Bill Text: MN HF233 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Nursing facility rate equalization phased out.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2013-02-04 - Authors added Nornes and Scott [HF233 Detail]
Download: Minnesota-2013-HF233-Introduced.html
1.2relating to human services; phasing out nursing facility rate equalization;
1.3amending Minnesota Statutes 2012, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2012, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. (a) A nursing facility is not eligible to receive
1.7medical assistance payments unless itrefrains from all of the following: complies with the
1.8prohibitions and requirements in this subdivision.
1.9(a) Charging (b) A nursing facility must not charge private paying residents rates for
1.10similar services which exceed those which are approved by the state agency for medical
1.11assistance recipients as determined by the prospective desk audit rate, except under the
1.12following circumstances:
1.13(1) the nursing facility may(1) (i) charge private paying residents a higher rate for a
1.14private room, and(2) (ii) charge for special services which are not included in the daily
1.15rate if medical assistance residents are charged separately at the same rate for the same
1.16services in addition to the daily rate paid by the commissioner;
1.17(2) effective October 1, 2013, nursing facilities may charge private paying residents
1.18up to two percent higher than the sum of the medical assistance allowable payment rate in
1.19effect on September 30, 2013, plus an adjustment equal to the incremental increase of any
1.20other rate increase provided in law, for the RUGS group currently assigned to the resident;
1.21(3) effective October 1, 2014, nursing facilities may charge private paying residents
1.22rates up to four percent higher than the sum of the medical assistance allowable payment
1.23rate in effect on September 30, 2014, plus an adjustment equal to the incremental increase
2.1of any other rate increase provided in law, for the RUGS group currently assigned to the
2.2resident;
2.3(4) effective October 1, 2015, nursing facilities may charge private paying residents
2.4rates up to six percent higher than the sum of the medical assistance allowable payment
2.5rate in effect on September 30, 2015, plus an adjustment equal to the incremental increase
2.6of any other rate increase provided in law, for the RUGS group currently assigned to the
2.7resident; and
2.8(5) effective October 1, 2016, nursing facilities may charge private paying residents
2.9rates up to eight percent higher than the sum of the medical assistance allowable payment
2.10rate in effect on September 30, 2016, plus an adjustment equal to the incremental increase
2.11of any other rate increase provided in law, for the RUGS group currently assigned to
2.12the resident. Nothing in this section precludes a nursing facility from charging a rate
2.13allowable under the nursing facility's single room election option under Minnesota Rules,
2.14part 9549.0060, subpart 11, or the enhanced rates under section 256B.431, subdivision 32.
2.15Services covered by the payment rate must be the same regardless of payment
2.16source. Special services, if offered, must be available to all residents in all areas of the
2.17nursing facility and charged separately at the same rate. Residents are free to select
2.18or decline special services. Special services must not include services which must be
2.19provided by the nursing facility in order to comply with licensure or certification standards
2.20and that if not provided would result in a deficiency or violation by the nursing facility.
2.21Services beyond those required to comply with licensure or certification standards must
2.22not be charged separately as a special service if they were included in the payment rate
2.23for the previous reporting year. A nursing facility that charges a private paying resident a
2.24rate in violation of thisclause paragraph is subject to an action by the state of Minnesota
2.25or any of its subdivisions or agencies for civil damages. A private paying resident or the
2.26resident's legal representative has a cause of action for civil damages against a nursing
2.27facility that charges the resident rates in violation of thisclause paragraph. The damages
2.28awarded shall include three times the payments that result from the violation, together with
2.29costs and disbursements, including reasonable attorney fees or their equivalent. A private
2.30paying resident or the resident's legal representative, the state, subdivision or agency, or a
2.31nursing facility may request a hearing to determine the allowed rate or rates at issue in
2.32the cause of action. Within 15 calendar days after receiving a request for such a hearing,
2.33the commissioner shall request assignment of an administrative law judge under sections
2.3414.48
to
14.56 to conduct the hearing as soon as possible or according to agreement by
2.35the parties. The administrative law judge shall issue a report within 15 calendar days
2.36following the close of the hearing. The prohibition set forth in thisclause paragraph shall
3.1not apply to facilities licensed as boarding care facilities which are not certified as skilled
3.2or intermediate care facilities level I or II for reimbursement through medical assistance.
3.3(b) (c) Effective October 1, 2017, paragraph (b) no longer applies, except that special
3.4services, if offered, must be available to all residents of the nursing facility and charged
3.5separately at the same rate. Residents are free to select or decline special services. Special
3.6services must not include services that must be provided by the nursing facility in order to
3.7comply with licensure or certification standards and that, if not provided, would result in a
3.8deficiency or violation by the nursing facility.
3.9(d) A nursing facility shall refrain from all of the following:
3.10(1) charging, soliciting, accepting, or receiving from an applicant for admission to
3.11the facility, or from anyone acting in behalf of the applicant, as a condition of admission,
3.12expediting the admission, or as a requirement for the individual's continued stay, any
3.13fee, deposit, gift, money, donation, or other consideration not otherwise required as
3.14payment under the state plan. For residents on medical assistance, payment of the medical
3.15assistance rate according to the state plan must be accepted as payment in full for services
3.16included in the daily rate for continued stay, except where otherwise provided for in statute;
3.17(2) requiring an individual, or anyone acting in behalf of the individual, to loan
3.18any money to the nursing facility;
3.19(3) requiring an individual, or anyone acting in behalf of the individual, to promise
3.20to leave all or part of the individual's estate to the facility; or
3.21(4) requiring a third-party guarantee of payment to the facility as a condition of
3.22admission, expedited admission, or continued stay in the facility.
3.23Nothing in this paragraph would prohibit discharge for nonpayment of services in
3.24accordance with state and federal regulations.
3.25(c) Requiring (e) A nursing facility must not require any resident of the nursing
3.26facility to utilize a vendor of health care services chosen by the nursing facility. A
3.27nursing facility may require a resident to use pharmacies that utilize unit dose packing
3.28systems approved by the Minnesota Board of Pharmacy, and may require a resident to use
3.29pharmacies that are able to meet the federal regulations for safe and timely administration
3.30of medications such as systems with specific number of doses, prompt delivery of
3.31medications, or access to medications on a 24-hour basis. Notwithstanding the provisions
3.32of this paragraph, nursing facilities shall not restrict a resident's choice of pharmacy
3.33because the pharmacy utilizes a specific system of unit dose drug packing.
3.34(d) Providing (f) A nursing facility must not provide differential treatment on the
3.35basis of status with regard to public assistance.
4.1(e) Discriminating (g) A nursing facility must not discriminate in admissions,
4.2services offered, or room assignment on the basis of status with regard to public assistance
4.3or refusal to purchase special services. Discrimination in admissions discrimination shall
4.4include, but is not limited to:
4.5(1) basing admissions decisions upon assurance by the applicant to the nursing
4.6facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
4.7nor will seek information or assurances regarding current or future eligibility for public
4.8assistance for payment of nursing facility carecosts; and
4.9(2) engaging in preferential selection from waiting lists based on an applicant's
4.10ability to pay privately or an applicant's refusal to pay for a special service.
4.11The collection and use by a nursing facility of financial information of any applicant
4.12pursuant to a preadmission screening program established by law shall not raise an
4.13inference that the nursing facility is utilizing that information for any purpose prohibited
4.14by this paragraph.
4.15(f) Requiring (h) A nursing facility must not require any vendor of medical care as
4.16defined by section256B.02, subdivision 7 , who is reimbursed by medical assistance under
4.17a separate fee schedule, to pay any amount based on utilization or service levels or any
4.18portion of the vendor's fee to the nursing facility except as payment for renting or leasing
4.19space or equipment or purchasing support services from the nursing facility as limited by
4.20section256B.433 . All agreements must be disclosed to the commissioner upon request of
4.21the commissioner. Nursing facilities and vendors of ancillary services that are found to be
4.22in violation of this provision shall each be subject to an action by the state of Minnesota or
4.23any of its subdivisions or agencies for treble civil damages on the portion of the fee in
4.24excess of that allowed by this provision and section256B.433 . Damages awarded must
4.25include three times the excess payments together with costs and disbursements including
4.26reasonable attorney fees or their equivalent.
4.27(g) Refusing (i) A nursing facility must not refuse, for more than 24 hours, to accept a
4.28resident returning to the same bed or a bed certified for the same level of care, in accordance
4.29with a physician's order authorizing transfer, after receiving inpatient hospital services.
4.30(j) For a period not to exceed 180 days, the commissioner may continue to make
4.31medical assistance payments to a nursing facility or boarding care homewhich that is in
4.32violation of thissection subdivision if extreme hardship to the residents would result. In
4.33these cases the commissioner shall issue an order requiring the nursing facility to correct
4.34the violation. The nursing facility shall have 20 days from its receipt of the order to correct
4.35the violation. If the violation is not corrected within the 20-day period the commissioner
4.36may reduce the payment rate to the nursing facility by up to 20 percent. The amount of the
5.1payment rate reduction shall be related to the severity of the violation and shall remain
5.2in effect until the violation is corrected. The nursing facility or boarding care home may
5.3appeal the commissioner's action pursuant to the provisions of chapter 14 pertaining to
5.4contested cases. An appeal shall be considered timely if written notice of appeal is received
5.5by the commissioner within 20 days of notice of the commissioner's proposed action.
5.6In the event that the commissioner determines that a nursing facility is not eligible
5.7for reimbursement for a resident who is eligible for medical assistance, the commissioner
5.8may authorize the nursing facility to receive reimbursement on a temporary basis until the
5.9resident can be relocated to a participating nursing facility.
5.10Certified beds in facilitieswhich that do not allow medical assistance intake on July
5.111, 1984, or after shall be deemed to be decertified for purposes of section144A.071 only.
1.3amending Minnesota Statutes 2012, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2012, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. (a) A nursing facility is not eligible to receive
1.7medical assistance payments unless it
1.8prohibitions and requirements in this subdivision.
1.9
1.10similar services which exceed those which are approved by the state agency for medical
1.11assistance recipients as determined by the prospective desk audit rate, except under the
1.12following circumstances:
1.13(1) the nursing facility may
1.14private room, and
1.15rate if medical assistance residents are charged separately at the same rate for the same
1.16services in addition to the daily rate paid by the commissioner;
1.17(2) effective October 1, 2013, nursing facilities may charge private paying residents
1.18up to two percent higher than the sum of the medical assistance allowable payment rate in
1.19effect on September 30, 2013, plus an adjustment equal to the incremental increase of any
1.20other rate increase provided in law, for the RUGS group currently assigned to the resident;
1.21(3) effective October 1, 2014, nursing facilities may charge private paying residents
1.22rates up to four percent higher than the sum of the medical assistance allowable payment
1.23rate in effect on September 30, 2014, plus an adjustment equal to the incremental increase
2.1of any other rate increase provided in law, for the RUGS group currently assigned to the
2.2resident;
2.3(4) effective October 1, 2015, nursing facilities may charge private paying residents
2.4rates up to six percent higher than the sum of the medical assistance allowable payment
2.5rate in effect on September 30, 2015, plus an adjustment equal to the incremental increase
2.6of any other rate increase provided in law, for the RUGS group currently assigned to the
2.7resident; and
2.8(5) effective October 1, 2016, nursing facilities may charge private paying residents
2.9rates up to eight percent higher than the sum of the medical assistance allowable payment
2.10rate in effect on September 30, 2016, plus an adjustment equal to the incremental increase
2.11of any other rate increase provided in law, for the RUGS group currently assigned to
2.12the resident. Nothing in this section precludes a nursing facility from charging a rate
2.13allowable under the nursing facility's single room election option under Minnesota Rules,
2.14part 9549.0060, subpart 11, or the enhanced rates under section 256B.431, subdivision 32.
2.15Services covered by the payment rate must be the same regardless of payment
2.16source. Special services, if offered, must be available to all residents in all areas of the
2.17nursing facility and charged separately at the same rate. Residents are free to select
2.18or decline special services. Special services must not include services which must be
2.19provided by the nursing facility in order to comply with licensure or certification standards
2.20and that if not provided would result in a deficiency or violation by the nursing facility.
2.21Services beyond those required to comply with licensure or certification standards must
2.22not be charged separately as a special service if they were included in the payment rate
2.23for the previous reporting year. A nursing facility that charges a private paying resident a
2.24rate in violation of this
2.25or any of its subdivisions or agencies for civil damages. A private paying resident or the
2.26resident's legal representative has a cause of action for civil damages against a nursing
2.27facility that charges the resident rates in violation of this
2.28awarded shall include three times the payments that result from the violation, together with
2.29costs and disbursements, including reasonable attorney fees or their equivalent. A private
2.30paying resident or the resident's legal representative, the state, subdivision or agency, or a
2.31nursing facility may request a hearing to determine the allowed rate or rates at issue in
2.32the cause of action. Within 15 calendar days after receiving a request for such a hearing,
2.33the commissioner shall request assignment of an administrative law judge under sections
2.35the parties. The administrative law judge shall issue a report within 15 calendar days
2.36following the close of the hearing. The prohibition set forth in this
3.1not apply to facilities licensed as boarding care facilities which are not certified as skilled
3.2or intermediate care facilities level I or II for reimbursement through medical assistance.
3.3
3.4services, if offered, must be available to all residents of the nursing facility and charged
3.5separately at the same rate. Residents are free to select or decline special services. Special
3.6services must not include services that must be provided by the nursing facility in order to
3.7comply with licensure or certification standards and that, if not provided, would result in a
3.8deficiency or violation by the nursing facility.
3.9(d) A nursing facility shall refrain from all of the following:
3.10(1) charging, soliciting, accepting, or receiving from an applicant for admission to
3.11the facility, or from anyone acting in behalf of the applicant, as a condition of admission,
3.12expediting the admission, or as a requirement for the individual's continued stay, any
3.13fee, deposit, gift, money, donation, or other consideration not otherwise required as
3.14payment under the state plan. For residents on medical assistance, payment of the medical
3.15assistance rate according to the state plan must be accepted as payment in full for services
3.16included in the daily rate for continued stay, except where otherwise provided for in statute;
3.17(2) requiring an individual, or anyone acting in behalf of the individual, to loan
3.18any money to the nursing facility;
3.19(3) requiring an individual, or anyone acting in behalf of the individual, to promise
3.20to leave all or part of the individual's estate to the facility; or
3.21(4) requiring a third-party guarantee of payment to the facility as a condition of
3.22admission, expedited admission, or continued stay in the facility.
3.23Nothing in this paragraph would prohibit discharge for nonpayment of services in
3.24accordance with state and federal regulations.
3.25
3.26facility to utilize a vendor of health care services chosen by the nursing facility. A
3.27nursing facility may require a resident to use pharmacies that utilize unit dose packing
3.28systems approved by the Minnesota Board of Pharmacy, and may require a resident to use
3.29pharmacies that are able to meet the federal regulations for safe and timely administration
3.30of medications such as systems with specific number of doses, prompt delivery of
3.31medications, or access to medications on a 24-hour basis. Notwithstanding the provisions
3.32of this paragraph, nursing facilities shall not restrict a resident's choice of pharmacy
3.33because the pharmacy utilizes a specific system of unit dose drug packing.
3.34
3.35basis of status with regard to public assistance.
4.1
4.2services offered, or room assignment on the basis of status with regard to public assistance
4.3
4.4include, but is not limited to
4.5
4.6
4.7
4.8assistance for payment of nursing facility care
4.9
4.10
4.11The collection and use by a nursing facility of financial information of any applicant
4.12pursuant to a preadmission screening program established by law shall not raise an
4.13inference that the nursing facility is utilizing that information for any purpose prohibited
4.14by this paragraph.
4.15
4.16defined by section
4.17a separate fee schedule, to pay any amount based on utilization or service levels or any
4.18portion of the vendor's fee to the nursing facility except as payment for renting or leasing
4.19space or equipment or purchasing support services from the nursing facility as limited by
4.20section
4.21the commissioner. Nursing facilities and vendors of ancillary services that are found to be
4.22in violation of this provision shall each be subject to an action by the state of Minnesota or
4.23any of its subdivisions or agencies for treble civil damages on the portion of the fee in
4.24excess of that allowed by this provision and section
4.25include three times the excess payments together with costs and disbursements including
4.26reasonable attorney fees or their equivalent.
4.27
4.28resident returning to the same bed or a bed certified for the same level of care, in accordance
4.29with a physician's order authorizing transfer, after receiving inpatient hospital services.
4.30(j) For a period not to exceed 180 days, the commissioner may continue to make
4.31medical assistance payments to a nursing facility or boarding care home
4.32violation of this
4.33these cases the commissioner shall issue an order requiring the nursing facility to correct
4.34the violation. The nursing facility shall have 20 days from its receipt of the order to correct
4.35the violation. If the violation is not corrected within the 20-day period the commissioner
4.36may reduce the payment rate to the nursing facility by up to 20 percent. The amount of the
5.1payment rate reduction shall be related to the severity of the violation and shall remain
5.2in effect until the violation is corrected. The nursing facility or boarding care home may
5.3appeal the commissioner's action pursuant to the provisions of chapter 14 pertaining to
5.4contested cases. An appeal shall be considered timely if written notice of appeal is received
5.5by the commissioner within 20 days of notice of the commissioner's proposed action.
5.6In the event that the commissioner determines that a nursing facility is not eligible
5.7for reimbursement for a resident who is eligible for medical assistance, the commissioner
5.8may authorize the nursing facility to receive reimbursement on a temporary basis until the
5.9resident can be relocated to a participating nursing facility.
5.10Certified beds in facilities
5.111, 1984, or after shall be deemed to be decertified for purposes of section
