In preparation for the shutdown webinar on June 30, we forwarded a series of questions to the departments of health and human services in order to better respond to your inquiries. Since the questions were sent, the court has subsequently issued a ruling that state Medicaid payments would be an essential service, so wherever the response below refers to the “Governor’s revised list of critical functions” it means that Medicaid payments will continue, and that new people will be able to access Medicaid (medical assistance). Most of the questions and answers below were included in the June 30 webinar we held on this topic—if you missed that webinar, it has been archived for you in the Archived Online Education section of the Association website.

IMPORTANT UPDATE: Since the webinar this morning, we received updated information from the Department of Human Services—the Alternative Care program WILL continue to be funded under a government shutdown.

1. Are MSHO plans obligated by contract with DHS to pay the providers of service or is that payment optional? (MSHO payment includes both Medicare and Medicaid payments so the Medicare payments should still be available.)
Yes. This issue should be resolved with the Governor’s revised list of critical functions.

2. State law says we cannot admit/serve folks who have not had a preadmission (long-term care consultation) screening. If there are no screeners, can we admit folks and have the screening apply retroactively?
Under the Governor’s revised petition new people will continue to be added to programs as well as new admissions to nursing facilities; we assume counties and health plans will continue to provide preadmission screenings.

3. Will the counties and state still process and approve Medicaid applications?
Yes. This issue should be resolved with the Governor’s revised list of critical functions.

4. State law requires background checks for our workers—if no staff members are at DHS to process them, can we still hire staff and submit the background checks retroactively?
No. The Human Services Background Study Act requires that a background study is initiated by the license holder prior to a newly hired individual beginning in a position that provides direct contact services or that allows unsupervised access to residents or their property. Until the license holder receives a response from DHS, that new individual must be continuously supervised. The Department does not have the authority to waive these statutory requirements. Therefore, if a new employee begins providing services or has unsupervised access to residents or their property, without a background study first being initiated, the facility will be out of compliance with the statutory requirements. Regarding retroactive submission of background study requests, that will be possible.

5. Do we still send in our surcharge payment if we are not receiving any Medicaid payment?
Providers will be expected to continue to make timely payment of the surcharge if Medicaid payments to them are continued.

6. Can we submit our July claims early before the shutdown happens?
No.

7. Does the nursing home rate equalization law apply—if there is no Medicaid payment, can we still collect from private paying residents?
The rate equalization law will continue to apply. Under that law, private pay rates are tied to the “prospective desk audit rate,” which will not change should there be an event when payment is delayed.

8. Will the state approve Medicaid services for those applicants that need to go through the State Medicare Review Team? If no, please explain how this will work.
Yes.

9. Will the plans who have Elderly waiver, CADI or TBI contracts, continue to make payments to the providers?
Yes.

10. Will the state ombudsman office be open to take complaints/concerns from seniors and their families who may be having difficulty accessing services?
The Ombudsman for Long-Term Care will continue.

11. Will the common entry points be staffed? Will adult protection be staffed?
Common entry points are usually the county social services offices and/or the local sheriff’s department. It is expected that these entities will continue to function during a shutdown but the person should contact those organizations directly. State adult protection for training and technical assistance will not be staffed.

12. Will surveys for federal and state nursing facility compliance continue (licensing and certification surveyors)?
NO.

13. Will surveys for life safety code compliance continue (state fire marshals)?
NO.

14. Will complaint surveys/investigations continue for nursing facility and home health agencies (OHFC surveyors/investigators)?
YES, but with limited staff, per MDH notice posted on June 24, 2011.

15. Will Class A and Class F surveys continue for licensed-home care agencies?
NO, per MDH notice posted on June 24, 2011.

16. Will on-line abuse/neglect reports be received, acknowledged, and processed?
YES but with limited staff, per MDH notice posted on June 24, 2011.

17. What happens if nursing facility surveys have been conducted and they do not received a timely 2567 form from MDH as a result of the shutdown?
We are uncertain. MDH has informed us that they will be sending all “open” surveys to CMS Chicago. It is unclear what CMS will do with this information. In this instance, the facility should create plans of correction based on the draft 2567 received at survey exit, and begin implementing corrective actions within the facility.

18. If a nursing facility sends in a 2567 survey form with their plans of correction (POC) within the required 10 days, will that be documented and processed during a shutdown?
We are uncertain how mail will be handled. MDH has informed us that they will be sending all “open” surveys to CMS Chicago. It is unclear what CMS will do with this information. However, the timelines regarding the facility’s plans of correction should still be adhered to, as either MDH (once reinstated) or CMS (unknown timeframe) may be out for a resurvey after your correction period, and as a result of the shutdown, periods of any noncompliance could be extended (along with remedies).

19. Will emergency services (flooding, disasters, etc.) assistance be available?
YES, but potentially limited to situations requiring the State’s Incident Command Systems.

20. Will infectious disease reporting be available?
YES. A minimal number of MDH Infectious Disease Epidemiology, Prevention and Control staff will be available during the shutdown to provide consultation of urgent matters regarding infectious disease, infection prevention and control, and to take reports of communicable diseases that require immediate MDH notification. Please contact the usual phone number, 651-201-5414 (toll-free 1-877-201-5414).

21. Will the nursing assistant registry be updated so we can check our new hires?
NO, per MDH notice posted on June 24, 2011.

22. How will I know what services are going to be continued?
The main pages of the state agencies should have a list (www.health.state.mn.us or www.dhs.state.mn.us) or go to www.bereadymn.com.

23. Will transportation services, therapy services, and pharmacy services continue?
All Medicaid providers/vendors will be paid, so if the services are Medicaid services, then yes.

24. How will Minnesota non-emergency transportation (MNET) and its functions relating to access transportation services (ATS), special transportation services (STS), and the level of need screenings (LON) be impacted by the government shut-down?
Based on discussions with DHS staff on June 30, 2011, how MNET will be impacted is not known.
  a. For residents in a nursing facility with a living arrangement code of 41, 42, 44, or 45, a LON is not needed, and presumably transportation may be arranged and reimbursed as usual.
  b. For clients in other settings that require a LON screening or scheduling of transportation by MNET, DHS did not have an answer at this point.
  c. DHS is drafting a new question-and-answer document that will hopefully specify that MNET, ATS, and STS are to remain open and reimbursed as appropriate. This has not yet been determined.

25. What about a staff member who is participating in an approved nursing assistant training course, has passed a background check, and is just completing the course or will complete it soon. Can we employ this person without them being on the Registry?
An individual not on the Registry can be hired as a nursing assistant if they are immediately enrolled in an approved nursing assistant training course at the time of hire, complete the course and competency test and get on the Minnesota Registry within 4 months. The facility must assure that the person is competent to provide cares to residents. Persons working for a temporary agency must be on the Registry before they are eligible to work in a nursing facility.

26. If the State Fire Marshal’s office is closed during a shutdown, who do we contact during a fire watch?
The NFPA requirement for nursing facilities requires the “authority having jurisdiction” (AHJ) to be notified whenever the required fire alarm system is out of service for more than four hours (fire watch). For nursing facilities in Minnesota, the AHJ is the state fire marshal’s office. If the state fire marshal’s office is not available during a shutdown (we have been told the fire marshal inspectors will not be considered essential), then the facility should document that an attempt to notify the AHJ was made, and notify the local fire authority of the fire watch.

27. What about business license renewals that occur during a shutdown (HWS registration, home care agency license, nursing home license, etc.)?
MDH has informed us that licenses that are up for renewal will not be cancelled or terminated as a result of the shutdown. If possible, process the renewal paperwork and payment, or document your attempt of such and keep on file. Renewals will be processed in the order they were received upon state employees returning to work.

How will Case Mix, OBRA and PPS MDS assessments be handled during a shutdown?
Go to http://www.health.state.mn.us/divs/fpc/profinfo/cms/Revision2063011.pdf to see the response from MDH.

We want to be able to fully understand the implication of a government shutdown on your services, so if you are running into operational/payment difficulties because of the shutdown, or if services you thought were essential are not being covered, let us know.

Regulatory issues: Doug Beardsley dbeardsl@careproviders.org

Payment issues: Todd Bergstrom tbergstrom@careproviders.org

Other: Patti Cullen pcullen@careproviders.org

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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