Long-Term Care

Skilled Nursing Facilities (SNF) or boarding care homes (BCH) certified by MDH are eligible to provide long-term care (LTC) services. Swing Bed hospital provider eligibility information is specified in the Swing Bed section of this chapter.

Facilities with distinct part certification must admit and care only for those PrimeWest Health members certified as requiring the same level of care as the bed certification.

Exemption: An SNF that is operated, listed, and certified as a Christian Science sanatorium by the First Church of Christ, Scientist, of Boston, Massachusetts, is not subject to the Federal regulations for utilization control in order to receive PrimeWest Health payments for the cost of member care.

MN Stat. sec. 256B.48, subd. 1 provides that a nursing home is not eligible to receive Medical Assistance (Medicaid) payments unless it refrains from requiring any resident of the nursing facility (NF) to utilize a vendor of health care services chosen by the NF.

MN Stat. sec. 256B.48, subd. 1 addresses payment agreements between nursing homes and providers of ancillary medical care. It provides that a nursing home is not eligible to receive Medical Assistance (Medicaid) payments unless it refrains from requiring any vendor of medical care (as defined by MN Stat. sec. 256B.02, subd. 7), who is reimbursed by Medical Assistance (Medicaid) under a separate fee schedule, to pay any portion of the provider’s fee to the nursing home except as payment for renting or leasing space or equipment or purchasing support services from the NF as limited by MN Stat. sec. 256B.433.

MN Stat. sec. 256B.48, subd. 1 addresses payment rates and special services for nursing homes and its private pay residents. It provides that a nursing home is not eligible to receive Medical Assistance (Medicaid) payments unless it refrains from requiring its residents to pay more than its Medical Assistance (Medicaid) rate for similar services. Exceptions are made for the following:

1. Private paying residents in private/single bedrooms; and
2. Special services not included in the daily rate, if Medical Assistance (Medicaid) residents are charged the same rate for the same service.

In addition, an NF participating in the demonstration project under MN Stat. sec. 256B.434 may charge private pay residents up to the Medicare rate for the first 100 days after admission only if the private pay resident’s stay is less than 101 days. Refer to this Statute for additional details of these provisions. Legal references are also included at the end of this chapter.

Conditions of Participation

Termination of Provider Agreement

An LTCF that chooses not to comply with the Equalization Law may voluntarily withdraw or involuntarily be withdrawn from the Medicaid program. Under most of these circumstances, the provider becomes ineligible to receive payment under other State and county programs. Special laws apply to nursing facility providers that withdraw from the Medicaid program (contact Nursing Home Rates and Policy at 1-651-431-2281 for more information). If discharge of residents is necessary, discharge planning and relocation must be done in accordance with all provisions of State and Federal Resident Rights and the State Resident Relocation Law.

Segregation of Medicaid Residents

Partial certification or de-certification of a distinct part of a nursing facility may result in the segregation of Medical Assistance (Medicaid) residents. These practices discriminate against residents based on their source of funding and may violate both the Equalization Law and anti-discrimination laws. DHS will not enroll facilities that stigmatize residents receiving public assistance or practice other forms of resident discrimination. LTCFs that intend to or have segregated Medical Assistance (Medicaid) residents will be investigated by DHS.

Solicitation of Contributions

Federal law prohibits soliciting contributions, donations, or gifts directly from Medical Assistance (Medicaid) residents or family members. General public appeals for contributions are not considered direct solicitation of Medical Assistance (Medicaid) residents or families. If a Medical Assistance (Medicaid) resident or family member makes a free-will contribution, the LTC provider is required to execute a statement for signature by the contributor and the LTC administrator, stating services provided in the LTCF are not predicated upon contributions or donations and the gifts are free-will contributions.

Change of Ownership

The Social Security Act requires an LTCF to promptly report any organizational or ownership changes to MDH to maintain enrollment with PrimeWest Health. MDH will determine if the LTCF continues to meet minimal State and Federal standards under new ownership. MDH will submit copies of the certification to the LTCF, PrimeWest Health, and the county.

If PrimeWest Health receives notification that an entity has changed ownership, PrimeWest Health will follow up with the provider to see if the provider wants to continue to be part of the PrimeWest Health network. If the provider does, PrimeWest Health will send them the appropriate documents to reflect the change. Once PrimeWest Health has received the appropriate documents, it will inactivate the old “owner” and make a new entry in Provider Management Application (PMA) with the new/updated information with the effective date of the change.

According to State law, the owner of the LTCF is liable for any overpayment amount owed by a former owner for any facility sold, transferred, or reorganized.