Case Mix Review
Minnesota Case Mix Review Program
Minnesota Case Mix is a system that classifies residents into distinct groups, called Resource Utilization Groups (RUGs), based on the resident’s condition and the care the resident receives. These groups determine the daily rate the facility charges for the resident's care. DHS assigns a value to each classification, which they use to calculate the daily rate of payment for private pay and Medicaid stays.
Announcements
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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 nonsubmission
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 noncomprehensive 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.
A new Frequently-Asked Questions page has been added to the Minnesota Case Mix Review website. This page includes answers to questions that Case Mix Review staff have received about the Optional State Assessment and Section S of the OBRA Assessment. It also includes updated information about the 2021 statute changes for determining when the OSA is required at the end of therapy and isolation services.
Revisions have also been made to Appendix D of the Minnesota Case Mix Review Manual regarding the coding of A0300B.
- A0300B must = 5 indicating other payment assessment in all situations.
Guidance and Information
- Minnesota Case Mix Review Manual (PDF) (updated June 2024)
- Case Mix Review Frequently-Asked Questions: Answers to common questions about the MDS 3.0 and Optional State Assessment (OSA).
- Prevent delays in payments by correctly entering Therapy Start and End Dates (PDF) (07/2022)
- Information for Residents, their Families, and Responsible Parties
- Information to help residents and families better understand the Case Mix System.
- Case Mix Information for Providers
- Information designed for providers including the Case Mix Classification Manual for Nursing Facilities.
- MDS and RAI Information
- Information about the MDS assessment instrument and the RAI manual including links to pertinent CMS web pages.