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REQUEST FOR RECONSIDERATION - RESIDENT
NOTIFICATION
A nursing facility is required to give written notice to a
resident or resident's representative of the facility's intent to
file for a reconsideration of the resident's classification.
State of Minnesota Statute (144.0722) requires that this notice
contain certain information and that a copy of the notice
must be submitted with the reconsideration request to the Health
Department. The request must be denied and no further
requests by the facility on that specific classification will be
allowed if the facility fails to include a copy with the
reconsideration request or if any of the required elements* are
omitted from the notice. Telephone notification to the
resident or the resident's representative is not acceptable.
*The notice must inform the resident of the following:
| 1. |
That a request for reconsideration has
been submitted |
| 2. |
The reason for the request |
| 3. |
That the reimbursement rate for the
resident will change if the request is granted |
| 4 |
The extent of the change in rate |
| 5. |
That copies of the request and
supporting documentation are available for review by the
resident or the resident's representative |
| 6. |
That the resident also has the right to
submit a request for reconsideration if they do not agree
with the determination |
SUGGESTED FORMAT FOR A NOTIFICATION
LETTER
| Name Address
City, State, Zipcode
Date
This notice is to inform you that (Facility
name) is requesting a reconsideration of the
case mix classification assigned to (Resident's
name) by the Minnesota Department of Health.
We feel that the assessment is inaccurate in the
following areas:
The present case mix classification assigned is ,
for which the rate is $ per day.
If the reconsideration request is granted, the case mix
classification would change to , and the rate would be $
per day.
Copies of the request and supporting documentation
are available for your review and may be obtained from
the Director of Nursing. You also have the right to
request a reconsideration if you do not agree with the
determination.
Sincerely,
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Updated Tuesday, 16-Nov-2010 08:51:38 CST
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