HF 3342

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/19/2024 12:11pm

A bill for an act
relating to human services; providing for a nursing facility workforce incentive
program, nursing facility payments, and a nursing facility temporary rate add-on;
providing partial reimbursement to hospitals for qualifying avoidable patient days;
appropriating money; proposing coding for new law in Minnesota Statutes, chapter
256.

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

Section 1.

new text begin [256.4766] NURSING FACILITY WORKFORCE INCENTIVE GRANT
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Grant program established. new text end

new text begin The commissioner of human services shall
establish grants for nursing facilities to assist with recruiting and retaining eligible workers.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Eligible employer" means a nursing facility as defined in section 256R.02,
subdivision 33.
new text end

new text begin (d) "Eligible worker" means a worker who earns $30 per hour or less and is currently
employed or recruited to be employed by an eligible employer.
new text end

new text begin Subd. 3. new text end

new text begin Allowable uses of grant money. new text end

new text begin (a) Grantees must use grant money to provide
payments to eligible workers for the following purposes:
new text end

new text begin (1) retention, recruitment, and incentive payments;
new text end

new text begin (2) employee-owned benefits, such as health savings accounts, HRSA, and flexible
spending accounts;
new text end

new text begin (3) employee contributions to a 401k account;
new text end

new text begin (4) education, professional development, and financial counseling;
new text end

new text begin (5) child care, meals, transportation, and housing;
new text end

new text begin (6) health and wellness; and
new text end

new text begin (7) other flexible needs related to workforce challenges as determined by the
commissioner.
new text end

new text begin (b) An eligible worker may receive payments of up to $3,000 per year from the workforce
incentive grant account and all other state money intended for the same purpose.
new text end

new text begin (c) The commissioner must develop a grant cycle distribution plan that allows for
equitable distribution of money among eligible employers. The commissioner's determination
of the grant awards and amounts is final and is not subject to appeal.
new text end

new text begin Subd. 4. new text end

new text begin Attestation. new text end

new text begin As a condition of obtaining grant payments under this section, an
eligible employer must attest and agree to the following:
new text end

new text begin (1) the employer is an eligible employer;
new text end

new text begin (2) the total number of eligible employees;
new text end

new text begin (3) the employer will distribute the entire value of the grant to eligible workers allowed
under this section;
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new text begin (4) the employer will create and maintain records under subdivision 6;
new text end

new text begin (5) the employer will not use the money appropriated under this section for any purpose
other than the purposes permitted under this section; and
new text end

new text begin (6) the entire value of any grant amounts will be distributed to eligible workers identified
by the employer.
new text end

new text begin Subd. 5. new text end

new text begin Distribution plan; report. new text end

new text begin (a) Each grantee shall prepare, and upon request
submit to the commissioner, a distribution plan that specifies the amount of money the
grantee expects to receive and how that money will be distributed for workforce incentives
for eligible employees. Within 60 days of receiving the grant, the grantee must post the
distribution plan and leave the plan posted for a period of at least six months in an area of
the grantee's operation to which all direct support professionals have access.
new text end

new text begin (b) Within 12 months of receiving a grant under this section, each grantee that receives
a grant shall submit a report to the commissioner that includes the following information:
new text end

new text begin (1) a description of how grant money was distributed to eligible employees; and
new text end

new text begin (2) the total dollar amount distributed.
new text end

new text begin (c) Failure to submit the report under paragraph (b) will result in recoupment of grant
money.
new text end

new text begin Subd. 6. new text end

new text begin Audits and recoupment. new text end

new text begin (a) The commissioner may perform an audit under
this section up to six years after a grant is awarded to ensure that:
new text end

new text begin (1) the grantee used the money solely for allowable purposes under subdivision 3;
new text end

new text begin (2) the grantee was truthful when making attestations under subdivision 4; and
new text end

new text begin (3) the grantee complied with the conditions of receiving a grant under this section.
new text end

new text begin (b) If the commissioner determines that a grantee used grant money for purposes not
authorized under this section, the commissioner must treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner must recover any
overpayment.
new text end

new text begin Subd. 7. new text end

new text begin Grants not to be considered income. new text end

new text begin (a) Notwithstanding any law to the
contrary, grant awards under this section must not be considered income, assets, or personal
property for purposes of determining eligibility or recertifying eligibility for:
new text end

new text begin (1) child care assistance programs under chapter 119B;
new text end

new text begin (2) general assistance, Minnesota supplemental aid, and food support under chapter
256D;
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new text begin (3) housing support under chapter 256I;
new text end

new text begin (4) the Minnesota family investment program and diversionary work program under
chapter 256J; and
new text end

new text begin (5) economic assistance programs under chapter 256P.
new text end

new text begin (b) The commissioner must not consider grant awards under this section as income or
assets under section 256B.056, subdivision 1a, paragraph (a), 3, or 3c, or for persons with
eligibility determined under section 256B.057, subdivision 3, 3a, 3b, 4, or 9.
new text end

new text begin Subd. 8. new text end

new text begin Income tax subtractions. new text end

new text begin (a) For the purposes of this section, "subtraction"
has the meaning given in section 290.0132, subdivision 1, and the rules in that subdivision
apply for this section. The definitions in section 290.01 apply to this section.
new text end

new text begin (b) The amount of a payment received under this section is a subtraction.
new text end

new text begin (c) Payments under this section are excluded from income as defined in sections 290.0674,
subdivision 2a, and 290A.03, subdivision 3.
new text end

new text begin Subd. 9. new text end

new text begin Account created. new text end

new text begin A nursing facility workforce incentive grant account is created
in the special revenue fund. Appropriations made for grants and payments administered
under this section may be transferred to this account. Amounts in the account are appropriated
to the commissioner of human services. Appropriations transferred to this account cancel
and are returned to the fund of origin on the date the original appropriations would have
lapsed.
new text end

new text begin Subd. 10. new text end

new text begin Nursing facilities; applicable credit. new text end

new text begin The commissioner must treat grant
payments awarded under this section as an applicable credit as defined under section 256R.10,
subdivision 6.
new text end

Sec. 2. new text begin PAYMENTS TO NURSING FACILITIES NOT TO EXCEED FORECAST
SPENDING.
new text end

new text begin Subdivision 1. new text end

new text begin Payments established. new text end

new text begin The commissioner of human services shall provide
a onetime payment to nursing facilities. For the purposes of this section, the payment is not
an applicable credit as defined under Minnesota Statutes, section 256R.02, subdivision 6,
and referenced in Minnesota Statutes, section 256R.10, subdivision 6.
new text end

new text begin Subd. 2. new text end

new text begin Payment amount. new text end

new text begin (a) Each nursing facility reimbursed under Minnesota
Statutes, chapter 256R, must receive a payment based on the sum of clauses (1) and (2):
new text end

new text begin (1) $225,000; and
new text end

new text begin (2) the remainder of the appropriation divided by the total number of active nursing
facility beds in Minnesota as of May 12, 2023, multiplied by the total number of active beds
in the nursing facility as of May 12, 2023.
new text end

new text begin The total sum for each nursing facility shall be distributed in two equal payments on August
1, 2023, and August 1, 2024.
new text end

new text begin (b) The commissioner may adjust the amount in paragraph (a), clause (1), in order to
expend the full amount of this appropriation.
new text end

new text begin (c) Each facility must expend the total payment amount by September 30, 2025.
new text end

new text begin Subd. 3. new text end

new text begin Allowable uses and attestation. new text end

new text begin To receive a payment, each nursing facility
must attest on the forms and according to the timelines established by the commissioner
that the payment will be used for the following nursing facility related operations:
new text end

new text begin (1) covering operating- or property-related long-term debt payments;
new text end

new text begin (2) closing lines of credit;
new text end

new text begin (3) debt restructuring;
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new text begin (4) paying off covenants or avoiding receivership as of the day following enactment;
new text end

new text begin (5) rent payments in arrears as of the day following enactment;
new text end

new text begin (6) physical plant improvements and maintenance not claimed for a rate increase; and
new text end

new text begin (7) any other item deemed allowable by the commissioner.
new text end

new text begin Subd. 4. new text end

new text begin Payments to related organizations prohibited. new text end

new text begin A payment awarded under
this section may not be used for payments to related organizations as defined in Minnesota
Statutes, section 256R.02, subdivision 43.
new text end

new text begin Subd. 5. new text end

new text begin Reporting requirements. new text end

new text begin Each nursing facility shall report to the commissioner
on the forms and according to the timelines established by the commissioner regarding uses
of payments awarded under this section.
new text end

new text begin Subd. 6. new text end

new text begin Audits and recoupment. new text end

new text begin (a) The commissioner may perform an audit under
this section up to six years after a payment is awarded to ensure that:
new text end

new text begin (1) the nursing facility used the money solely for allowable purposes under subdivision
3;
new text end

new text begin (2) the nursing facility was truthful when making attestations under subdivision 3; and
new text end

new text begin (3) the nursing facility complied with the conditions of receiving a payment under this
section.
new text end

new text begin (b) If the commissioner determines that a nursing facility used the payment for purposes
not authorized under this section, the commissioner must treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner must recover any
overpayment.
new text end

new text begin Subd. 7. new text end

new text begin Overspending relative to forecast. new text end

new text begin (a) The commissioner shall determine total
projected medical assistance payments to nursing facilities in fiscal years 2024 to 2027
based on the February 2023 forecast plus the impact of the temporary rate add-on in section
3 and any subsequent rate adjustments in the 2024 legislative session.
new text end

new text begin (b) By December 31, 2028, the commissioner shall determine actual total medical
assistance payments to nursing facilities for fiscal years 2024 to 2027. The determination
of total actual medical assistance payments shall not include the appropriation for the
payments under this section.
new text end

new text begin (c) The commissioner shall compare the amount in paragraph (a) to the amount in
paragraph (b). If the amount in paragraph (a) exceeds the amount in paragraph (b), the
payments in subdivision 2 shall be determined to have not increased medical assistance
payments to nursing facilities. If the amount in paragraph (b) exceeds the amount in paragraph
(a), the payments in subdivision 2 shall be determined to have increased medical assistance
payments to nursing facilities and the commissioner shall adjust each nursing facility's rates
in an amount proportional to the payment received by the nursing facility in subdivision 2
to reduce aggregate medical assistance payments to nursing facilities in rate year 2029 by
an amount equal to the amount by which actual total medical assistance payments to nursing
facilities for fiscal years 2024 to 2027, as determined in paragraph (b), exceeds the projected
medical assistance payments to nursing facilities for fiscal years 2024 to 2027 based on the
amount in paragraph (a).
new text end

new text begin (d) The commissioner's determinations under this subdivision are final and not subject
to appeal.
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. 3. new text begin NURSING FACILITY TEMPORARY RATE ADD-ON.
new text end

new text begin Effective July 1, 2023, the commissioner of human services shall provide a temporary
rate add-on for nursing facilities reimbursed under Minnesota Statutes, chapter 256R, in an
amount equal to $12.35 per resident day. The rate add-on under this section shall expire
December 31, 2024.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 4. new text begin PARTIAL REIMBURSEMENT TO HOSPITALS FOR QUALIFYING
AVOIDABLE PATIENT DAYS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "High-acuity patient" means a hospital patient with obesity or who has a disability,
has a need for wound care, has a mental illness, has high behavior needs, has a substance
use disorder, is receiving intravenous fluid or intravenous medication, or requires dialysis.
new text end

new text begin (c) "Qualifying avoidable patient day" means:
new text end

new text begin (1) any day a high-acuity patient was boarded in an emergency department because the
patient did not meet the applicable admission criteria and the hospital could not identify a
setting to which the patient could be safely released; or
new text end

new text begin (2) every day after the seventh consecutive day on which a high-acuity patient was
eligible for discharge from the hospital, but the hospital could not identify any setting to
which the patient could be safely discharged.
new text end

new text begin Subd. 2. new text end

new text begin Partial reimbursement to hospitals. new text end

new text begin (a) Beginning July 1, 2023, the
commissioner of human services shall make payments to hospitals as partial reimbursement
for qualifying avoidable patient days. The commissioner shall make payments of up to
$1,400 per submitted qualifying avoidable patient day.
new text end

new text begin (b) By June 15, 2023, a hospital seeking a payment under this section must submit to
the commissioner of human services the total number of qualifying avoidable patient days
at the hospital between January 1, 2023, and May 31, 2023. To determine the payment
amount for each qualifying avoidable patient day, the commissioner must divide the
appropriation available for this purpose by the number of submitted qualifying avoidable
patient days. If a portion of the available appropriation remains after all payments have been
made based on the initial submission of qualifying avoidable patient days, the commissioner
must solicit the submission by hospitals of additional qualifying avoidable patient days
between June 1, 2023, and a date to be determined by the commissioner that the
commissioner estimates will result in the complete expenditure of the available appropriation
after making payments that closely approximate the amount of the original round of
payments.
new text end

new text begin (c) When making payments under this section, the commissioner must not consider the
source of reimbursement for the services provided to the high-acuity patient.
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. 5. new text begin APPROPRIATIONS GIVEN EFFECT ONCE.
new text end

new text begin If an appropriation or transfer in this act is enacted more than once during the 2023
regular session, the appropriation or transfer must be given effect once.
new text end

Sec. 6. new text begin APPROPRIATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Nursing facility workforce incentive grant program. new text end

new text begin $74,500,000 in
fiscal year 2024 is appropriated from the general fund to the commissioner of human services
for the nursing facility workforce incentive grant program under Minnesota Statutes, section
256.4766. Notwithstanding Minnesota Statutes, section 16A.28, subdivisions 1 and 3, this
appropriation is available until June 30, 2029. This is a onetime appropriation.
new text end

new text begin Subd. 2. new text end

new text begin Payments to nursing facilities not to exceed forecast spending. new text end

new text begin $173,137,000
in fiscal year 2024 is appropriated from the general fund to the commissioner of human
services for payments to nursing facilities not to exceed forecast spending. This is a onetime
appropriation and is available until June 30, 2025.
new text end

new text begin Subd. 3. new text end

new text begin Nursing facility temporary rate add-on. new text end

new text begin $21,344,000 in fiscal year 2024 and
$15,169,000 in fiscal year 2025 are appropriated from the general fund to the commissioner
of human services for a nursing facility temporary rate add-on.
new text end

new text begin Subd. 4. new text end

new text begin Administration. new text end

new text begin $1,250,000 in fiscal year 2024 is appropriated from the general
fund to the commissioner of human services for the administration of the activities in
subdivisions 1 and 3. Notwithstanding Minnesota Statutes, section 16A.28, subdivisions 1
and 3, this amount is available until June 30, 2029. This is a onetime appropriation.
new text end

new text begin Subd. 5. new text end

new text begin Payments to hospitals. new text end

new text begin $18,000,000 in fiscal year 2024 is appropriated from
the general fund to the commissioner of human services for payments to hospitals for partial
reimbursement for qualifying avoidable patient days.
new text end