SF2893

SF2893 (Legislative Session 94 (2025-2026))

Health case mix reimbursement modification for federal conformity

Related bill: HF2756

AI Generated Summary

Purpose of the Bill

The bill aims to update and modify the case mix reimbursement system for nursing facilities in Minnesota to align with federal requirements, particularly those set by the Centers for Medicare and Medicaid Services (CMS).

Main Provisions

Definitions: The bill revises key definitions related to the assessment process, case mix index, and reimbursement classifications to ensure clarity and federal conformity.
Patient Driven Payment Model (PDPM): Introduces the PDPM as the classification system for assessing residents in nursing facilities, effective for assessments with an Assessment Reference Date (ARD) on or after October 1, 2025. This model focuses on the resident's condition, diagnosis, and care received.
Resident Case Mix Reimbursement Classifications: Updates the method for determining how nursing facilities are reimbursed based on individual resident assessments. These assessments are part of the Minimum Data Set (MDS) and must align with the guidelines established by CMS.
Resident Assessment Schedule: Specifies requirements for conducting resident assessments, including timeframes for new admission, annual, significant change of status, and quarterly assessments, with specific conditions under which reassessments must occur.
Notices and Audits: Details the process for notifying residents or their representatives of their case mix classification, as well as the audit process to ensure compliance and accuracy of assessments. Audits can be unannounced and may result in reclassification if inaccuracies are found.

Significant Changes to Existing Law

Implementation of PDPM: Shifts from the Resource Utilization Groups (RUG) system to the PDPM from October 2025, reflecting a more individualized approach for payment based on specific resident needs and conditions.
Mandatory Audits: Establishes structured audit procedures and conditions under which nursing facilities might face audits, including frequent assessment changes, history of inaccuracies, or suspected fraud, ensuring that facilities maintain accurate records and proper assessment procedures.
End of Isolation Assessments: Adds requirements for significant change assessments following the cessation of isolation due to infectious diseases.

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)
Long-Term Care Facility Resident Assessment Instrument

Bill text versions

Introduction PDF file

Actions

Date	Chamber	Where	Type	Name	Committee Name
March 23, 2025	Senate	Floor	Action	Introduction and first reading
March 23, 2025	Senate	Floor	Action	Referred to	Human Services

Citations

[
  {
    "analysis": {
      "added": [
        "Amendments to clauses defining various terms such as 'Assessment reference date,' 'Case mix index,' and others related to MDS assessment."
      ],
      "removed": [],
      "summary": "This section provides definitions relevant to case mix reimbursement relating to health.",
      "modified": [
        "Definitions were updated to conform with current health assessment standards."
      ]
    },
    "citation": "144.0724",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section outlines resident case mix reimbursement classifications.",
      "modified": [
        "Adjustments to include specific version of the assessment instrument mandated by CMS."
      ]
    },
    "citation": "144.0724",
    "subdivision": "subdivision 3a"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section dictates the resident assessment schedule.",
      "modified": [
        "The schedule for conducting and submitting assessments to the federal database was revised."
      ]
    },
    "citation": "144.0724",
    "subdivision": "subdivision 4"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section relates to preadmission screening by the Senior LinkAge Line for determining nursing facility level of care.",
      "modified": []
    },
    "citation": "256.975",
    "subdivision": "subdivisions 7a to 7c"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section relates to nursing facility level of care determination as part of face-to-face long-term care consultation.",
      "modified": []
    },
    "citation": "256B.0911",
    "subdivision": "subdivision 26"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "CADI and BI waiver services are associated with determining nursing facility level of care.",
      "modified": []
    },
    "citation": "256B.49",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "State payment of alternative care services is involved in determining nursing facility level of care.",
      "modified": []
    },
    "citation": "256B.0913",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section authorizes audit to ensure accuracy of resident assessments.",
      "modified": [
        "Audit methods and frequency include desk audits and on-site reviews."
      ]
    },
    "citation": "256R.17",
    "subdivision": ""
  }
]