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
Subscribe to Minnesota Case Mix Review updates
To prevent delays in processing payments, staff must ensure that the therapy and isolation start and end dates are correctly entered on all Prospective Payment System (PPS), Omnibus Budget Reconciliation Act (OBRA) comprehensive, OBRA noncomprehensive assessments, and Optional State Assessment (OSA) when appropriate. When the end of therapy dates, and/or start and end dates for isolation are not on the assessment, this assessment will not be immediately processed requiring a call from the Case Mix Review staff for further information.
Discrepancies in the Resource Utilization Group (RUG) classification between the OSA and the classification letter
If the RUG classification on the OSA does not match the classification letter received on the CMR Portal, review the documentation entered on both the OBRA and OSA to make sure the data matches. If the data does not match in the OBRA and OSA contact Case Mix Review at health.fpc-cmr@state.mn.us.
Short stay facilities
If you have elected to be a short stay facility, neither an OSA and/or admission assessment is required to be completed until the resident is in the facility for more than 14 days.
When to complete an OSA
The OSA is required for most admissions to nursing facilities that are Medicare and Medicaid certified regardless of who the payer is. The OSA is not required with PPS, discharge or entry tracking. The OSA is required:
- Each time an OBRA comprehensive, quarterly, or Significant Correction to prior Quarterly Assessment (SCQA) assessment is completed, and
- When all therapy and isolation services end, if the most recent assessment (either an OBRA assessment with an ARD on or before 9/30/2023 or an OSA with an ARD on or after 10/1/2023) resulted in a rehabilitation or isolation RUG-IV classification in Z0200A.
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.
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.
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.