Minnesota Administrative Rules

9549.0056 DETERMINATION OF OPERATING COST PAYMENT RATE.

Subpart 1.

Nonadjusted case mix and other care related payment rate.

For each nursing facility, the nonadjusted case mix and other care related payment rate for each resident class must be determined according to items A to D.

A.

The nursing facility's allowable historical case mix operating cost standardized per diem established in part 9549.0054, subpart 3, must be multiplied by the weight for each resident class listed in part 9549.0058.

B.

The allowable historical other care related operating cost per diem established in part 9549.0054, subpart 4, must be added to each weighted per diem established in item A.

C.

If the amount determined in item B for each resident class is below the limit for that resident class and group established in part 9549.0055, subpart 2, item C, as indexed in part 9549.0055, subpart 3, the nursing facility's nonadjusted case mix and other care related payment rate must be the amount determined in item B for each resident class.

D.

If the amount determined in item B for each resident class is at or above the limit for that resident class and group established in part 9549.0055, subpart 2, item C, as indexed in part 9549.0055, subpart 3, the nursing facility's nonadjusted case mix and other care related payment rate must be set at the limit.

Subp. 2.

Adjusted prospective case mix and other care-related payment rate.

For each nursing facility, the adjusted prospective case mix and other care-related payment rate for each resident class must be the nonadjusted case mix and other care-related payment rate multiplied by the case mix and other care-related adjustment factor determined in part 9549.0055, subpart 1, item A. If the nursing facility is eligible to receive the phase in in subpart 7, the phase in reduced by the amount of the efficiency incentive, if any, must be added to the adjusted prospective case mix and other care-related payment rate.

Subp. 3.

Nonadjusted other operating cost payment rate.

The nonadjusted other operating cost payment rate must be determined according to items A and B.

A.

If the allowable historical other operating cost per diem determined in part 9549.0054, subpart 5, is below the limit for that group established in part 9549.0055, subpart 2, item E, as indexed in part 9549.0055, subpart 3, the nursing facility's nonadjusted other operating cost payment rate must be the allowable historical other operating cost per diem.

B.

If the allowable historical other operating cost per diem determined in part 9549.0054, subpart 5, is at or above the limit for that group established in part 9549.0055, subpart 2, item E, as indexed in part 9549.0055, subpart 3, the nursing facility's nonadjusted other operating cost payment rate must be set at that limit.

Subp. 4.

Adjusted prospective other operating cost payment rate.

The adjusted prospective other operating cost payment rate must be determined according to items A to D.

A.

Except as provided in item B, if the nursing facility's nonadjusted other operating cost payment rate is below the limit for that group established in part 9549.0055, subpart 2, item E, as indexed in part 9549.0055, subpart 3, the nursing facility's adjusted prospective other operating cost payment rate must be the nonadjusted other operating cost payment rate determined in subpart 3, item A, multiplied by the other operating cost adjustment factor determined in part 9549.0055, subpart 1, item B, plus an efficiency incentive equal to the difference between the limit in part 9549.0055, subpart 2, item E, as indexed in part 9549.0055, subpart 3, and the nonadjusted other operating cost payment rate in subpart 3 up to a maximum of two dollars per resident day.

B.

For any short length of stay facility and any nursing facility licensed on June 1, 1983, by the commissioner to provide residential services for persons with physical disabilities under parts 9570.2000 to 9570.3600 that is under the limits established in part 9549.0055, subpart 2, item E, subitem (3), as indexed in part 9549.0055, subpart 3, the nursing facility's adjusted prospective other operating cost payment rate must be the nonadjusted other operating cost payment rate determined in subpart 3, item A, multiplied by the other operating cost adjustment factor determined in part 9549.0055, subpart 1, item B, plus an efficiency incentive equal to the difference between the limit in part 9549.0055, subpart 2, item E, subitem (2), as indexed in part 9549.0055, subpart 3, and the nonadjusted other operating cost payment rate in subpart 3, up to a maximum of two dollars per resident day.

C.

If the nursing facility's nonadjusted other operating cost payment rate is at or above the limit for that group established in part 9549.0055, subpart 2, item E, as indexed in part 9549.0055, subpart 3, the nursing facility's adjusted prospective other operating cost payment rate must be the nonadjusted other operating cost payment rate determined in subpart 3, item B, multiplied by the other operating cost adjustment factor determined in part 9549.0055, subpart 1, item B, except as provided in subpart 7.

D.

If the nursing facility is eligible to receive the phase in in subpart 7, the phase in must be added to the adjusted prospective other operating cost payment rate.

Subp. 5.

Total operating cost payment rate.

The nursing facility's total operating cost payment rate must be the sum of the adjusted prospective case mix and other care related payment rate determined in subpart 2 and the adjusted other operating cost payment rate determined in subpart 4.

Subp. 6.

One-time adjustment.

Items A to F set forth the procedure to be applied to establish a one-time adjustment to the nursing facility's case mix operating costs per diem for the period October 1, 1986, to September 30, 1987.

A.

To qualify for a one-time adjustment to the case mix operating costs per diem, the nursing facility or portion of the nursing facility for which the adjustment is requested must be licensed under Minnesota Statutes, chapter 144A and the nursing facility must not have received an interim or settle up payment rate during the reporting year ending September 30, 1985.

B.

To apply for the one-time adjustment to case mix operating costs per diem, the nursing facility must have submitted a written request to the commissioner on or before July 31, 1986. The written request must include the information required in subitems (1) to (3).

(1)

Documentation indicating that based on the productive nursing hours and standardized resident days for the reporting period, ending September 30, 1985, the nursing facility cannot provide a minimum of 0.95 productive nursing hours per standardized resident day by reallocating existing staff and costs and that the nursing facility cannot use other available resources, including any efficiency incentives effective July 1, 1986, to increase productive nursing hours to meet the minimum of 0.95 productive nursing hours per standardized resident day.

(2)

A list of the number and type of staff positions including annual hours worked, and related fringe benefits and payroll taxes for the reporting years ending September 30, 1984 and September 30, 1985.

(3)

A written nursing plan describing how the nursing facility will meet the minimum of 0.95 productive nursing hours per standardized resident day if the nursing facility receives a one-time adjustment. The plan must include the number and types of staff to be added to the current staff complement and the projected cost of the salary and related fringe benefits and payroll taxes for the additional staff. The plan must also specify any other increases in case mix operating costs.

C.

The commissioner of human services and the commissioner of health shall review the documentation submitted by the nursing facility under item B to determine if the nursing facility meets the criteria in subitems (1) to (5).

(1)

The nursing facility meets the criteria in item A.

(2)

The nursing facility has submitted the documentation required in item B.

(3)

The nursing facility provided less than a minimum of 0.95 productive nursing hours per standardized resident day for the reporting period ending September 30, 1985.

(4)

The nursing facility cannot meet the minimum of 0.95 productive nursing hours per standardized resident day by reallocating staff and costs including efficiency incentives.

(5)

The nursing facility's allowable historical case mix and other care related operating cost per diem plus the one-time adjustment is less than the case mix and other care related operating cost limit.

D.

If the request meets the criteria in item C, the commissioner shall make a one-time adjustment to the nursing facility's payment rate. The one-time adjustment must be determined according to subitems (1) to (9) and must not exceed the amount computed in subitem (3).

(1)

The nursing facility's productive nursing hours per standardized resident day for the reporting period ending September 30, 1985, must be subtracted from 0.95 and the result must be multiplied by the nursing facility's standardized resident days for the period beginning October 1, 1984, and ending September 30, 1985.

(2)

The nursing facility's nursing cost per hour must be determined by dividing the nursing facility's total allowable historical case mix operating costs by the nursing facility's total productive nursing hours for the reporting period ending September 30, 1985.

(3)

The amount determined in subitem (1) must be multiplied by the amount determined in subitem (2) to determine the total maximum nursing costs required to meet the minimum of 0.95 productive nursing hours per standardized resident day.

(4)

If the amount requested in the nursing hours plan submitted under item B is less than the amount in subitem (3) the difference must be subtracted from the amount in subitem (3).

(5)

The amount determined in subitem (4) must be divided by the nursing facility's standardized resident days for the reporting period ending September 30, 1985, to compute the maximum standardized case mix per diem costs to be allowed under this subpart.

(6)

Any efficiency incentive included in the nursing facility's total operating costs payment on July 1, 1986, must be subtracted from the amounts in subitem (5).

(7)

Any further reduction that the commissioner determines would be possible by reallocating the nursing facility's staff and costs must be subtracted from the amount computed in subitem (6).

(8)

The amount computed in subitem (7) must be multiplied by the weight for each resident class contained in part 9549.0058, subpart 2.

(9)

The amount computed in subitem (8) must be added to the adjusted prospective case mix and other care related payment rates for each corresponding resident class.

E.

The one-time adjustment determined in item D, subitem (9) shall be implemented beginning October 1, 1986. No portion of the adjustment may be used to provide services that are not case mix operating costs according to part 9549.0051, subpart 5. The commissioner shall perform a fiscal review of the nursing facility's cost report submitted for the reporting period ending September 30, 1987, and of any additional documentation required by the commissioner to determine if the nursing facility provided 0.95 productive nursing hours per standardized resident day and to determine whether the nursing facility has implemented the provisions of the plan specified in item B. The commissioner shall consult with the commissioner of health to verify compliance with any applicable care related licensing or certification standards. Based on the results of the fiscal review and the information provided by the commissioner of health, the commissioner shall implement either subitem (1), (2), or (3).

(1)

If the nursing facility has failed to implement the plan required in item B, the commissioner shall recover the total amount paid under this subpart in accordance with part 9549.0070, subpart 4 and shall disallow any increases in costs incurred by the nursing facility under this subpart in establishing the payment rate for the rate year beginning July 1, 1988.

(2)

If the nursing facility has implemented or partially implemented the plan specified in item B and the actual case mix operating costs incurred during the reporting year ending September 30, 1987, are below the payment made under this subpart, the commissioner shall reduce the adjustment to the nursing facility's payment rate and recover any overpayments in accordance with part 9549.0070, subpart 4. The reduced adjustment to the nursing facility's total payment rate shall continue to be paid to the nursing facility until June 30, 1988.

(3)

If the actual costs of implementing the plan specified in item B, subitem (3) incurred during the reporting period ending September 30, 1987, exceed the payments made under this subpart there shall be no retroactive cost settle up. The adjustment to the nursing facility's total payment rate shall continue to be paid to the nursing facility at the same level until June 30, 1988.

F.

The nursing facility must record the costs associated with this subpart separately from other nursing facility costs until the commissioner's fiscal and compliance review under item E establishes that the nursing facility has implemented the plan required in item B and has provided at least 0.95 productive nursing hours per standardized resident day during the reporting period ending September 30, 1987. To prevent duplicate payments, the case mix operating costs associated with this subpart are nonallowable until after the commissioner has reviewed and approved the costs under item E. If the commissioner approves the costs, the additional case mix operating costs incurred under this subpart are allowable costs and must be included in the computation of the allowable historical case mix operating cost per diem for the rate year beginning July 1, 1988.

Subp. 7.

Phase in of rates.

Nursing facility rate limits shall be phased in in accordance with Minnesota Statutes, section 256B.431, subdivision 2h.

Statutory Authority:

MS s 256B.41; 256B.431

History:

11 SR 1990; L 1992 c 513 art 7 s 136; L 2005 c 56 s 2

Published Electronically:

August 12, 2013