Minnesota 2025-2026 Regular Session

Minnesota House Bill HF2756 Compare Versions

Only one version of the bill is available at this time.

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1	1	1.1 A bill for an act
2	2	1.2 relating to health; modifying case mix reimbursement for federal conformity;
3	3	1.3 amending Minnesota Statutes 2024, section 144.0724, subdivisions 2, 3a, 4, 7, 9.
4	4	1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
5	5	1.5 Section 1. Minnesota Statutes 2024, section 144.0724, subdivision 2, is amended to read:
6	6	1.6 Subd. 2.Definitions.For purposes of this section, the following terms have the meanings
7	7	1.7given.
8	8	1.8 (a) "Assessment reference date" or "ARD" means the specific end point for look-back
9	9	1.9periods in the MDS assessment process. This look-back period is also called the observation
10	10	1.10or assessment period.
11	11	1.11 (b) "Case mix index" means the weighting factors assigned to the case mix reimbursement
12	12	1.12classifications determined by an assessment.
13	13	1.13 (c) "Index maximization" means classifying a resident who could be assigned to more
14	14	1.14than one category, to the category with the highest case mix index.
15	15	1.15 (d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,
16	16	1.16and functional status elements, that include common definitions and coding categories
17	17	1.17specified by the Centers for Medicare and Medicaid Services and designated by the
18	18	1.18Department of Health.
19	19	1.19 (e) "Representative" means a person who is the resident's guardian or conservator, the
20	20	1.20person authorized to pay the nursing home expenses of the resident, a representative of the
21	21	1.21Office of Ombudsman for Long-Term Care whose assistance has been requested, or any
22	22	1.22other individual designated by the resident.
23	23	1Section 1.
24	24	REVISOR EB/MI 25-0030701/13/25
25	25	State of Minnesota
26	26	This Document can be made available
27	27	in alternative formats upon request
28	28	HOUSE OF REPRESENTATIVES
29	29	H. F. No. 2756
30	30	NINETY-FOURTH SESSION
31	31	Authored by Bierman03/24/2025
32	32	The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1 (f) "Activities of daily living" or "ADL" includes personal hygiene, dressing, bathing,
33	33	2.2transferring, bed mobility, locomotion, eating, and toileting.
34	34	2.3 (g) "Patient Driven Payment Model" or "PDPM" means a case mix classification system
35	35	2.4for residents in nursing facilities based on the resident's condition, diagnosis, and the care
36	36	2.5the resident is receiving based on data supplied in the facility's MDS for assessments with
37	37	2.6an ARD on or after October 1, 2025.
38	38	2.7 (g) (h) "Nursing facility level of care determination" means the assessment process that
39	39	2.8results in a determination of a resident's or prospective resident's need for nursing facility
40	40	2.9level of care as established in subdivision 11 for purposes of medical assistance payment
41	41	2.10of long-term care services for:
42	42	2.11 (1) nursing facility services under chapter 256R;
43	43	2.12 (2) elderly waiver services under chapter 256S;
44	44	2.13 (3) CADI and BI waiver services under section 256B.49; and
45	45	2.14 (4) state payment of alternative care services under section 256B.0913.
46	46	2.15 (i) "Resource utilization groups" or "RUG" means a system for grouping a nursing
47	47	2.16facility's residents according to the resident's clinical and functional status identified in data
48	48	2.17supplied by the facility's minimum data set with an ARD on or prior to September 30, 2025.
49	49	2.18 Sec. 2. Minnesota Statutes 2024, section 144.0724, subdivision 3a, is amended to read:
50	50	2.19 Subd. 3a.Resident case mix reimbursement classifications.(a) Resident case mix
51	51	2.20reimbursement classifications shall be based on the Minimum Data Set, version 3.0
52	52	2.21assessment instrument, or its successor version mandated by the Centers for Medicare and
53	53	2.22Medicaid Services that nursing facilities are required to complete for all residents. Case
54	54	2.23mix reimbursement classifications shall also be based on assessments required under
55	55	2.24subdivision 4. Assessments must be completed according to the Long Term Care Facility
56	56	2.25Resident Assessment Instrument User's Manual Version 3.0 or a successor manual issued
57	57	2.26by the Centers for Medicare and Medicaid Services. On or before September 30, 2025, the
58	58	2.27optional state assessment must be completed according to the OSA Manual Version 1.0 v.2.
59	59	2.28 (b) Each resident must be classified based on the information from the Minimum Data
60	60	2.29Set according to the general categories issued by the Minnesota Department of Health,
61	61	2.30utilized for reimbursement purposes.
62	62	2Sec. 2.
63	63	REVISOR EB/MI 25-0030701/13/25 3.1 Sec. 3. Minnesota Statutes 2024, section 144.0724, subdivision 4, is amended to read:
64	64	3.2 Subd. 4.Resident assessment schedule.(a) A facility must conduct and electronically
65	65	3.3submit to the federal database MDS assessments that conform with the assessment schedule
66	66	3.4defined by the Long Term Care Facility Resident Assessment Instrument User's Manual,
67	67	3.5version 3.0, or its successor issued by the Centers for Medicare and Medicaid Services. The
68	68	3.6commissioner of health may substitute successor manuals or question and answer documents
69	69	3.7published by the United States Department of Health and Human Services, Centers for
70	70	3.8Medicare and Medicaid Services, to replace or supplement the current version of the manual
71	71	3.9or document.
72	72	3.10 (b) The assessments required under the Omnibus Budget Reconciliation Act of 1987
73	73	3.11(OBRA) used to determine a case mix reimbursement classification include:
74	74	3.12 (1) a new admission comprehensive assessment, which must have an assessment reference
75	75	3.13date (ARD) within 14 calendar days after admission, excluding readmissions;
76	76	3.14 (2) an annual comprehensive assessment, which must have an ARD within 92 days of
77	77	3.15a previous quarterly review assessment or a previous comprehensive assessment, which
78	78	3.16must occur at least once every 366 days;
79	79	3.17 (3) a significant change in status comprehensive assessment, which must have an ARD
80	80	3.18within 14 days after the facility determines, or should have determined, that there has been
81	81	3.19a significant change in the resident's physical or mental condition, whether an improvement
82	82	3.20or a decline, and regardless of the amount of time since the last comprehensive assessment
83	83	3.21or quarterly review assessment. Effective October 1, 2025, a significant change in status
84	84	3.22assessment is also required when isolation for an infectious disease has ended. If isolation
85	85	3.23was not coded on the most recent OBRA assessment completed, then the significant change
86	86	3.24in status assessment is not required. The ARD of this assessment must be set on day 15 after
87	87	3.25isolation has ended;
88	88	3.26 (4) a quarterly review assessment must have an ARD within 92 days of the ARD of the
89	89	3.27previous quarterly review assessment or a previous comprehensive assessment;
90	90	3.28 (5) any significant correction to a prior comprehensive assessment, if the assessment
91	91	3.29being corrected is the current one being used for reimbursement classification;
92	92	3.30 (6) any significant correction to a prior quarterly review assessment, if the assessment
93	93	3.31being corrected is the current one being used for reimbursement classification; and
94	94	3.32 (7) any modifications to the most recent assessments under clauses (1) to (6).
95	95	3Sec. 3.
96	96	REVISOR EB/MI 25-0030701/13/25 4.1 (c) On or before September 30, 2025, the optional state assessment must accompany all
97	97	4.2OBRA assessments. The optional state assessment is also required to determine
98	98	4.3reimbursement when:
99	99	4.4 (1) all speech, occupational, and physical therapies have ended. If the most recent optional
100	100	4.5state assessment completed does not result in a rehabilitation case mix reimbursement
101	101	4.6classification, then the optional state assessment is not required. The ARD of this assessment
102	102	4.7must be set on day eight after all therapy services have ended; and
103	103	4.8 (2) isolation for an infectious disease has ended. If isolation was not coded on the most
104	104	4.9recent optional state assessment completed, then the optional state assessment is not required.
105	105	4.10The ARD of this assessment must be set on day 15 after isolation has ended.
106	106	4.11 (d) In addition to the assessments listed in paragraphs (b) and (c), the assessments used
107	107	4.12to determine nursing facility level of care include the following:
108	108	4.13 (1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
109	109	4.14the Senior LinkAge Line or other organization under contract with the Minnesota Board on
110	110	4.15Aging; and
111	111	4.16 (2) a nursing facility level of care determination as provided for under section 256B.0911,
112	112	4.17subdivision 26, as part of a face-to-face long-term care consultation assessment completed
113	113	4.18under section 256B.0911, by a county, tribe, or managed care organization under contract
114	114	4.19with the Department of Human Services.
115	115	4.20 Sec. 4. Minnesota Statutes 2024, section 144.0724, subdivision 7, is amended to read:
116	116	4.21 Subd. 7.Notice of resident case mix reimbursement classification.(a) The
117	117	4.22commissioner of health shall provide to a nursing facility a notice for each resident of the
118	118	4.23classification established under subdivision 1. The notice must inform the resident of the
119	119	4.24case mix reimbursement classification assigned, the opportunity to review the documentation
120	120	4.25supporting the classification, the opportunity to obtain clarification from the commissioner,
121	121	4.26the opportunity to request a reconsideration of the classification, and the address and
122	122	4.27telephone number of the Office of Ombudsman for Long-Term Care. The commissioner
123	123	4.28must transmit the notice of resident classification by electronic means to the nursing facility.
124	124	4.29The nursing facility is responsible for the distribution of the notice to each resident or the
125	125	4.30resident's representative. This notice must be distributed within three business days after
126	126	4.31the facility's receipt.
127	127	4.32 (b) If a facility submits a modified assessment resulting in a change in the case mix
128	128	4.33reimbursement classification, the facility must provide a written notice to the resident or
129	129	4Sec. 4.
130	130	REVISOR EB/MI 25-0030701/13/25 5.1the resident's representative regarding the item or items that were modified and the reason
131	131	5.2for the modifications. The written notice must be provided within three business days after
132	132	5.3distribution of the resident case mix reimbursement classification notice.
133	133	5.4 Sec. 5. Minnesota Statutes 2024, section 144.0724, subdivision 9, is amended to read:
134	134	5.5 Subd. 9.Audit authority.(a) The commissioner shall audit the accuracy of resident
135	135	5.6assessments performed under section 256R.17 through any of the following: desk audits;
136	136	5.7on-site review of residents and their records; and interviews with staff, residents, or residents'
137	137	5.8families. The commissioner shall reclassify a resident if the commissioner determines that
138	138	5.9the resident was incorrectly classified.
139	139	5.10 (b) The commissioner is authorized to conduct on-site audits on an unannounced basis.
140	140	5.11 (c) A facility must grant the commissioner access to examine the medical records relating
141	141	5.12to the resident assessments selected for audit under this subdivision. The commissioner may
142	142	5.13also observe and speak to facility staff and residents.
143	143	5.14 (d) The commissioner shall consider documentation under the time frames for coding
144	144	5.15items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment
145	145	5.16Instrument User's Manual or on or before September 30, 2025, the OSA Manual version
146	146	5.171.0 v.2 published by the Centers for Medicare and Medicaid Services.
147	147	5.18 (e) The commissioner shall develop an audit selection procedure that includes the
148	148	5.19following factors:
149	149	5.20 (1) Each facility shall be audited annually. If a facility has two successive audits in which
150	150	5.21the percentage of change is five percent or less and the facility has not been the subject of
151	151	5.22a special audit in the past 36 months, the facility may be audited biannually. A stratified
152	152	5.23sample of 15 percent, with a minimum of ten assessments, of the most current assessments
153	153	5.24shall be selected for audit. If more than 20 percent of the case mix reimbursement
154	154	5.25classifications are changed as a result of the audit, the audit shall be expanded to a second
155	155	5.2615 percent sample, with a minimum of ten assessments. If the total change between the first
156	156	5.27and second samples is 35 percent or greater, the commissioner may expand the audit to all
157	157	5.28of the remaining assessments.
158	158	5.29 (2) If a facility qualifies for an expanded audit, the commissioner may audit the facility
159	159	5.30again within six months. If a facility has two expanded audits within a 24-month period,
160	160	5.31that facility will be audited at least every six months for the next 18 months.
161	161	5Sec. 5.
162	162	REVISOR EB/MI 25-0030701/13/25 6.1 (3) The commissioner may conduct special audits if the commissioner determines that
163	163	6.2circumstances exist that could alter or affect the validity of case mix reimbursement
164	164	6.3classifications of residents. These circumstances include, but are not limited to, the following:
165	165	6.4 (i) frequent changes in the administration or management of the facility;
166	166	6.5 (ii) an unusually high percentage of residents in a specific case mix reimbursement
167	167	6.6classification;
168	168	6.7 (iii) a high frequency in the number of reconsideration requests received from a facility;
169	169	6.8 (iv) frequent adjustments of case mix reimbursement classifications as the result of
170	170	6.9reconsiderations or audits;
171	171	6.10 (v) a criminal indictment alleging provider fraud;
172	172	6.11 (vi) other similar factors that relate to a facility's ability to conduct accurate assessments;
173	173	6.12 (vii) an atypical pattern of scoring minimum data set items;
174	174	6.13 (viii) nonsubmission of assessments;
175	175	6.14 (ix) late submission of assessments; or
176	176	6.15 (x) a previous history of audit changes of 35 percent or greater.
177	177	6.16 (f) If the audit results in a case mix reimbursement classification change, the
178	178	6.17commissioner must transmit the audit classification notice by electronic means to the nursing
179	179	6.18facility within 15 business days of completing an audit. The nursing facility is responsible
180	180	6.19for distribution of the notice to each resident or the resident's representative. This notice
181	181	6.20must be distributed by the nursing facility within three business days after receipt. The
182	182	6.21notice must inform the resident of the case mix reimbursement classification assigned, the
183	183	6.22opportunity to review the documentation supporting the classification, the opportunity to
184	184	6.23obtain clarification from the commissioner, the opportunity to request a reconsideration of
185	185	6.24the classification, and the address and telephone number of the Office of Ombudsman for
186	186	6.25Long-Term Care.
187	187	6Sec. 5.
188	188	REVISOR EB/MI 25-0030701/13/25