Minnesota Case Mix Review Program

On October 1, 2002, the Minnesota Department of Human Services and the Minnesota Department of Health implemented a new case mix system for nursing homes certified for medical assistance. The case mix system is based on the federally required minimum data set (MDS). The RUGS-III, 34 group model is used to establish a case mix classification.

From this page you can read and download forms, manuals, and other information pertaining to the new system.

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Contact Us

WHO TO CALL FOR HELP-- Click here if you need to talk to someone about the new Case Mix System, or need help viewing or downloading forms. (pdf) Revised 9/6/2006

EMAIL CASE MIX REVIEW--Click here to contact Case Mix Review by Email, or send an email message to health.FPC-CMR@state.mn.us

News and Announcements

A document titled Recommendations for Documentation of MDS Assessments has been posted in the Case Mix Clarifications and Guidance Topic area under 'Documentation'. The document provides recommendations for documenting MDS assessments used for case mix.

Resident Classification Notices to be Transmitted Electronically - The 2008 Minnesota Legislature amended Minnesota Statutes § 144.0724 to require that the Minnesota Department of Health (MDH) transmit the notice of resident classification by electronic means to nursing facilities. The nursing facility then prints and distributes the classification notices to the resident or resident’s representative within three (3) business days of receipt of the notices. Effective August 1, 2008, the legislation deletes the provision for nursing homes to elect the option of receiving the case mix classification notices by first class mail from MDH.

The Election Period for Making the Annual Election for Short Stay Residents – Nursing facilities have from May 19, 2008, thru June 20, 2008, to make their annual election for short stay residents in the Minnesota Case Mix Review Program.

2009 Election Letter and Instructions - Click here to view the election letter and instructions for 2009.

Instructions for Accessing Electronic Case Mix Classification Notices – The “Instructions for Accessing Electronic Case Mix Classification Notices” have been updated. Click here to view instructions for accessing and printing case mix classification notices.

Audit of Minnesota Quality Indicators/Quality Measures - Beginning December 2007, the Case Mix Review program began auditing selected minimum data set (MDS) items that are used to compute both the federal and Minnesota quality indicators (QI) and quality measures (QM). For additional information Click Here to read the informational bulletin.

Consumer Pamphlet Update - The Consumer Pamphlet has been updated to reflect the change to using all quarterly assessments for Case Mix Classification. We have also updated all telephone numbers within the pamphlet. Updated: 4/22/08.

CMS Educational Programs - Educational programs provided by Centers for Medicare and Medicaid Services (CMS) can be viewed at: http://www.cms.internetstreaming.com Participants must register the first time. There is no charge to view the programs. They are available to view for one year after the program completion date.

Case Mix Manuals

Facility Manual for Case Mix Classification Document size 1M, long download time may occur. Facility Manual for Case Mix Classification dated 3/21/03 has been revised to include references to the Revised LTC RAI User's Manual, Version 2.0, December 2002, along with some minor editorial changes. (PDF format: Updated: 8/1/03-page 4) (Address and telephone changes effective 7-5-06)

The LTC RAI User’s manual, Version 2.0, contains instructions for coding the Minimum Data Set (MDS). It also defines when MDS assessments are due, gives instructions on how to make corrections to MDS assessments, and provides other essential information related to the RAI process. The manual can be viewed or downloaded from the CMS website http://www.cms.hhs.gov/NursingHomeQualityInits/20_NHQIMDS20.asp (10/07/09)

Minnesota Case Mix Validation Report

MN Case Mix Validation Report revised and explanation provided. Effective with MDS submissions made on June 9, 2003 a revised MN Case Mix Validation Report will be produced. An explanation of the MN Case Mix Validation Report is also available. See Minnesota Case Mix Validation Report (11/4/03)

Case Mix Clarifications and Guidance

Case Mix Clarifications and Guidance-- Click here to find clarification and guidance concerning the Case Mix System, including billing concerns (See--AA7 Medicaid Number)  (Last Updated: 4/2/2007)

Documentation--  Click here to go to the document called "Recommendations for Documentation of MDS Assessments"  (PDF: 2 pages) (Revised August 2009)

RAI Coding Questions and Answers

RAI Coding Questions and Answers-- Click here to find questions and answers to coding the MDS assessment items used for case mix. (Last Updated: January 2008)  (PDF: 7 pages)

Other Case Mix Information

Penalty Classification (BC1) for assessments completed late or submitted late.
Facilities that elect a default rate for all residents who stay less than 14 days in lieu of submitting an initial assessment submit a discharge tracking form coded "08" in Reason for Assessment, AA8a (Discharged prior to completing initial assessment). Facilities that elect the default rate are reminded that the penalty classification (BC1) will be applied to discharge tracking forms coded "08" that are completed late or submitted late when the discharge tracking form is being used in lieu of an admission assessment. The penalty rate will be in effect from the day of admission (AB1) until the resident returns to the facility (A4a). Page 4 of the Facility Manual for Case Mix Classification has been updated to include this information. (8/1/03)

Facility Initiated request for Reconsideration.
The Facility Manual for Case Mix Classification, pages 40 and 41, gives instructions on how to request a reconsideration of a resident's case mix classification. A common error made when facility staff initiate a reconsideration request is omitting the copy of the notice sent to the resident or resident's representative that informs them that a reconsideration is being requested (see sample of notice page 41). Note that the reconsideration must be denied if the information listed in the manual is not included with the reconsideration request. (8/1/03)

Description of Case Mix Classification (Link to file)

Admission Assessment Scenarios - Examples of different scenarios for facilities that elected to complete an Admission assessment (AA8a=01) for all admissions. (7/2/03) (PDF Format)

Default Scenarios - Examples of different scenarios for facilities that elected the default (DDF) classification, on short stays. (7/2/03) (PDF Format)

Consumer Pamphlet - How Your Nursing Home Charges are Determined.  (PDF)

New System Case Mix Index , June 2002- Index Order

New System Case Mix Index , June 2002- Hierarchal Order

MN Case Mix Classification (RUGS-III) Summary Sheet Updated 9/01 (PDF)

Historical Files (8/1/03)

Case Mix Election Letter 2007 (PDF 5/17/07)
Case Mix Election Procedures 2007 (PDF 5/07)
Case Mix Electronic Classification Notices Letter (PDF 3/13/07)
Election Letter and Instructions 2006  (PDF 5/26/06)
Default Resident Classification Notice - July 2005 (PDF 4/20/05)
Resident Classification Notice - July 2005 (PDF 7/05)
Election Letter and Instructions 2005  (PDF 4/30/05)
Election Letter and Instructions 2004  (PDF 4/27/04)
Default Resident Classification Notice - July 2003 (PDF Format)
Resident Classification Notice - July 2003 (PDF Format)
Election Letter 2003 (PDF Format)
Election Response Form 2003 (PDF Format)
MDS Audit/Recon worksheet (PDF)
Resident Classification Notice - June 2002
Facility Manual Resident Classification Notice - June 2002 (MS-Word)

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