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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Nov. 20, 2023: Frequently-Asked Questions for Optional State Assessment and Section S now available
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.
Oct. 6, 2023: New Section S and OSA Requirements in effect as of October 1, 2023
As of October 1, 2023, the new and revised elements for the Minimum Data Set (MDS) 3.0 Assessment will go into effect; providers should review the updates to the Resident Assessment Instrument (RAI) Manual version 1.18.11 to ensure they understand the changes. Detailed information is available on the CMS Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual website.
Minnesota nursing facilities will be required to complete the Optional State Assessment (OSA) each time a comprehensive (admission, annual, significant change in status, and significant correction of a prior comprehensive) and non-comprehensive (quarterly and significant correction of a prior quarterly) assessment is completed. Minnesota also has added two new Section S items to the MDS and the start and end dates of isolation will be required. Facilities will need to ensure that their software vendors are also aware of this change. Information about these changes has been added to the Minnesota Case Mix Review Manual.
The recording of the webinar held by MDH Case Mix Review Program staff to review the changes to the MDS 3.0 and the OSA Implementation is now available for review on the MDS and RAI Information page.
May 1, 2022: IQIES MDS FAQs for Providers, v 1.0 is now available on the CMS website
A FAQ for providers on who use IQIES for MDS submission can now be found on the CMS webpage Nursing Home (MDS)/Swing Bed Providers (cms.gov).
Guidance and Information
- Minnesota Case Mix Review Manual (PDF) (updated 11/2023)
- 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.