Nursing homes: policies and procedures

Closure of nursing facility beds

Minnesota state law calls for a planned, collaborative process for closing nursing home beds, whether a partial or complete facility closure.  These laws may also apply to nursing facilities undergoing a change in operation that may encourage or could result in resident relocations (e.g. a moratorium or construction project, etc.).

Nursing facilities - Resident Relocation

Nursing facilities are required by law to follow a process whenever a facility closes beds and in particular when nursing facility bed closures or operational changes result in or encourage the relocation of residents. The Department has developed a Guide (PDF) and chronological checklist that provides an overview of the closure and resident relocation process; with contacts, templates and statutory references useful to nursing facilities. For any nursing facility considering the closure of beds, the first step in this process should be to contact our staff liaison.

County agencies - Resident Relocation 

Local county social services agencies serve as the lead agency on behalf of DHS, when resident relocations are involved in the closure of nursing facility beds. The Department has developed guidance and a chronological checklist that provides an overview of the closure and resident relocation process from the County perspective, along with contacts, templates and statutory references that are useful to the County lead agencies when fulfilling their obligations under the law.  Please contact our staff liaison for more information.

Planned Closure Rate Adjustment (PCRA) for Closing Beds

Applications for the Planned Closure Rate Adjustment (PCRA) for facilities closing beds are coordinated with the Resident Relocation process outlined above and all applicable regulatory obligations regarding resident relocation must be met first. To get more information on the PCRA process or to request an application, please contact our staff liaison.

Resources for Operational Flexibility

Here are some resources for MN nursing facilities looking for operational flexibility that may assist with staffing issues, help to avoid the closure of beds or provide other operational flexibility.

Resources:

• Minnesota Department of Health Emergency Preparedness website
• Minnesota Homeland Security and Emergency Management (HSEM)
• Homeland Security and Emergency Management Contacts: Regional Program Managers and County Emergency Managers
• State Emergency Operations Center (SEOC) – for news releases and situation reports

Employee scholarship program

The Minnesota Department of Human Services Nursing Facility Employee Scholarship Program provides Minnesota nursing facilities the opportunity to grant scholarships to eligible facility employees for education and training leading to advancement in the long-term care field or within the facility. Scholarship monies are available for limited uses and for eligible employees only.

Eligibility

• Facilities must be Minnesota Medicaid-certified
• Facilities must be participating in the program to receive scholarship funds
• Most employees must work a minimum (average) of 10 hours per week in the facility (some exceptions)
• Educational expenses must be allowable
• Types of education/training must be allowable

Guidance

The following documents and guidance are available to assist facilities in implementing a facility scholarship program:

• Day Care Log (documents day care expense claims)
• Excel data collection form (mimics the online reporting form with same fields and values)
• Reporting instructions and a list of valid values
• Scholarship Implementation Guidance document
• Student Loan Repayment Attestation form (for reimbursement of nursing loans)
• Transportation Log (documents transportation expense claims)

Please contact our staff for a copy of any of these documents, for questions about the program, or to request training on the scholarship program.

Scholarship Reporting

Scholarship information is reported on Section 7 of the online facility Statistical and Cost Report - through the password protected Provider Portal. Please note: beginning with the Cost Report due 2/1/25, the scholarship section will be moved to Section 8 of the Cost Report. The final due date for submitting the 2024 reporting forms (for the period 10/1/2023 - 9/30/2024) is February 1, 2025.

Training Available

If your facility is new to the Employee Scholarship Program, has questions or would like training on policies or procedures, please contact our staff to schedule an online webinar or teleconference call for training.

Medicaid-certified nursing facilities in Minnesota must submit an annual statistical and cost report to the Department. After these reports are audited, the data is used to calculate the per diem (daily) payment rates for nursing facility residents. Some historic statistical and cost report data is available upon request, although there may be a charge for this data. To request historical data, please contact our staff via email. 

Please use the staff contact link to submit your request and receive an estimate of any associated cost.

This guide helps nursing homes stay in compliance with state and federal regulations regarding leave days and issues normally associated with leave days.

Leave Day Guidance document

A list of Department bulletins, arranged by program area and year can be found on the DHS bulletins home page.

Under federal law, nursing facilities are obligated to assist residents in obtaining needed transportation services. Like other services provided to nursing facility residents, these services should be provided in a manner that maintains resident dignity, safety and the highest level of functioning.

Nursing facilities have a responsibility to ensure that residents receive necessary medical care and treatment, and that which is needed to fulfill the resident’s plan of care. In some cases, the resident’s care and treatment may be provided within the facility. However, if this is not possible or desirable, the nursing facility is responsible for helping the resident to find transportation services. Facilities also have an obligation to protect residents, to provide for their well-being and safeguard them against harm and accidents. Therefore, each resident must receive adequate supervision and assistance devices to prevent accidents. Facilities must help to arrange for escorts or attendants to accompany residents to medical appointments when needed.

Under no circumstances is it acceptable for a nursing facility to send an unaccompanied resident to an appointment if the resident is not coherent or fully cognizant, or is suffering from dementia or any other condition that impairs the resident’s ability to conduct themselves safely. It is also not acceptable to affix name tags or other identifying information on a resident’s body as a means of identifying the resident. If the resident is unable to identify themselves and where they currently reside and display competent self-preservation skills, the resident should not be traveling unescorted.

For more information on transportation of nursing facility residents, contact us.

In all disaster situations, the health and welfare of the residents should be the first priority.

Upon declaration of a natural disaster, Minnesota Statutes 12A.0 gives the Department of Human Services (DHS) authority to provide Medical Assistance or MA funding for eligible expenses to nursing facilities affected by natural disasters and other emergency situations for up to 60 days following the disaster.

In the event of an evacuation, the normal daily rate continues to be paid by DHS to the evacuating facility as long as the residents are not formally discharged. Receiving (sheltering) facilities may apply for assistance.  DHS will consider individual facility concerns or unusual circumstances with regard to payment under 12A on a case-by-case basis.

Evacuating facilities should notify DHS as soon as possible with the names, dates and destinations of evacuated residents using the Facility Evacuation Form available through the DHS reimbursement coordinator. Evacuating facilities are also responsible to notify DHS immediately upon return of residents to their facility.

Note: For Minnesota nursing facilities that have any resident who is being evacuated and that resident is the financial responsibility of the North Dakota Medicaid (MA) Program, please email the North Dakota Department of Human Services.

Related Disaster Resources

• Minnesota Department of Health Emergency Preparedness website
• Minnesota Homeland Security and Emergency Management (HSEM)
• Homeland Security and Emergency Management Contacts: Regional Program Managers and County Emergency Managers
• State Emergency Operations Center (SEOC) – for news releases and situation reports

Minnesota nursing facilities are able to contract with DHS to earn performance-incentive Medical Assistance payments of up to 5 percent of the operating payment rate. The incentive payments are time-limited rate adjustments. More information is available on the DHS Grants and RFPs page.

The Medical Assistance (MA) program allows payment for the placement of a Minnesota MA recipient in a private room when medical necessity exists. Requests must be submitted to the Department of Human Services for review by our staff.
If you have questions about this process or would like to submit an application, please contact us.

Information and detailed descriptions of the Minnesota Quality Indicators and Adjusters can be found in the Minnesota Nursing Home Report Card Technical User Guide.

The Medical Assistance (MA) program allows payment for the placement of a Minnesota MA recipient in an out-of-state nursing facility in situations where the request meets both federal and state requirements. Requests must be submitted to the Department of Human Services  for review by our staff. 

If you have questions about this process, contact us.

Both federal and state law allow certain small rural hospitals to enter into a swing bed agreement. This agreement essentially allows a hospital to use its beds to provide post-hospital skilled nursing facility (SNF) care to a patient (while retaining their ability to utilize the bed as a traditional hospital acute-care bed, hence the term “swing bed”).  

Swing Beds – Definition

As defined in federal regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has approval from the Centers for Medicare and Medicaid Services (CMS) to provide post-hospital SNF care and meets certain requirements. These requirements are defined under 42 CFR 482.58 or 485.645, respectively (for hospitals or critical access hospitals).

Swing Beds – Medicaid Enrollment

Medicaid-certified hospitals interested in enrolling as Swing Bed providers should email the Department, to first determine their eligibility. Each hospital provider making such a request will be assessed to see if they meet existing requirements for Medicaid Swing Bed providers. The hospital provider will be notified of the outcome. If a provider is determined to meet all the swing bed requirements, swing bed rates will be entered into the MMIS system on their behalf.

Providers must meet all of the following swing bed criteria, namely the provider must:

• be licensed as a hospital (with Medicare swing bed license condition) in Minnesota,
• be a Medicare-certified hospital or critical access hospital (CAH) and be in compliance with the federal Medicare conditions of participation and the federal requirements for hospital providers of long-term care services,
• enroll as a Medicaid provider in Minnesota,
• sign a Medicaid swing bed provider agreement, and
• be eligible as a sole community provider (as defined under federal law) or is a public hospital owned by a government entity with 15 or fewer licensed acute care beds. Note: the sole community provider requirement is waived if the hospital was a Medicaid swing bed provider as of 1/1/2004.

In addition, to bill for Medicaid for swing bed services, the provider must show that:

• the patient no longer requires acute care services,
• has received the required screenings as provided by law, and
• no nursing facility beds are available within 25 miles of the facility.

Medicaid will provide up to 10 days of swing bed coverage for a patient if all the following conditions are met:

• the patient’s physician certifies that the patient has a terminal illness or condition that is likely to result in death within 30 days and that moving the patient would not be in the best interests of the patient and patient’s family,
• no open nursing facility beds are available within 25 miles of the facility, and
• no open beds are available in any Medicare hospice program within 50 miles of the facility.

Rates

Medicaid swing bed providers are paid the statewide weighted average per diem rate for all Medicaid residents residing in swing beds in the facility. This rate is determined by the Department.
For providers that meet the eligibility requirements, the Medicaid swing bed rate is uploaded to the provider’s rate file.

Notes

Please note that Swing Bed status for Medicare purposes is a separate issue and is determined completely separately from Medicaid. A provider’s Medicare swing bed status does not confer nor guarantee Medicaid swing bed eligibility.

Questions

If there are questions, please contact our department:
Munna Yasiri
Compliance and Intergovernmental Relations Director
Nursing Facility Rates & Policy Division
munna.yasiri@state.mn.us

The Nursing Facility Annual Statistical and Cost Report for the report year ending Sept. 30 becomes available for data entry in December of the same calendar year. You can find this on the Provider Portal. This is a password protected site. The due date to submit this report is Feb. 1 of the following calendar year.

Scholarship information is reported on Section 7 of the facility Annual Statistical and Cost Report, through the Provider Portal. Please note: beginning with the Cost Report due 2/1/25, the scholarship section will be moved to Section 8 of the Cost Report. Scholarship information for the report year ending Sept. 30 is due when the Annual Statistical and Cost Report is submitted (no later than Feb. 1 of the following calendar year).

Information obtained from the scholarship reporting forms filed for the Cost Report year ending Sept. 30 is used to set scholarship payment rates for the following rate year.

If you are an employee of a Medicaid-certified nursing home in Minnesota, follow this link to find information about the DHS Nursing Facility Employee Scholarship Program.

Cultural competency is necessary in doing business with the diverse populations served by Minnesota’s health and human services programs. These resources will help providers develop services that focus on the culturally specific needs and desires of the people they serve as well as promote workforce diversity.

Culture Care Connection
This Stratis Health website provides information, assessment tools, resources, and training on diversity and cultural competency for health care providers.

Minnesota Department of Human Services cultural competency statement 
This statement outlines the department's commitment to cultural competency, in terms of both its workforce and its services and programs.

Health care interpreter roster 
The Minnesota Department of Health (MDH) maintains this roster of health care interpreters.

Resource Library for Advancing Health Equity in Public Health  
Maintained by the Minnesota Department of Health (MDH), this website provides tools, templates, and resources to build health equity capacity.

Translation Services for MHCP Members
Nursing facility providers are generally required to provide (or arrange for) linguistically appropriate care (i.e. translation) for MNHCP members in their care. Provider translation services for non-billing providers or for member access to more translation services, please reference the individual health plan information in this document for additional instructions.