Bill Text: MN SF607 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Nursing facility equal rates provision sunset
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-03-07 - Referred to Health and Human Services [SF607 Detail]
Download: Minnesota-2011-SF607-Introduced.html
1.2relating to human services; placing a sunset on the nursing facility equal rates
1.3provision; amending Minnesota Statutes 2010, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
1.7medical assistance payments unless it refrains from all of the following:
1.8(a) Charging private paying residents rates for similar services which exceed those
1.9which are approved by the state agency for medical assistance recipients as determined by
1.10the prospective desk audit rate, except under the following circumstances: the nursing
1.11facility may (1) charge private paying residents a higher rate for a private room, and (2)
1.12charge for special services which are not included in the daily rate if medical assistance
1.13residents are charged separately at the same rate for the same services in addition to
1.14the daily rate paid by the commissioner. Services covered by the payment rate must be
1.15the same regardless of payment source. Special services, if offered, must be available
1.16to all residents in all areas of the nursing facility and charged separately at the same
1.17rate. Residents are free to select or decline special services. Special services must not
1.18include services which must be provided by the nursing facility in order to comply with
1.19licensure or certification standards and that if not provided would result in a deficiency
1.20or violation by the nursing facility. Services beyond those required to comply with
1.21licensure or certification standards must not be charged separately as a special service if
1.22they were included in the payment rate for the previous reporting year. A nursing facility
1.23that charges a private paying resident a rate in violation of this clause is subject to an
1.24action by the state of Minnesota or any of its subdivisions or agencies for civil damages.
2.1A private paying resident or the resident's legal representative has a cause of action for
2.2civil damages against a nursing facility that charges the resident rates in violation of this
2.3clause. The damages awarded shall include three times the payments that result from the
2.4violation, together with costs and disbursements, including reasonable attorneys' fees or
2.5their equivalent. A private paying resident or the resident's legal representative, the state,
2.6subdivision or agency, or a nursing facility may request a hearing to determine the allowed
2.7rate or rates at issue in the cause of action. Within 15 calendar days after receiving a
2.8request for such a hearing, the commissioner shall request assignment of an administrative
2.9law judge under sections14.48 to
14.56 to conduct the hearing as soon as possible or
2.10according to agreement by the parties. The administrative law judge shall issue a report
2.11within 15 calendar days following the close of the hearing. The prohibition set forth in
2.12this clause shallnot apply to facilities licensed as boarding care facilities which are not
2.13certified as skilled or intermediate care facilities level I or II for reimbursement through
2.14medical assistance expire effective July 1, 2011.
2.15(b)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
2.16to the facility, or from anyone acting in behalf of the applicant, as a condition of
2.17admission, expediting the admission, or as a requirement for the individual's continued
2.18stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
2.19as payment under the state plan;
2.20(2) requiring an individual, or anyone acting in behalf of the individual, to loan
2.21any money to the nursing facility;
2.22(3) requiring an individual, or anyone acting in behalf of the individual, to promise
2.23to leave all or part of the individual's estate to the facility; or
2.24(4) requiring a third-party guarantee of payment to the facility as a condition of
2.25admission, expedited admission, or continued stay in the facility.
2.26Nothing in this paragraph would prohibit discharge for nonpayment of services in
2.27accordance with state and federal regulations.
2.28(c) Requiring any resident of the nursing facility to utilize a vendor of health care
2.29services chosen by the nursing facility. A nursing facility may require a resident to use
2.30pharmacies that utilize unit dose packing systems approved by the Minnesota Board of
2.31Pharmacy, and may require a resident to use pharmacies that are able to meet the federal
2.32regulations for safe and timely administration of medications such as systems with specific
2.33number of doses, prompt delivery of medications, or access to medications on a 24-hour
2.34basis. Notwithstanding the provisions of this paragraph, nursing facilities shall not restrict
2.35a resident's choice of pharmacy because the pharmacy utilizes a specific system of unit
2.36dose drug packing.
3.1(d) Providing differential treatment on the basis of status with regard to public
3.2assistance.
3.3(e) Discriminating in admissions, services offered, or room assignment on the
3.4basis of status with regard to public assistance or refusal to purchase special services.
3.5Admissions discrimination shall include, but is not limited to:
3.6(1) basing admissions decisions upon assurance by the applicant to the nursing
3.7facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
3.8nor will seek public assistance for payment of nursing facility care costs; and
3.9(2) engaging in preferential selection from waiting lists based on an applicant's
3.10ability to pay privately or an applicant's refusal to pay for a special service.
3.11The collection and use by a nursing facility of financial information of any applicant
3.12pursuant to a preadmission screening program established by law shall not raise an
3.13inference that the nursing facility is utilizing that information for any purpose prohibited
3.14by this paragraph.
3.15(f) Requiring any vendor of medical care as defined by section256B.02, subdivision
3.167 , who is reimbursed by medical assistance under a separate fee schedule, to pay any
3.17amount based on utilization or service levels or any portion of the vendor's fee to the
3.18nursing facility except as payment for renting or leasing space or equipment or purchasing
3.19support services from the nursing facility as limited by section256B.433 . All agreements
3.20must be disclosed to the commissioner upon request of the commissioner. Nursing
3.21facilities and vendors of ancillary services that are found to be in violation of this provision
3.22shall each be subject to an action by the state of Minnesota or any of its subdivisions or
3.23agencies for treble civil damages on the portion of the fee in excess of that allowed by
3.24this provision and section256B.433 . Damages awarded must include three times the
3.25excess payments together with costs and disbursements including reasonable attorney's
3.26fees or their equivalent.
3.27(g) Refusing, for more than 24 hours, to accept a resident returning to the same
3.28bed or a bed certified for the same level of care, in accordance with a physician's order
3.29authorizing transfer, after receiving inpatient hospital services.
3.30For a period not to exceed 180 days, the commissioner may continue to make
3.31medical assistance payments to a nursing facility or boarding care home which is in
3.32violation of this section if extreme hardship to the residents would result. In these cases
3.33the commissioner shall issue an order requiring the nursing facility to correct the violation.
3.34The nursing facility shall have 20 days from its receipt of the order to correct the violation.
3.35If the violation is not corrected within the 20-day period the commissioner may reduce
3.36the payment rate to the nursing facility by up to 20 percent. The amount of the payment
4.1rate reduction shall be related to the severity of the violation and shall remain in effect
4.2until the violation is corrected. The nursing facility or boarding care home may appeal the
4.3commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
4.4cases. An appeal shall be considered timely if written notice of appeal is received by the
4.5commissioner within 20 days of notice of the commissioner's proposed action.
4.6In the event that the commissioner determines that a nursing facility is not eligible
4.7for reimbursement for a resident who is eligible for medical assistance, the commissioner
4.8may authorize the nursing facility to receive reimbursement on a temporary basis until the
4.9resident can be relocated to a participating nursing facility.
4.10Certified beds in facilities which do not allow medical assistance intake on July 1,
4.111984, or after shall be deemed to be decertified for purposes of section144A.071 only.
4.12EFFECTIVE DATE.This section is effective July 1, 2011.
1.3provision; amending Minnesota Statutes 2010, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
1.7medical assistance payments unless it refrains from all of the following:
1.8(a) Charging private paying residents rates for similar services which exceed those
1.9which are approved by the state agency for medical assistance recipients as determined by
1.10the prospective desk audit rate, except under the following circumstances: the nursing
1.11facility may (1) charge private paying residents a higher rate for a private room, and (2)
1.12charge for special services which are not included in the daily rate if medical assistance
1.13residents are charged separately at the same rate for the same services in addition to
1.14the daily rate paid by the commissioner. Services covered by the payment rate must be
1.15the same regardless of payment source. Special services, if offered, must be available
1.16to all residents in all areas of the nursing facility and charged separately at the same
1.17rate. Residents are free to select or decline special services. Special services must not
1.18include services which must be provided by the nursing facility in order to comply with
1.19licensure or certification standards and that if not provided would result in a deficiency
1.20or violation by the nursing facility. Services beyond those required to comply with
1.21licensure or certification standards must not be charged separately as a special service if
1.22they were included in the payment rate for the previous reporting year. A nursing facility
1.23that charges a private paying resident a rate in violation of this clause is subject to an
1.24action by the state of Minnesota or any of its subdivisions or agencies for civil damages.
2.1A private paying resident or the resident's legal representative has a cause of action for
2.2civil damages against a nursing facility that charges the resident rates in violation of this
2.3clause. The damages awarded shall include three times the payments that result from the
2.4violation, together with costs and disbursements, including reasonable attorneys' fees or
2.5their equivalent. A private paying resident or the resident's legal representative, the state,
2.6subdivision or agency, or a nursing facility may request a hearing to determine the allowed
2.7rate or rates at issue in the cause of action. Within 15 calendar days after receiving a
2.8request for such a hearing, the commissioner shall request assignment of an administrative
2.9law judge under sections
2.10according to agreement by the parties. The administrative law judge shall issue a report
2.11within 15 calendar days following the close of the hearing. The prohibition set forth in
2.12this clause shall
2.13
2.14
2.15(b)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
2.16to the facility, or from anyone acting in behalf of the applicant, as a condition of
2.17admission, expediting the admission, or as a requirement for the individual's continued
2.18stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
2.19as payment under the state plan;
2.20(2) requiring an individual, or anyone acting in behalf of the individual, to loan
2.21any money to the nursing facility;
2.22(3) requiring an individual, or anyone acting in behalf of the individual, to promise
2.23to leave all or part of the individual's estate to the facility; or
2.24(4) requiring a third-party guarantee of payment to the facility as a condition of
2.25admission, expedited admission, or continued stay in the facility.
2.26Nothing in this paragraph would prohibit discharge for nonpayment of services in
2.27accordance with state and federal regulations.
2.28(c) Requiring any resident of the nursing facility to utilize a vendor of health care
2.29services chosen by the nursing facility. A nursing facility may require a resident to use
2.30pharmacies that utilize unit dose packing systems approved by the Minnesota Board of
2.31Pharmacy, and may require a resident to use pharmacies that are able to meet the federal
2.32regulations for safe and timely administration of medications such as systems with specific
2.33number of doses, prompt delivery of medications, or access to medications on a 24-hour
2.34basis. Notwithstanding the provisions of this paragraph, nursing facilities shall not restrict
2.35a resident's choice of pharmacy because the pharmacy utilizes a specific system of unit
2.36dose drug packing.
3.1(d) Providing differential treatment on the basis of status with regard to public
3.2assistance.
3.3(e) Discriminating in admissions, services offered, or room assignment on the
3.4basis of status with regard to public assistance or refusal to purchase special services.
3.5Admissions discrimination shall include, but is not limited to:
3.6(1) basing admissions decisions upon assurance by the applicant to the nursing
3.7facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
3.8nor will seek public assistance for payment of nursing facility care costs; and
3.9(2) engaging in preferential selection from waiting lists based on an applicant's
3.10ability to pay privately or an applicant's refusal to pay for a special service.
3.11The collection and use by a nursing facility of financial information of any applicant
3.12pursuant to a preadmission screening program established by law shall not raise an
3.13inference that the nursing facility is utilizing that information for any purpose prohibited
3.14by this paragraph.
3.15(f) Requiring any vendor of medical care as defined by section
3.167
3.17amount based on utilization or service levels or any portion of the vendor's fee to the
3.18nursing facility except as payment for renting or leasing space or equipment or purchasing
3.19support services from the nursing facility as limited by section
3.20must be disclosed to the commissioner upon request of the commissioner. Nursing
3.21facilities and vendors of ancillary services that are found to be in violation of this provision
3.22shall each be subject to an action by the state of Minnesota or any of its subdivisions or
3.23agencies for treble civil damages on the portion of the fee in excess of that allowed by
3.24this provision and section
3.25excess payments together with costs and disbursements including reasonable attorney's
3.26fees or their equivalent.
3.27(g) Refusing, for more than 24 hours, to accept a resident returning to the same
3.28bed or a bed certified for the same level of care, in accordance with a physician's order
3.29authorizing transfer, after receiving inpatient hospital services.
3.30For a period not to exceed 180 days, the commissioner may continue to make
3.31medical assistance payments to a nursing facility or boarding care home which is in
3.32violation of this section if extreme hardship to the residents would result. In these cases
3.33the commissioner shall issue an order requiring the nursing facility to correct the violation.
3.34The nursing facility shall have 20 days from its receipt of the order to correct the violation.
3.35If the violation is not corrected within the 20-day period the commissioner may reduce
3.36the payment rate to the nursing facility by up to 20 percent. The amount of the payment
4.1rate reduction shall be related to the severity of the violation and shall remain in effect
4.2until the violation is corrected. The nursing facility or boarding care home may appeal the
4.3commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
4.4cases. An appeal shall be considered timely if written notice of appeal is received by the
4.5commissioner within 20 days of notice of the commissioner's proposed action.
4.6In the event that the commissioner determines that a nursing facility is not eligible
4.7for reimbursement for a resident who is eligible for medical assistance, the commissioner
4.8may authorize the nursing facility to receive reimbursement on a temporary basis until the
4.9resident can be relocated to a participating nursing facility.
4.10Certified beds in facilities which do not allow medical assistance intake on July 1,
4.111984, or after shall be deemed to be decertified for purposes of section
4.12EFFECTIVE DATE.This section is effective July 1, 2011.
