Subdivision 1. Method for determining budget-neutral nursing facility rates for relocated beds. Nursing facility rates for bed relocations must be calculated by comparing the estimated medical assistance costs prior to and after the proposed bed relocation using the calculations in this section. All payment rates are based on a case mix index of 1.0, with other case mix adjusted rates determined accordingly. Nursing facility beds on layaway status that are being moved must be included in the calculation for both the originating and receiving facility and treated as though they were in active status with the occupancy characteristics of the active beds of the originating facility.
Subd. 2. Determination of costs in originating facility. Medical assistance costs of the beds in the originating nursing facilities must be calculated as follows:
(1) multiply each originating facility's total payment rate for a case mix index of 1.0 by the facility's percentage of medical assistance days on its most recent available cost report;
(2) take the products in clause (1) and multiply by each facility's average case mix index for medical assistance residents on its most recent available cost report;
(3) take the products in clause (2) and multiply by the number of beds being relocated, times 365; and
(4) calculate the sum of the amounts determined in clause (3).
Subd. 3. Determination of costs in receiving facility. Medical assistance costs in the receiving facility, prior to the bed relocation, must be calculated as follows:
(1) multiply the facility's total payment rate for a case mix index of 1.0 by the medical assistance days on the most recent cost report; and
(2) multiply the product in clause (1) by the facility average case mix index of medical assistance residents on the most recent cost report.
Subd. 4. Determination of costs prior to relocation. The commissioner shall determine the medical assistance costs prior to the bed relocation which must be the sum of the amounts determined in subdivisions 2 and 3.
Subd. 5. Estimation of costs after bed relocation. The commissioner shall estimate the medical assistance costs after the bed relocation as follows:
(1) estimate the medical assistance days in the receiving facility after the bed relocation. The commissioner may use the current medical assistance portion, or if data does not exist, may use the statewide average, or may use the provider's estimate of the medical assistance utilization of the relocated beds;
(2) estimate the receiving facility's average case mix index of medical assistance residents after the bed relocation. The commissioner may use current facility average case mix index or, if data does not exist, may use the statewide average case mix index, or may use the provider's estimate of the facility average case mix index; and
(3) multiply the amount determined in clause (1) by the amount determined in clause (2) by the total payment rate for a case mix index of 1.0 that is the highest rate of the facilities from which the relocated beds either originate or to which they are being relocated so long as that rate is associated with ten percent or more of the total number of beds to be in the receiving facility after the bed relocation.
Subd. 6. Determination of rate adjustment. (a) If the amount determined in subdivision 5 is less than or equal to the amount determined in subdivision 4, the commissioner shall allow a total payment rate equal to the amount used in subdivision 5, clause (3).
(b) If the amount determined in subdivision 5 is greater than the amount determined in subdivision 4, the commissioner shall allow a rate with a case mix index of 1.0 that when used in subdivision 5, clause (3), results in the amount determined in subdivision 5 being equal to the amount determined in subdivision 4.
(c) If the commissioner relies upon provider estimates in subdivision 5, clause (1) or (2), then annually, for three years after the rates determined in this section take effect, the commissioner shall determine the accuracy of the alternative factors of medical assistance case load and the facility average case mix index used in this section and shall reduce the total payment rate if the factors used result in medical assistance costs exceeding the amount in subdivision 4. If the actual medical assistance costs exceed the estimates by more than five percent, the commissioner shall also recover the difference between the estimated costs in subdivision 5 and the actual costs according to section 256B.0641. The commissioner may require submission of data from the receiving facility needed to implement this paragraph.
(d) When beds approved for relocation are put into active service at the destination facility, rates determined in this section must be adjusted by any adjustment amounts that were implemented after the date of the letter of approval.
(e) Rate adjustments determined under this subdivision expire after three full rate years following the effective date of the rate adjustment. This subdivision expires when the final rate adjustment determined under this subdivision expires.
2016 c 99 art 1 s 37; 1Sp2019 c 9 art 4 s 26
Structure Minnesota Statutes
Chapters 245 - 267 — Public Welfare And Related Activities
Chapter 256R — Nursing Facility Rates
Section 256R.02 — Definitions.
Section 256R.03 — Conditions For Funding.
Section 256R.04 — Prohibited Practices.
Section 256R.05 — Required Practices.
Section 256R.06 — Private Pay Residents; Required Practices.
Section 256R.07 — Adequate Documentation.
Section 256R.08 — Reporting Of Financial Statements.
Section 256R.09 — Reporting Of Statistical And Cost Reports.
Section 256R.10 — Allowed Costs.
Section 256R.11 — Nonallowed Costs.
Section 256R.12 — Cost Allocation.
Section 256R.13 — Auditing Requirements.
Section 256R.16 — Quality Of Care.
Section 256R.18 — Report By Commissioner Of Human Services.
Section 256R.21 — Total Payment Rate.
Section 256R.22 — Case Mix Adjusted Total Payment Rate.
Section 256R.23 — Total Care-related Payment Rates.
Section 256R.24 — Other Operating Payment Rate.
Section 256R.25 — External Fixed Costs Payment Rate.
Section 256R.26 — Property Payment Rate.
Section 256R.261 — Property Rate Definitions.
Section 256R.265 — Appraisals And Determination Of Replacement Costs.
Section 256R.267 — Threshold Project Property Payment Rate Interim Adjustments.
Section 256R.27 — Interim And Settle-up Payment Rates.
Section 256R.36 — Hold Harmless.
Section 256R.37 — Scholarships.
Section 256R.38 — Performance-based Incentive Payments.
Section 256R.39 — Quality Improvement Incentive Program.
Section 256R.40 — Nursing Facility Voluntary Closure; Alternatives.
Section 256R.41 — Single-bed Room Incentive.
Section 256R.42 — Rate Adjustment For The First 30 Days.
Section 256R.44 — Rate Adjustment For Private Rooms For Medical Necessity.
Section 256R.45 — Rate Adjustment For Ventilator-dependent Persons.
Section 256R.46 — Specialized Care Facilities.
Section 256R.47 — Rate Adjustment For Critical Access Nursing Facilities.
Section 256R.48 — Publicly Owned Facilities.
Section 256R.481 — Rate Adjustments For Border City Facilities.
Section 256R.50 — Bed Relocations.
Section 256R.51 — Rate Adjustment For Special Dietary Needs.
Section 256R.52 — Nursing Facility Receivership Fees.