Bill Text: MN SF626 | 2011-2012 | 87th Legislature | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Nursing home bed moratorium exception for hardship areas; Bloomington nursing facility project moratorium exception funding
Spectrum: Bipartisan Bill
Status: (Passed) 2011-05-16 - Secretary of State Chapter 22 05/13/11 [SF626 Detail]
Download: Minnesota-2011-SF626-Engrossed.html
Bill Title: Nursing home bed moratorium exception for hardship areas; Bloomington nursing facility project moratorium exception funding
Spectrum: Bipartisan Bill
Status: (Passed) 2011-05-16 - Secretary of State Chapter 22 05/13/11 [SF626 Detail]
Download: Minnesota-2011-SF626-Engrossed.html
1.2relating to human services; modifying certain nursing facility provisions;
1.3amending Minnesota Statutes 2010, sections 12A.10, by adding a subdivision;
1.4144A.071, subdivisions 3, 4a; 144A.073, subdivision 3c, by adding a subdivision;
1.5256B.431, subdivision 26; 256B.437, subdivision 4; 256B.441, by adding a
1.6subdivision; repealing Minnesota Statutes 2010, section 144A.073, subdivisions
1.74, 5.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.11 Section 1. Minnesota Statutes 2010, section 12A.10, is amended by adding a
1.12subdivision to read:
1.13 Subd. 4. Nursing home bed layaway. Notwithstanding section 144A.071,
1.14subdivision 4b, the commissioner of health may approve the placement on and removal
1.15from layaway status of nursing home beds at any time when a partial or complete
1.16evacuation of a nursing home occurs in response to a natural disaster, a possible natural
1.17disaster, or another event that threatens the health and safety of residents of a nursing home.
1.18 Sec. 2. Minnesota Statutes 2010, section 144A.071, subdivision 3, is amended to read:
1.19 Subd. 3. Exceptions authorizing increase in beds; hardship areas. (a) The
1.20commissioner of health, in coordination with the commissioner of human services, may
1.21approve the addition ofa new certified bed or the addition of a new licensed and Medicare
1.22and Medicaid certified nursing homebed beds, under using the following conditions:
1.23criterion and process set forth in this subdivision.
2.1(a) to license or certify a new bed in place of one decertified after July 1, 1993, as
2.2long as the number of certified plus newly certified or recertified beds does not exceed the
2.3number of beds licensed or certified on July 1, 1993, or to address an extreme hardship
2.4situation, in a particular county that, together with all contiguous Minnesota counties, has
2.5fewer nursing home beds per 1,000 elderly than the number that is ten percent higher than
2.6the national average of nursing home beds per 1,000 elderly individuals. For the purposes
2.7of this section, the national average of nursing home beds shall be the most recent figure
2.8that can be supplied by the federal Centers for Medicare and Medicaid Services and the
2.9number of elderly in the county or the nation shall be determined by the most recent
2.10federal census or the most recent estimate of the state demographer as of July 1, of each
2.11year of persons age 65 and older, whichever is the most recent at the time of the request for
2.12replacement. An extreme hardship situation can only be found after the county documents
2.13the existence of unmet medical needs that cannot be addressed by any other alternatives;
2.14(b) The commissioner, in cooperation with the commissioner of human services,
2.15shall consider the following criteria when determining that an area of the state is a
2.16hardship area with regard to access to nursing facility services:
2.17(1) a low number of beds per thousand in a specified area using as a standard the
2.18beds per thousand people age 65 and older, in five year age groups, using data from the
2.19most recent census and population projections, weighted by each groups' most recent
2.20nursing home utilization, of the county at the 20th percentile, as determined by the
2.21commissioner of human services;
2.22(2) a high level of out-migration for nursing facility services associated with a
2.23described area from the county or counties of residence to other Minnesota counties, as
2.24determined by the commissioner of human services, using as a standard an amount greater
2.25than the out-migration of the county ranked at the 50th percentile;
2.26(3) an adequate level of availability of noninstitutional long-term care services
2.27measured as public spending for home and community-based long-term care services per
2.28individual age 65 and older, in five year age groups, using data from the most recent
2.29census and population projections, weighted by each groups' most recent nursing home
2.30utilization, as determined by the commissioner of human services using as a standard an
2.31amount greater than the 50th percentile of counties;
2.32(4) there must be a declaration of hardship resulting from insufficient access to
2.33nursing home beds by local county agencies; and
2.34(5) other factors that may demonstrate the need to add new nursing facility beds.
2.35(c) On August 15 of odd-numbered years, the commissioner, in cooperation with
2.36the commissioner of human services, may publish in the State Register a request for
3.1information in which interested parties, using the data provided under section 144A.351,
3.2along with any other relevant data, demonstrate that a specified area is a hardship area
3.3with regard to access to nursing facility services. For a response to be considered, the
3.4commissioner must receive it by November 15. The commissioner shall make responses
3.5to the request for information available to the public and shall allow 30 days for comment.
3.6The commissioner shall review responses and comments and determine if any areas of
3.7the state are to be declared hardship areas.
3.8(d) For each designated hardship area determined in paragraph (c), the commissioner
3.9shall publish a request for proposals in accordance with section 144A.073. The request
3.10for proposals must be published in the State Register by March 15 following receipt of
3.11responses to the request for information. The request for proposals must specify the
3.12number of new beds which may be added in the designated hardship area, which must not
3.13exceed the number which, if added to the existing number of beds in the area, including
3.14beds in layaway status, would have prevented it from being determined to be a hardship
3.15area under paragraph (b), clause (1). Beginning July 1, 2011, the number of new beds
3.16approved must not exceed 200 beds statewide per biennium. After June 30, 2019, the
3.17number of new beds that may be approved in a biennium must not exceed 300 statewide.
3.18For a proposal to be considered, the commissioner must receive it within six months of
3.19the publication of the request for proposals. The commissioner shall review responses to
3.20the request for proposals and shall approve or disapprove each proposal by the following
3.21July 15, in accordance with section 144A.073. The commissioner shall base approvals
3.22or disapprovals on a comparison and ranking of proposals using only the criteria in
3.23subdivision 4a. Approval of a proposal expires after 18 months unless the facility has
3.24added the new beds using existing space, subject to approval by the commissioner, or
3.25has commenced construction as defined in section 144A.071, subdivision 1a, paragraph
3.26(d). Operating payment rates shall be determined according to Minnesota Rules, part
3.279549.0057, using the limits under section 256B.441. External fixed payment rates must
3.28be determined according to section 256B.441, subdivision 53. Property payment rates
3.29for facilities with beds added under this subdivision must be determined in the same
3.30manner as rate determinations resulting from projects approved and completed under
3.31section 144A.073.
3.32(b) to (e) The commissioner may:
3.33(1) certify or license new beds in a new facility that is to be operated by the
3.34commissioner of veterans affairs or when the costs of constructing and operating the new
3.35beds are to be reimbursed by the commissioner of veterans affairs or the United States
3.36Veterans Administration; and
4.1(c) to (2) license or certify beds in a facility that has been involuntarily delicensed or
4.2decertified for participation in the medical assistance program, provided that an application
4.3for relicensure or recertification is submitted to the commissioner by an organization that
4.4is not a related organization as defined in section 256B.441, subdivision 34, to the prior
4.5licensee within 120 days after delicensure or decertification;.
4.6(d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994,
4.7that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and
4.81993, and which began construction of four attached assisted living units in April 1993; or
4.9(e) to certify four existing beds in a facility in Winona with 139 beds, of which 129
4.10beds are certified.
4.11 Sec. 3. Minnesota Statutes 2010, section 144A.073, subdivision 3c, is amended to read:
4.12 Subd. 3c. Cost neutral relocation projects. (a) Notwithstanding subdivision 3, the
4.13commissioner may at any time accept proposals, or amendments to proposals previously
4.14approved under this section, for relocations that are cost neutral with respect to state costs
4.15as defined in section144A.071, subdivision 5a . The commissioner, in consultation with
4.16the commissioner of human services, shall evaluate proposals according to subdivision
4.174 4a, clauses (1), (2), (3), and (9) (4), (5), (6), and (8), and other criteria established in
4.18rule. or law. The commissioner of human services shall determine the allowable payment
4.19rates of the facility receiving the beds in accordance with section 256B.441, subdivision
4.2060. The commissioner shall approve or disapprove a project within 90 days.Proposals
4.21and amendments approved under this subdivision are not subject to the six-mile limit
4.22in subdivision 5, paragraph (e).
4.23 (b) For the purposes of paragraph (a), cost neutrality shall be measured over the first
4.24three 12-month periods of operation after completion of the project.
4.25 Sec. 4. Minnesota Statutes 2010, section 144A.073, is amended by adding a
4.26subdivision to read:
4.27 Subd. 4a. Criteria for review. In reviewing the application materials and submitted
4.28costs by an applicant to the moratorium process, the review panel shall consider the
4.29following criteria in recommending proposals:
4.30(1) the extent to which the proposed nursing home project is integrated with other
4.31health and long-term care services for older adults;
4.32(2) the extent to which the project provides for the complete replacement of an
4.33outdated physical plant;
5.1(3) the extent to which the project results in a reduction of nursing facility beds in an
5.2area that has a relatively high number of beds per thousand occupied by persons age 85
5.3and over;
5.4(4) the extent to which the project produces improvements in health; safety,
5.5including life safety code corrections; quality of life; and privacy of residents;
5.6(5) the extent to which, under the current facility ownership and management, the
5.7provider has shown the ability to provide good quality of care based on health-related
5.8findings on certification surveys, quality indicator scores, and quality-of-life scores,
5.9including those from the Minnesota nursing home report card;
5.10(6) the extent to which the project integrates the latest technology and design
5.11features in a way that improves the resident experience and improves the working
5.12environment for employees;
5.13(7) the extent to which the sustainability of the nursing facility can be demonstrated
5.14based on the need for services in the area and the proposed financing of the project; and
5.15(8) the extent to which the project provides or maintains access to nursing facility
5.16services needed in the community.
5.17 Sec. 5. Minnesota Statutes 2010, section 256B.441, is amended by adding a
5.18subdivision to read:
5.19 Subd. 60. Method for determining budget-neutral nursing facility rates for
5.20relocated beds. (a) Nursing facility rates for bed relocations must be calculated by
5.21comparing the estimated medical assistance costs prior to and after the proposed bed
5.22relocation using the calculations in this subdivision. All payment rates are based on a 1.0
5.23case mix level, with other case mix rates determined accordingly. Nursing facility beds
5.24on layaway status that are being moved must be included in the calculation for both the
5.25originating and receiving facility and treated as though they were in active status with the
5.26occupancy characteristics of the active beds of the originating facility.
5.27(b) Medical assistance costs of the beds in the originating nursing facilities must
5.28be calculated as follows:
5.29(1) multiply each originating facility's total payment rate for a RUGS weight of 1.0
5.30by the facility's percentage of medical assistance days on its most recent available cost
5.31report;
5.32(2) take the products in clause (1) and multiply by each facility's average case mix
5.33score for medical assistance residents on its most recent available cost report;
5.34(3) take the products in clause (2) and multiply by the number of beds being
5.35relocated, times 365; and
6.1(4) calculate the sum of the amounts determined in clause (3).
6.2(c) Medical assistance costs in the receiving facility, prior to the bed relocation, must
6.3be calculated as follows:
6.4(1) multiply the facility's total payment rate for a RUGS weight of 1.0 by the medical
6.5assistance days on the most recent cost report; and
6.6(2) multiply the product in clause (1) by the average case mix weight of medical
6.7assistance residents on the most recent cost report.
6.8(d) The commissioner shall determine the medical assistance costs prior to the bed
6.9relocation which must be the sum of the amounts determined in paragraphs (b) and (c).
6.10(e) The commissioner shall estimate the medical assistance costs after the bed
6.11relocation as follows:
6.12(1) estimate the medical assistance days in the receiving facility after the bed
6.13relocation. The commissioner may use the current medical assistance portion, or if data
6.14does not exist, may use the statewide average, or may use the provider's estimate of the
6.15medical assistance utilization of the relocated beds;
6.16(2) estimate the average case mix weight of medical assistance residents in the
6.17receiving facility after the bed relocation. The commissioner may use current average
6.18case mix weight or, if data does not exist, may use the statewide average, or may use the
6.19provider's estimate of the average case mix weight; and
6.20(3) multiply the amount determined in clause (1) by the amount determined in
6.21clause (2) by the total payment rate for a RUGS weight of 1.0 that is the highest rate of
6.22the facilities from which the relocated beds either originate or to which they are being
6.23relocated so long as that rate is associated with ten percent or more of the total number of
6.24beds to be in the receiving facility after the bed relocation.
6.25(f) If the amount determined in paragraph (e) is less than or equal to the amount
6.26determined in paragraph (d), the commissioner shall allow a total payment rate equal to
6.27the amount used in paragraph (e), clause (3).
6.28(g) If the amount determined in paragraph (e) is greater than the amount determined
6.29in paragraph (d), the commissioner shall allow a rate with a RUGS weight of 1.0 that
6.30when used in paragraph (e), clause (3), results in the amount determined in paragraph (e)
6.31being equal to the amount determined in paragraph (d).
6.32(h) If the commissioner relies upon provider estimates in paragraph (e), clause (1)
6.33or (2), then annually, for three years after the rates determined in this subdivision take
6.34effect, the commissioner shall determine the accuracy of the alternative factors of medical
6.35assistance case load and RUGS weight used in this subdivision and shall reduce the total
6.36payment rate for a RUGS weight of 1.0 if the factors used result in medical assistance
7.1costs exceeding the amount in paragraph (d). If the actual medical assistance costs exceed
7.2the estimates by more than five percent, the commissioner shall also recover the difference
7.3between the estimated costs in paragraph (e) and the actual costs according to section
7.4256B.0641. The commissioner may require submission of data from the receiving facility
7.5needed to implement this paragraph.
7.6(i) When beds approved for relocation are put into active service at the destination
7.7facility, rates determined in this subdivision must be adjusted by any adjustment amounts
7.8that were implemented after the date of the letter of approval.
7.9 Sec. 6. REPEALER.
7.10Minnesota Statutes 2010, section 144A.073, subdivisions 4 and 5, are repealed.
7.11 Sec. 7. EFFECTIVE DATE.
7.12This article is effective the day following final enactment.
7.15 Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 4a, is amended to
7.16read:
7.17 Subd. 4a. Exceptions for replacement beds. It is in the best interest of the state
7.18to ensure that nursing homes and boarding care homes continue to meet the physical
7.19plant licensing and certification requirements by permitting certain construction projects.
7.20Facilities should be maintained in condition to satisfy the physical and emotional needs
7.21of residents while allowing the state to maintain control over nursing home expenditure
7.22growth.
7.23 The commissioner of health in coordination with the commissioner of human
7.24services, may approve the renovation, replacement, upgrading, or relocation of a nursing
7.25home or boarding care home, under the following conditions:
7.26 (a) to license or certify beds in a new facility constructed to replace a facility or to
7.27make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by
7.28fire, lightning, or other hazard provided:
7.29 (i) destruction was not caused by the intentional act of or at the direction of a
7.30controlling person of the facility;
7.31 (ii) at the time the facility was destroyed or damaged the controlling persons of the
7.32facility maintained insurance coverage for the type of hazard that occurred in an amount
7.33that a reasonable person would conclude was adequate;
8.1 (iii) the net proceeds from an insurance settlement for the damages caused by the
8.2hazard are applied to the cost of the new facility or repairs;
8.3 (iv) the new facility is constructed on the same site as the destroyed facilityor on
8.4another site subject to the restrictions in section
144A.073, subdivision 5;
8.5 (v) the number of licensed and certified beds in the new facility does not exceed the
8.6number of licensed and certified beds in the destroyed facility; and
8.7 (vi) the commissioner determines that the replacement beds are needed to prevent an
8.8inadequate supply of beds.
8.9Project construction costs incurred for repairs authorized under this clause shall not be
8.10considered in the dollar threshold amount defined in subdivision 2;
8.11 (b) to license or certify beds that are moved from one location to another within a
8.12nursing home facility, provided the total costs of remodeling performed in conjunction
8.13with the relocation of beds does not exceed $1,000,000;
8.14 (c) to license or certify beds in a project recommended for approval under section
8.15144A.073
;
8.16 (d) to license or certify beds that are moved from an existing state nursing home to
8.17a different state facility, provided there is no net increase in the number of state nursing
8.18home beds;
8.19 (e) to certify and license as nursing home beds boarding care beds in a certified
8.20boarding care facility if the beds meet the standards for nursing home licensure, or in a
8.21facility that was granted an exception to the moratorium under section144A.073 , and if
8.22the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care
8.23beds are licensed as nursing home beds, the number of boarding care beds in the facility
8.24must not increase beyond the number remaining at the time of the upgrade in licensure.
8.25The provisions contained in section144A.073 regarding the upgrading of the facilities
8.26do not apply to facilities that satisfy these requirements;
8.27 (f) to license and certify up to 40 beds transferred from an existing facility owned and
8.28operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
8.29same location as the existing facility that will serve persons with Alzheimer's disease and
8.30other related disorders. The transfer of beds may occur gradually or in stages, provided
8.31the total number of beds transferred does not exceed 40. At the time of licensure and
8.32certification of a bed or beds in the new unit, the commissioner of health shall delicense
8.33and decertify the same number of beds in the existing facility. As a condition of receiving
8.34a license or certification under this clause, the facility must make a written commitment
8.35to the commissioner of human services that it will not seek to receive an increase in its
8.36property-related payment rate as a result of the transfers allowed under this paragraph;
9.1 (g) to license and certify nursing home beds to replace currently licensed and certified
9.2boarding care beds which may be located either in a remodeled or renovated boarding care
9.3or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
9.4nursing home facility within the identifiable complex of health care facilities in which the
9.5currently licensed boarding care beds are presently located, provided that the number of
9.6boarding care beds in the facility or complex are decreased by the number to be licensed
9.7as nursing home beds and further provided that, if the total costs of new construction,
9.8replacement, remodeling, or renovation exceed ten percent of the appraised value of
9.9the facility or $200,000, whichever is less, the facility makes a written commitment to
9.10the commissioner of human services that it will not seek to receive an increase in its
9.11property-related payment rate by reason of the new construction, replacement, remodeling,
9.12or renovation. The provisions contained in section144A.073 regarding the upgrading of
9.13facilities do not apply to facilities that satisfy these requirements;
9.14 (h) to license as a nursing home and certify as a nursing facility a facility that is
9.15licensed as a boarding care facility but not certified under the medical assistance program,
9.16but only if the commissioner of human services certifies to the commissioner of health that
9.17licensing the facility as a nursing home and certifying the facility as a nursing facility will
9.18result in a net annual savings to the state general fund of $200,000 or more;
9.19 (i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing
9.20home beds in a facility that was licensed and in operation prior to January 1, 1992;
9.21 (j) to license and certify new nursing home beds to replace beds in a facility acquired
9.22by the Minneapolis Community Development Agency as part of redevelopment activities
9.23in a city of the first class, provided the new facility is located within three miles of the site
9.24of the old facility. Operating and property costs for the new facility must be determined
9.25and allowed under section256B.431 or
256B.434 ;
9.26 (k) to license and certify up to 20 new nursing home beds in a community-operated
9.27hospital and attached convalescent and nursing care facility with 40 beds on April 21,
9.281991, that suspended operation of the hospital in April 1986. The commissioner of human
9.29services shall provide the facility with the same per diem property-related payment rate
9.30for each additional licensed and certified bed as it will receive for its existing 40 beds;
9.31 (l) to license or certify beds in renovation, replacement, or upgrading projects as
9.32defined in section144A.073 , subdivision 1, so long as the cumulative total costs of the
9.33facility's remodeling projects do not exceed $1,000,000;
9.34 (m) to license and certify beds that are moved from one location to another for the
9.35purposes of converting up to five four-bed wards to single or double occupancy rooms
10.1in a nursing home that, as of January 1, 1993, was county-owned and had a licensed
10.2capacity of 115 beds;
10.3 (n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified
10.4nursing facility located in Minneapolis to layaway all of its licensed and certified nursing
10.5home beds. These beds may be relicensed and recertified in a newly constructed teaching
10.6nursing home facility affiliated with a teaching hospital upon approval by the legislature.
10.7The proposal must be developed in consultation with the interagency committee on
10.8long-term care planning. The beds on layaway status shall have the same status as
10.9voluntarily delicensed and decertified beds, except that beds on layaway status remain
10.10subject to the surcharge in section256.9657 . This layaway provision expires July 1, 1998;
10.11 (o) to allow a project which will be completed in conjunction with an approved
10.12moratorium exception project for a nursing home in southern Cass County and which is
10.13directly related to that portion of the facility that must be repaired, renovated, or replaced,
10.14to correct an emergency plumbing problem for which a state correction order has been
10.15issued and which must be corrected by August 31, 1993;
10.16 (p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified
10.17nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to
10.18the commissioner, up to 30 of the facility's licensed and certified beds by converting
10.19three-bed wards to single or double occupancy. Beds on layaway status shall have the
10.20same status as voluntarily delicensed and decertified beds except that beds on layaway
10.21status remain subject to the surcharge in section256.9657 , remain subject to the license
10.22application and renewal fees under section144A.07 and shall be subject to a $100 per bed
10.23reactivation fee. In addition, at any time within three years of the effective date of the
10.24layaway, the beds on layaway status may be:
10.25 (1) relicensed and recertified upon relocation and reactivation of some or all of
10.26the beds to an existing licensed and certified facility or facilities located in Pine River,
10.27Brainerd, or International Falls; provided that the total project construction costs related to
10.28the relocation of beds from layaway status for any facility receiving relocated beds may
10.29not exceed the dollar threshold provided in subdivision 2 unless the construction project
10.30has been approved through the moratorium exception process under section144A.073 ;
10.31 (2) relicensed and recertified, upon reactivation of some or all of the beds within the
10.32facility which placed the beds in layaway status, if the commissioner has determined a
10.33need for the reactivation of the beds on layaway status.
10.34 The property-related payment rate of a facility placing beds on layaway status
10.35must be adjusted by the incremental change in its rental per diem after recalculating the
10.36rental per diem as provided in section256B.431 , subdivision 3a, paragraph (c). The
11.1property-related payment rate for a facility relicensing and recertifying beds from layaway
11.2status must be adjusted by the incremental change in its rental per diem after recalculating
11.3its rental per diem using the number of beds after the relicensing to establish the facility's
11.4capacity day divisor, which shall be effective the first day of the month following the
11.5month in which the relicensing and recertification became effective. Any beds remaining
11.6on layaway status more than three years after the date the layaway status became effective
11.7must be removed from layaway status and immediately delicensed and decertified;
11.8 (q) to license and certify beds in a renovation and remodeling project to convert 12
11.9four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
11.10home that, as of January 1, 1994, met the following conditions: the nursing home was
11.11located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked
11.12among the top 15 applicants by the 1993 moratorium exceptions advisory review panel.
11.13The total project construction cost estimate for this project must not exceed the cost
11.14estimate submitted in connection with the 1993 moratorium exception process;
11.15 (r) to license and certify up to 117 beds that are relocated from a licensed and
11.16certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed
11.17hospital beds located in South St. Paul, provided that the nursing facility and hospital are
11.18owned by the same or a related organization and that prior to the date the relocation is
11.19completed the hospital ceases operation of its inpatient hospital services at that hospital.
11.20After relocation, the nursing facility's status under section256B.431 , subdivision 2j, shall
11.21be the same as it was prior to relocation. The nursing facility's property-related payment
11.22rate resulting from the project authorized in this paragraph shall become effective no
11.23earlier than April 1, 1996. For purposes of calculating the incremental change in the
11.24facility's rental per diem resulting from this project, the allowable appraised value of
11.25the nursing facility portion of the existing health care facility physical plant prior to the
11.26renovation and relocation may not exceed $2,490,000;
11.27 (s) to license and certify two beds in a facility to replace beds that were voluntarily
11.28delicensed and decertified on June 28, 1991;
11.29 (t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed
11.30nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding
11.31the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed
11.32nursing home facility after completion of a construction project approved in 1993 under
11.33section144A.073 , to be laid away upon 30 days' prior written notice to the commissioner.
11.34Beds on layaway status shall have the same status as voluntarily delicensed or decertified
11.35beds except that they shall remain subject to the surcharge in section256.9657 . The
11.3616 beds on layaway status may be relicensed as nursing home beds and recertified at
12.1any time within five years of the effective date of the layaway upon relocation of some
12.2or all of the beds to a licensed and certified facility located in Watertown, provided that
12.3the total project construction costs related to the relocation of beds from layaway status
12.4for the Watertown facility may not exceed the dollar threshold provided in subdivision
12.52 unless the construction project has been approved through the moratorium exception
12.6process under section144A.073 .
12.7 The property-related payment rate of the facility placing beds on layaway status
12.8must be adjusted by the incremental change in its rental per diem after recalculating the
12.9rental per diem as provided in section256B.431 , subdivision 3a, paragraph (c). The
12.10property-related payment rate for the facility relicensing and recertifying beds from
12.11layaway status must be adjusted by the incremental change in its rental per diem after
12.12recalculating its rental per diem using the number of beds after the relicensing to establish
12.13the facility's capacity day divisor, which shall be effective the first day of the month
12.14following the month in which the relicensing and recertification became effective. Any
12.15beds remaining on layaway status more than five years after the date the layaway status
12.16became effective must be removed from layaway status and immediately delicensed
12.17and decertified;
12.18 (u) to license and certify beds that are moved within an existing area of a facility or
12.19to a newly constructed addition which is built for the purpose of eliminating three- and
12.20four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary
12.21service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had
12.22a licensed capacity of 129 beds;
12.23 (v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County
12.24to a 160-bed facility in Crow Wing County, provided all the affected beds are under
12.25common ownership;
12.26 (w) to license and certify a total replacement project of up to 49 beds located in
12.27Norman County that are relocated from a nursing home destroyed by flood and whose
12.28residents were relocated to other nursing homes. The operating cost payment rates for
12.29the new nursing facility shall be determined based on the interim and settle-up payment
12.30provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
12.31section256B.431 , except that subdivision 26, paragraphs (a) and (b), shall not apply until
12.32the second rate year after the settle-up cost report is filed. Property-related reimbursement
12.33rates shall be determined under section256B.431 , taking into account any federal or state
12.34flood-related loans or grants provided to the facility;
12.35 (x) to license and certify a total replacement project of up to 129 beds located
12.36in Polk County that are relocated from a nursing home destroyed by flood and whose
13.1residents were relocated to other nursing homes. The operating cost payment rates for
13.2the new nursing facility shall be determined based on the interim and settle-up payment
13.3provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
13.4section256B.431 , except that subdivision 26, paragraphs (a) and (b), shall not apply until
13.5the second rate year after the settle-up cost report is filed. Property-related reimbursement
13.6rates shall be determined under section256B.431 , taking into account any federal or state
13.7flood-related loans or grants provided to the facility;
13.8 (y) to license and certify beds in a renovation and remodeling project to convert 13
13.9three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and
13.10add improvements in a nursing home that, as of January 1, 1994, met the following
13.11conditions: the nursing home was located in Ramsey County, was not owned by a hospital
13.12corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15
13.13applicants by the 1993 moratorium exceptions advisory review panel. The total project
13.14construction cost estimate for this project must not exceed the cost estimate submitted in
13.15connection with the 1993 moratorium exception process;
13.16 (z) to license and certify up to 150 nursing home beds to replace an existing 285
13.17bed nursing facility located in St. Paul. The replacement project shall include both the
13.18renovation of existing buildings and the construction of new facilities at the existing
13.19site. The reduction in the licensed capacity of the existing facility shall occur during the
13.20construction project as beds are taken out of service due to the construction process. Prior
13.21to the start of the construction process, the facility shall provide written information to the
13.22commissioner of health describing the process for bed reduction, plans for the relocation
13.23of residents, and the estimated construction schedule. The relocation of residents shall be
13.24in accordance with the provisions of law and rule;
13.25 (aa) to allow the commissioner of human services to license an additional 36 beds
13.26to provide residential services for the physically disabled under Minnesota Rules, parts
13.279570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
13.28the total number of licensed and certified beds at the facility does not increase;
13.29 (bb) to license and certify a new facility in St. Louis County with 44 beds
13.30constructed to replace an existing facility in St. Louis County with 31 beds, which has
13.31resident rooms on two separate floors and an antiquated elevator that creates safety
13.32concerns for residents and prevents nonambulatory residents from residing on the second
13.33floor. The project shall include the elimination of three- and four-bed rooms;
13.34 (cc) to license and certify four beds in a 16-bed certified boarding care home in
13.35Minneapolis to replace beds that were voluntarily delicensed and decertified on or
13.36before March 31, 1992. The licensure and certification is conditional upon the facility
14.1periodically assessing and adjusting its resident mix and other factors which may
14.2contribute to a potential institution for mental disease declaration. The commissioner of
14.3human services shall retain the authority to audit the facility at any time and shall require
14.4the facility to comply with any requirements necessary to prevent an institution for mental
14.5disease declaration, including delicensure and decertification of beds, if necessary;
14.6 (dd) to license and certify 72 beds in an existing facility in Mille Lacs County with
14.780 beds as part of a renovation project. The renovation must include construction of
14.8an addition to accommodate ten residents with beginning and midstage dementia in a
14.9self-contained living unit; creation of three resident households where dining, activities,
14.10and support spaces are located near resident living quarters; designation of four beds
14.11for rehabilitation in a self-contained area; designation of 30 private rooms; and other
14.12improvements;
14.13 (ee) to license and certify beds in a facility that has undergone replacement or
14.14remodeling as part of a planned closure under section256B.437 ;
14.15 (ff) to license and certify a total replacement project of up to 124 beds located
14.16in Wilkin County that are in need of relocation from a nursing home significantly
14.17damaged by flood. The operating cost payment rates for the new nursing facility shall
14.18be determined based on the interim and settle-up payment provisions of Minnesota
14.19Rules, part 9549.0057, and the reimbursement provisions of section256B.431 , except
14.20that section256B.431 , subdivision 26, paragraphs (a) and (b), shall not apply until the
14.21second rate year after the settle-up cost report is filed. Property-related reimbursement
14.22rates shall be determined under section256B.431 , taking into account any federal or state
14.23flood-related loans or grants provided to the facility;
14.24 (gg) to allow the commissioner of human services to license an additional nine beds
14.25to provide residential services for the physically disabled under Minnesota Rules, parts
14.269570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
14.27total number of licensed and certified beds at the facility does not increase;
14.28 (hh) to license and certify up to 120 new nursing facility beds to replace beds in a
14.29facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the
14.30new facility is located within four miles of the existing facility and is in Anoka County.
14.31Operating and property rates shall be determined and allowed under section256B.431 and
14.32Minnesota Rules, parts 9549.0010 to 9549.0080, or section256B.434 or
256B.435 . The
14.33provisions of section256B.431 , subdivision 26, paragraphs (a) and (b), do not apply until
14.34the second rate year following settle-up; or
14.35 (ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County
14.36that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed
15.1nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The
15.2transfer is effective when the receiving facility notifies the commissioner in writing of the
15.3number of beds accepted. The commissioner shall place all transferred beds on layaway
15.4status held in the name of the receiving facility. The layaway adjustment provisions of
15.5section256B.431 , subdivision 30, do not apply to this layaway. The receiving facility
15.6may only remove the beds from layaway for recertification and relicensure at the receiving
15.7facility's current site, or at a newly constructed facility located in Anoka County. The
15.8receiving facility must receive statutory authorization before removing these beds from
15.9layaway status, or may remove these beds from layaway status if removal from layaway
15.10status is part of a moratorium exception project approved by the commissioner under
15.11section144A.073 .
15.12 Sec. 2. Minnesota Statutes 2010, section 256B.431, subdivision 26, is amended to read:
15.13 Subd. 26. Changes to nursing facility reimbursement beginning July 1, 1997.
15.14The nursing facility reimbursement changes in paragraphs (a) to (e) shall apply in the
15.15sequence specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section,
15.16beginning July 1, 1997.
15.17(a) For rate years beginning on or after July 1, 1997, the commissioner shall limit a
15.18nursing facility's allowable operating per diem for each case mix category for each rate
15.19year. The commissioner shall group nursing facilities into two groups, freestanding and
15.20nonfreestanding, within each geographic group, using their operating cost per diem for
15.21the case mix A classification. A nonfreestanding nursing facility is a nursing facility
15.22whose other operating cost per diem is subject to the hospital attached, short length of
15.23stay, or the rule 80 limits. All other nursing facilities shall be considered freestanding
15.24nursing facilities. The commissioner shall then array all nursing facilities in each grouping
15.25by their allowable case mix A operating cost per diem. In calculating a nursing facility's
15.26operating cost per diem for this purpose, the commissioner shall exclude the raw food
15.27cost per diem related to providing special diets that are based on religious beliefs, as
15.28determined in subdivision 2b, paragraph (h). For those nursing facilities in each grouping
15.29whose case mix A operating cost per diem:
15.30(1) is at or below the median of the array, the commissioner shall limit the nursing
15.31facility's allowable operating cost per diem for each case mix category to the lesser of
15.32the prior reporting year's allowable operating cost per diem as specified in Laws 1996,
15.33chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established
15.34in paragraph (d), clause (2), increased by two percentage points, or the current reporting
15.35year's corresponding allowable operating cost per diem; or
16.1(2) is above the median of the array, the commissioner shall limit the nursing
16.2facility's allowable operating cost per diem for each case mix category to the lesser of
16.3the prior reporting year's allowable operating cost per diem as specified in Laws 1996,
16.4chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established
16.5in paragraph (d), clause (2), increased by one percentage point, or the current reporting
16.6year's corresponding allowable operating cost per diem.
16.7For purposes of paragraph (a), if a nursing facility reports on its cost report a
16.8reduction in cost due to a refund or credit for a rate year beginning on or after July 1, 1998,
16.9the commissioner shall increase that facility's spend-up limit for the rate year following
16.10the current rate year by the amount of the cost reduction divided by its resident days for
16.11the reporting year preceding the rate year in which the adjustment is to be made.
16.12(b) For rate years beginning on or after July 1, 1997, the commissioner shall limit the
16.13allowable operating cost per diem for high cost nursing facilities. After application of the
16.14limits in paragraph (a) to each nursing facility's operating cost per diem, the commissioner
16.15shall group nursing facilities into two groups, freestanding or nonfreestanding, within each
16.16geographic group. A nonfreestanding nursing facility is a nursing facility whose other
16.17operating cost per diem are subject to hospital attached, short length of stay, or rule 80
16.18limits. All other nursing facilities shall be considered freestanding nursing facilities. The
16.19commissioner shall then array all nursing facilities within each grouping by their allowable
16.20case mix A operating cost per diem. In calculating a nursing facility's operating cost per
16.21diem for this purpose, the commissioner shall exclude the raw food cost per diem related to
16.22providing special diets that are based on religious beliefs, as determined in subdivision 2b,
16.23paragraph (h). For those nursing facilities in each grouping whose case mix A operating
16.24cost per diem exceeds 1.0 standard deviation above the median, the commissioner shall
16.25reduce their allowable operating cost per diem by three percent. For those nursing
16.26facilities in each grouping whose case mix A operating cost per diem exceeds 0.5 standard
16.27deviation above the median but is less than or equal to 1.0 standard deviation above the
16.28median, the commissioner shall reduce their allowable operating cost per diem by two
16.29percent. However, in no case shall a nursing facility's operating cost per diem be reduced
16.30below its grouping's limit established at 0.5 standard deviations above the median.
16.31(c) For rate years beginning on or after July 1, 1997, the commissioner shall
16.32determine a nursing facility's efficiency incentive by first computing the allowable
16.33difference, which is the lesser of $4.50 or the amount by which the facility's other
16.34operating cost limit exceeds its nonadjusted other operating cost per diem for that rate
16.35year. The commissioner shall compute the efficiency incentive by:
16.36(1) subtracting the allowable difference from $4.50 and dividing the result by $4.50;
17.1(2) multiplying 0.20 by the ratio resulting from clause (1), and then;
17.2(3) adding 0.50 to the result from clause (2); and
17.3(4) multiplying the result from clause (3) times the allowable difference.
17.4The nursing facility's efficiency incentive payment shall be the lesser of $2.25 or the
17.5product obtained in clause (4).
17.6(d) For rate years beginning on or after July 1, 1997, the forecasted price index for
17.7a nursing facility's allowable operating cost per diem shall be determined under clauses
17.8(1) and (2) using the change in the Consumer Price Index-All Items (United States city
17.9average) (CPI-U) as forecasted by Data Resources, Inc. The commissioner shall use the
17.10indices as forecasted in the fourth quarter of the calendar year preceding the rate year,
17.11subject to subdivision 2l, paragraph (c).
17.12(1) The CPI-U forecasted index for allowable operating cost per diem shall be based
17.13on the 21-month period from the midpoint of the nursing facility's reporting year to the
17.14midpoint of the rate year following the reporting year.
17.15(2) For rate years beginning on or after July 1, 1997, the forecasted index for
17.16operating cost limits referred to in subdivision 21, paragraph (b), shall be based on
17.17the CPI-U for the 12-month period between the midpoints of the two reporting years
17.18preceding the rate year.
17.19(e) After applying these provisions for the respective rate years, the commissioner
17.20shall index these allowable operating cost per diem by the inflation factor provided for in
17.21paragraph (d), clause (1), and add the nursing facility's efficiency incentive as computed in
17.22paragraph (c).
17.23(f) For the rate years beginning on July 1, 1997, July 1, 1998, and July 1, 1999, a
17.24nursing facility licensed for 40 beds effective May 1, 1992, with a subsequent increase of
17.2520 Medicare/Medicaid certified beds, effective January 26, 1993, in accordance with an
17.26increase in licensure is exempt from paragraphs (a) and (b).
17.27(g) For a nursing facility whose construction project was authorized according to
17.28section
144A.073, subdivision 5, paragraph (g), the operating cost payment rates for
17.29the new location shall be determined based on Minnesota Rules, part 9549.0057. The
17.30relocation allowed under section
144A.073, subdivision 5, paragraph (g), and the rate
17.31determination allowed under this paragraph must meet the cost neutrality requirements
17.32of section
144A.073, subdivision 3c. Paragraphs (a) and (b) shall not apply until the
17.33second rate year after the settle-up cost report is filed. Notwithstanding subdivision 2b,
17.34paragraph (g), real estate taxes and special assessments payable by the new location, a
17.35501(c)(3) nonprofit corporation, shall be included in the payment rates determined under
17.36this subdivision for all subsequent rate years.
18.1(h) (g) For the rate year beginning July 1, 1997, the commissioner shall compute
18.2the payment rate for a nursing facility licensed for 94 beds on September 30, 1996,
18.3that applied in October 1993 for approval of a total replacement under the moratorium
18.4exception process in section144A.073 , and completed the approved replacement in June
18.51995, with other operating cost spend-up limit under paragraph (a), increased by $3.98,
18.6and after computing the facility's payment rate according to this section, the commissioner
18.7shall make a one-year positive rate adjustment of $3.19 for operating costs related to the
18.8newly constructed total replacement, without application of paragraphs (a) and (b). The
18.9facility's per diem, before the $3.19 adjustment, shall be used as the prior reporting year's
18.10allowable operating cost per diem for payment rate calculation for the rate year beginning
18.11July 1, 1998. A facility described in this paragraph is exempt from paragraph (b) for the
18.12rate years beginning July 1, 1997, and July 1, 1998.
18.13(i) (h) For the purpose of applying the limit stated in paragraph (a), a nursing facility
18.14in Kandiyohi County licensed for 86 beds that was granted hospital-attached status on
18.15December 1, 1994, shall have the prior year's allowable care-related per diem increased
18.16by $3.207 and the prior year's other operating cost per diem increased by $4.777 before
18.17adding the inflation in paragraph (d), clause (2), for the rate year beginning on July 1, 1997.
18.18(j) (i) For the purpose of applying the limit stated in paragraph (a), a 117 bed nursing
18.19facility located in Pine County shall have the prior year's allowable other operating cost
18.20per diem increased by $1.50 before adding the inflation in paragraph (d), clause (2), for
18.21the rate year beginning on July 1, 1997.
18.22(k) (j) For the purpose of applying the limit under paragraph (a), a nursing facility in
18.23Hibbing licensed for 192 beds shall have the prior year's allowable other operating cost
18.24per diem increased by $2.67 before adding the inflation in paragraph (d), clause (2),
18.25for the rate year beginning July 1, 1997.
18.26 Sec. 3. Minnesota Statutes 2010, section 256B.437, subdivision 4, is amended to read:
18.27 Subd. 4. Criteria for review of application. In reviewing and approving closure
18.28proposals, the commissioner shall consider, but not be limited to, the following criteria:
18.29(1) improved quality of care and quality of life for consumers;
18.30(2) closure of a nursing facility that has a poor physical plant, which may be
18.31evidenced by the conditions referred to in section
144A.073, subdivision 4, clauses (4)
18.32and (5);
18.33(3) the existence of excess nursing facility beds, measured in terms of beds per
18.34thousand persons aged 85 or older. The excess must be measured in reference to:
18.35(i) the county in which the facility is located;
19.1(ii) the county and all contiguous counties;
19.2(iii) the region in which the facility is located; or
19.3(iv) the facility's service area;
19.4the facility shall indicate in its application the service area it believes is appropriate for this
19.5measurement. A facility in a county that is in the lowest quartile of counties with reference
19.6to beds per thousand persons aged 85 or older is not in an area of excess capacity;
19.7(4) low-occupancy rates, provided that the unoccupied beds are not the result of
19.8a personnel shortage. In analyzing occupancy rates, the commissioner shall examine
19.9waiting lists in the applicant facility and at facilities in the surrounding area, as determined
19.10under clause (3);
19.11(5) evidence of coordination between the community planning process and the
19.12facility application. If the planning group does not support a level of nursing facility
19.13closures that the commissioner considers to be reasonable, the commissioner may approve
19.14a planned closure proposal without its support;
19.15(6) proposed usage of funds available from a planned closure rate adjustment for
19.16care-related purposes;
19.17(7) innovative use planned for the closed facility's physical plant;
19.18(8) evidence that the proposal serves the interests of the state; and
19.19(9) evidence of other factors that affect the viability of the facility, including
19.20excessive nursing pool costs.
19.21 Sec. 4. EFFECTIVE DATE.
19.22This article is effective the day following final enactment.
1.3amending Minnesota Statutes 2010, sections 12A.10, by adding a subdivision;
1.4144A.071, subdivisions 3, 4a; 144A.073, subdivision 3c, by adding a subdivision;
1.5256B.431, subdivision 26; 256B.437, subdivision 4; 256B.441, by adding a
1.6subdivision; repealing Minnesota Statutes 2010, section 144A.073, subdivisions
1.74, 5.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.11 Section 1. Minnesota Statutes 2010, section 12A.10, is amended by adding a
1.12subdivision to read:
1.13 Subd. 4. Nursing home bed layaway. Notwithstanding section 144A.071,
1.14subdivision 4b, the commissioner of health may approve the placement on and removal
1.15from layaway status of nursing home beds at any time when a partial or complete
1.16evacuation of a nursing home occurs in response to a natural disaster, a possible natural
1.17disaster, or another event that threatens the health and safety of residents of a nursing home.
1.18 Sec. 2. Minnesota Statutes 2010, section 144A.071, subdivision 3, is amended to read:
1.19 Subd. 3. Exceptions authorizing increase in beds; hardship areas. (a) The
1.20commissioner of health, in coordination with the commissioner of human services, may
1.21approve the addition of
1.22and Medicaid certified nursing home
1.23criterion and process set forth in this subdivision.
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
2.14(b) The commissioner, in cooperation with the commissioner of human services,
2.15shall consider the following criteria when determining that an area of the state is a
2.16hardship area with regard to access to nursing facility services:
2.17(1) a low number of beds per thousand in a specified area using as a standard the
2.18beds per thousand people age 65 and older, in five year age groups, using data from the
2.19most recent census and population projections, weighted by each groups' most recent
2.20nursing home utilization, of the county at the 20th percentile, as determined by the
2.21commissioner of human services;
2.22(2) a high level of out-migration for nursing facility services associated with a
2.23described area from the county or counties of residence to other Minnesota counties, as
2.24determined by the commissioner of human services, using as a standard an amount greater
2.25than the out-migration of the county ranked at the 50th percentile;
2.26(3) an adequate level of availability of noninstitutional long-term care services
2.27measured as public spending for home and community-based long-term care services per
2.28individual age 65 and older, in five year age groups, using data from the most recent
2.29census and population projections, weighted by each groups' most recent nursing home
2.30utilization, as determined by the commissioner of human services using as a standard an
2.31amount greater than the 50th percentile of counties;
2.32(4) there must be a declaration of hardship resulting from insufficient access to
2.33nursing home beds by local county agencies; and
2.34(5) other factors that may demonstrate the need to add new nursing facility beds.
2.35(c) On August 15 of odd-numbered years, the commissioner, in cooperation with
2.36the commissioner of human services, may publish in the State Register a request for
3.1information in which interested parties, using the data provided under section 144A.351,
3.2along with any other relevant data, demonstrate that a specified area is a hardship area
3.3with regard to access to nursing facility services. For a response to be considered, the
3.4commissioner must receive it by November 15. The commissioner shall make responses
3.5to the request for information available to the public and shall allow 30 days for comment.
3.6The commissioner shall review responses and comments and determine if any areas of
3.7the state are to be declared hardship areas.
3.8(d) For each designated hardship area determined in paragraph (c), the commissioner
3.9shall publish a request for proposals in accordance with section 144A.073. The request
3.10for proposals must be published in the State Register by March 15 following receipt of
3.11responses to the request for information. The request for proposals must specify the
3.12number of new beds which may be added in the designated hardship area, which must not
3.13exceed the number which, if added to the existing number of beds in the area, including
3.14beds in layaway status, would have prevented it from being determined to be a hardship
3.15area under paragraph (b), clause (1). Beginning July 1, 2011, the number of new beds
3.16approved must not exceed 200 beds statewide per biennium. After June 30, 2019, the
3.17number of new beds that may be approved in a biennium must not exceed 300 statewide.
3.18For a proposal to be considered, the commissioner must receive it within six months of
3.19the publication of the request for proposals. The commissioner shall review responses to
3.20the request for proposals and shall approve or disapprove each proposal by the following
3.21July 15, in accordance with section 144A.073. The commissioner shall base approvals
3.22or disapprovals on a comparison and ranking of proposals using only the criteria in
3.23subdivision 4a. Approval of a proposal expires after 18 months unless the facility has
3.24added the new beds using existing space, subject to approval by the commissioner, or
3.25has commenced construction as defined in section 144A.071, subdivision 1a, paragraph
3.26(d). Operating payment rates shall be determined according to Minnesota Rules, part
3.279549.0057, using the limits under section 256B.441. External fixed payment rates must
3.28be determined according to section 256B.441, subdivision 53. Property payment rates
3.29for facilities with beds added under this subdivision must be determined in the same
3.30manner as rate determinations resulting from projects approved and completed under
3.31section 144A.073.
3.32
3.33(1) certify or license new beds in a new facility that is to be operated by the
3.34commissioner of veterans affairs or when the costs of constructing and operating the new
3.35beds are to be reimbursed by the commissioner of veterans affairs or the United States
3.36Veterans Administration; and
4.1
4.2decertified for participation in the medical assistance program, provided that an application
4.3for relicensure or recertification is submitted to the commissioner by an organization that
4.4is not a related organization as defined in section 256B.441, subdivision 34, to the prior
4.5licensee within 120 days after delicensure or decertification
4.6
4.7
4.8
4.9
4.10
4.11 Sec. 3. Minnesota Statutes 2010, section 144A.073, subdivision 3c, is amended to read:
4.12 Subd. 3c. Cost neutral relocation projects. (a) Notwithstanding subdivision 3, the
4.13commissioner may at any time accept proposals, or amendments to proposals previously
4.14approved under this section, for relocations that are cost neutral with respect to state costs
4.15as defined in section
4.16the commissioner of human services, shall evaluate proposals according to subdivision
4.17
4.18rule
4.19rates of the facility receiving the beds in accordance with section 256B.441, subdivision
4.2060. The commissioner shall approve or disapprove a project within 90 days.
4.21
4.22
4.23 (b) For the purposes of paragraph (a), cost neutrality shall be measured over the first
4.24three 12-month periods of operation after completion of the project.
4.25 Sec. 4. Minnesota Statutes 2010, section 144A.073, is amended by adding a
4.26subdivision to read:
4.27 Subd. 4a. Criteria for review. In reviewing the application materials and submitted
4.28costs by an applicant to the moratorium process, the review panel shall consider the
4.29following criteria in recommending proposals:
4.30(1) the extent to which the proposed nursing home project is integrated with other
4.31health and long-term care services for older adults;
4.32(2) the extent to which the project provides for the complete replacement of an
4.33outdated physical plant;
5.1(3) the extent to which the project results in a reduction of nursing facility beds in an
5.2area that has a relatively high number of beds per thousand occupied by persons age 85
5.3and over;
5.4(4) the extent to which the project produces improvements in health; safety,
5.5including life safety code corrections; quality of life; and privacy of residents;
5.6(5) the extent to which, under the current facility ownership and management, the
5.7provider has shown the ability to provide good quality of care based on health-related
5.8findings on certification surveys, quality indicator scores, and quality-of-life scores,
5.9including those from the Minnesota nursing home report card;
5.10(6) the extent to which the project integrates the latest technology and design
5.11features in a way that improves the resident experience and improves the working
5.12environment for employees;
5.13(7) the extent to which the sustainability of the nursing facility can be demonstrated
5.14based on the need for services in the area and the proposed financing of the project; and
5.15(8) the extent to which the project provides or maintains access to nursing facility
5.16services needed in the community.
5.17 Sec. 5. Minnesota Statutes 2010, section 256B.441, is amended by adding a
5.18subdivision to read:
5.19 Subd. 60. Method for determining budget-neutral nursing facility rates for
5.20relocated beds. (a) Nursing facility rates for bed relocations must be calculated by
5.21comparing the estimated medical assistance costs prior to and after the proposed bed
5.22relocation using the calculations in this subdivision. All payment rates are based on a 1.0
5.23case mix level, with other case mix rates determined accordingly. Nursing facility beds
5.24on layaway status that are being moved must be included in the calculation for both the
5.25originating and receiving facility and treated as though they were in active status with the
5.26occupancy characteristics of the active beds of the originating facility.
5.27(b) Medical assistance costs of the beds in the originating nursing facilities must
5.28be calculated as follows:
5.29(1) multiply each originating facility's total payment rate for a RUGS weight of 1.0
5.30by the facility's percentage of medical assistance days on its most recent available cost
5.31report;
5.32(2) take the products in clause (1) and multiply by each facility's average case mix
5.33score for medical assistance residents on its most recent available cost report;
5.34(3) take the products in clause (2) and multiply by the number of beds being
5.35relocated, times 365; and
6.1(4) calculate the sum of the amounts determined in clause (3).
6.2(c) Medical assistance costs in the receiving facility, prior to the bed relocation, must
6.3be calculated as follows:
6.4(1) multiply the facility's total payment rate for a RUGS weight of 1.0 by the medical
6.5assistance days on the most recent cost report; and
6.6(2) multiply the product in clause (1) by the average case mix weight of medical
6.7assistance residents on the most recent cost report.
6.8(d) The commissioner shall determine the medical assistance costs prior to the bed
6.9relocation which must be the sum of the amounts determined in paragraphs (b) and (c).
6.10(e) The commissioner shall estimate the medical assistance costs after the bed
6.11relocation as follows:
6.12(1) estimate the medical assistance days in the receiving facility after the bed
6.13relocation. The commissioner may use the current medical assistance portion, or if data
6.14does not exist, may use the statewide average, or may use the provider's estimate of the
6.15medical assistance utilization of the relocated beds;
6.16(2) estimate the average case mix weight of medical assistance residents in the
6.17receiving facility after the bed relocation. The commissioner may use current average
6.18case mix weight or, if data does not exist, may use the statewide average, or may use the
6.19provider's estimate of the average case mix weight; and
6.20(3) multiply the amount determined in clause (1) by the amount determined in
6.21clause (2) by the total payment rate for a RUGS weight of 1.0 that is the highest rate of
6.22the facilities from which the relocated beds either originate or to which they are being
6.23relocated so long as that rate is associated with ten percent or more of the total number of
6.24beds to be in the receiving facility after the bed relocation.
6.25(f) If the amount determined in paragraph (e) is less than or equal to the amount
6.26determined in paragraph (d), the commissioner shall allow a total payment rate equal to
6.27the amount used in paragraph (e), clause (3).
6.28(g) If the amount determined in paragraph (e) is greater than the amount determined
6.29in paragraph (d), the commissioner shall allow a rate with a RUGS weight of 1.0 that
6.30when used in paragraph (e), clause (3), results in the amount determined in paragraph (e)
6.31being equal to the amount determined in paragraph (d).
6.32(h) If the commissioner relies upon provider estimates in paragraph (e), clause (1)
6.33or (2), then annually, for three years after the rates determined in this subdivision take
6.34effect, the commissioner shall determine the accuracy of the alternative factors of medical
6.35assistance case load and RUGS weight used in this subdivision and shall reduce the total
6.36payment rate for a RUGS weight of 1.0 if the factors used result in medical assistance
7.1costs exceeding the amount in paragraph (d). If the actual medical assistance costs exceed
7.2the estimates by more than five percent, the commissioner shall also recover the difference
7.3between the estimated costs in paragraph (e) and the actual costs according to section
7.4256B.0641. The commissioner may require submission of data from the receiving facility
7.5needed to implement this paragraph.
7.6(i) When beds approved for relocation are put into active service at the destination
7.7facility, rates determined in this subdivision must be adjusted by any adjustment amounts
7.8that were implemented after the date of the letter of approval.
7.9 Sec. 6. REPEALER.
7.10Minnesota Statutes 2010, section 144A.073, subdivisions 4 and 5, are repealed.
7.11 Sec. 7. EFFECTIVE DATE.
7.12This article is effective the day following final enactment.
7.15 Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 4a, is amended to
7.16read:
7.17 Subd. 4a. Exceptions for replacement beds. It is in the best interest of the state
7.18to ensure that nursing homes and boarding care homes continue to meet the physical
7.19plant licensing and certification requirements by permitting certain construction projects.
7.20Facilities should be maintained in condition to satisfy the physical and emotional needs
7.21of residents while allowing the state to maintain control over nursing home expenditure
7.22growth.
7.23 The commissioner of health in coordination with the commissioner of human
7.24services, may approve the renovation, replacement, upgrading, or relocation of a nursing
7.25home or boarding care home, under the following conditions:
7.26 (a) to license or certify beds in a new facility constructed to replace a facility or to
7.27make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by
7.28fire, lightning, or other hazard provided:
7.29 (i) destruction was not caused by the intentional act of or at the direction of a
7.30controlling person of the facility;
7.31 (ii) at the time the facility was destroyed or damaged the controlling persons of the
7.32facility maintained insurance coverage for the type of hazard that occurred in an amount
7.33that a reasonable person would conclude was adequate;
8.1 (iii) the net proceeds from an insurance settlement for the damages caused by the
8.2hazard are applied to the cost of the new facility or repairs;
8.3 (iv) the new facility is constructed on the same site as the destroyed facility
8.4
8.5 (v) the number of licensed and certified beds in the new facility does not exceed the
8.6number of licensed and certified beds in the destroyed facility; and
8.7 (vi) the commissioner determines that the replacement beds are needed to prevent an
8.8inadequate supply of beds.
8.9Project construction costs incurred for repairs authorized under this clause shall not be
8.10considered in the dollar threshold amount defined in subdivision 2;
8.11 (b) to license or certify beds that are moved from one location to another within a
8.12nursing home facility, provided the total costs of remodeling performed in conjunction
8.13with the relocation of beds does not exceed $1,000,000;
8.14 (c) to license or certify beds in a project recommended for approval under section
8.16 (d) to license or certify beds that are moved from an existing state nursing home to
8.17a different state facility, provided there is no net increase in the number of state nursing
8.18home beds;
8.19 (e) to certify and license as nursing home beds boarding care beds in a certified
8.20boarding care facility if the beds meet the standards for nursing home licensure, or in a
8.21facility that was granted an exception to the moratorium under section
8.22the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care
8.23beds are licensed as nursing home beds, the number of boarding care beds in the facility
8.24must not increase beyond the number remaining at the time of the upgrade in licensure.
8.25The provisions contained in section
8.26do not apply to facilities that satisfy these requirements;
8.27 (f) to license and certify up to 40 beds transferred from an existing facility owned and
8.28operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
8.29same location as the existing facility that will serve persons with Alzheimer's disease and
8.30other related disorders. The transfer of beds may occur gradually or in stages, provided
8.31the total number of beds transferred does not exceed 40. At the time of licensure and
8.32certification of a bed or beds in the new unit, the commissioner of health shall delicense
8.33and decertify the same number of beds in the existing facility. As a condition of receiving
8.34a license or certification under this clause, the facility must make a written commitment
8.35to the commissioner of human services that it will not seek to receive an increase in its
8.36property-related payment rate as a result of the transfers allowed under this paragraph;
9.1 (g) to license and certify nursing home beds to replace currently licensed and certified
9.2boarding care beds which may be located either in a remodeled or renovated boarding care
9.3or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
9.4nursing home facility within the identifiable complex of health care facilities in which the
9.5currently licensed boarding care beds are presently located, provided that the number of
9.6boarding care beds in the facility or complex are decreased by the number to be licensed
9.7as nursing home beds and further provided that, if the total costs of new construction,
9.8replacement, remodeling, or renovation exceed ten percent of the appraised value of
9.9the facility or $200,000, whichever is less, the facility makes a written commitment to
9.10the commissioner of human services that it will not seek to receive an increase in its
9.11property-related payment rate by reason of the new construction, replacement, remodeling,
9.12or renovation. The provisions contained in section
9.13facilities do not apply to facilities that satisfy these requirements;
9.14 (h) to license as a nursing home and certify as a nursing facility a facility that is
9.15licensed as a boarding care facility but not certified under the medical assistance program,
9.16but only if the commissioner of human services certifies to the commissioner of health that
9.17licensing the facility as a nursing home and certifying the facility as a nursing facility will
9.18result in a net annual savings to the state general fund of $200,000 or more;
9.19 (i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing
9.20home beds in a facility that was licensed and in operation prior to January 1, 1992;
9.21 (j) to license and certify new nursing home beds to replace beds in a facility acquired
9.22by the Minneapolis Community Development Agency as part of redevelopment activities
9.23in a city of the first class, provided the new facility is located within three miles of the site
9.24of the old facility. Operating and property costs for the new facility must be determined
9.25and allowed under section
9.26 (k) to license and certify up to 20 new nursing home beds in a community-operated
9.27hospital and attached convalescent and nursing care facility with 40 beds on April 21,
9.281991, that suspended operation of the hospital in April 1986. The commissioner of human
9.29services shall provide the facility with the same per diem property-related payment rate
9.30for each additional licensed and certified bed as it will receive for its existing 40 beds;
9.31 (l) to license or certify beds in renovation, replacement, or upgrading projects as
9.32defined in section
9.33facility's remodeling projects do not exceed $1,000,000;
9.34 (m) to license and certify beds that are moved from one location to another for the
9.35purposes of converting up to five four-bed wards to single or double occupancy rooms
10.1in a nursing home that, as of January 1, 1993, was county-owned and had a licensed
10.2capacity of 115 beds;
10.3 (n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified
10.4nursing facility located in Minneapolis to layaway all of its licensed and certified nursing
10.5home beds. These beds may be relicensed and recertified in a newly constructed teaching
10.6nursing home facility affiliated with a teaching hospital upon approval by the legislature.
10.7The proposal must be developed in consultation with the interagency committee on
10.8long-term care planning. The beds on layaway status shall have the same status as
10.9voluntarily delicensed and decertified beds, except that beds on layaway status remain
10.10subject to the surcharge in section
10.11 (o) to allow a project which will be completed in conjunction with an approved
10.12moratorium exception project for a nursing home in southern Cass County and which is
10.13directly related to that portion of the facility that must be repaired, renovated, or replaced,
10.14to correct an emergency plumbing problem for which a state correction order has been
10.15issued and which must be corrected by August 31, 1993;
10.16 (p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified
10.17nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to
10.18the commissioner, up to 30 of the facility's licensed and certified beds by converting
10.19three-bed wards to single or double occupancy. Beds on layaway status shall have the
10.20same status as voluntarily delicensed and decertified beds except that beds on layaway
10.21status remain subject to the surcharge in section
10.22application and renewal fees under section
10.23reactivation fee. In addition, at any time within three years of the effective date of the
10.24layaway, the beds on layaway status may be:
10.25 (1) relicensed and recertified upon relocation and reactivation of some or all of
10.26the beds to an existing licensed and certified facility or facilities located in Pine River,
10.27Brainerd, or International Falls; provided that the total project construction costs related to
10.28the relocation of beds from layaway status for any facility receiving relocated beds may
10.29not exceed the dollar threshold provided in subdivision 2 unless the construction project
10.30has been approved through the moratorium exception process under section
10.31 (2) relicensed and recertified, upon reactivation of some or all of the beds within the
10.32facility which placed the beds in layaway status, if the commissioner has determined a
10.33need for the reactivation of the beds on layaway status.
10.34 The property-related payment rate of a facility placing beds on layaway status
10.35must be adjusted by the incremental change in its rental per diem after recalculating the
10.36rental per diem as provided in section
11.1property-related payment rate for a facility relicensing and recertifying beds from layaway
11.2status must be adjusted by the incremental change in its rental per diem after recalculating
11.3its rental per diem using the number of beds after the relicensing to establish the facility's
11.4capacity day divisor, which shall be effective the first day of the month following the
11.5month in which the relicensing and recertification became effective. Any beds remaining
11.6on layaway status more than three years after the date the layaway status became effective
11.7must be removed from layaway status and immediately delicensed and decertified;
11.8 (q) to license and certify beds in a renovation and remodeling project to convert 12
11.9four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
11.10home that, as of January 1, 1994, met the following conditions: the nursing home was
11.11located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked
11.12among the top 15 applicants by the 1993 moratorium exceptions advisory review panel.
11.13The total project construction cost estimate for this project must not exceed the cost
11.14estimate submitted in connection with the 1993 moratorium exception process;
11.15 (r) to license and certify up to 117 beds that are relocated from a licensed and
11.16certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed
11.17hospital beds located in South St. Paul, provided that the nursing facility and hospital are
11.18owned by the same or a related organization and that prior to the date the relocation is
11.19completed the hospital ceases operation of its inpatient hospital services at that hospital.
11.20After relocation, the nursing facility's status under section
11.21be the same as it was prior to relocation. The nursing facility's property-related payment
11.22rate resulting from the project authorized in this paragraph shall become effective no
11.23earlier than April 1, 1996. For purposes of calculating the incremental change in the
11.24facility's rental per diem resulting from this project, the allowable appraised value of
11.25the nursing facility portion of the existing health care facility physical plant prior to the
11.26renovation and relocation may not exceed $2,490,000;
11.27 (s) to license and certify two beds in a facility to replace beds that were voluntarily
11.28delicensed and decertified on June 28, 1991;
11.29 (t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed
11.30nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding
11.31the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed
11.32nursing home facility after completion of a construction project approved in 1993 under
11.33section
11.34Beds on layaway status shall have the same status as voluntarily delicensed or decertified
11.35beds except that they shall remain subject to the surcharge in section
11.3616 beds on layaway status may be relicensed as nursing home beds and recertified at
12.1any time within five years of the effective date of the layaway upon relocation of some
12.2or all of the beds to a licensed and certified facility located in Watertown, provided that
12.3the total project construction costs related to the relocation of beds from layaway status
12.4for the Watertown facility may not exceed the dollar threshold provided in subdivision
12.52 unless the construction project has been approved through the moratorium exception
12.6process under section
12.7 The property-related payment rate of the facility placing beds on layaway status
12.8must be adjusted by the incremental change in its rental per diem after recalculating the
12.9rental per diem as provided in section
12.10property-related payment rate for the facility relicensing and recertifying beds from
12.11layaway status must be adjusted by the incremental change in its rental per diem after
12.12recalculating its rental per diem using the number of beds after the relicensing to establish
12.13the facility's capacity day divisor, which shall be effective the first day of the month
12.14following the month in which the relicensing and recertification became effective. Any
12.15beds remaining on layaway status more than five years after the date the layaway status
12.16became effective must be removed from layaway status and immediately delicensed
12.17and decertified;
12.18 (u) to license and certify beds that are moved within an existing area of a facility or
12.19to a newly constructed addition which is built for the purpose of eliminating three- and
12.20four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary
12.21service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had
12.22a licensed capacity of 129 beds;
12.23 (v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County
12.24to a 160-bed facility in Crow Wing County, provided all the affected beds are under
12.25common ownership;
12.26 (w) to license and certify a total replacement project of up to 49 beds located in
12.27Norman County that are relocated from a nursing home destroyed by flood and whose
12.28residents were relocated to other nursing homes. The operating cost payment rates for
12.29the new nursing facility shall be determined based on the interim and settle-up payment
12.30provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
12.31section
12.32the second rate year after the settle-up cost report is filed. Property-related reimbursement
12.33rates shall be determined under section
12.34flood-related loans or grants provided to the facility;
12.35 (x) to license and certify a total replacement project of up to 129 beds located
12.36in Polk County that are relocated from a nursing home destroyed by flood and whose
13.1residents were relocated to other nursing homes. The operating cost payment rates for
13.2the new nursing facility shall be determined based on the interim and settle-up payment
13.3provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
13.4section
13.5the second rate year after the settle-up cost report is filed. Property-related reimbursement
13.6rates shall be determined under section
13.7flood-related loans or grants provided to the facility;
13.8 (y) to license and certify beds in a renovation and remodeling project to convert 13
13.9three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and
13.10add improvements in a nursing home that, as of January 1, 1994, met the following
13.11conditions: the nursing home was located in Ramsey County, was not owned by a hospital
13.12corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15
13.13applicants by the 1993 moratorium exceptions advisory review panel. The total project
13.14construction cost estimate for this project must not exceed the cost estimate submitted in
13.15connection with the 1993 moratorium exception process;
13.16 (z) to license and certify up to 150 nursing home beds to replace an existing 285
13.17bed nursing facility located in St. Paul. The replacement project shall include both the
13.18renovation of existing buildings and the construction of new facilities at the existing
13.19site. The reduction in the licensed capacity of the existing facility shall occur during the
13.20construction project as beds are taken out of service due to the construction process. Prior
13.21to the start of the construction process, the facility shall provide written information to the
13.22commissioner of health describing the process for bed reduction, plans for the relocation
13.23of residents, and the estimated construction schedule. The relocation of residents shall be
13.24in accordance with the provisions of law and rule;
13.25 (aa) to allow the commissioner of human services to license an additional 36 beds
13.26to provide residential services for the physically disabled under Minnesota Rules, parts
13.279570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
13.28the total number of licensed and certified beds at the facility does not increase;
13.29 (bb) to license and certify a new facility in St. Louis County with 44 beds
13.30constructed to replace an existing facility in St. Louis County with 31 beds, which has
13.31resident rooms on two separate floors and an antiquated elevator that creates safety
13.32concerns for residents and prevents nonambulatory residents from residing on the second
13.33floor. The project shall include the elimination of three- and four-bed rooms;
13.34 (cc) to license and certify four beds in a 16-bed certified boarding care home in
13.35Minneapolis to replace beds that were voluntarily delicensed and decertified on or
13.36before March 31, 1992. The licensure and certification is conditional upon the facility
14.1periodically assessing and adjusting its resident mix and other factors which may
14.2contribute to a potential institution for mental disease declaration. The commissioner of
14.3human services shall retain the authority to audit the facility at any time and shall require
14.4the facility to comply with any requirements necessary to prevent an institution for mental
14.5disease declaration, including delicensure and decertification of beds, if necessary;
14.6 (dd) to license and certify 72 beds in an existing facility in Mille Lacs County with
14.780 beds as part of a renovation project. The renovation must include construction of
14.8an addition to accommodate ten residents with beginning and midstage dementia in a
14.9self-contained living unit; creation of three resident households where dining, activities,
14.10and support spaces are located near resident living quarters; designation of four beds
14.11for rehabilitation in a self-contained area; designation of 30 private rooms; and other
14.12improvements;
14.13 (ee) to license and certify beds in a facility that has undergone replacement or
14.14remodeling as part of a planned closure under section
14.15 (ff) to license and certify a total replacement project of up to 124 beds located
14.16in Wilkin County that are in need of relocation from a nursing home significantly
14.17damaged by flood. The operating cost payment rates for the new nursing facility shall
14.18be determined based on the interim and settle-up payment provisions of Minnesota
14.19Rules, part 9549.0057, and the reimbursement provisions of section
14.20that section
14.21second rate year after the settle-up cost report is filed. Property-related reimbursement
14.22rates shall be determined under section
14.23flood-related loans or grants provided to the facility;
14.24 (gg) to allow the commissioner of human services to license an additional nine beds
14.25to provide residential services for the physically disabled under Minnesota Rules, parts
14.269570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
14.27total number of licensed and certified beds at the facility does not increase;
14.28 (hh) to license and certify up to 120 new nursing facility beds to replace beds in a
14.29facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the
14.30new facility is located within four miles of the existing facility and is in Anoka County.
14.31Operating and property rates shall be determined and allowed under section
14.32Minnesota Rules, parts 9549.0010 to 9549.0080, or section
14.33provisions of section
14.34the second rate year following settle-up; or
14.35 (ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County
14.36that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed
15.1nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The
15.2transfer is effective when the receiving facility notifies the commissioner in writing of the
15.3number of beds accepted. The commissioner shall place all transferred beds on layaway
15.4status held in the name of the receiving facility. The layaway adjustment provisions of
15.5section
15.6may only remove the beds from layaway for recertification and relicensure at the receiving
15.7facility's current site, or at a newly constructed facility located in Anoka County. The
15.8receiving facility must receive statutory authorization before removing these beds from
15.9layaway status, or may remove these beds from layaway status if removal from layaway
15.10status is part of a moratorium exception project approved by the commissioner under
15.11section
15.12 Sec. 2. Minnesota Statutes 2010, section 256B.431, subdivision 26, is amended to read:
15.13 Subd. 26. Changes to nursing facility reimbursement beginning July 1, 1997.
15.14The nursing facility reimbursement changes in paragraphs (a) to (e) shall apply in the
15.15sequence specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section,
15.16beginning July 1, 1997.
15.17(a) For rate years beginning on or after July 1, 1997, the commissioner shall limit a
15.18nursing facility's allowable operating per diem for each case mix category for each rate
15.19year. The commissioner shall group nursing facilities into two groups, freestanding and
15.20nonfreestanding, within each geographic group, using their operating cost per diem for
15.21the case mix A classification. A nonfreestanding nursing facility is a nursing facility
15.22whose other operating cost per diem is subject to the hospital attached, short length of
15.23stay, or the rule 80 limits. All other nursing facilities shall be considered freestanding
15.24nursing facilities. The commissioner shall then array all nursing facilities in each grouping
15.25by their allowable case mix A operating cost per diem. In calculating a nursing facility's
15.26operating cost per diem for this purpose, the commissioner shall exclude the raw food
15.27cost per diem related to providing special diets that are based on religious beliefs, as
15.28determined in subdivision 2b, paragraph (h). For those nursing facilities in each grouping
15.29whose case mix A operating cost per diem:
15.30(1) is at or below the median of the array, the commissioner shall limit the nursing
15.31facility's allowable operating cost per diem for each case mix category to the lesser of
15.32the prior reporting year's allowable operating cost per diem as specified in Laws 1996,
15.33chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established
15.34in paragraph (d), clause (2), increased by two percentage points, or the current reporting
15.35year's corresponding allowable operating cost per diem; or
16.1(2) is above the median of the array, the commissioner shall limit the nursing
16.2facility's allowable operating cost per diem for each case mix category to the lesser of
16.3the prior reporting year's allowable operating cost per diem as specified in Laws 1996,
16.4chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established
16.5in paragraph (d), clause (2), increased by one percentage point, or the current reporting
16.6year's corresponding allowable operating cost per diem.
16.7For purposes of paragraph (a), if a nursing facility reports on its cost report a
16.8reduction in cost due to a refund or credit for a rate year beginning on or after July 1, 1998,
16.9the commissioner shall increase that facility's spend-up limit for the rate year following
16.10the current rate year by the amount of the cost reduction divided by its resident days for
16.11the reporting year preceding the rate year in which the adjustment is to be made.
16.12(b) For rate years beginning on or after July 1, 1997, the commissioner shall limit the
16.13allowable operating cost per diem for high cost nursing facilities. After application of the
16.14limits in paragraph (a) to each nursing facility's operating cost per diem, the commissioner
16.15shall group nursing facilities into two groups, freestanding or nonfreestanding, within each
16.16geographic group. A nonfreestanding nursing facility is a nursing facility whose other
16.17operating cost per diem are subject to hospital attached, short length of stay, or rule 80
16.18limits. All other nursing facilities shall be considered freestanding nursing facilities. The
16.19commissioner shall then array all nursing facilities within each grouping by their allowable
16.20case mix A operating cost per diem. In calculating a nursing facility's operating cost per
16.21diem for this purpose, the commissioner shall exclude the raw food cost per diem related to
16.22providing special diets that are based on religious beliefs, as determined in subdivision 2b,
16.23paragraph (h). For those nursing facilities in each grouping whose case mix A operating
16.24cost per diem exceeds 1.0 standard deviation above the median, the commissioner shall
16.25reduce their allowable operating cost per diem by three percent. For those nursing
16.26facilities in each grouping whose case mix A operating cost per diem exceeds 0.5 standard
16.27deviation above the median but is less than or equal to 1.0 standard deviation above the
16.28median, the commissioner shall reduce their allowable operating cost per diem by two
16.29percent. However, in no case shall a nursing facility's operating cost per diem be reduced
16.30below its grouping's limit established at 0.5 standard deviations above the median.
16.31(c) For rate years beginning on or after July 1, 1997, the commissioner shall
16.32determine a nursing facility's efficiency incentive by first computing the allowable
16.33difference, which is the lesser of $4.50 or the amount by which the facility's other
16.34operating cost limit exceeds its nonadjusted other operating cost per diem for that rate
16.35year. The commissioner shall compute the efficiency incentive by:
16.36(1) subtracting the allowable difference from $4.50 and dividing the result by $4.50;
17.1(2) multiplying 0.20 by the ratio resulting from clause (1), and then;
17.2(3) adding 0.50 to the result from clause (2); and
17.3(4) multiplying the result from clause (3) times the allowable difference.
17.4The nursing facility's efficiency incentive payment shall be the lesser of $2.25 or the
17.5product obtained in clause (4).
17.6(d) For rate years beginning on or after July 1, 1997, the forecasted price index for
17.7a nursing facility's allowable operating cost per diem shall be determined under clauses
17.8(1) and (2) using the change in the Consumer Price Index-All Items (United States city
17.9average) (CPI-U) as forecasted by Data Resources, Inc. The commissioner shall use the
17.10indices as forecasted in the fourth quarter of the calendar year preceding the rate year,
17.11subject to subdivision 2l, paragraph (c).
17.12(1) The CPI-U forecasted index for allowable operating cost per diem shall be based
17.13on the 21-month period from the midpoint of the nursing facility's reporting year to the
17.14midpoint of the rate year following the reporting year.
17.15(2) For rate years beginning on or after July 1, 1997, the forecasted index for
17.16operating cost limits referred to in subdivision 21, paragraph (b), shall be based on
17.17the CPI-U for the 12-month period between the midpoints of the two reporting years
17.18preceding the rate year.
17.19(e) After applying these provisions for the respective rate years, the commissioner
17.20shall index these allowable operating cost per diem by the inflation factor provided for in
17.21paragraph (d), clause (1), and add the nursing facility's efficiency incentive as computed in
17.22paragraph (c).
17.23(f) For the rate years beginning on July 1, 1997, July 1, 1998, and July 1, 1999, a
17.24nursing facility licensed for 40 beds effective May 1, 1992, with a subsequent increase of
17.2520 Medicare/Medicaid certified beds, effective January 26, 1993, in accordance with an
17.26increase in licensure is exempt from paragraphs (a) and (b).
17.27
17.28
17.29
17.30
17.31
17.32
17.33
17.34
17.35
17.36
18.1
18.2the payment rate for a nursing facility licensed for 94 beds on September 30, 1996,
18.3that applied in October 1993 for approval of a total replacement under the moratorium
18.4exception process in section
18.51995, with other operating cost spend-up limit under paragraph (a), increased by $3.98,
18.6and after computing the facility's payment rate according to this section, the commissioner
18.7shall make a one-year positive rate adjustment of $3.19 for operating costs related to the
18.8newly constructed total replacement, without application of paragraphs (a) and (b). The
18.9facility's per diem, before the $3.19 adjustment, shall be used as the prior reporting year's
18.10allowable operating cost per diem for payment rate calculation for the rate year beginning
18.11July 1, 1998. A facility described in this paragraph is exempt from paragraph (b) for the
18.12rate years beginning July 1, 1997, and July 1, 1998.
18.13
18.14in Kandiyohi County licensed for 86 beds that was granted hospital-attached status on
18.15December 1, 1994, shall have the prior year's allowable care-related per diem increased
18.16by $3.207 and the prior year's other operating cost per diem increased by $4.777 before
18.17adding the inflation in paragraph (d), clause (2), for the rate year beginning on July 1, 1997.
18.18
18.19facility located in Pine County shall have the prior year's allowable other operating cost
18.20per diem increased by $1.50 before adding the inflation in paragraph (d), clause (2), for
18.21the rate year beginning on July 1, 1997.
18.22
18.23Hibbing licensed for 192 beds shall have the prior year's allowable other operating cost
18.24per diem increased by $2.67 before adding the inflation in paragraph (d), clause (2),
18.25for the rate year beginning July 1, 1997.
18.26 Sec. 3. Minnesota Statutes 2010, section 256B.437, subdivision 4, is amended to read:
18.27 Subd. 4. Criteria for review of application. In reviewing and approving closure
18.28proposals, the commissioner shall consider, but not be limited to, the following criteria:
18.29(1) improved quality of care and quality of life for consumers;
18.30(2) closure of a nursing facility that has a poor physical plant
18.31
18.32
18.33(3) the existence of excess nursing facility beds, measured in terms of beds per
18.34thousand persons aged 85 or older. The excess must be measured in reference to:
18.35(i) the county in which the facility is located;
19.1(ii) the county and all contiguous counties;
19.2(iii) the region in which the facility is located; or
19.3(iv) the facility's service area;
19.4the facility shall indicate in its application the service area it believes is appropriate for this
19.5measurement. A facility in a county that is in the lowest quartile of counties with reference
19.6to beds per thousand persons aged 85 or older is not in an area of excess capacity;
19.7(4) low-occupancy rates, provided that the unoccupied beds are not the result of
19.8a personnel shortage. In analyzing occupancy rates, the commissioner shall examine
19.9waiting lists in the applicant facility and at facilities in the surrounding area, as determined
19.10under clause (3);
19.11(5) evidence of coordination between the community planning process and the
19.12facility application. If the planning group does not support a level of nursing facility
19.13closures that the commissioner considers to be reasonable, the commissioner may approve
19.14a planned closure proposal without its support;
19.15(6) proposed usage of funds available from a planned closure rate adjustment for
19.16care-related purposes;
19.17(7) innovative use planned for the closed facility's physical plant;
19.18(8) evidence that the proposal serves the interests of the state; and
19.19(9) evidence of other factors that affect the viability of the facility, including
19.20excessive nursing pool costs.
19.21 Sec. 4. EFFECTIVE DATE.
19.22This article is effective the day following final enactment.
