Bill Text: MN SF1109 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Nursing facilities private pay rates authority and special services availability requirements modification
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-04-07 - Referred to Health and Human Services [SF1109 Detail]
Download: Minnesota-2011-SF1109-Introduced.html
1.2relating to human services; modifying nursing home rate equalization;amending
1.3Minnesota Statutes 2010, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
1.7medical assistance payments unless it refrains from all of the following:
1.8(a) Charging private paying residents rates for similar services which exceed those
1.9which are approved by the state agency for medical assistance recipients as determined by
1.10the prospective desk audit rate, except under the following circumstances:
1.11(1) the nursing facility may:
1.12(1) (i) charge private paying residents a higher rate for a private room,; and
1.13(2) (ii) charge for special services which are not included in the daily rate if medical
1.14assistance residents are charged separately at the same rate for the same services in
1.15addition to the daily rate paid by the commissioner.;
1.16(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge
1.17private paying residents rates up to two percent higher than the allowable payment rate
1.18determined by the commissioner for the RUGS group currently assigned to the resident;
1.19(3) effective October 1, 2012, through September 30, 2013, nursing facilities
1.20may charge private paying residents rates up to four percent higher than the allowable
1.21payment rate determined by the commissioner for the RUGS group currently assigned
1.22to the resident; and
1.23(4) effective October 1, 2013, through September 30, 2014, nursing facilities may
1.24charge private paying residents rates up to six percent higher than the allowable payment
2.1rate determined by the commissioner for the RUGS group currently assigned to the
2.2resident.
2.3Nothing in this section precludes a nursing facility from charging a rate allowable
2.4under the facility's single room election option under Minnesota Rules, part 9549.0060,
2.5subpart 11. Services covered by the payment rate must be the same regardless of payment
2.6source. Special services, if offered, must be available to all residents in all areas of the
2.7nursing facility and charged separately at the same rate. Residents are free to select
2.8or decline special services. Special services must not include services which must be
2.9provided by the nursing facility in order to comply with licensure or certification standards
2.10and that if not provided would result in a deficiency or violation by the nursing facility.
2.11Services beyond those required to comply with licensure or certification standards must
2.12not be charged separately as a special service if they were included in the payment rate for
2.13the previous reporting year. A nursing facility that charges a private paying resident a rate
2.14in violation of this clause is subject to an action by the state of Minnesota or any of its
2.15subdivisions or agencies for civil damages. A private paying resident or the resident's legal
2.16representative has a cause of action for civil damages against a nursing facility that charges
2.17the resident rates in violation of this clause. The damages awarded shall include three
2.18times the payments that result from the violation, together with costs and disbursements,
2.19including reasonable attorneys' fees or their equivalent. A private paying resident or the
2.20resident's legal representative, the state, subdivision or agency, or a nursing facility may
2.21request a hearing to determine the allowed rate or rates at issue in the cause of action.
2.22Within 15 calendar days after receiving a request for such a hearing, the commissioner
2.23shall request assignment of an administrative law judge under sections14.48 to
14.56 to
2.24conduct the hearing as soon as possible or according to agreement by the parties. The
2.25administrative law judge shall issue a report within 15 calendar days following the close
2.26of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed
2.27as boarding care facilities which are not certified as skilled or intermediate care facilities
2.28level I or II for reimbursement through medical assistance.
2.29(b) Effective October 1, 2014, paragraph (a) no longer applies, except that special
2.30services, if offered, must be available to all residents of the nursing facility and charged
2.31separately at the same rate. Residents are free to select or decline special services. Special
2.32services must not include services which must be provided by the nursing facility in order
2.33to comply with licensure or certification standards and that if not provided would result in
2.34a deficiency or violation by the nursing facility.
2.35(c)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
2.36to the facility, or from anyone acting in behalf of the applicant, as a condition of
3.1admission, expediting the admission, or as a requirement for the individual's continued
3.2stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
3.3as payment under the state plan. For residents on medical assistance, medical assistance
3.4payment according to the state plan must be accepted as payment in full for continued
3.5stay, except where otherwise provided for under statute;
3.6(2) requiring an individual, or anyone acting in behalf of the individual, to loan
3.7any money to the nursing facility;
3.8(3) requiring an individual, or anyone acting in behalf of the individual, to promise
3.9to leave all or part of the individual's estate to the facility; or
3.10(4) requiring a third-party guarantee of payment to the facility as a condition of
3.11admission, expedited admission, or continued stay in the facility.
3.12Nothing in this paragraph would prohibit discharge for nonpayment of services in
3.13accordance with state and federal regulations.
3.14(c) (d) Requiring any resident of the nursing facility to utilize a vendor of health
3.15care services chosen by the nursing facility. A nursing facility may require a resident
3.16to use pharmacies that utilize unit dose packing systems approved by the Minnesota
3.17Board of Pharmacy, and may require a resident to use pharmacies that are able to meet
3.18the federal regulations for safe and timely administration of medications such as systems
3.19with specific number of doses, prompt delivery of medications, or access to medications
3.20on a 24-hour basis. Notwithstanding the provisions of this paragraph, nursing facilities
3.21shall not restrict a resident's choice of pharmacy because the pharmacy utilizes a specific
3.22system of unit dose drug packing.
3.23(d) (e) Providing differential treatment on the basis of status with regard to public
3.24assistance.
3.25(e) (f) Discriminating in admissions, services offered, or room assignment on the
3.26basis of status with regard to public assistanceor refusal to purchase special services.
3.27Discrimination in admissionsdiscrimination, services offered, or room assignment shall
3.28include, but is not limited to:
3.29(1) basing admissions decisions uponassurance by the applicant to the nursing
3.30facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
3.31nor will seek information or assurances regarding current or future eligibility for public
3.32assistance for payment of nursing facility carecosts; and
3.33(2) engaging in preferential selection from waiting lists based on an applicant's
3.34ability to pay privately or an applicant's refusal to pay for a special service.
3.35The collection and use by a nursing facility of financial information of any applicant
3.36pursuant to a preadmission screening program established by law shall not raise an
4.1inference that the nursing facility is utilizing that information for any purpose prohibited
4.2by this paragraph.
4.3(f) (g) Requiring any vendor of medical care as defined by section
256B.02,
4.4subdivision 7 , who is reimbursed by medical assistance under a separate fee schedule,
4.5to pay any amount based on utilization or service levels or any portion of the vendor's
4.6fee to the nursing facility except as payment for renting or leasing space or equipment
4.7or purchasing support services from the nursing facility as limited by section256B.433 .
4.8All agreements must be disclosed to the commissioner upon request of the commissioner.
4.9Nursing facilities and vendors of ancillary services that are found to be in violation of
4.10this provision shall each be subject to an action by the state of Minnesota or any of its
4.11subdivisions or agencies for treble civil damages on the portion of the fee in excess of that
4.12allowed by this provision and section256B.433 . Damages awarded must include three
4.13times the excess payments together with costs and disbursements including reasonable
4.14attorney's fees or their equivalent.
4.15(g) (h) Refusing, for more than 24 hours, to accept a resident returning to the same
4.16bed or a bed certified for the same level of care, in accordance with a physician's order
4.17authorizing transfer, after receiving inpatient hospital services.
4.18(i) For a period not to exceed 180 days, the commissioner may continue to make
4.19medical assistance payments to a nursing facility or boarding care home which is in
4.20violation of this section if extreme hardship to the residents would result. In these cases
4.21the commissioner shall issue an order requiring the nursing facility to correct the violation.
4.22The nursing facility shall have 20 days from its receipt of the order to correct the violation.
4.23If the violation is not corrected within the 20-day period the commissioner may reduce
4.24the payment rate to the nursing facility by up to 20 percent. The amount of the payment
4.25rate reduction shall be related to the severity of the violation and shall remain in effect
4.26until the violation is corrected. The nursing facility or boarding care home may appeal the
4.27commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
4.28cases. An appeal shall be considered timely if written notice of appeal is received by the
4.29commissioner within 20 days of notice of the commissioner's proposed action.
4.30In the event that the commissioner determines that a nursing facility is not eligible
4.31for reimbursement for a resident who is eligible for medical assistance, the commissioner
4.32may authorize the nursing facility to receive reimbursement on a temporary basis until the
4.33resident can be relocated to a participating nursing facility.
4.34Certified beds in facilities which do not allow medical assistance intake on July 1,
4.351984, or after shall be deemed to be decertified for purposes of section144A.071 only.
1.3Minnesota Statutes 2010, section 256B.48, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
1.6 Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
1.7medical assistance payments unless it refrains from all of the following:
1.8(a) Charging private paying residents rates for similar services which exceed those
1.9which are approved by the state agency for medical assistance recipients as determined by
1.10the prospective desk audit rate, except under the following circumstances:
1.11(1) the nursing facility may:
1.12
1.13
1.14assistance residents are charged separately at the same rate for the same services in
1.15addition to the daily rate paid by the commissioner
1.16(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge
1.17private paying residents rates up to two percent higher than the allowable payment rate
1.18determined by the commissioner for the RUGS group currently assigned to the resident;
1.19(3) effective October 1, 2012, through September 30, 2013, nursing facilities
1.20may charge private paying residents rates up to four percent higher than the allowable
1.21payment rate determined by the commissioner for the RUGS group currently assigned
1.22to the resident; and
1.23(4) effective October 1, 2013, through September 30, 2014, nursing facilities may
1.24charge private paying residents rates up to six percent higher than the allowable payment
2.1rate determined by the commissioner for the RUGS group currently assigned to the
2.2resident.
2.3Nothing in this section precludes a nursing facility from charging a rate allowable
2.4under the facility's single room election option under Minnesota Rules, part 9549.0060,
2.5subpart 11. Services covered by the payment rate must be the same regardless of payment
2.6source. Special services, if offered, must be available to all residents in all areas of the
2.7nursing facility and charged separately at the same rate. Residents are free to select
2.8or decline special services. Special services must not include services which must be
2.9provided by the nursing facility in order to comply with licensure or certification standards
2.10and that if not provided would result in a deficiency or violation by the nursing facility.
2.11Services beyond those required to comply with licensure or certification standards must
2.12not be charged separately as a special service if they were included in the payment rate for
2.13the previous reporting year. A nursing facility that charges a private paying resident a rate
2.14in violation of this clause is subject to an action by the state of Minnesota or any of its
2.15subdivisions or agencies for civil damages. A private paying resident or the resident's legal
2.16representative has a cause of action for civil damages against a nursing facility that charges
2.17the resident rates in violation of this clause. The damages awarded shall include three
2.18times the payments that result from the violation, together with costs and disbursements,
2.19including reasonable attorneys' fees or their equivalent. A private paying resident or the
2.20resident's legal representative, the state, subdivision or agency, or a nursing facility may
2.21request a hearing to determine the allowed rate or rates at issue in the cause of action.
2.22Within 15 calendar days after receiving a request for such a hearing, the commissioner
2.23shall request assignment of an administrative law judge under sections
2.24conduct the hearing as soon as possible or according to agreement by the parties. The
2.25administrative law judge shall issue a report within 15 calendar days following the close
2.26of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed
2.27as boarding care facilities which are not certified as skilled or intermediate care facilities
2.28level I or II for reimbursement through medical assistance.
2.29(b) Effective October 1, 2014, paragraph (a) no longer applies, except that special
2.30services, if offered, must be available to all residents of the nursing facility and charged
2.31separately at the same rate. Residents are free to select or decline special services. Special
2.32services must not include services which must be provided by the nursing facility in order
2.33to comply with licensure or certification standards and that if not provided would result in
2.34a deficiency or violation by the nursing facility.
2.35(c)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
2.36to the facility, or from anyone acting in behalf of the applicant, as a condition of
3.1admission, expediting the admission, or as a requirement for the individual's continued
3.2stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
3.3as payment under the state plan. For residents on medical assistance, medical assistance
3.4payment according to the state plan must be accepted as payment in full for continued
3.5stay, except where otherwise provided for under statute;
3.6(2) requiring an individual, or anyone acting in behalf of the individual, to loan
3.7any money to the nursing facility;
3.8(3) requiring an individual, or anyone acting in behalf of the individual, to promise
3.9to leave all or part of the individual's estate to the facility; or
3.10(4) requiring a third-party guarantee of payment to the facility as a condition of
3.11admission, expedited admission, or continued stay in the facility.
3.12Nothing in this paragraph would prohibit discharge for nonpayment of services in
3.13accordance with state and federal regulations.
3.14
3.15care services chosen by the nursing facility. A nursing facility may require a resident
3.16to use pharmacies that utilize unit dose packing systems approved by the Minnesota
3.17Board of Pharmacy, and may require a resident to use pharmacies that are able to meet
3.18the federal regulations for safe and timely administration of medications such as systems
3.19with specific number of doses, prompt delivery of medications, or access to medications
3.20on a 24-hour basis. Notwithstanding the provisions of this paragraph, nursing facilities
3.21shall not restrict a resident's choice of pharmacy because the pharmacy utilizes a specific
3.22system of unit dose drug packing.
3.23
3.24assistance.
3.25
3.26basis of status with regard to public assistance
3.27Discrimination in admissions
3.28include, but is not limited to:
3.29(1) basing admissions decisions upon
3.30
3.31
3.32assistance for payment of nursing facility care
3.33(2) engaging in preferential selection from waiting lists based on an applicant's
3.34ability to pay privately or an applicant's refusal to pay for a special service.
3.35The collection and use by a nursing facility of financial information of any applicant
3.36pursuant to a preadmission screening program established by law shall not raise an
4.1inference that the nursing facility is utilizing that information for any purpose prohibited
4.2by this paragraph.
4.3
4.4subdivision 7
4.5to pay any amount based on utilization or service levels or any portion of the vendor's
4.6fee to the nursing facility except as payment for renting or leasing space or equipment
4.7or purchasing support services from the nursing facility as limited by section
4.8All agreements must be disclosed to the commissioner upon request of the commissioner.
4.9Nursing facilities and vendors of ancillary services that are found to be in violation of
4.10this provision shall each be subject to an action by the state of Minnesota or any of its
4.11subdivisions or agencies for treble civil damages on the portion of the fee in excess of that
4.12allowed by this provision and section
4.13times the excess payments together with costs and disbursements including reasonable
4.14attorney's fees or their equivalent.
4.15
4.16bed or a bed certified for the same level of care, in accordance with a physician's order
4.17authorizing transfer, after receiving inpatient hospital services.
4.18(i) For a period not to exceed 180 days, the commissioner may continue to make
4.19medical assistance payments to a nursing facility or boarding care home which is in
4.20violation of this section if extreme hardship to the residents would result. In these cases
4.21the commissioner shall issue an order requiring the nursing facility to correct the violation.
4.22The nursing facility shall have 20 days from its receipt of the order to correct the violation.
4.23If the violation is not corrected within the 20-day period the commissioner may reduce
4.24the payment rate to the nursing facility by up to 20 percent. The amount of the payment
4.25rate reduction shall be related to the severity of the violation and shall remain in effect
4.26until the violation is corrected. The nursing facility or boarding care home may appeal the
4.27commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
4.28cases. An appeal shall be considered timely if written notice of appeal is received by the
4.29commissioner within 20 days of notice of the commissioner's proposed action.
4.30In the event that the commissioner determines that a nursing facility is not eligible
4.31for reimbursement for a resident who is eligible for medical assistance, the commissioner
4.32may authorize the nursing facility to receive reimbursement on a temporary basis until the
4.33resident can be relocated to a participating nursing facility.
4.34Certified beds in facilities which do not allow medical assistance intake on July 1,
4.351984, or after shall be deemed to be decertified for purposes of section
