1.1                          A bill for an act 
  1.2             relating to human services; modifying nursing facility 
  1.3             case mix calculations; amending Minnesota Statutes 
  1.4             2002, sections 144.0724, subdivisions 3, 4; 256B.438, 
  1.5             subdivision 4. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 2002, section 144.0724, 
  1.8   subdivision 3, is amended to read: 
  1.9      Subd. 3.  [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a) 
  1.10  Resident reimbursement classifications shall be based on the 
  1.11  minimum data set, version 2.0 assessment instrument, or its 
  1.12  successor version mandated by the Centers for Medicare and 
  1.13  Medicaid Services that nursing facilities are required to 
  1.14  complete for all residents.  The commissioner of health shall 
  1.15  establish resident classes according to the 34 group, resource 
  1.16  utilization groups, version III or RUG-III model.  Resident 
  1.17  classes must be established based on the individual items on the 
  1.18  minimum data set and must be completed according to the facility 
  1.19  manual for case mix classification issued by the Minnesota 
  1.20  Department of Health.  The facility manual for case mix 
  1.21  classification shall be drafted by the Minnesota Department of 
  1.22  Health and presented to the chairs of health and human services 
  1.23  legislative committees by December 31, 2001. 
  1.24     (b) Each resident must be classified based on the 
  1.25  information from the minimum data set according to general 
  2.1   domains in clauses (1) to (7): 
  2.2      (1) extensive services where a resident requires 
  2.3   intravenous feeding or medications, suctioning, or tracheostomy 
  2.4   care, or is on a ventilator or respirator; 
  2.5      (2) rehabilitation where a resident requires physical, 
  2.6   occupational, or speech therapy; 
  2.7      (3) special care where a resident has cerebral palsy; 
  2.8   quadriplegia; multiple sclerosis; pressure ulcers; ulcers; fever 
  2.9   with vomiting, weight loss, pneumonia, or dehydration; surgical 
  2.10  wounds with treatment; or tube feeding and aphasia; or is 
  2.11  receiving radiation therapy; 
  2.12     (4) clinically complex status where a resident has tube 
  2.13  feeding, burns, coma, septicemia, pneumonia, internal bleeding, 
  2.14  chemotherapy, dialysis, oxygen, transfusions, foot infections or 
  2.15  lesions with treatment, heiplegia/hemiparesis 
  2.16  hemiplegia/hemiparesis, physician visits or order changes, or 
  2.17  diabetes with injections and order changes; 
  2.18     (5) impaired cognition where a resident has poor cognitive 
  2.19  performance; 
  2.20     (6) behavior problems where a resident exhibits wandering 
  2.21  or socially inappropriate or disruptive behavior, has 
  2.22  hallucinations or delusions, is physically or verbally abusive 
  2.23  toward others, or resists care, unless the resident's other 
  2.24  condition would place the resident in other categories; and 
  2.25     (7) reduced physical functioning where a resident has no 
  2.26  special clinical conditions. 
  2.27     (c) Notwithstanding the requirements of paragraph (b), the 
  2.28  following shall be used to calculate a case mix classification 
  2.29  only if provided in the nursing facility: 
  2.30     (1) IV medications; 
  2.31     (2) oxygen therapy; 
  2.32     (3) transfusions; and 
  2.33     (4) ventilator/respirator. 
  2.34     (d) The commissioner of health shall establish resident 
  2.35  classification according to a 34 group model based on the 
  2.36  information on the minimum data set and within the general 
  3.1   domains listed in paragraph (b), clauses (1) to (7).  Detailed 
  3.2   descriptions of each resource utilization group shall be defined 
  3.3   in the facility manual for case mix classification issued by the 
  3.4   Minnesota Department of Health.  The 34 groups are described as 
  3.5   follows: 
  3.6      (1) SE3:  requires four or five extensive services; 
  3.7      (2) SE2:  requires two or three extensive services; 
  3.8      (3) SE1:  requires one extensive service; 
  3.9      (4) RAD:  requires rehabilitation services and is dependent 
  3.10  in activity of daily living (ADL) at a count of 17 or 18; 
  3.11     (5) RAC:  requires rehabilitation services and ADL count is 
  3.12  14 to 16; 
  3.13     (6) RAB:  requires rehabilitation services and ADL count is 
  3.14  ten to 13; 
  3.15     (7) RAA:  requires rehabilitation services and ADL count is 
  3.16  four to nine; 
  3.17     (8) SSC:  requires special care and ADL count is 17 or 18; 
  3.18     (9) SSB:  requires special care and ADL count is 15 or 16; 
  3.19     (10) SSA:  requires special care and ADL count is seven to 
  3.20  14; 
  3.21     (11) CC2:  clinically complex with depression and ADL count 
  3.22  is 17 or 18; 
  3.23     (12) CC1:  clinically complex with no depression and ADL 
  3.24  count is 17 or 18; 
  3.25     (13) CB2:  clinically complex with depression and ADL count 
  3.26  is 12 to 16; 
  3.27     (14) CB1:  clinically complex with no depression and ADL 
  3.28  count is 12 to 16; 
  3.29     (15) CA2:  clinically complex with depression and ADL count 
  3.30  is four to 11; 
  3.31     (16) CA1:  clinically complex with no depression and ADL 
  3.32  count is four to 11; 
  3.33     (17) IB2:  impaired cognition with nursing rehabilitation 
  3.34  and ADL count is six to ten; 
  3.35     (18) IB1:  impaired cognition with no nursing 
  3.36  rehabilitation and ADL count is six to ten; 
  4.1      (19) IA2:  impaired cognition with nursing rehabilitation 
  4.2   and ADL count is four or five; 
  4.3      (20) IA1:  impaired cognition with no nursing 
  4.4   rehabilitation and ADL count is four or five; 
  4.5      (21) BB2:  behavior problems with nursing rehabilitation 
  4.6   and ADL count is six to ten; 
  4.7      (22) BB1:  behavior problems with no nursing rehabilitation 
  4.8   and ADL count is six to ten; 
  4.9      (23) BA2:  behavior problems with nursing rehabilitation 
  4.10  and ADL count is four to five; 
  4.11     (24) BA1:  behavior problems with no nursing rehabilitation 
  4.12  and ADL count is four to five; 
  4.13     (25) PE2:  reduced physical functioning with nursing 
  4.14  rehabilitation and ADL count is 16 to 18; 
  4.15     (26) PE1:  reduced physical functioning with no nursing 
  4.16  rehabilitation and ADL count is 16 to 18; 
  4.17     (27) PD2:  reduced physical functioning with nursing 
  4.18  rehabilitation and ADL count is 11 to 15; 
  4.19     (28) PD1:  reduced physical functioning with no nursing 
  4.20  rehabilitation and ADL count is 11 to 15; 
  4.21     (29) PC2:  reduced physical functioning with nursing 
  4.22  rehabilitation and ADL count is nine or ten; 
  4.23     (30) PC1:  reduced physical functioning with no nursing 
  4.24  rehabilitation and ADL count is nine or ten; 
  4.25     (31) PB2:  reduced physical functioning with nursing 
  4.26  rehabilitation and ADL count is six to eight; 
  4.27     (32) PB1:  reduced physical functioning with no nursing 
  4.28  rehabilitation and ADL count is six to eight; 
  4.29     (33) PA2:  reduced physical functioning with nursing 
  4.30  rehabilitation and ADL count is four or five; and 
  4.31     (34) PA1:  reduced physical functioning with no nursing 
  4.32  rehabilitation and ADL count is four or five. 
  4.33     Sec. 2.  Minnesota Statutes 2002, section 144.0724, 
  4.34  subdivision 4, is amended to read: 
  4.35     Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility 
  4.36  must conduct and electronically submit to the commissioner of 
  5.1   health case mix assessments that conform with the assessment 
  5.2   schedule defined by Code of Federal Regulations, title 42, 
  5.3   section 483.20, and published by the United States Department of 
  5.4   Health and Human Services, Centers for Medicare and Medicaid 
  5.5   Services, in the Long Term Care Assessment Instrument User's 
  5.6   Manual, version 2.0, October 1995 December 2002, and subsequent 
  5.7   clarifications made in the Long-Term Care Assessment Instrument 
  5.8   Questions and Answers, version 2.0, August 1996.  The 
  5.9   commissioner of health may substitute successor manuals or 
  5.10  question and answer documents published by the United States 
  5.11  Department of Health and Human Services, Centers for Medicare 
  5.12  and Medicaid Services, to replace or supplement the current 
  5.13  version of the manual or document. 
  5.14     (b) The assessments used to determine a case mix 
  5.15  classification for reimbursement include the following: 
  5.16     (1) a new admission assessment must be completed by day 14 
  5.17  following admission; 
  5.18     (2) an annual assessment must be completed within 366 days 
  5.19  of the last comprehensive assessment; 
  5.20     (3) a significant change assessment must be completed 
  5.21  within 14 days of the identification of a significant change; 
  5.22  and 
  5.23     (4) the second quarterly assessment following either a new 
  5.24  admission assessment, an annual assessment, or a significant 
  5.25  change assessment assessments.  Each quarterly assessment must 
  5.26  be completed within 92 days of the previous assessment. 
  5.27     Sec. 3.  Minnesota Statutes 2002, section 256B.438, 
  5.28  subdivision 4, is amended to read: 
  5.29     Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing 
  5.30  facilities shall conduct and submit case mix assessments 
  5.31  according to the schedule established by the commissioner of 
  5.32  health under section 144.0724, subdivisions 4 and 5. 
  5.33     (b) The resident reimbursement classifications established 
  5.34  under section 144.0724, subdivision 3, shall be effective the 
  5.35  day of admission for new admission assessments.  The effective 
  5.36  date for significant change assessments shall be the assessment 
  6.1   reference date.  The effective date for annual and second 
  6.2   quarterly assessments shall be the first day of the month 
  6.3   following assessment reference date.