Purpose of the Bill

The bill aims to modify the case mix reimbursement system for nursing facilities in Minnesota to align with federal standards. This involves updating the way residents in these facilities are assessed and classified for reimbursement purposes.

Main Provisions

• Updated Assessment Process: The bill includes amendments to the definitions related to the Minimum Data Set (MDS) assessment process, emphasizing the importance of the Assessment Reference Date (ARD) and introducing the Patient-Driven Payment Model (PDPM) for classifying residents based on their condition and care needs.

• Resident Classification Changes: It updates the classification system for resident case mix reimbursement to ensure it is based on the most current version of the Minimum Data Set, as mandated by the Centers for Medicare and Medicaid Services. The optional state assessment must be completed with all OBRA assessments.

• Adjustment to Assessment Schedules: The bill outlines specific timelines and criteria for conducting various types of assessments (e.g., new admission comprehensive, annual, significant change, and quarterly review assessments).

• Audit Procedures: It details the authority and process for audits by the commissioner, including the conditions under which audits may be expanded, and the circumstances that may trigger special audits.

Significant Changes to Existing Law

• Case Mix Reimbursement Classifications: Shifts from the Resource Utilization Groups (RUG) system to the Patient-Driven Payment Model (PDPM) starting October 1, 2025, for determining resident classifications in nursing facilities.

• New Audit Requirements: Introduces more frequent and structured audits, with specific triggers such as unusual resident classification patterns or recent changes in management, to ensure the accuracy of assessments.

Relevant Terms

• Case mix reimbursement
• Minimum Data Set (MDS)
• Assessment Reference Date (ARD)
• Patient-Driven Payment Model (PDPM)
• Resource Utilization Groups (RUG)
• Centers for Medicare and Medicaid Services (CMS)
• Omnibus Budget Reconciliation Act of 1987 (OBRA)
• Nursing facility audits