documentation regarding a
6.18reconsideration necessary to make an accurate reconsideration determination.
6.19    Subd. 9. Audit authority. (a) The commissioner shall audit the accuracy of resident
6.20assessments performed under section 256B.438 through any of the following: desk
6.21audits; on-site review of residents and their records; and interviews with staff, residents,
6.22or residents' families. The commissioner shall reclassify a resident if the commissioner
6.23determines that the resident was incorrectly classified.
6.24(b) The commissioner is authorized to conduct on-site audits on an unannounced
6.25basis.
6.26(c) A facility must grant the commissioner access to examine the medical records
6.27relating to the resident assessments selected for audit under this subdivision. The
6.28commissioner may also observe and speak to facility staff and residents.
6.29(d) The commissioner shall consider documentation under the time frames for
6.30coding items on the minimum data set as set out in the Long-Term Care Facility Resident
6.31Assessment Instrument User's Manual published by the Centers for Medicare and
6.32Medicaid Services.
6.33(e) The commissioner shall develop an audit selection procedure that includes the
6.34following factors:
6.35(1) Each facility shall be audited annually. If a facility has two successive audits in
6.36which the percentage of change is five percent or less and the facility has not been the
7.1subject of a special audit in the past 36 months, the facility may be audited biannually.
7.2A stratified sample of 15 percent, with a minimum of ten assessments, of the most
7.3current assessments shall be selected for audit. If more than 20 percent of the RUG-IV
7.4classifications are changed as a result of the audit, the audit shall be expanded to a second
7.515 percent sample, with a minimum of ten assessments. If the total change between
7.6the first and second samples is 35 percent or greater, the commissioner may expand the
7.7audit to all of the remaining assessments.
7.8(2) If a facility qualifies for an expanded audit, the commissioner may audit the
7.9facility again within six months. If a facility has two expanded audits within a 24-month
7.10period, that facility will be audited at least every six months for the next 18 months.
7.11(3) The commissioner may conduct special audits if the commissioner determines
7.12that circumstances exist that could alter or affect the validity of case mix classifications of
7.13residents. These circumstances include, but are not limited to, the following:
7.14(i) frequent changes in the administration or management of the facility;
7.15(ii) an unusually high percentage of residents in a specific case mix classification;
7.16(iii) a high frequency in the number of reconsideration requests received from
7.17a facility;
7.18(iv) frequent adjustments of case mix classifications as the result of reconsiderations
7.19or audits;
7.20(v) a criminal indictment alleging provider fraud;
7.21(vi) other similar factors that relate to a facility's ability to conduct accurate
7.22assessments;
7.23(vii) an atypical pattern of scoring minimum data set items;
7.24(viii) nonsubmission of assessments;
7.25(ix) late submission of assessments; or
7.26(x) a previous history of audit changes of 35 percent or greater.
7.27(f) Within 15 working days of completing the audit process, the commissioner shall
7.28make available electronically the results of the audit to the facility. If the results of the
7.29audit reflect a change in the resident's case mix classification, a case mix classification
7.30notice will be made available electronically to the facility, using the procedure in
7.31subdivision 7, paragraph (a). The notice must contain the resident's classification and a
7.32statement informing the resident, the resident's authorized representative, and the facility
7.33of their right to review the commissioner's documents supporting the classification and to
7.34request a reconsideration of the classification. This notice must also include the address
7.35and telephone number of the Office of Ombudsman for Long-Term Care.
8.1    Subd. 10. Transition. After implementation of this section, reconsiderations
8.2requested for classifications made under section 144.0722, subdivision 1, shall be
8.3determined under section 144.0722, subdivision 3.
8.4    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
8.5payment of long-term care services, a recipient must be determined, using assessments
8.6defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
8.7    (1) the person requires formal clinical monitoring at least once per day;
8.8    (2) the person needs the assistance of another person or constant supervision to begin
8.9and complete at least four of the following activities of living: bathing, bed mobility,
8.10dressing, eating, grooming, toileting, transferring, and walking;
8.11    (3) the person needs the assistance of another person or constant supervision to begin
8.12and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
8.13    (4) the person has significant difficulty with memory, using information, daily
8.14decision making, or behavioral needs that require intervention;
8.15    (5) the person has had a qualifying nursing facility stay of at least 90 days;
8.16    (6) the person meets the nursing facility level of care criteria determined 90 days
8.17after admission or on the first quarterly assessment after admission, whichever is later; or
8.18    (7) the person is determined to be at risk for nursing facility admission or
8.19readmission through a face-to-face long-term care consultation assessment as specified
8.20in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
8.21organization under contract with the Department of Human Services. The person is
8.22considered at risk under this clause if the person currently lives alone or will live alone
8.23upon discharge or be homeless without his or her current housing type and also meets one
8.24of the following criteria:
8.25    (i) the person has experienced a fall resulting in a fracture;
8.26    (ii) the person has been determined to be at risk of maltreatment or neglect,
8.27including self-neglect; or
8.28    (iii) the person has a sensory impairment that substantially impacts functional ability
8.29and maintenance of a community residence.
8.30    (b) The assessment used to establish medical assistance payment for nursing facility
8.31services must be the most recent assessment performed under subdivision 4, paragraph
8.32(b), that occurred no more than 90 calendar days before the effective date of medical
8.33assistance eligibility for payment of long-term care services. In no case shall medical
8.34assistance payment for long-term care services occur prior to the date of the determination
8.35of nursing facility level of care.
9.1    (c) The assessment used to establish medical assistance payment for long-term care
9.2services provided under sections 256B.0915 and 256B.49 and alternative care payment
9.3for services provided under section 256B.0913 must be the most recent face-to-face
9.4assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
9.5no more than 60 calendar days before the effective date of medical assistance eligibility
9.6for payment of long-term care services.
9.7    Subd. 12. Appeal of nursing facility level of care determination. A resident or
9.8prospective resident whose level of care determination results in a denial of long-term care
9.9services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
9.10paragraph (h), clause (9).
9.11EFFECTIVE DATE.This section is effective January 1, 2015."
9.12Renumber the sections in sequence and correct the internal references
9.13Amend the title accordingly