HF 1522

as introduced - 91st Legislature (2019 - 2020) Posted on 03/14/2019 04:39pm

A bill for an act
relating to health; modifying licensing requirements for prescribed pediatric
extended care (PPEC) centers; phasing in licensing of PPEC centers; establishing
PPEC basic services as services covered by medical assistance and setting medical
assistance reimbursement rates; amending Minnesota Statutes 2018, sections
144.057, subdivision 1; 144H.01, subdivision 5; 144H.04, subdivision 1, by adding
a subdivision; 144H.06; 144H.07, subdivisions 1, 2; 144H.08, subdivision 2;
144H.11, subdivisions 2, 3, 4; 256B.0625, by adding a subdivision; proposing
coding for new law in Minnesota Statutes, chapter 256B; repealing Minnesota
Statutes 2018, section 144H.08, subdivision 1.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2018, section 144.057, subdivision 1, is amended to read:

Subdivision 1.

Background studies required.

The commissioner of health shall contract
with the commissioner of human services to conduct background studies of:

(1) individuals providing services which have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; residential care homes licensed under
chapter 144B, and board and lodging establishments that are registered to provide supportive
or health supervision services under section 157.17;

(2) individuals specified in section 245C.03, subdivision 1, who perform direct contact
services in a nursing home or a home care agency licensed under chapter 144A or a boarding
care home licensed under sections 144.50 to 144.58. If the individual under study resides
outside Minnesota, the study must include a check for substantiated findings of maltreatment
of adults and children in the individual's state of residence when the information is made
available by that state, and must include a check of the National Crime Information Center
database;

(3) beginning July 1, 1999, all other employees in nursing homes licensed under chapter
144A, and boarding care homes licensed under sections 144.50 to 144.58. A disqualification
of an individual in this section shall disqualify the individual from positions allowing direct
contact or access to patients or residents receiving services. "Access" means physical access
to a client or the client's personal property without continuous, direct supervision as defined
in section 245C.02, subdivision 8, when the employee's employment responsibilities do not
include providing direct contact services;

(4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities; deleted text begin and
deleted text end

(5) controlling persons of a supplemental nursing services agency, as defined under
section 144A.70. new text begin ; and
new text end

new text begin (6) individuals providing services who have direct contact, as defined under section
245C.02, subdivision 11, with medically complex or technologically dependent children at
a PPEC center licensed under chapter 144H.
new text end

If a facility or program is licensed by the Department of Human Services and subject to
the background study provisions of chapter 245C and is also licensed by the Department
of Health, the Department of Human Services is solely responsible for the background
studies of individuals in the jointly licensed programs.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 2.

Minnesota Statutes 2018, section 144H.01, subdivision 5, is amended to read:

Subd. 5.

Medically complex or technologically dependent child.

"Medically complex
or technologically dependent child" means a child under 21 years of age who deleted text begin , because of
a medical condition, requires continuous therapeutic interventions or skilled nursing
supervision which must be prescribed by a licensed physician and administered by, or under
the direct supervision of, a licensed registered nurse. deleted text end new text begin :
new text end

new text begin (1) needs skilled assessment and intervention multiple times during a 24-hour period to
maintain health and prevent deterioration of health status;
new text end

new text begin (2) has both predictable health needs and the potential for changes in condition that
could lead to rapid deterioration or life-threatening episodes;
new text end

new text begin (3) requires a 24-hour plan of care, including a backup plan to reasonably ensure health
and safety in the community; and
new text end

new text begin (4) is expected to require frequent or continuous care in a hospital without the provision
of services in the child's home or a community setting.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 3.

Minnesota Statutes 2018, section 144H.04, subdivision 1, is amended to read:

Subdivision 1.

Licenses.

A person seeking licensure for a PPEC center must submit a
completed application for licensure to the commissioner, in a form and manner determined
by the commissioner. The applicant must also submit the application fee, in the amount
specified in section 144H.05, subdivision 1. deleted text begin Effective January 1, 2018, deleted text end new text begin Beginning July 1,
2020, new text end the commissioner shall issue a license for a PPEC center if the commissioner
determines that the applicant and center meet the requirements of this chapter and rules that
apply to PPEC centers. A license issued under this subdivision is valid for two years.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2018.
new text end

Sec. 4.

Minnesota Statutes 2018, section 144H.04, is amended by adding a subdivision to
read:

new text begin Subd. 1a. new text end

new text begin Licensure phase-in. new text end

new text begin (a) The commissioner shall phase in licensure of PPEC
centers by issuing prior to June 30, 2022, no more than two licenses to applicants the
commissioner determines meet the requirements of this chapter. A license issued under this
subdivision is valid until June 30, 2022.
new text end

new text begin (b) This subdivision expires July 1, 2022.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon the effective date of section 12.
new text end

Sec. 5.

Minnesota Statutes 2018, section 144H.06, is amended to read:

144H.06 APPLICATION OF RULES FOR HOSPICE SERVICES AND
RESIDENTIAL HOSPICE FACILITIES.

Minnesota Rules, chapter 4664, shall apply to PPEC centers licensed under this chapter,
except that the following parts, subparts, new text begin and new text end items deleted text begin , and subitems deleted text end do not apply:

(1) Minnesota Rules, part 4664.0003, subparts 2, 6, 7, 11, 12, 13, 14, and 38;

(2) Minnesota Rules, part 4664.0008;

(3) Minnesota Rules, part 4664.0010, subparts 3; 4, deleted text begin items A, subitem (6), and deleted text end new text begin item new text end B;
and 8;

(4) Minnesota Rules, part 4664.0020, subpart 13;

(5) Minnesota Rules, part 4664.0370, subpart 1;

(6) Minnesota Rules, part 4664.0390, subpart 1, items A, C, and E;

(7) Minnesota Rules, part 4664.0420;

(8) Minnesota Rules, part 4664.0425, subparts 3, item A; 4; and 6;

(9) Minnesota Rules, part 4664.0430, subparts 3, 4, 5, 7, 8, 9, 10, 11, and 12;

(10) Minnesota Rules, part 4664.0490; and

(11) Minnesota Rules, part 4664.0520.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 6.

Minnesota Statutes 2018, section 144H.07, subdivision 1, is amended to read:

Subdivision 1.

Services.

A PPEC center must provide basic services to medically complex
or technologically dependent children, based on a protocol of care established for each child.
A PPEC center may provide services up to deleted text begin 14 deleted text end new text begin 12.5 new text end hours a day and up to six days a week new text begin
with hours of operation during normal waking hours new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 7.

Minnesota Statutes 2018, section 144H.07, subdivision 2, is amended to read:

Subd. 2.

Limitations.

A PPEC center must comply with the following standards related
to services:

(1) a child is prohibited from attending a PPEC center for more than deleted text begin 14 deleted text end new text begin 12.5 new text end hours within
a 24-hour period;

(2) a PPEC center is prohibited from providing services other than those provided to
medically complex or technologically dependent children; and

(3) the maximum capacity for medically complex or technologically dependent children
at a center shall not exceed 45 children.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 8.

Minnesota Statutes 2018, section 144H.08, subdivision 2, is amended to read:

Subd. 2.

deleted text begin Duties of administrator deleted text end new text begin Administrators new text end .

new text begin (a) new text end The center administrator is
responsible and accountable for overall management of the center. The administrator must:

(1) designate in writing a person to be responsible for the center when the administrator
is absent from the center for more than 24 hours;

(2) maintain the following written records, in a place and form and using a system that
allows for inspection of the records by the commissioner during normal business hours:

(i) a daily census record, which indicates the number of children currently receiving
services at the center;

(ii) a record of all accidents or unusual incidents involving any child or staff member
that caused, or had the potential to cause, injury or harm to a person at the center or to center
property;

(iii) copies of all current agreements with providers of supportive services or contracted
services;

(iv) copies of all current agreements with consultants employed by the center,
documentation of each consultant's visits, and written, dated reports; and

(v) a personnel record for each employee, which must include an application for
employment, references, employment history for the preceding five years, and copies of all
performance evaluations;

(3) develop and maintain a current job description for each employee;

(4) provide necessary qualified personnel and ancillary services to ensure the health,
safety, and proper care for each child; and

(5) develop and implement infection control policies that comply with rules adopted by
the commissioner regarding infection control.

new text begin (b) In order to serve as an administrator of a PPEC center, an individual must have at
least two years of experience in the past five years caring for or managing the care of
medically complex or technologically dependent individuals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 9.

Minnesota Statutes 2018, section 144H.11, subdivision 2, is amended to read:

Subd. 2.

Registered nurses.

A registered nurse employed by a PPEC center must be a
registered nurse licensed in Minnesota, new text begin and new text end hold a current certification in cardiopulmonary
resuscitation deleted text begin , and have experience in the previous 24 months in being responsible for the
care of acutely ill or chronically ill children deleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 10.

Minnesota Statutes 2018, section 144H.11, subdivision 3, is amended to read:

Subd. 3.

Licensed practical nurses.

A licensed practical nurse employed by a PPEC
center must be supervised by a registered nurse and must be a licensed practical nurse
licensed in Minnesota, deleted text begin have at least two years of experience in pediatrics, deleted text end and hold a current
certification in cardiopulmonary resuscitation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 11.

Minnesota Statutes 2018, section 144H.11, subdivision 4, is amended to read:

Subd. 4.

Other direct care personnel.

(a) Direct care personnel governed by this
subdivision new text begin may new text end include nursing assistants deleted text begin and deleted text end new text begin or new text end individuals with training and experience
in the field of education, social services, or child care.

(b) All direct care personnel employed by a PPEC center must work under the supervision
of a registered nurse and are responsible for providing direct care to children at the center.
Direct care personnel must have extensive, documented education and skills training in
providing care to infants and toddlers, provide employment references documenting skill
in the care of infants and children, and hold a current certification in cardiopulmonary
resuscitation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 12.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 66. new text end

new text begin Prescribed pediatric extended care (PPEC) center basic services. new text end

new text begin Medical
assistance covers PPEC center basic services as defined under section 144H.01, subdivision
2. PPEC basic services shall be reimbursed according to section 256B.86.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the commissioner
of health and the revisor of statutes when federal approval is obtained.
new text end

Sec. 13.

new text begin [256B.86] PRESCRIBED PEDIATRIC EXTENDED CARE (PPEC) CENTER
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Reimbursement rates. new text end

new text begin The daily per-child payment rates for PPEC basic
services covered by medical assistance and provided at PPEC centers licensed under chapter
144H are:
new text end

new text begin (1) for intense complexity: $550 for four or more hours and $275 for less than four hours;
new text end

new text begin (2) for high complexity: $450 for four or more hours and $225 for less than four hours;
and
new text end

new text begin (3) for moderate complexity: $400 for four or more hours and $200 for less than four
hours.
new text end

new text begin Subd. 2. new text end

new text begin Determination of complexity level. new text end

new text begin Complexity level shall be determined
based on the level of nursing intervention required for each child using an assessment tool
approved by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 14. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
QUALITY MEASURES FOR PRESCRIBED PEDIATRIC EXTENDED CARE
(PPEC) CENTERS.
new text end

new text begin The commissioner of human services, in consultation with PPEC centers licensed prior
to June 30, 2022, shall develop quality measures for PPEC centers, procedures for PPEC
centers to report quality measures to the commissioner, and methods for the commissioner
to make the results of the quality measures available to the public.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon the effective date of section 12.
new text end

Sec. 15. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
PRESCRIBED PEDIATRIC EXTENDED CARE.
new text end

new text begin No later than October 15, 2019, the commissioner of human services shall submit to the
federal Centers for Medicare and Medicaid Services any medical assistance state plan
amendments necessary to cover PPEC center basic services according to Minnesota Statutes,
sections 256B.0625, subdivision 66, and 256B.86.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, section 144H.08, subdivision 1, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

APPENDIX

Repealed Minnesota Statutes: 19-2954

144H.08 ADMINISTRATION AND MANAGEMENT.

Subdivision 1.

Duties of owner.

(a) The owner of a PPEC center shall have full legal authority and responsibility for the operation of the center. A PPEC center must be organized according to a written table of organization, describing the lines of authority and communication to the child care level. The organizational structure must be designed to ensure an integrated continuum of services for the children served.

(b) The owner must designate one person as a center administrator, who is responsible and accountable for overall management of the center.