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Tip Sheets
NURSING HOME RATE CHANGES
Nursing home rates are
established by the state of Minnesota. They can change based
on:
How might my nursing home rates
change?
Nursing home rates may
change for two reasons: when the care needs of the
individual change or when government-approved rates change.
With respect to
government-approved changes, the 2003 session of the
Minnesota legislature allowed a rate variance of $5.56 per
day related to an increase in the surcharge (user fee) the
facility pays to the state. This increase was effective June
1, 2003. While no additional cost of living adjustments were
authorized, the Minnesota Department of Human Services may
permit increases for factors unique to each facility.
Will I receive a notice from the
nursing home about rate changes?
Yes. Nursing facilities must notify the
resident (or the person responsible for payment) in writing
prior to any increase.
With respect to the $5.56 per day
surcharge increase referenced above -and for changes
associated with care needs - there is no required time
period for receiving the written notification.
For most other increases, advance
written
notice of at least 30 days is required. Facilities may meet
this obligation by sending a written notice advising that
rates are expected to go up (without providing specifics.)
Such a notice, most often given when the state has not yet
made a final determination on actual rates, satisfies the
notification requirement when followed by a second notice
announcing the actual amount of the increase.
Please note that facilities are permitted
to charge the amount they anticipate that the state will
authorize with the provision that the facility will refund
(with interest) any amount that exceed what is actually
approved.
Can I appeal a rate increase?
You may appeal an
increase related to care needs (case mix classification).
That appeal process – called a Case Mix Reconsideration
– must start within 30 days of receiving the notification
of the change. Forms to start this process are available
through your nursing home. The Office of Ombudsman for Older
Minnesotans can provide information on the process and help
if you want assistance with the appeal process (phone:
1/800-657-3591.) There is no right to appeal the surcharge
or other government approved rate increase.
Are there other rates I should be
aware of?
Yes. Your nursing home
is permitted to charge 120% of the case mix rate for the
first 30 calendar days of residence. The rationale for the
20% increase is that a resident may require additional care
during the initial period of adjustment to the facility. On
day 31, the rate will be the standard case mix
classification rate determined by the care needs of the
resident.
In the past,
facilities were permitted to charge 110% of the case mix
rate for days 31 to 90. As of July 30, 2003 an enhancement
for days 31 to 90 is no longer permitted.
Should a resident
leave the facility for hospitalization or therapeutic leave,
the facility may charge 60% of the case mix rate for holding
the bed for the resident’s return. (Note: prior to July 1,
2003 the rate was 79%).
Residents may decide
whether or not to pay to have their bed held during these
leave days. If payment is not made to hold the bed, the
facility may choose to start the discharge process by
issuing a 30-day notice of discharge. The resident may
appeal this discharge.
Please be aware that
the facility may also apply the 20% enhanced rate referenced
in the preceding paragraph if the resident has a bed held
during the first 30 days after admission.
For help in understanding your rate
increase or for other assistance, call the Office of
Ombudsman for Older Minnesotans toll-free at
800-657-3591 or 651-431-2555.
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