Minnesota Case Mix Review Program

This information is intended for Long Term Care Facility Administrators, Directors of Nursing, Minimum Data Set (MDS) Coordinators, and staff who work with the MDS.

New data elements added to Quarterly Assessments

Effective 10/1/24, I0100 (Cancer), I3700 (Arthritis) and I6500 (Cataracts, Glaucoma and Macular Degeneration) are required on all quarterly assessments. These items do not appear on the Optional State Assessment (OSA) as they do not impact payment. Contact your software vendor if these items do not appear on your quarterly assessments.

Prevent delays in processing payments

• Staff must ensure that the Therapy and Isolation Start and End Dates are correctly entered on all Omnibus Budget Reconciliation Act (OBRA) comprehensive assessments, OBRA non-comprehensive assessments and OSA, when appropriate. When these dates are not on the assessment, this assessment will not be immediately processed, requiring a call from the Case Mix Review staff for further information.
• Staff must ensure the OBRA assessment and the corresponding OSA are submitted in the same batch.

When to complete an OSA

The OSA is required for most admissions to nursing facilities that are Medicare and Medicaid certified, regardless of who the payer is. The OSA is not required with Perspective Payment System (PPS) assessments, Discharge Assessments and Tracking Records. The OSA is required:

• Each time an OBRA comprehensive, quarterly or Significant Correction to prior Quarterly Assessment (SCQA) assessment is completed, and
• When all therapy and isolation services end, if the most recent OSA resulted in a rehabilitation RUG-IV classification in Z0200A or isolation was coded on the assessment.
• The OSA should not be used as a standalone assessment to capture a higher RUG classification. When completing a Significant Change in Status Assessment (SCSA) staff must ensure the criteria on pages 2-24 to 2-29 of the current RAI manual is met. A SCSA is not required when all therapy or isolation services end.
• The OSA for the end of therapy and the end of isolation cannot have the same ARD as an OBRA assessment. When a OSA has the same ARD as a Quarterly or Comprehensive assessment, the effective date of the OSA is the first of the month following the ARD. The standalone OSA completed when therapy or isolation ends is effective on the ARD of the OSA.

Contact information

If you have any questions, please contact Case Mix Review by email at health.fpc-cmr@state.mn.us or call 651-201-4200.

During the 2024 Legislative Session, Minnesota Statutes 144.0724 Resident Reimbursement Classification was updated to include the changes described below. These changes are important for providers to be aware of when submitting assessments and are effective immediately.

The Minnesota Case Mix Review Manual has been updated to reflect these changes. You can find the full text of the statute and the changes at the Office of the Revisor of Statutes website: Section 144.0724 MN Statutes.

Subdivision 4. Resident assessment schedule

Subdivision 4 has been amended to read:

(c) The optional state assessment must accompany all OBRA assessments. The optional state assessment is also required to determine reimbursement when:

(i) all speech, occupational, and physical therapy have ended. If the most recent optional state assessment completed does not result in a rehabilitation case mix reimbursement classification, then the optional state assessment is not required. The ARD of this assessment must be set on day eight after all therapy services have ended; and 

(ii) isolation for an infectious disease has ended. If isolation was not coded on the most recent optional state assessment completed, then the optional state assessment is not required. The ARD of this assessment must be set on day 15 after isolation has ended.  

Subdivision 6. Penalties for late or non-submission

Subdivision 6 has been amended to read:

(a) A facility that fails to complete or submit an assessment according to subdivisions 4 and 5 for a case mix reimbursement classification when the assessment is due is subject to a reduced rate for that resident. The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the day of admission for new admission assessments, on the ARD for significant change in status assessments, or on the day that the assessment was due for all other assessments and continues in effect until the first day of the month following the date of submission and acceptance of the resident's assessment.

To prevent delays in processing payments, staff must ensure that the therapy and isolation start and end dates are correctly entered on all Prospective Payment System (PPS), Omnibus Budget Reconciliation Act (OBRA) comprehensive, OBRA non-comprehensive assessments, and Optional State Assessment (OSA) when appropriate. When the end of therapy dates, and/or start and end dates for isolation are not on the assessment, this assessment will not be immediately processed requiring a call from the Case Mix Review staff for further information.

Discrepancies in the Resource Utilization Group (RUG) classification between the OSA and the classification letter

If the RUG classification on the OSA does not match the classification letter received on the CMR Portal, review the documentation entered on both the OBRA and OSA to make sure the data matches. If the data does not match in the OBRA and OSA contact Case Mix Review at health.fpc-cmr@state.mn.us.

Short stay facilities

If you have elected to be a short stay facility, neither an OSA and/or admission assessment is required to be completed until the resident is in the facility for more than 14 days.

When to complete an OSA

The OSA is required for most admissions to nursing facilities that are Medicare and Medicaid certified regardless of who the payer is. The OSA is not required with PPS, discharge or entry tracking. The OSA is required:

• Each time an OBRA comprehensive, quarterly, or Significant Correction to prior Quarterly Assessment (SCQA) assessment is completed, and
• When all therapy and isolation services end, if the most recent assessment (either an OBRA assessment with an ARD on or before 9/30/2023 or an OSA with an ARD on or after 10/1/2023) resulted in a rehabilitation or isolation RUG-IV classification in Z0200A.