Leadership Insights: MN Reimbursement Changes

Minnesota Medicaid Changes – Is Your facility Prepared for Success?

Over the years, long-term care has seen many changes. The environment is entrenched with the need to understand the history and the reasons for all of the change! How does a new LTC professional keep their head above water while desperately attempting to maneuver the waves and rip tides? Minnesota nursing home Medicaid reimbursement has undergone dramatic change for 2016. 
Many facilities have experienced an increase in payment rates, a few have not received any changes in rates and there are some facilities with lower rates that experienced in 2015. The changes were effective January 1, 2016.

Minnesota legislature took action to align state reimbursement with the changes in federal reimbursement. CMS is making direct connections between quality outcomes and payment rates for Medicare through a variety of innovations, including ACOs and Bundled payments. The new Minnesota Medicaid reimbursement system mirrors the CMS payment transformation to Value-Based Purchasing.

The facility’s operating costs will now be more accurately reimbursed, including the costs of employee health insurance and other operating costs that have risen dramatically in the last few years. The Care component of facility rates is affected by resident acuity and quality.

MDS Considerations: 

Resident acuity is represented by a case mix index score for each Medicaid RUG category in Minnesota. The RUG case mix index is derived from Minimum Data Set (MDS) coding. The MDS is the source for both case mix and Quality Indicator (QI) data. MDS nurses need to have the resources and time to complete MDSs accurately and timely to provide the best regulatory and reimbursement outcomes for the facility. Ensure the following:

  • Do you have the right number of MDS nurses to achieve the best MDS coding?
  • Do they have the best computers the facility can provide?
  • Have they been asked to add tasks to their job that take time away from accurate, complete, timely MDS completion?

Consider how to best support the most efficient and effective MDS performance. The facility’s Quality score also has an impact on care related payment rates.

Quality Indicators Impact:
The Quality Score is comprised of the 10 domains of Minnesota Quality Indicators (QI), the facility’s
Quality of Life score and the facility’s annual survey outcomes. The QI score can be up to 50 points. The Quality of Life score can be up to 40 points and the survey history score can be up to 10 points. This score is used to determine the facility’s care related upward limit for rate increases.

The Minnesota QI scores are derived from MDS data. A facility can impact its’ Quality Indicators by examining the QI reports regularly and addressing variations from state average scores. A Performance Improvement plan to address system issues that contribute to high QI scores can enhance reimbursement for the following year. Additionally, improvement in care systems positively impacts the quality of care for residents and improves survey outcomes.

  • Do you review the facility’s QI report routinely?
  • Do you have an active QAPI process for addressing QI scores that need improvement?

Technology Adoption & Improvement:
Minnesota Performance Incentive Payment Program (PIPP) grants remain available for 2016. The State legislature has reinstated the use of PIPP grant dollars for adoption of technology. With the use of data as the driving force for reimbursement and quality it is important to have comprehensive and robust health information systems, decision-support software, data analytics software and a healthy electronic billing system. Additionally, CMS continues the drive for interoperable health information exchange between the segments of the health care continuum. Is now is the time to consider new or improved technology in your facility?

Data has become the framework for healthcare reimbursement, quality and survey success. Minnesota’s new reimbursement structure reflects the federal initiates that provide higher reimbursement for high quality and positive resident outcomes. Are you prepared for success? Contact us to learn more.

Karolee Alexander, RN, RAC-CT,
Director of Reimbursement and Clinical Consulting,
Pathway Health