Minnesota Department of Health

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HOW TO SUBMIT A REQUEST FOR RECONSIDERATION
OF A NURSING FACILITY CASE MIX CLASSIFICATION

A request for reconsideration can be processed promptly and a response sent to the facility in a timely manner when the request is submitted with all the required information.

When to submit? No more than 30 days after receipt of the classification list/letter

• What to include?
  1. Completed Transmittal Sheet. See attachment VI of the manual.
  
  2. A copy of the assessment form with the items you believe to be incorrect items circled.
  
  3. Documentation from the resident's medical record supporting the requested change(s), e.g.:
  • a. Nursing notes describing the resident's care needs and which services were provided on and prior to the date of the assessment.
    b. Physician notes/orders.
    c. A copy of the interdisciplinary care plan.
    d. Any other information which may support the request (e.g. diagnoses, admitting orders, medication/treatment sheets, behavior management plan, clinical monitoring data.

  4. For requests initiated by the facility: A copy of the notice informing the resident that the facility has requested a reconsideration. See page 2 for more information and a sample notification letter)

How long does it take? The Department has 15 working days after receiving all the information to notify the facility in writing of the result.

Denial of a request is usually based on one or more of the following reasons:

1. The request was not submitted within 30 days after receipt of the classification letter.

2. The documentation does not support a change in the classification because (a) it was insufficient to establish a dependency or (b) it covered a time period after the assessment date.

3. The requested change in the assessment, if granted, would not result in a change in the classification.

4. No written notice regarding the facility's intent to submit a request was given to the resident or the resident's representative, or a copy of that notice was not submitted with the request.

5. The assessment in question was audited by the Health Department simultaneously with the submission of the request for reconsideration. Since the audit is based on the same information as was submitted with reconsideration there is not need to process both. The determination is based on the audit result.

(Continued next page)

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Updated Tuesday, 16-Nov-2010 08:51:38 CST