Minnesota Case Mix

When admitted to a nursing home, staff will assess health care needs. This information is recorded on an assessment form called the Minimum Data Set (MDS) used to plan the resident's care. The MDS assessment and care planning process help improve communication between residents and the health care team. The MDS is also used to determine the Minnesota Case Mix Classification that has a corresponding daily payment rate. The Case Mix Classification is based on care needs, required treatments, diagnoses and medical follow-up. These could include:

• Assistance with Activities of Daily Living (ADLs)
   
  Bed mobility, transferring from one position to another, eating and toilet use. A total ADL score of 4 to 18 is possible and is a main part of determining case mix classification. The more assistance needed, the higher the ADL score.
   
• Treatments such as intravenous (IV) medication, fluids or nutrition.
• Depression or behavioral symptoms.
• Decreased ability to communicate or make decisions.
• Speech, occupational, and/or physical therapy.

There are 36 Minnesota Case Mix Classifications. State law requires nursing homes to charge both private pay and Medicaid residents the same rate for the same services. Nursing homes may charge more for private rooms or other services that they are not required to provide. The Minnesota Case Mix Classification system applies to all residents of Medicaid certified nursing homes and board and care homes.

After the MDS has been completed and sent to the Minnesota Department of Health (MDH), a notice explaining your Case Mix Classification will be sent within one to two months after admission and about every three months thereafter. If the care needed changes enough, the MDS assessment may result in a different case mix classification.

Staff from MDH audit a percentage of MDS assessments. A notice is sent whenever the classification changes.