as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to health; regulating hospice care providers; 1.3 amending Minnesota Statutes 2000, sections 13.381, 1.4 subdivision 10; 144A.43, subdivisions 1, 3, 4; 1.5 144A.45, subdivisions 1, 2; 144A.46, subdivisions 3a, 1.6 3b, 4; 144A.4605, subdivisions 2, 3, 4; 145C.01, 1.7 subdivision 7; 157.17, subdivision 2; 609.7495, 1.8 subdivision 1; proposing coding for new law in 1.9 Minnesota Statutes, chapter 144A; repealing Minnesota 1.10 Statutes 2000, section 144A.48. 1.11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.12 Section 1. Minnesota Statutes 2000, section 13.381, 1.13 subdivision 10, is amended to read: 1.14 Subd. 10. [HOME CARE AND HOSPICE PROGRAM.] Data regarding 1.15 a home carehospiceprogram under sections 144A.43 to144A.481.16 144A.47 are governed by section 144A.45. Data regarding a 1.17 hospice program under sections 144A.70 to 144A.705 are governed 1.18 by sections 144A.702 and 144A.704. 1.19 Sec. 2. Minnesota Statutes 2000, section 144A.43, 1.20 subdivision 1, is amended to read: 1.21 Subdivision 1. [APPLICABILITY.] The definitions in this 1.22 section apply to sections 144.699, subdivision 2, and 144A.43 to 1.23144A.48144A.47. 1.24 Sec. 3. Minnesota Statutes 2000, section 144A.43, 1.25 subdivision 3, is amended to read: 1.26 Subd. 3. [HOME CARE SERVICE.] "Home care service" means 1.27 any of the following services when delivered in a place of 1.28 residence to a person whose illness, disability, or physical 2.1 condition creates a need for the service: 2.2 (1) nursing services, including the services of a home 2.3 health aide; 2.4 (2) personal care services not included under sections 2.5 148.171 to 148.285; 2.6 (3) physical therapy; 2.7 (4) speech therapy; 2.8 (5) respiratory therapy; 2.9 (6) occupational therapy; 2.10 (7) nutritional services; 2.11 (8) home management services when provided to a person who 2.12 is unable to perform these activities due to illness, 2.13 disability, or physical condition. Home management services 2.14 include at least two of the following services: housekeeping, 2.15 meal preparation, and shopping; 2.16 (9) medical social services; 2.17 (10) the provision of medical supplies and equipment when 2.18 accompanied by the provision of a home care service; and 2.19 (11)the provision of a hospice program as specified in2.20section 144A.48; and2.21(12)other similar medical services and health-related 2.22 support services identified by the commissioner in rule. 2.23 "Home care service" does not include the following 2.24 activities conducted by the commissioner of health or a board of 2.25 health as defined in section 145A.02, subdivision 2: 2.26 communicable disease investigations or testing; administering or 2.27 monitoring a prescribed therapy necessary to control or prevent 2.28 a communicable disease; or the monitoring of an individual's 2.29 compliance with a health directive as defined in section 2.30 144.4172, subdivision 6. 2.31 Sec. 4. Minnesota Statutes 2000, section 144A.43, 2.32 subdivision 4, is amended to read: 2.33 Subd. 4. [HOME CARE PROVIDER.] "Home care provider" means 2.34 an individual, organization, association, corporation, unit of 2.35 government, or other entity that is regularly engaged in the 2.36 delivery, directly or by contractual arrangement, of home care 3.1 services for a fee. At least one home care service must be 3.2 provided directly, although additional home care services may be 3.3 provided by contractual arrangements."Home care provider"3.4includes a hospice program defined in section 144A.48."Home 3.5 care provider" does not include: 3.6 (1) any home care or nursing services conducted by and for 3.7 the adherents of any recognized church or religious denomination 3.8 for the purpose of providing care and services for those who 3.9 depend upon spiritual means, through prayer alone, for healing; 3.10 (2) an individual who only provides services to a relative; 3.11 (3) an individual not connected with a home care provider 3.12 who provides assistance with home management services or 3.13 personal care needs if the assistance is provided primarily as a 3.14 contribution and not as a business; 3.15 (4) an individual not connected with a home care provider 3.16 who shares housing with and provides primarily housekeeping or 3.17 homemaking services to an elderly or disabled person in return 3.18 for free or reduced-cost housing; 3.19 (5) an individual or agency providing home-delivered meal 3.20 services; 3.21 (6) an agency providing senior companion services and other 3.22 older American volunteer programs established under the Domestic 3.23 Volunteer Service Act of 1973, Public Law Number 98-288; 3.24 (7) an employee of a nursing home licensed under this 3.25 chapter or an employee of a boarding care home licensed under 3.26 sections 144.50 to 144.56 who responds to occasional emergency 3.27 calls from individuals residing in a residential setting that is 3.28 attached to or located on property contiguous to the nursing 3.29 home or boarding care home; 3.30 (8) a member of a professional corporation organized under 3.31 chapter 319B that does not regularly offer or provide home care 3.32 services as defined in subdivision 3; 3.33 (9) the following organizations established to provide 3.34 medical or surgical services that do not regularly offer or 3.35 provide home care services as defined in subdivision 3: a 3.36 business trust organized under sections 318.01 to 318.04, a 4.1 nonprofit corporation organized under chapter 317A, a 4.2 partnership organized under chapter 323, or any other entity 4.3 determined by the commissioner; 4.4 (10) an individual or agency that provides medical supplies 4.5 or durable medical equipment, except when the provision of 4.6 supplies or equipment is accompanied by a home care service; 4.7 (11) an individual licensed under chapter 147; or 4.8 (12) an individual who provides home care services to a 4.9 person with a developmental disability who lives in a place of 4.10 residence with a family, foster family, or primary caregiver. 4.11 Sec. 5. Minnesota Statutes 2000, section 144A.45, 4.12 subdivision 1, is amended to read: 4.13 Subdivision 1. [RULES.] The commissioner shall adopt rules 4.14 for the regulation of home care providers pursuant to sections 4.15 144A.43 to144A.48144A.47. The rules shall include the 4.16 following: 4.17 (a) provisions to assure, to the extent possible, the 4.18 health, safety and well-being, and appropriate treatment of 4.19 persons who receive home care services; 4.20 (b) requirements that home care providers furnish the 4.21 commissioner with specified information necessary to implement 4.22 sections 144A.43 to144A.48144A.47; 4.23 (c) standards of training of home care provider personnel, 4.24 which may vary according to the nature of the services provided 4.25 or the health status of the consumer; 4.26 (d) standards for medication management which may vary 4.27 according to the nature of the services provided, the setting in 4.28 which the services are provided, or the status of the consumer. 4.29 Medication management includes the central storage, handling, 4.30 distribution, and administration of medications; 4.31 (e) standards for supervision of home care services 4.32 requiring supervision by a registered nurse or other appropriate 4.33 health care professional which must occur on site at least every 4.34 62 days, or more frequently if indicated by a clinical 4.35 assessment, and in accordance with sections 148.171 to 148.285 4.36 and rules adopted thereunder; 5.1 (f) standards for client evaluation or assessment which may 5.2 vary according to the nature of the services provided or the 5.3 status of the consumer; 5.4 (g) requirements for the involvement of a consumer's 5.5 physician, the documentation of physicians' orders, if required, 5.6 and the consumer's treatment plan, and the maintenance of 5.7 accurate, current clinical records; 5.8 (h) the establishment of different classes of licenses for 5.9 different types of providers and different standards and 5.10 requirements for different kinds of home care services; and 5.11 (i) operating procedures required to implement the home 5.12 care bill of rights. 5.13 Sec. 6. Minnesota Statutes 2000, section 144A.45, 5.14 subdivision 2, is amended to read: 5.15 Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner 5.16 shall: 5.17 (1) evaluate, monitor, and license home care providers in 5.18 accordance with sections 144A.45 to144A.48144A.47; 5.19 (2) inspect the office and records of a provider during 5.20 regular business hours without advance notice to the home care 5.21 provider; 5.22 (3) with the consent of the consumer, visit the home where 5.23 services are being provided; 5.24 (4) issue correction orders and assess civil penalties in 5.25 accordance with section 144.653, subdivisions 5 to 8, for 5.26 violations of sections 144A.43 to144A.48144A.47 or the rules 5.27 adopted under those sections; and 5.28 (5) take other action reasonably required to accomplish the 5.29 purposes of sections 144A.43 to144A.48144A.47. 5.30 (b) In the exercise of the authority granted in sections 5.31 144A.43 to144A.48144A.47, the commissioner shall comply with 5.32 the applicable requirements of section 144.122, the Government 5.33 Data Practices Act, and the Administrative Procedure Act. 5.34 Sec. 7. Minnesota Statutes 2000, section 144A.46, 5.35 subdivision 3a, is amended to read: 5.36 Subd. 3a. [INJUNCTIVE RELIEF.] In addition to any other 6.1 remedy provided by law, the commissioner may bring an action in 6.2 district court to enjoin a person who is involved in the 6.3 management, operation, or control of a home care provider, or an 6.4 employee of the home care provider from illegally engaging in 6.5 activities regulated by sections 144A.43 to144A.48144A.47. 6.6 The commissioner may bring an action under this subdivision in 6.7 the district court in Ramsey county or in the district in which 6.8 a home care provider is providing services. The court may grant 6.9 a temporary restraining order in the proceeding if continued 6.10 activity by the person who is involved in the management, 6.11 operation, or control of a home care provider, or by an employee 6.12 of the home care provider, would create an imminent risk of harm 6.13 to a recipient of home care services. 6.14 Sec. 8. Minnesota Statutes 2000, section 144A.46, 6.15 subdivision 3b, is amended to read: 6.16 Subd. 3b. [SUBPOENA.] In matters pending before the 6.17 commissioner under sections 144A.43 to144A.48144A.47, the 6.18 commissioner may issue subpoenas and compel the attendance of 6.19 witnesses and the production of all necessary papers, books, 6.20 records, documents, and other evidentiary material. If a person 6.21 fails or refuses to comply with a subpoena or order of the 6.22 commissioner to appear or testify regarding any matter about 6.23 which the person may be lawfully questioned or to produce any 6.24 papers, books, records, documents, or evidentiary materials in 6.25 the matter to be heard, the commissioner may apply to the 6.26 district court in any district, and the court shall order the 6.27 person to comply with the commissioner's order or subpoena. The 6.28 commissioner of health may administer oaths to witnesses, or 6.29 take their affirmation. Depositions may be taken in or outside 6.30 the state in the manner provided by law for the taking of 6.31 depositions in civil actions. A subpoena or other process or 6.32 paper may be served upon a named person anywhere within the 6.33 state by an officer authorized to serve subpoenas in civil 6.34 actions, with the same fees and mileage and in the same manner 6.35 as prescribed by law for process issued out of a district 6.36 court. A person subpoenaed under this subdivision shall receive 7.1 the same fees, mileage, and other costs that are paid in 7.2 proceedings in district court. 7.3 Sec. 9. Minnesota Statutes 2000, section 144A.46, 7.4 subdivision 4, is amended to read: 7.5 Subd. 4. [RELATION TO OTHER REGULATORY PROGRAMS.] In the 7.6 exercise of the authority granted under sections 144A.43 to 7.7144A.48144A.47, the commissioner shall not duplicate or replace 7.8 standards and requirements imposed under another state 7.9 regulatory program. The commissioner shall not impose 7.10 additional training or education requirements upon members of a 7.11 licensed or registered occupation or profession, except as 7.12 necessary to address or prevent problems that are unique to the 7.13 delivery of services in the home or to enforce and protect the 7.14 rights of consumers listed in section 144A.44. The commissioner 7.15 of health shall not require a home care provider certified under 7.16 the Medicare program to comply with a rule adopted under section 7.17 144A.45 if the home care provider is required to comply with any 7.18 equivalent federal law or regulation relating to the same 7.19 subject matter. The commissioner of health shall specify in the 7.20 rules those provisions that are not applicable to certified home 7.21 care providers. To the extent possible, the commissioner shall 7.22 coordinate the inspections required under sections 144A.45 to 7.23144A.48144A.47 with the health facility licensure inspections 7.24 required under sections 144.50 to 144.58 or 144A.10 when the 7.25 health care facility is also licensed under the provisions of 7.26 Laws 1987, chapter 378. 7.27 Sec. 10. Minnesota Statutes 2000, section 144A.4605, 7.28 subdivision 2, is amended to read: 7.29 Subd. 2. [ASSISTED LIVING HOME CARE LICENSE ESTABLISHED.] 7.30 A home care provider license category entitled assisted living 7.31 home care provider is hereby established. A home care provider 7.32 may obtain an assisted living license if the program meets the 7.33 following requirements: 7.34 (a) nursing services, delegated nursing services, other 7.35 services performed by unlicensed personnel, or central storage 7.36 of medications under the assisted living license are provided 8.1 solely for residents of one or more housing with services 8.2 establishments registered under chapter 144D; 8.3 (b) unlicensed personnel perform home health aide and home 8.4 care aide tasks identified in Minnesota Rules, parts 4668.0100, 8.5 subparts 1 and 2, and 4668.0110, subpart 1. Qualifications to 8.6 perform these tasks shall be established in accordance with 8.7 subdivision 3; 8.8 (c) periodic supervision of unlicensed personnel is 8.9 provided as required by rule; 8.10 (d) notwithstanding Minnesota Rules, part 4668.0160, 8.11 subpart 6, item D, client records shall include: 8.12 (1) daily records or a weekly summary of home care services 8.13 provided; 8.14 (2) documentation each time medications are administered to 8.15 a client; and 8.16 (3) documentation on the day of occurrence of any 8.17 significant change in the client's status or any significant 8.18 incident, such as a fall or refusal to take medications. 8.19 All entries must be signed by the staff providing the 8.20 services and entered into the record no later than two weeks 8.21 after the end of the service day, except as specified in clauses 8.22 (2) and (3); 8.23 (e) medication and treatment orders, if any, are included 8.24 in the client record and are renewed at least every 12 months, 8.25 or more frequently when indicated by a clinical assessment; 8.26 (f) the central storage of medications in a housing with 8.27 services establishment registered under chapter 144D is managed 8.28 under a system that is established by a registered nurse and 8.29 addresses the control of medications, handling of medications, 8.30 medication containers, medication records, and disposition of 8.31 medications; and 8.32 (g) in other respects meets the requirements established by 8.33 rules adopted under sections 144A.45 to144A.48144A.47. 8.34 Sec. 11. Minnesota Statutes 2000, section 144A.4605, 8.35 subdivision 3, is amended to read: 8.36 Subd. 3. [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.] 9.1 (a) Unlicensed personnel must: 9.2 (1) satisfy the training or competency requirements 9.3 established by rule under sections 144A.45 to144A.48144A.47; 9.4 or 9.5 (2) be trained or determined competent by a registered 9.6 nurse in each task identified under Minnesota Rules, part 9.7 4668.0100, subparts 1 and 2, when offered to clients in a 9.8 housing with services establishment as described in paragraphs 9.9 (b) to (e). 9.10 (b) Training for tasks identified under Minnesota Rules, 9.11 part 4668.0100, subparts 1 and 2, shall use a curriculum which 9.12 meets the requirements in Minnesota Rules, part 4668.0130. 9.13 (c) Competency evaluations for tasks identified under 9.14 Minnesota Rules, part 4668.0100, subparts 1 and 2, must be 9.15 completed and documented by a registered nurse. 9.16 (d) Unlicensed personnel performing tasks identified under 9.17 Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be 9.18 trained or demonstrate competency in the following topics: 9.19 (1) an overview of sections 144A.43 to144A.48144A.47 and 9.20 rules adopted thereunder; 9.21 (2) recognition and handling of emergencies and use of 9.22 emergency services; 9.23 (3) reporting the maltreatment of vulnerable minors or 9.24 adults under sections 626.556 and 626.557; 9.25 (4) home care bill of rights; 9.26 (5) handling of clients' complaints and reporting of 9.27 complaints to the office of health facility complaints; 9.28 (6) services of the ombudsman for older Minnesotans; 9.29 (7) observation, reporting, and documentation of client 9.30 status and of the care or services provided; 9.31 (8) basic infection control; 9.32 (9) maintenance of a clean, safe, and healthy environment; 9.33 (10) communication skills; 9.34 (11) basic elements of body functioning and changes in body 9.35 function that must be reported to an appropriate health care 9.36 professional; and 10.1 (12) physical, emotional, and developmental needs of 10.2 clients, and ways to work with clients who have problems in 10.3 these areas, including respect for the client, the client's 10.4 property, and the client's family. 10.5 (e) Unlicensed personnel who administer medications must 10.6 comply with rules relating to the administration of medications 10.7 in Minnesota Rules, part 4668.0100, subpart 2, except that 10.8 unlicensed personnel need not comply with the requirements of 10.9 Minnesota Rules, part 4668.0100, subpart 5. 10.10 Sec. 12. Minnesota Statutes 2000, section 144A.4605, 10.11 subdivision 4, is amended to read: 10.12 Subd. 4. [LICENSE REQUIRED.] (a) A housing with services 10.13 establishment registered under chapter 144D that is required to 10.14 obtain a home care license must obtain an assisted living home 10.15 care license according to this section or a class A or class E 10.16 license according to rule. A housing with services 10.17 establishment that obtains a class E license under this 10.18 subdivision remains subject to the payment limitations in 10.19 sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915, 10.20 subdivision 3, paragraph (g). 10.21 (b) A board and lodging establishment registered for 10.22 special services as of December 31, 1996, and also registered as 10.23 a housing with services establishment under chapter 144D, must 10.24 deliver home care services according to sections 144A.43 to 10.25144A.48144A.47, and may apply for a waiver from requirements 10.26 under Minnesota Rules, parts 4668.0002 to 4668.0240, to operate 10.27 a licensed agency under the standards of section 157.17. Such 10.28 waivers as may be granted by the department will expire upon 10.29 promulgation of home care rules implementing section 144A.4605. 10.30 (c) An adult foster care provider licensed by the 10.31 department of human services and registered under chapter 144D 10.32 may continue to provide health-related services under its foster 10.33 care license until the promulgation of home care rules 10.34 implementing this section. 10.35 Sec. 13. [144A.70] [DEFINITIONS.] 10.36 Subdivision 1. [APPLICABILITY.] For the purposes of 11.1 sections 144A.70 to 144A.705, the following terms have the 11.2 meanings given to them. 11.3 Subd. 2. [COMMISSIONER.] "Commissioner" means the 11.4 commissioner of health. 11.5 Subd. 3. [CORE SERVICES.] "Core services" means physician 11.6 services, registered nursing services, medical social services, 11.7 pastoral care or other counseling services, and volunteer 11.8 services that are provided either directly by a hospice care 11.9 provider or through a service contract or other arrangement. 11.10 Subd. 4. [HOSPICE CARE.] "Hospice care" means palliative 11.11 and supportive care and other services provided by an 11.12 interdisciplinary team under the direction of an identifiable 11.13 hospice administration to terminally ill hospice patients and 11.14 their families to meet the physical, nutritional, emotional, 11.15 social, spiritual, and special needs experienced during the 11.16 final stages of illness, dying, and bereavement, through a 11.17 centrally coordinated program that ensures continuity and 11.18 consistency of home and inpatient care provided directly or 11.19 through an agreement. 11.20 Subd. 5. [HOSPICE PATIENT.] "Hospice patient" means an 11.21 individual who has been diagnosed as terminally ill, as 11.22 documented by the individual's attending physician and hospice 11.23 medical director, who alone or, when unable, through the 11.24 individual's family, has voluntarily consented to and received 11.25 admission to a hospice care program. 11.26 Subd. 6. [HOSPICE PATIENT'S FAMILY.] "Hospice patient's 11.27 family" means relatives of the hospice patient, the hospice 11.28 patient's guardian or primary caregiver, or persons identified 11.29 by the hospice patient as having significant personal ties. 11.30 Subd. 7. [INTERDISCIPLINARY TEAM.] "Interdisciplinary team" 11.31 means a group of qualified individuals with expertise in meeting 11.32 the special needs of hospice patients and their families, 11.33 including, at a minimum, those individuals who are providers of 11.34 core services. 11.35 Subd. 8. [MEDICAL DIRECTOR.] "Medical director" means a 11.36 licensed physician who is knowledgeable about palliative 12.1 medicine and assumes overall responsibility for the medical 12.2 component of the hospice care program. 12.3 Subd. 9. [PALLIATIVE CARE.] "Palliative care" means care 12.4 directed at managing the pain and symptoms experienced by a 12.5 hospice patient and intended to enhance the quality of life for 12.6 the patient and the hospice patient's family but not directed at 12.7 curing the illness. 12.8 Subd. 10. [RESIDENTIAL HOSPICE FACILITY.] "Residential 12.9 hospice facility" means a facility located in a residential area 12.10 that directly provides 24-hour residential and support services 12.11 in a home-like setting for hospice patients as an integral part 12.12 of the continuum of home care provided by a hospice and that 12.13 houses: 12.14 (1) no more than eight hospice patients; or 12.15 (2) at least nine and no more than 12 hospice patients with 12.16 the approval of the local governing authority, notwithstanding 12.17 section 462.357, subdivision 8. 12.18 Subd. 11. [VOLUNTEER SERVICES.] "Volunteer services" means 12.19 services by volunteers who provide a personal presence that 12.20 augments a variety of professional and nonprofessional services 12.21 available to the hospice patient, the hospice patient's family, 12.22 and the hospice care provider. 12.23 Sec. 14. [144A.701] [HOSPICE BILL OF RIGHTS.] 12.24 Subdivision 1. [STATEMENT OF RIGHTS.] An individual who 12.25 receives hospice care and the individual's family have the right 12.26 to: 12.27 (1) receive written information about rights in advance of 12.28 receiving hospice care or during the initial evaluation visit 12.29 before the initiation of hospice care, including what to do if 12.30 rights are violated; 12.31 (2) receive care and services according to a suitable 12.32 hospice plan of care and subject to accepted hospice care 12.33 standards and to take an active part in creating and changing 12.34 the plan and evaluating care and services; 12.35 (3) be told in advance of receiving care about the services 12.36 that will be provided, the disciplines that will furnish care, 13.1 the frequency of visits proposed to be furnished, other choices 13.2 that are available, and the consequence of these choices, 13.3 including the consequences of refusing these services; 13.4 (4) be told in advance, whenever possible, of any change in 13.5 the hospice plan of care and to take an active part in any 13.6 change; 13.7 (5) refuse services or treatment; 13.8 (6) know, in advance, any limits to the services available 13.9 from a provider, and the provider's grounds for a termination of 13.10 services; 13.11 (7) know in advance of receiving care whether the services 13.12 are covered by health insurance, medical assistance, or other 13.13 health programs, the charges for services that will not be 13.14 covered by Medicare, and the charges that the individual may 13.15 have to pay; 13.16 (8) know what the charges are for services, no matter who 13.17 will be paying the bill; 13.18 (9) know that there may be other services available in the 13.19 community, including other end of life services and other 13.20 hospice care providers, and to know where to go for information 13.21 about these services; 13.22 (10) choose freely among available providers and change 13.23 providers after services have begun, within the limits of health 13.24 insurance, medical assistance, or other health programs; 13.25 (11) have personal, financial, and medical information kept 13.26 private and be advised of the provider's policies and procedures 13.27 regarding disclosure of such information; 13.28 (12) be allowed access to records and written information 13.29 from records in accordance with law; 13.30 (13) be served by people who are properly trained and 13.31 competent to perform their duties; 13.32 (14) be treated with courtesy and respect and to have the 13.33 patient's property treated with respect; 13.34 (15) be free from physical and verbal abuse; 13.35 (16) reasonable, advance notice of changes in services or 13.36 charges; 14.1 (17) a coordinated transfer when there will be a change in 14.2 the provider of services; 14.3 (18) voice grievances regarding treatment or care that is, 14.4 or fails to be, furnished or regarding the lack of courtesy or 14.5 respect to the patient or the patient's property; 14.6 (19) know how to contact an individual associated with the 14.7 provider who is responsible for handling problems and to have 14.8 the provider investigate and attempt to resolve the grievance or 14.9 complaint; 14.10 (20) know the name and address of the state or county 14.11 agency to contact for additional information or assistance; 14.12 (21) assert these rights personally, or have them asserted 14.13 by the hospice patient's family when the patient has been judged 14.14 incompetent, without retaliation; and 14.15 (22) have pain and symptoms managed to the patient's 14.16 desired level of comfort. 14.17 Subd. 2. [INTERPRETATION AND ENFORCEMENT OF RIGHTS.] The 14.18 rights under this section are established for the benefit of 14.19 individuals who receive hospice care. A hospice care provider 14.20 may not require a person to surrender these rights as a 14.21 condition of receiving hospice care. A guardian or conservator 14.22 or, when there is no guardian or conservator, a designated 14.23 person, may seek to enforce these rights. This statement of 14.24 rights does not replace or diminish other rights and liberties 14.25 that may exist relative to persons receiving hospice care, 14.26 persons providing hospice care, or hospice care providers 14.27 licensed under section 144A.703. 14.28 Subd. 3. [DISCLOSURE.] A copy of these rights must be 14.29 provided to an individual at the time hospice care is 14.30 initiated. The copy shall contain the address and telephone 14.31 number of the office of health facility complaints and the 14.32 office of the ombudsman for older Minnesotans and a brief 14.33 statement describing how to file a complaint with these 14.34 offices. Information about how to contact the office of the 14.35 ombudsman for older Minnesotans shall be included in notices of 14.36 change in client fees and in notices where hospice care 15.1 providers initiate transfer or discontinuation of services. 15.2 Sec. 15. [144A.702] [REGULATION OF HOSPICE CARE.] 15.3 Subdivision 1. [RULES.] The commissioner shall adopt rules 15.4 for the regulation of hospice care providers according to 15.5 sections 144A.70 to 144A.705. The rules shall include the 15.6 following: 15.7 (1) provisions to ensure, to the extent possible, the 15.8 health, safety, well-being, and appropriate treatment of persons 15.9 who receive hospice care; 15.10 (2) requirements that hospice care providers furnish the 15.11 commissioner with specified information necessary to implement 15.12 sections 144A.70 to 144A.705; 15.13 (3) standards of training of hospice care provider 15.14 personnel; 15.15 (4) standards for medication management, which may vary 15.16 according to the nature of the hospice care provided, the 15.17 setting in which the hospice care is provided, or the status of 15.18 the patient; 15.19 (5) standards for supervision of hospice care requiring 15.20 supervision by a registered nurse or other appropriate hospice 15.21 professional, which must occur on site at least every 62 days, 15.22 or more frequently if indicated by a clinical assessment, and as 15.23 appropriate according to sections 144A.70 to 144A.705; 15.24 (6) standards for hospice patient and hospice patient's 15.25 family evaluation or assessment, which may vary according to the 15.26 nature of the hospice care provided or the status of the 15.27 patient; and 15.28 (7) requirements for the involvement of a patient's 15.29 physician; documentation of physicians' orders, if required, and 15.30 the patient's hospice plan of care; and maintenance of accurate, 15.31 current clinical records. 15.32 Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner 15.33 shall: 15.34 (1) evaluate, monitor, and license hospice care providers 15.35 according to sections 144A.70 to 144A.705; 15.36 (2) inspect the office and records of a hospice care 16.1 provider during regular business hours without advance notice to 16.2 the hospice care provider; 16.3 (3) with the consent of the patient, visit the home where 16.4 services are being provided; 16.5 (4) issue correction orders and assess civil penalties 16.6 according to section 144.653, subdivisions 5 to 8, for 16.7 violations of sections 144A.70 to 144A.705 or rules adopted 16.8 thereunder; and 16.9 (5) take other action reasonably required to accomplish the 16.10 purposes of sections 144A.70 to 144A.705. 16.11 (b) In the exercise of the authority granted under this 16.12 section, the commissioner shall comply with the applicable 16.13 requirements of the Government Data Practices Act, the 16.14 Administrative Procedure Act, and other applicable law. 16.15 Subd. 3. [RELATION TO OTHER REGULATORY PROGRAMS.] In the 16.16 exercise of the authority granted under sections 144A.70 to 16.17 144A.705, the commissioner shall not duplicate or replace 16.18 standards and requirements imposed under another regulatory 16.19 program of the state. The commissioner shall not impose 16.20 additional training or education requirements upon members of a 16.21 licensed or registered occupation or profession, except as 16.22 necessary to address or prevent problems that are unique to the 16.23 delivery of hospice care in the home or to enforce and protect 16.24 the rights of patients listed under section 144A.701. The 16.25 commissioner shall not require a hospice care provider certified 16.26 under the Medicare program to comply with a rule adopted under 16.27 this section if the hospice care provider is required to comply 16.28 with any equivalent federal law or regulation relating to the 16.29 same subject matter. The commissioner shall specify in the 16.30 rules those provisions that are not applicable to certified 16.31 hospice care providers. To the extent possible, the 16.32 commissioner shall coordinate required inspections with the 16.33 health facility licensure inspections required under chapters 16.34 144 and 144A. 16.35 Subd. 4. [MEDICAID REIMBURSEMENT.] Certification by the 16.36 federal Medicare program must not be a requirement of Medicaid 17.1 payment for room and board services delivered in a residential 17.2 hospice facility. 17.3 Sec. 16. [144A.703] [LICENSURE.] 17.4 Subdivision 1. [LICENSE REQUIRED; APPLICATION.] (a) A 17.5 hospice care provider may not operate in the state without a 17.6 valid license issued by the commissioner. 17.7 (b) Within ten days after receiving an application for a 17.8 license, the commissioner shall acknowledge receipt of the 17.9 application in writing. The acknowledgment must indicate 17.10 whether the application appears to be complete or whether 17.11 additional information is required before the application is 17.12 considered complete. Within 90 days after receiving a complete 17.13 application, the commissioner shall either grant or deny the 17.14 license. If an applicant is not granted or denied a license 17.15 within 90 days after submitting a complete application, the 17.16 license must be deemed granted. An applicant whose license has 17.17 been deemed granted must provide written notice to the 17.18 commissioner before providing hospice care. 17.19 (c) Each application for a hospice care provider license, 17.20 or for a renewal of a license, shall be accompanied by a fee to 17.21 be set by the commissioner. 17.22 Subd. 2. [LICENSING REQUIREMENTS.] The commissioner shall 17.23 license hospice care providers using the authorities under 17.24 sections 144A.70 to 144A.705. To receive a license, a hospice 17.25 care provider must: 17.26 (1) provide centrally coordinated core services in the home 17.27 and inpatient settings; 17.28 (2) require that the medical components of the hospice care 17.29 program be under the direction of a licensed physician who 17.30 serves as medical director; 17.31 (3) require that the palliative care provided to a hospice 17.32 patient be under the direction of a licensed physician; 17.33 (4) utilize an interdisciplinary team that meets regularly 17.34 to develop, implement, and evaluate the hospice program's plan 17.35 of care for each hospice patient and the patient's family; 17.36 (5) provide accessible hospice care, 24 hours a day, seven 18.1 days a week; 18.2 (6) utilize an ongoing system of quality assurance; 18.3 (7) require that volunteer services be provided by 18.4 individuals who have completed a hospice volunteer training 18.5 program and are trained to provide the services required; 18.6 (8) provide a planned program of supportive services 18.7 available to patients and families during hospice care and the 18.8 bereavement period following the death of the hospice patient; 18.9 and 18.10 (9) require that inpatient services be provided directly or 18.11 by arrangement in a licensed hospital or nursing home. 18.12 Subd. 3. [NOMENCLATURE.] A hospice care provider may not 18.13 operate in the state or use the words "hospice," "hospice care," 18.14 "hospice care program," or "hospice care provider" without a 18.15 valid license issued by the commissioner. 18.16 Sec. 17. [144A.704] [ENFORCEMENT.] 18.17 Subdivision 1. [ENFORCEMENT.] (a) The commissioner may 18.18 refuse to grant or renew a license, or may suspend or revoke a 18.19 license, for violation of statutes or rules relating to hospice 18.20 care or for conduct detrimental to the welfare of a patient. 18.21 Prior to any suspension, revocation, or refusal to renew a 18.22 license, the hospice care provider is entitled to notice and a 18.23 hearing as provided by chapter 14. 18.24 (b) In addition to any other remedy provided by law, the 18.25 commissioner may, without a prior contested case hearing, 18.26 temporarily suspend a license or prohibit delivery of hospice 18.27 care by a provider for not more than 60 days if the commissioner 18.28 determines that the health or safety of a patient is in imminent 18.29 danger, provided: 18.30 (1) advance notice is given to the provider; 18.31 (2) after notice, the provider fails to correct the 18.32 problem; 18.33 (3) the commissioner has reason to believe that other 18.34 administrative remedies are not likely to be effective; and 18.35 (4) there is an opportunity for a contested case hearing 18.36 within the 60 days. 19.1 (c) The process of suspending or revoking a license must 19.2 include a plan for transferring affected patients to other 19.3 providers. 19.4 (d) The owner and managerial officials of a hospice care 19.5 provider, the license of which has not been renewed or has been 19.6 revoked because of noncompliance with applicable law, are not 19.7 eligible to apply for and shall not be granted a license for 19.8 five years following the effective date of the nonrenewal or 19.9 revocation. 19.10 (e) The commissioner shall not issue a license to a hospice 19.11 care provider if an owner or managerial official includes an 19.12 individual who was an owner or managerial official of a hospice 19.13 care provider whose license was not renewed or was revoked as 19.14 described in paragraph (d) for five years following the 19.15 effective date of nonrenewal or revocation. 19.16 (f) Notwithstanding the provisions of paragraph (a), the 19.17 commissioner shall not renew or shall suspend or revoke the 19.18 license of a hospice care provider that includes an individual 19.19 as an owner or managerial official who was an owner or 19.20 managerial official of a hospice care provider whose license was 19.21 not renewed or was revoked as described in paragraph (d) for 19.22 five years following the effective date of the nonrenewal or 19.23 revocation. 19.24 (g) The commissioner shall notify the hospice care provider 19.25 30 days in advance of the date of nonrenewal, suspension, or 19.26 revocation of the license. Within ten days after the receipt of 19.27 this notification, the hospice care provider may request, in 19.28 writing, that the commissioner stay the nonrenewal, revocation, 19.29 or suspension of the license. The hospice care provider shall 19.30 specify the reasons for requesting the stay; the steps that will 19.31 be taken to attain or maintain compliance with the licensure 19.32 laws; any limits on the authority or responsibility of the 19.33 owners or managerial officials whose actions resulted in the 19.34 notice of nonrenewal, revocation, or suspension; and any other 19.35 information to establish that the continuing affiliation with 19.36 these individuals will not jeopardize patient health, safety, or 20.1 well-being. The commissioner shall determine whether the stay 20.2 will be granted within 30 days of receiving the provider's 20.3 request. The commissioner may propose additional restrictions 20.4 or limitations on the provider's license and require that the 20.5 granting of the stay be contingent upon compliance with those 20.6 provisions. The commissioner shall take into consideration the 20.7 following factors when determining whether the stay should be 20.8 granted: 20.9 (1) the threat that continued involvement of the owners and 20.10 managerial officials in the hospice care provider poses to 20.11 patient health, safety, and well-being; 20.12 (2) the compliance history of the hospice care provider; 20.13 and 20.14 (3) the appropriateness of any limits suggested by the 20.15 hospice care provider. 20.16 (h) If the commissioner grants the stay, the order shall 20.17 include any restrictions or limitations on the provider's 20.18 license. The failure of the provider to comply with any 20.19 restrictions or limitations shall result in the immediate 20.20 removal of the stay and the commissioner shall take immediate 20.21 action to suspend, revoke, or not renew the license. 20.22 (i) The provisions contained in paragraphs (d) and (e) 20.23 apply to any nonrenewal or revocation of a hospice care provider 20.24 license occurring after the effective date of the rules adopted 20.25 under section 144A.702. 20.26 (j) For the purposes of this subdivision, owners of a 20.27 hospice care provider are those individuals whose ownership 20.28 interest provides sufficient authority or control to affect or 20.29 change decisions related to the operation of the hospice care 20.30 provider. An owner includes a sole proprietor, a general 20.31 partner, or any other individual whose individual ownership 20.32 interest can affect the management and direction of the policies 20.33 of the hospice care provider. For the purposes of this 20.34 subdivision, managerial officials are those individuals who had 20.35 the responsibility for the ongoing management or direction of 20.36 the policies, services, or employees of the hospice care 21.1 provider relating to the areas of noncompliance that led to the 21.2 license revocation or nonrenewal. 21.3 Subd. 2. [INJUNCTIVE RELIEF.] In addition to any other 21.4 remedy provided by law, the commissioner may bring an action in 21.5 district court to enjoin a person who is involved in the 21.6 management, operation, or control of a hospice care provider or 21.7 an employee of the hospice care provider from illegally engaging 21.8 in activities regulated under sections 144A.70 to 144A.705. The 21.9 commissioner may bring an action under this subdivision in the 21.10 district court in Ramsey county or in the district in which a 21.11 hospice care provider is providing hospice care. The court may 21.12 grant a temporary restraining order in the proceeding if 21.13 continued activity by the person who is involved in the 21.14 management, operation, or control of a hospice care provider or 21.15 an employee of the hospice care provider would create an 21.16 imminent risk of harm to a recipient of hospice care. 21.17 Subd. 3. [SUBPOENA.] In matters pending before the 21.18 commissioner under sections 144A.70 to 144A.705, the 21.19 commissioner may issue subpoenas and compel the attendance of 21.20 witnesses and the production of all necessary papers, books, 21.21 records, documents, and other evidentiary material. If a person 21.22 fails or refuses to comply with a subpoena or order of the 21.23 commissioner to appear or testify regarding any matter about 21.24 which the person may be lawfully questioned or to produce any 21.25 papers, books, records, documents, or evidentiary materials in 21.26 the matter to be heard, the commissioner may apply to the 21.27 district court in any district and the court shall order the 21.28 person to comply with the commissioner's order or subpoena. The 21.29 commissioner may administer oaths to witnesses or take their 21.30 affirmation. Depositions may be taken in or outside the state 21.31 in the manner provided by law for the taking of depositions in 21.32 civil actions. A subpoena or other process or paper may be 21.33 served upon a named person anywhere within the state by an 21.34 officer authorized to serve subpoenas in civil actions, with the 21.35 same fees and mileage and in the same manner as prescribed by 21.36 law for process issued out of a district court. A person 22.1 subpoenaed under this subdivision shall receive the same fees, 22.2 mileage, and other costs that are paid in proceedings in 22.3 district court. 22.4 Subd. 4. [TIME LIMITS FOR APPEALS.] To appeal an action 22.5 against a license under this section, a hospice care provider 22.6 must request a hearing no later than 15 days after the provider 22.7 receives notice of the action. 22.8 Subd. 5. [PRIOR CRIMINAL CONVICTIONS.] (a) Before the 22.9 commissioner issues an initial or renewal license, an owner or 22.10 managerial official is required to complete a background study 22.11 under section 144.057. No person may be involved in the 22.12 management, operation, or control of a hospice care provider if 22.13 the person has been disqualified under the provisions of chapter 22.14 245A. Individuals disqualified under these provisions may 22.15 request a reconsideration, and if the disqualification is set 22.16 aside, are then eligible to be involved in the management, 22.17 operation, or control of the provider. For purposes of this 22.18 section, owners of a hospice care provider subject to the 22.19 background check requirement are those individuals whose 22.20 ownership interest provides sufficient authority or control to 22.21 affect or change decisions related to the operation of the 22.22 hospice care provider. An owner includes a sole proprietor, a 22.23 general partner, or any other individual whose individual 22.24 ownership interest can affect the management and direction of 22.25 the policies of the hospice care provider. For the purposes of 22.26 this section, managerial officials subject to the background 22.27 check requirement are those individuals who provide "direct 22.28 contact" as defined in section 245A.04 or those individuals who 22.29 have the responsibility for the ongoing management or direction 22.30 of the policies, services, or employees of the hospice care 22.31 provider. Data collected under this subdivision are classified 22.32 as private data under section 13.02, subdivision 12. 22.33 (b) Employees, contractors, and volunteers of a hospice 22.34 care provider are subject to the background study required by 22.35 section 144.057. These individuals shall be disqualified under 22.36 the provisions of chapter 245A and Minnesota Rules, parts 23.1 9543.3000 to 9543.3090. Nothing in this section shall be 23.2 construed to prohibit a hospice care provider from requiring 23.3 self-disclosure of criminal conviction information. 23.4 (c) Termination of an employee in good faith reliance on 23.5 information or records obtained under paragraph (a) or (b) 23.6 regarding a confirmed conviction does not subject the hospice 23.7 care provider to civil liability or liability for unemployment 23.8 benefits. 23.9 Sec. 18. [144A.705] [INFORMATION AND REFERRAL SERVICES.] 23.10 The commissioner shall ensure that information and referral 23.11 services relating to hospice care are available in all regions 23.12 of the state. The commissioner shall collect and make available 23.13 information about available hospice care, sources of payment, 23.14 providers, and the rights of patients. The commissioner may 23.15 require hospice care providers to provide information requested 23.16 for the purposes of this section as a condition of licensure. 23.17 The commissioner may publish and make available: 23.18 (1) general information describing hospice care in the 23.19 state; 23.20 (2) limitations on hours, availability of services, and 23.21 eligibility for third-party payments, applicable to individual 23.22 providers; and 23.23 (3) other information the commissioner determines to be 23.24 appropriate. 23.25 Sec. 19. Minnesota Statutes 2000, section 145C.01, 23.26 subdivision 7, is amended to read: 23.27 Subd. 7. [HEALTH CARE FACILITY.] "Health care facility" 23.28 means a hospital or other entity licensed under sections 144.50 23.29 to 144.58, a nursing home licensed to serve adults under section 23.30 144A.02,ora home care provider licensed under sections 144A.43 23.31 to144A.48144A.47, or a hospice care provider licensed under 23.32 sections 144A.70 to 144A.705. 23.33 Sec. 20. Minnesota Statutes 2000, section 157.17, 23.34 subdivision 2, is amended to read: 23.35 Subd. 2. [REGISTRATION.] At the time of licensure or 23.36 license renewal, a boarding and lodging establishment or a 24.1 lodging establishment that provides supportive services or 24.2 health supervision services must be registered with the 24.3 commissioner, and must register annually thereafter. The 24.4 registration must include the name, address, and telephone 24.5 number of the establishment, the name of the operator, the types 24.6 of services that are being provided, a description of the 24.7 residents being served, the type and qualifications of staff in 24.8 the facility, and other information that is necessary to 24.9 identify the needs of the residents and the types of services 24.10 that are being provided. The commissioner shall develop and 24.11 furnish to the boarding and lodging establishment or lodging 24.12 establishment the necessary form for submitting the registration. 24.13 Housing with services establishments registered under 24.14 chapter 144D shall be considered registered under this section 24.15 for all purposes except that: 24.16 (1) the establishments shall operate under the requirements 24.17 of chapter 144D; and 24.18 (2) the criminal background check requirements of sections 24.19 299C.66 to 299C.71 apply. The criminal background check 24.20 requirements of section 144.057 apply only to personnel 24.21 providing home care services under sections 144A.43 to 24.22144A.48144A.47 and personnel providing hospice care under 24.23 sections 144A.70 to 144A.705. 24.24 Sec. 21. Minnesota Statutes 2000, section 609.7495, 24.25 subdivision 1, is amended to read: 24.26 Subdivision 1. [DEFINITIONS.] For the purposes of this 24.27 section, the following terms have the meanings given them. 24.28 (a) "Facility" means any of the following: 24.29 (1) a hospital or other health institution licensed under 24.30 sections 144.50 to 144.56; 24.31 (2) a medical facility as defined in section 144.561; 24.32 (3) an agency, clinic, or office operated under the 24.33 direction of or under contract with the commissioner of health 24.34 or a community health board, as defined in section 145A.02; 24.35 (4) a facility providing counseling regarding options for 24.36 medical services or recovery from an addiction; 25.1 (5) a facility providing emergency shelter services for 25.2 battered women, as defined in section 611A.31, subdivision 3, or 25.3 a facility providing transitional housing for battered women and 25.4 their children; 25.5 (6) a facility as defined in section 626.556, subdivision 25.6 2, paragraph (f); 25.7 (7) a facility as defined in section 626.5572, subdivision 25.8 6, where the services described in that paragraph are provided; 25.9 (8) a place to or from which ambulance service, as defined 25.10 in section 144E.001, is provided or sought to be provided; and 25.11 (9) a hospiceprogramprovider licensed under section 25.12144A.48144A.703. 25.13 (b) "Aggrieved party" means a person whose access to or 25.14 egress from a facility is obstructed in violation of subdivision 25.15 2, or the facility. 25.16 Sec. 22. [REPEALER.] 25.17 Minnesota Statutes 2000, section 144A.48, is repealed.