Budget Proposal Comparison Grid: Care Centers

Budget Item Governor’s Proposal House Proposal Senate Proposal

Across-the-Board 1% cut to all care centers effective No provision No provision
Rate Cuts 7/1/11
Low Case Mix Cut 10% operating rate reduction for No provision No provision
PA1 residents effective 7/1/11
Bed Hold Payments Bed hold payment reduced from Bed hold payment reduced from Bed hold payments eliminated
60% to 30% and the threshold is 60% to 30% and the threshold is effective 7/1
increased from 93% occupancy to increased from 93% occupancy to
96% 96%
Planned Closure No new planned closure rate No new planned closure rate No new planned closure rate
Rate Adjustments adjustments after 7/1/11 adjustments after 7/16/11 adjustments after 7/1/11
Single Bed No new single bed incentive No provision No new single bed incentive
Incentive Payments payments after 7/1/11 payments after 7/1/11
MA Private Room Payment differential reduced from No provision Payment differential eliminated
Rate for Medical 11.5% to 5.5% effective 7/1/11, no provision for
Necessity changing election
Enhanced Rates for No provision (originally would No provision No provision
First 30 Days have cut from 20% to 10%)
Surcharge Increase Increase in surcharge of $985 per No provision No provision
bed/per year in two phases with
corresponding rate increases
Surcharge Changes No provision Beginning July 15, 2013, care No provision
centers will be charged only for
beds that are occupied
Rate Compression No provision Operating rate reduction for care No provision
centers above the 95th percentile;
Cuts capped at 3%; “Specialized
facilities” exempt from cuts and
not included in array; Savings
distributed to care centers within a
quarter mile of a peer group with
higher limits; Any remaining
savings distributed to lowest rate
care centers up to 2% increase

Prepared by the LTC Imperative, April 8, 2011

 Budget Item Governor’s Proposal House Proposal Senate Proposal
Rate Equalization No provision Four year phase-out of rate Four year phase-out of rate
equalization beginning October 1, equalization beginning October 1,
2011 with 2% increasing 2011 with 2% increasing
differential allowed each year, cap differential allowed each year
at allowable cost after phase-in
Property Rates No provision Property rate inflation factor No provision
eliminated for the next two years
effective 10/1/11
Pay for No provision DHS required to submit a report on No provision
Performance implementing a pay-for-
performance payment system with
quality add-on by 1/15/12
State Licensure No provision MDH is to work with stakeholders No provision
Process Review to review the regulatory process
address efficiency, eliminate
duplication and ensure positive
clinical outcomes
LTC Consultation No provision Reduce nursing facility No provision
contribution for LTC consultation
services to 75% and shift 25% of
cost to private pay individuals
eligible for case management
services but not eligible for MA or
MNCare
Care Center No provision Allows for approval of proposals No provision
Consolidation where 65% of the state savings
from the closure of one or more
care centers is used to upgrade the
physical plant of other facilities.
Total Impact on 3.9% Funding Reduction 0.6% Revenue Reduction 3.3% Revenue Reduction
Care Centers $30.2 Million Cut $4.4 Million Cut $25.7 Million Cut

Prepared by the LTC Imperative, April 8, 2011

 Budget Proposal Comparison Grid: Home & Community Based Services

Budget Item Governor’s Proposal House Proposal Senate Proposal

Customized Living 2% cut to Customized Living Adopted Governor's original No provision
Component Rates components rates proposal of a 10 % cut to CL
component rates
HCBS Rates 2% cut to HCBS rates No provision No explicit rate cuts
CL and 24-Hour Eligibility criteria for 24-hour CL Eligibility criteria for 24-hour CL Eligibility criteria for 24-hour CL
Customized Living changed from 2 ADLs to 3 ADLs; changed from 2 ADLs to 3 ADLs changed from 2 ADLs to 3 ADLs
Eligibility Case Mix L not eligible for 24- and eating can qualify only with a and eating can qualify only with a
hour CL score of 3 or more; CL service rate score of 3 or more. New language
limit for Case Mix L set at 25 prohibiting billing clients or
percent less than the Case Mix A families for any costs for services
service rate limit for CL. New that exceed the rate limits or for
language prohibiting billing clients allowable services that are not
or families for any costs for authorized.
services that exceed the rate limits
or for allowable services that are
not authorized. MCOs can't exceed
the DHS CL component rates.
Case Mix L Community budget caps for EW Community budget caps for EW Community budget caps for EW
case mix L clients reduced from case mix L clients reduced from case mix L clients reduced from
$2272 to $1750; Those with up to $2272 to $1750; Those with up to $2272 to $1750; Those with up to
2 ADLs part of Case Mix L 2 ADLs part of Case Mix L 2 ADLs part of Case Mix L.
Service Rate Limits Reduced by undetermined amount CL service rate limit for Case Mix Case mix L CL service rate limit to
L set at 25 percent less than the be 25 percent of the Case Mix A
Case Mix A service rate limit for service rate limit effective July 1,
CL. 2011.
Customized Living Spending on CL and 24-hour CL No provision No provision.
Audits reduced by audits
Connection to Care Care center rate increases no Care center rate increases no Care center rate increases no
Center Rates longer affect EW community caps longer affect EW community caps longer affect EW community caps

Prepared by the LTC Imperative, April 8, 2011

 Budget Item Governor’s Proposal House Proposal
MA HCBS Waiver 2 % rate cut for waivers, AC, etc. CADI, TBI and DD waiver
Funds funding levels are capped; 5% of
funds set aside for emergency
situations; Requires at least the
same number of people served as
on 3/22/10; Gives DHS discretion
to meet funding cap through
adjustments in benefits, services,
case-mix capitation rates,
enrollment, eligibility, etc.
Alternative Care No provision. AC clients with up to 2 ADL
dependencies (Case Mix L) would
have their community budget cap
reduced from $600 to $593.
Global Medicaid No provision Seek global Medicaid Waiver to
Waiver receive “block grant” from federal
government; Details developed by
waiver implementation group;
Savings estimated at $300 million;
If savings not achieved by 7/1/12
DHS authorized to make
“contingent cuts” that include
Medicaid provider rate cuts,
although services to older adults
are exempt from cuts
Prepared by the LTC Imperative, April 8, 2011
Senate Proposal
Growth in EW to be limited to the
number served as of June 30, 2011.
CADI and TBI also to be limited.
Language also permits DHS to
develop methodology for CADI
and TBI risk adjusting payments
and to adjust MA basic elderly and
disability services. DD waiver
growth also limited. Priority for
allocation of funds for TBI and
CADI for those to be discharged
from institutional settings or those
who are at imminent risk for
placement in an institution.
Seek global Medicaid Waiver to
receive “block grant” from federal
government; Details developed by
waiver implementation group
 Budget Item Governor’s Proposal House Proposal Senate Proposal
HCB Attendant No provision Creates a new MA waiver called No provision.
Services and Community First Option; Allows
Supports higher federal match for program
costs; Eligible person must live in
their own apartment or home not
owned or operated by a service
provider; Could cover ADL and
other typical services as well as
security deposit, kitchen supplies,
etc.
Transitional No provision Transitional waiver language No provision.
Waivers originally proposed was deleted by
an amendment.
Co Payments No provision Requires DHS, upon federal No provision.
approval, to develop and
implement a co-payment schedule
for persons receiving MA HCBS
Adult Assistance No provision. A capped allocation to be provided
Grant Program to counties for flexible services for
adults no longer eligible for GA,
emergency GA, emergency
supplemental aid and MN
supplemental aide special needs
and special diets.
General Changes Revised case management
for Disability language for disability waivers.
Waivers Waiver recipient plan requirements
are revised—the plan is now called
the coordinated service and support
plan.
Reduction of Rates Original reductions eliminated For foster care settings servicing
for Congregate after revised forecast came out. CADI, DD, and TBI, the rates in
Living for persons effect on Jan. 1, 2011 will be
with lower Needs reduced by 10 %.
Total Impact on 4.1% Revenue Reduction for EW 8.2% Revenue Reduction for EW 3.7% Revenue Reduction for EW
HCBS $13.8 Million in cuts $27.4 Million in cuts $12.2 Million in cuts

Prepared by the LTC Imperative, April 8, 2011

 Budget Proposal Comparison Grid: Continuum Proposals

Budget Item Governor’s Proposal House Proposal Senate Proposal

MA Eligibility No proposal Establishes deadlines for MA No provision.
Determinations eligibility determinations
(generally 45 days for persons
65+) and requires the county to pay
the total non-federal MA cost if
deadlines are not met
Health Related No proposal Requires MDH and DHS to make No provision.
Licensing recommendations for the re-
organization of health and human
services regulatory functions,
including licensing of nursing
homes, home care, and regulation
of housing-with-services and
assisted living. Report due Feb. 15,
2012.
Elevator Code No proposal Allow for a three year extension No provision.
Requirements from elevator code requirements
currently required by 1/29/12
Nurse Aide No proposal Requires MDH to accept faxed or No provision.
Registry other electronic submissions of
applications and supporting
documentation for interstate
endorsements to the nurse aide
registry
Criminal DHS to charge $20 for background Requires criminal history record DHS to charge $20 for background
Background checks for DHS licensed providers. checks prior to the issuance of a checks for DHS licensed providers.
Checks nursing license
DHS Licensing DHS to restructure its licensing DHS to restructure licensing fees.
Fees fees. Fees are spelled out for various
DHS-licensed programs.

Prepared by the LTC Imperative, April 8, 2011

 Budget Item Governor’s Proposal House Proposal Senate Proposal
Elimination of No proposal No proposal Eliminates coverage for some
Optional MA optional MA services including
Services therapies, chiropractic, prosthetics
and dentures
Nursing Licensing Various fees spelled out for nurses. Various fees spelled out for nurses.
and Health-related Background checks, including FBI An administrative services Unit is
licensing boards. check, required for issuance of established for various health
license. related licensing boards.

Prepared by the LTC Imperative, April 8, 2011