HF 1976

as introduced - 91st Legislature (2019 - 2020) Posted on 03/04/2019 02:05pm

A bill for an act
relating to health; changing provisions covering health care, home care and nursing
homes, case mix assessments, and audiologists; amending Minnesota Statutes
2018, sections 62J.497, subdivisions 1, 3; 62J.498, subdivision 1; 62J.63,
subdivisions 1, 2; 62J.692, subdivisions 3, 4; 144.0724, subdivisions 4, 8; 144A.10,
subdivisions 6c, 6d, 6e, 7, 12, 14, 16; 144A.101, subdivisions 2, 5; 144A.43,
subdivisions 4, 26; 144A.473, subdivisions 1, 3; 144A.474, subdivision 12;
144A.4791, subdivision 9; 148.517, by adding a subdivision; repealing Minnesota
Statutes 2018, sections 62J.63, subdivision 3; 62J.692, subdivision 4a; 62Q.72,
subdivision 2; 144A.04, subdivision 10; 144A.10, subdivisions 6b, 11; 144A.101,
subdivision 3.

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

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2018, section 62J.497, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

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

(b) "Backward compatible" means that the newer version of a data transmission standard
would retain, at a minimum, the full functionality of the versions previously adopted, and
would permit the successful completion of the applicable transactions with entities that
continue to use the older versions.

(c) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 30.
Dispensing does not include the direct administering of a controlled substance to a patient
by a licensed health care professional.

(d) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.

(e) "Electronic media" has the meaning given under Code of Federal Regulations, title
45, part 160.103.

(f) "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.

(g) "Electronic prescription drug program" means a program that provides for
e-prescribing.

(h) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.

(i) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.

(j) "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.

(k) "NCPDP" means the National Council for Prescription Drug Programs, Inc.

(l) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version deleted text begin 1 deleted text end new text begin 3 new text end , Release 0, deleted text begin October 2005. deleted text end new text begin or the most recent standard adopted by the Centers
for Medicare and Medicaid Services for e-prescribing under Medicare Part D as required
by section 1860D-4(e)(4)(D) of the Social Security Act, and regulations adopted under it.
The standard shall be implemented according to the Centers for Medicare and Medicaid
Services schedule for compliance. Subsequently released versions of the NCPDP Formulary
and Benefits Standard may be used, provided that the new version of the standard is backward
compatible to the current version adopted by the Centers for Medicare and Medicaid Services.
new text end

(m) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug
Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide Version
deleted text begin 8 deleted text end new text begin 10 new text end , Release deleted text begin 1 deleted text end new text begin 6 new text end (Version deleted text begin 8.1 deleted text end new text begin 10.6 new text end ), deleted text begin October 2005, deleted text end or the most recent standard adopted by
the Centers for Medicare and Medicaid Services for e-prescribing under Medicare Part D
as required by section 1860D-4(e)(4)(D) of the Social Security Act, and regulations adopted
under it. The standards shall be implemented according to the Centers for Medicare and
Medicaid Services schedule for compliance. Subsequently released versions of the NCPDP
SCRIPT Standard may be used, provided that the new version of the standard is backward
compatible to the current version adopted by the Centers for Medicare and Medicaid Services.

(n) "Pharmacy" has the meaning given in section 151.01, subdivision 2.

(o) "Prescriber" means a licensed health care practitioner, other than a veterinarian, as
defined in section 151.01, subdivision 23.

(p) "Prescription-related information" means information regarding eligibility for drug
benefits, medication history, or related health or drug information.

(q) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.

Sec. 2.

Minnesota Statutes 2018, section 62J.497, subdivision 3, is amended to read:

Subd. 3.

Standards for electronic prescribing.

(a) Prescribers and dispensers must use
the NCPDP SCRIPT Standard for the communication of a prescription or prescription-related
information. deleted text begin The NCPDP SCRIPT Standard shall be used to conduct the following
transactions:
deleted text end

deleted text begin (1) get message transaction;
deleted text end

deleted text begin (2) status response transaction;
deleted text end

deleted text begin (3) error response transaction;
deleted text end

deleted text begin (4) new prescription transaction;
deleted text end

deleted text begin (5) prescription change request transaction;
deleted text end

deleted text begin (6) prescription change response transaction;
deleted text end

deleted text begin (7) refill prescription request transaction;
deleted text end

deleted text begin (8) refill prescription response transaction;
deleted text end

deleted text begin (9) verification transaction;
deleted text end

deleted text begin (10) password change transaction;
deleted text end

deleted text begin (11) cancel prescription request transaction; and
deleted text end

deleted text begin (12) cancel prescription response transaction.
deleted text end

(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP SCRIPT
Standard for communicating and transmitting medication history information.

(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and benefit
information.

(d) Providers, group purchasers, prescribers, and dispensers must use the national provider
identifier to identify a health care provider in e-prescribing or prescription-related transactions
when a health care provider's identifier is required.

(e) Providers, group purchasers, prescribers, and dispensers must communicate eligibility
information and conduct health care eligibility benefit inquiry and response transactions
according to the requirements of section 62J.536.

Sec. 3.

Minnesota Statutes 2018, section 62J.498, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) The following definitions apply to sections 62J.498 to
62J.4982:

(b) "Clinical data repository" means a real time database that consolidates data from a
variety of clinical sources to present a unified view of a single patient and is used by a
state-certified health information exchange service provider to enable health information
exchange among health care providers that are not related health care entities as defined in
section 144.291, subdivision 2, paragraph deleted text begin (j) deleted text end new text begin (k) new text end . This does not include clinical data that
are submitted to the commissioner for public health purposes required or permitted by law,
including any rules adopted by the commissioner.

(c) "Clinical transaction" means any meaningful use transaction or other health
information exchange transaction that is not covered by section 62J.536.

(d) "Commissioner" means the commissioner of health.

(e) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.

(f) "Health data intermediary" means an entity that provides the technical capabilities
or related products and services to enable health information exchange among health care
providers that are not related health care entities as defined in section 144.291, subdivision
2, paragraph deleted text begin (j) deleted text end new text begin (k) new text end . This includes but is not limited to: health information service providers
(HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries
as defined in section 62J.495.

(g) "Health information exchange" means the electronic transmission of health-related
information between organizations according to nationally recognized standards.

(h) "Health information exchange service provider" means a health data intermediary
or health information organization.

(i) "Health information organization" means an organization that oversees, governs, and
facilitates health information exchange among health care providers that are not related
health care entities as defined in section 144.291, subdivision 2, paragraph deleted text begin (j) deleted text end new text begin (k) new text end , to improve
coordination of patient care and the efficiency of health care delivery.

(j) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act as defined in section 62J.495.

(k) "Major participating entity" means:

(1) a participating entity that receives compensation for services that is greater than 30
percent of the health information organization's gross annual revenues from the health
information exchange service provider;

(2) a participating entity providing administrative, financial, or management services to
the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and

(3) a participating entity that nominates or appoints 30 percent or more of the board of
directors or equivalent governing body of the health information organization.

(l) "Master patient index" means an electronic database that holds unique identifiers of
patients registered at a care facility and is used by a state-certified health information
exchange service provider to enable health information exchange among health care providers
that are not related health care entities as defined in section 144.291, subdivision 2, paragraph
deleted text begin (j) deleted text end new text begin (k) new text end . This does not include data that are submitted to the commissioner for public health
purposes required or permitted by law, including any rules adopted by the commissioner.

(m) "Meaningful use" means use of certified electronic health record technology to
improve quality, safety, and efficiency and reduce health disparities; engage patients and
families; improve care coordination and population and public health; and maintain privacy
and security of patient health information as established by the Centers for Medicare and
Medicaid Services and the Minnesota Department of Human Services pursuant to sections
4101, 4102, and 4201 of the HITECH Act.

(n) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.

(o) "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization or health
data intermediary has contracts or other agreements for the provision of health information
exchange services:

(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;

(2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;

(3) a group, professional corporation, or other organization that provides the services of
individuals or entities identified in clause (2), including but not limited to a medical clinic,
a medical group, a home health care agency, an urgent care center, and an emergent care
center;

(4) a health plan as defined in section 62A.011, subdivision 3; and

(5) a state agency as defined in section 13.02, subdivision 17.

(p) "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of clinical transactions.

(q) "State-certified health data intermediary" means a health data intermediary that has
been issued a certificate of authority to operate in Minnesota.

(r) "State-certified health information organization" means a health information
organization that has been issued a certificate of authority to operate in Minnesota.

Sec. 4.

Minnesota Statutes 2018, section 62J.63, subdivision 1, is amended to read:

Subdivision 1.

Establishment; administration.

The commissioner of health shall
deleted text begin establish and administer the Center for Health Care Purchasing Improvement as an
administrative unit within the Department of Health. The Center for Health Care Purchasing
Improvement shall deleted text end support the state in its efforts to be a more prudent and efficient purchaser
of quality health care services deleted text begin . The center shall deleted text end new text begin , new text end aid the state in developing and using more
common strategies and approaches for health care performance measurement and health
care purchasing deleted text begin . The common strategies and approaches shall deleted text end new text begin , new text end promote greater transparency
of health care costs and quality, and greater accountability for health care results and
improvement deleted text begin . The center shall also deleted text end new text begin , and new text end identify barriers to more efficient, effective, quality
health care and options for overcoming the barriers.

Sec. 5.

Minnesota Statutes 2018, section 62J.63, subdivision 2, is amended to read:

Subd. 2.

Staffing; duties; scope.

deleted text begin (a) deleted text end The commissioner of health may deleted text begin appoint a director,
and up to three additional senior-level staff or codirectors, and other staff as needed who
are under the direction of the commissioner. The staff of the center are in the unclassified
service. deleted text end new text begin :
new text end

deleted text begin (b) With the authorization of the commissioner of health, and in consultation or
interagency agreement with the appropriate commissioners of state agencies, the director,
or codirectors, may:
deleted text end

deleted text begin (1) initiate projects to develop plan designs for state health care purchasing;
deleted text end

deleted text begin (2) deleted text end new text begin (1) new text end require reports or surveys to evaluate the performance of current health care
purchasing new text begin or administrative simplification new text end strategies;

deleted text begin (3) deleted text end new text begin (2) new text end calculate fiscal impacts, including net savings and return on investment, of health
care purchasing strategies and initiatives;

deleted text begin (4) conduct policy audits of state programs to measure conformity to state statute or
other purchasing initiatives or objectives;
deleted text end

deleted text begin (5) deleted text end new text begin (3) new text end support the Administrative Uniformity Committee under deleted text begin section deleted text end new text begin sections new text end 62J.50
new text begin and 62J.536, new text end and other relevant groups or activities to advance agreement on health care
administrative process streamlining;

deleted text begin (6) consult with the Health Economics Unit of the Department of Health regarding
reports and assessments of the health care marketplace;
deleted text end

deleted text begin (7) consult with the Department of Commerce regarding health care regulatory issues
and legislative initiatives;
deleted text end

deleted text begin (8) work with appropriate Department of Human Services staff and the Centers for
Medicare and Medicaid Services to address federal requirements and conformity issues for
health care purchasing;
deleted text end

deleted text begin (9) assist the Minnesota Comprehensive Health Association in health care purchasing
strategies;
deleted text end

deleted text begin (10) convene medical directors of agencies engaged in health care purchasing for advice,
collaboration, and exploring possible synergies;
deleted text end

deleted text begin (11) deleted text end new text begin (4) new text end contact and participate with other relevant health care task forces, study activities,
and similar efforts with regard to health care performance measurement and
performance-based purchasing; and

deleted text begin (12) deleted text end new text begin (5) new text end assist in seeking external funding through appropriate grants or other funding
opportunities and may administer grants and externally funded projects.

Sec. 6.

Minnesota Statutes 2018, section 62J.692, subdivision 3, is amended to read:

Subd. 3.

Application process.

(a) A clinical medical education program conducted in
Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners,
dentists, chiropractors, physician assistants, dental therapists and advanced dental therapists,
psychologists, clinical social workers, community paramedics, or community health workers
is eligible for funds under subdivision 4 if the program:

(1) is funded, in part, by patient care revenues;

(2) occurs in patient care settings that face increased financial pressure as a result of
competition with nonteaching patient care entities; and

(3) emphasizes primary care or specialties that are in undersupply in Minnesota.

(b) A clinical medical education program for advanced practice nursing is eligible for
funds under subdivision 4 if the program meets the eligibility requirements in paragraph
(a), clauses (1) to (3), and is sponsored by the University of Minnesota Academic Health
Center, the Mayo Foundation, or institutions that are part of the Minnesota State Colleges
and Universities system or members of the Minnesota Private College Council.

(c) Applications must be submitted to the commissioner by a sponsoring institution on
behalf of an eligible clinical medical education program and must be received by October
31 of each year for distribution in the following year. An application for funds must contain
the following information:

(1) the official name and address of the sponsoring institution and the official name and
site address of the clinical medical education programs on whose behalf the sponsoring
institution is applying;

(2) the name, title, and business address of those persons responsible for administering
the funds;

(3) for each clinical medical education program for which funds are being sought; the
type and specialty orientation of trainees in the program; the name, site address, and medical
assistance provider number and national provider identification number of each training
site used in the program; the federal tax identification number of each training site used in
the program, where available; the total number of trainees at each training site; and the total
number of eligible trainee FTEs at each site; and

(4) other supporting information the commissioner deems necessary to determine program
eligibility based on the criteria in paragraphs (a) and (b) and to ensure the equitable
distribution of funds.

deleted text begin (d) An application must include the information specified in clauses (1) to (3) for each
clinical medical education program on an annual basis for three consecutive years. After
that time, an application must include the information specified in clauses (1) to (3) when
requested, at the discretion of the commissioner:
deleted text end

deleted text begin (1) audited clinical training costs per trainee for each clinical medical education program
when available or estimates of clinical training costs based on audited financial data;
deleted text end

deleted text begin (2) a description of current sources of funding for clinical medical education costs,
including a description and dollar amount of all state and federal financial support, including
Medicare direct and indirect payments; and
deleted text end

deleted text begin (3) other revenue received for the purposes of clinical training.
deleted text end

deleted text begin (e) deleted text end new text begin (d) new text end An applicant that does not provide information requested by the commissioner
shall not be eligible for funds for the current funding cycle.

Sec. 7.

Minnesota Statutes 2018, section 62J.692, subdivision 4, is amended to read:

Subd. 4.

Distribution of funds.

(a) The commissioner shall annually distribute the
available medical education funds to all qualifying applicants based on a public program
volume factor, which is determined by the total volume of public program revenue received
by each training site as a percentage of all public program revenue received by all training
sites in the fund pool.

Public program revenue for the distribution formula includes revenue from medical
assistance and prepaid medical assistance. Training sites that receive no public program
revenue are ineligible for funds available under this subdivision. deleted text begin For purposes of determining
training-site level grants to be distributed under this paragraph, total statewide average costs
per trainee for medical residents is based on audited clinical training costs per trainee in
primary care clinical medical education programs for medical residents. Total statewide
average costs per trainee for dental residents is based on audited clinical training costs per
trainee in clinical medical education programs for dental students. Total statewide average
costs per trainee for pharmacy residents is based on audited clinical training costs per trainee
in clinical medical education programs for pharmacy students. deleted text end Training sites whose training
site level grant is less than $5,000, based on the formula described in this paragraph, or that
train fewer than 0.1 FTE eligible trainees, are ineligible for funds available under this
subdivision. No training sites shall receive a grant per FTE trainee that is in excess of the
95th percentile grant per FTE across all eligible training sites; grants in excess of this amount
will be redistributed to other eligible sites based on the formula described in this paragraph.

deleted text begin (b) For funds distributed in fiscal years 2014 and 2015, the distribution formula shall
include a supplemental public program volume factor, which is determined by providing a
supplemental payment to training sites whose public program revenue accounted for at least
0.98 percent of the total public program revenue received by all eligible training sites. The
supplemental public program volume factor shall be equal to ten percent of each training
site's grant for funds distributed in fiscal year 2014 and for funds distributed in fiscal year
2015. Grants to training sites whose public program revenue accounted for less than 0.98
percent of the total public program revenue received by all eligible training sites shall be
reduced by an amount equal to the total value of the supplemental payment. For fiscal year
2016 and beyond, the distribution of funds shall be based solely on the public program
volume factor as described in paragraph (a).
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Funds distributed shall not be used to displace current funding appropriations
from federal or state sources.

deleted text begin (d) deleted text end new text begin (c) new text end Funds shall be distributed to the sponsoring institutions indicating the amount to
be distributed to each of the sponsor's clinical medical education programs based on the
criteria in this subdivision and in accordance with the commissioner's approval letter. Each
clinical medical education program must distribute funds allocated under deleted text begin paragraphs deleted text end new text begin
paragraph new text end (a) deleted text begin and (b) deleted text end to the training sites as specified in the commissioner's approval letter.
Sponsoring institutions, which are accredited through an organization recognized by the
Department of Education or the Centers for Medicare and Medicaid Services, may contract
directly with training sites to provide clinical training. To ensure the quality of clinical
training, those accredited sponsoring institutions must:

(1) develop contracts specifying the terms, expectations, and outcomes of the clinical
training conducted at sites; and

(2) take necessary action if the contract requirements are not met. Action may include
the withholding of payments under this section or the removal of students from the site.

deleted text begin (e) deleted text end new text begin (d) new text end Use of funds is limited to expenses related to clinical training program costs for
eligible programs.

deleted text begin (f) deleted text end new text begin (e) new text end Any funds not distributed in accordance with the commissioner's approval letter
must be returned to the medical education and research fund within 30 days of receiving
notice from the commissioner. The commissioner shall distribute returned funds to the
appropriate training sites in accordance with the commissioner's approval letter.

deleted text begin (g) deleted text end new text begin (f) new text end A maximum of $150,000 of the funds dedicated to the commissioner under section
297F.10, subdivision 1, clause (2), may be used by the commissioner for administrative
expenses associated with implementing this section.

ARTICLE 2

NURSING HOMES AND HOME CARE

Section 1.

Minnesota Statutes 2018, section 144A.10, subdivision 6c, is amended to read:

Subd. 6c.

Overlap of fines.

If a nursing home is subject to fines under both deleted text begin subdivisions deleted text end new text begin
subdivision new text end 6 deleted text begin and 6b deleted text end new text begin and federal law new text end for the same requirement, condition, situation, or
practice, the commissioner shall assess either the fine provided by subdivision 6 or the
new text begin federal law new text end fine deleted text begin provided by subdivision 6b deleted text end .

Sec. 2.

Minnesota Statutes 2018, section 144A.10, subdivision 6d, is amended to read:

Subd. 6d.

Schedule of fines.

(a) The schedule of fines for noncompliance with correction
orders issued to nursing homes that was adopted under the provisions of section 144A.10,
subdivision 6, and in effect on May 1, 1989, is effective until repealed, modified, or
superseded by rule.

(b) By September 1, 1990, the commissioner shall amend the schedule of fines to increase
to $250 the fines for violations of section 144.651, subdivisions 18, 20, 21, 22, 27, and 30,
and for repeated violations.

deleted text begin (c) The commissioner shall adopt rules establishing the schedule of fines for deficiencies
in the requirements of section 1919(b), (c), and (d), of the Social Security Act, or regulations
adopted under that section of the Social Security Act.
deleted text end

Sec. 3.

Minnesota Statutes 2018, section 144A.10, subdivision 6e, is amended to read:

Subd. 6e.

Use of fines.

When the commissioner of health determines the use of, or
provides recommendations on the use of deleted text begin fines collected under subdivision 6 or 6b, deleted text end new text begin federal
civil monetary penalties, new text end two representatives of the nursing home industry, appointed by
nursing home trade associations, and two consumer representatives as appointed by the
commissioner must be included in the process of developing or preparing any information,
reviews, or recommendations on the use of the fines. This includes, but is not limited to,
including two representatives of the nursing home industry in any committee designed to
provide information and recommendations for the use of the fines.

Sec. 4.

Minnesota Statutes 2018, section 144A.10, subdivision 7, is amended to read:

Subd. 7.

Accumulation of fines.

A nursing home shall promptly notify the commissioner
of health in writing when a violation noted in a notice of noncompliance is corrected. Upon
receipt of written notification by the commissioner of health, the daily fine assessed for the
deficiency shall stop accruing. The facility shall be reinspected within three working days
after receipt of the notification. If upon reinspection the representative of the commissioner
of health determines that a deficiency has not been corrected as indicated by the notification
of compliance the daily fine assessment shall resume and the amount of fines which otherwise
would have accrued during the period prior to resumption shall be added to the total
assessment due from the nursing home. The commissioner of health shall notify the nursing
home of the resumption by certified mail new text begin or electronically to the administrator of the nursing
home new text end . The nursing home may challenge the resumption as a contested case in accordance
with the provisions of chapter 14. Recovery of the resumed fine shall be stayed if a
controlling person or a legal representative on behalf of the nursing home makes a written
request for a hearing on the resumption within 15 days of receipt of the notice of resumption.
The cost of a reinspection conducted pursuant to this subdivision shall be added to the total
assessment due from the nursing home.

Sec. 5.

Minnesota Statutes 2018, section 144A.10, subdivision 12, is amended to read:

Subd. 12.

Data on follow-up surveys.

(a) If requested, and not prohibited by federal
law, the commissioner shall make available to the nursing home associations deleted text begin and deleted text end the public
deleted text begin photocopies of deleted text end statements of deficiencies and related letters from the department pertaining
to federal certification surveys. deleted text begin The commissioner may charge for the actual cost of
reproduction of these documents.
deleted text end

(b) The commissioner shall also make available on a quarterly basis aggregate data for
all statements of deficiencies issued after federal certification follow-up surveys related to
surveys that were conducted in the quarter prior to the immediately preceding quarter. The
data shall include the number of facilities with deficiencies, the total number of deficiencies,
the number of facilities that did not have any deficiencies, the number of facilities for which
a resurvey or follow-up survey was not performed, and the average number of days between
the follow up or resurvey and the exit date of the preceding survey.

Sec. 6.

Minnesota Statutes 2018, section 144A.10, subdivision 14, is amended to read:

Subd. 14.

Immediate jeopardy.

When conducting survey certification and enforcement
activities related to regular, expanded, or extended surveys new text begin and if consistent new text end under Code of
Federal Regulations, title 42, part 488, the commissioner may not issue a finding of
immediate jeopardy unless the specific event or omission that constitutes the violation of
the requirements of participation poses an imminent risk of life-threatening or serious injury
to a resident. The commissioner may not issue any findings of immediate jeopardy after the
conclusion of a regular, expanded, or extended survey unless the survey team identified the
deficient practice or practices that constitute immediate jeopardy and the residents at risk
prior to the close of the exit conference new text begin if consistent with federal requirements new text end .

Sec. 7.

Minnesota Statutes 2018, section 144A.10, subdivision 16, is amended to read:

Subd. 16.

Independent informal dispute resolution.

(a) Notwithstanding subdivision
15, a facility certified under the federal Medicare or Medicaid programs may request from
the commissioner, in writing, an independent informal dispute resolution process regarding
any deficiency citation issued to the facility. The facility must specify in its written request
each deficiency citation that it disputes. The commissioner shall provide deleted text begin a hearing under
sections 14.57 to 14.62 deleted text end new text begin an informal dispute resolution procedure consistent with federal
requirements new text end . Upon the written request of the facility, deleted text begin the parties must submit the issues
raised to arbitration by an administrative law judge. deleted text end new text begin an informal dispute resolution proceeding
will be scheduled by the reviewer. The informal dispute resolution proceeding shall take
place within 90 days of the request. The commissioner may contract with the Office of
Administrative Hearings or another federally approved reviewer to conduct the informal
dispute resolution process.
new text end

(b) Upon receipt of a written request for an deleted text begin arbitration deleted text end new text begin informal dispute resolution new text end
proceeding, the commissioner shall file with the deleted text begin Office of Administrative Hearings a request
for the appointment of an arbitrator and simultaneously serve the facility with deleted text end new text begin reviewer a new text end
notice of the request. The deleted text begin arbitrator deleted text end new text begin reviewer new text end for the dispute shall be an administrative law
judge appointed by the Office of Administrative Hearings new text begin or another federally approved
reviewer new text end . The disclosure provisions of section 572B.12 and the notice provisions of section
572B.15, subsection (c), apply. The facility deleted text begin and the commissioner have deleted text end new text begin has new text end the right to be
represented by an attorney new text begin at the expense of the facility new text end .

(c) The commissioner and the facility deleted text begin may present written evidence, depositions, and
oral statements and arguments at the arbitration proceeding. deleted text end new text begin must abide by the federal
requirements for informal dispute resolution proceedings. new text end Oral statements and arguments
may be made by telephone.

(d) Within ten working days of the close of the deleted text begin arbitration deleted text end proceeding, the deleted text begin administrative
law judge deleted text end new text begin reviewer new text end shall issue findings regarding each of the deficiencies in dispute. The
findings shall be one or more of the following:

(1) Supported in full. The citation is supported in full, with no deletion of findings and
no change in the scope or severity assigned to the deficiency citation.

(2) Supported in substance. The citation is supported, but one or more findings are
deleted without any change in the scope or severity assigned to the deficiency.

(3) Deficient practice cited under wrong requirement of participation. The citation is
amended by moving it to the correct requirement of participation.

(4) Scope not supported. The citation is amended through a change in the scope assigned
to the citation.

(5) Severity not supported. The citation is amended through a change in the severity
assigned to the citation.

(6) No deficient practice. The citation is deleted because the findings did not support
the citation or the negative resident outcome was unavoidable. The findings of the arbitrator
are not binding on the commissioner.

deleted text begin (e) The commissioner shall reimburse the Office of Administrative Hearings for the
costs incurred by that office for the arbitration proceeding. The facility shall reimburse the
commissioner for the proportion of the costs that represent the sum of deficiency citations
supported in full under paragraph (d), clause (1), or in substance under paragraph (d), clause
(2), divided by the total number of deficiencies disputed. A deficiency citation for which
the administrative law judge's sole finding is that the deficient practice was cited under the
wrong requirements of participation shall not be counted in the numerator or denominator
in the calculation of the proportion of costs.
deleted text end

Sec. 8.

Minnesota Statutes 2018, section 144A.101, subdivision 2, is amended to read:

Subd. 2.

Statement of deficiencies.

The commissioner shall provide nursing facilities
deleted text begin with draft statements of deficiencies at the time of the survey exit process and shall provide
facilities deleted text end with completed statements of deficiencies within 15 working days of the exit
process.

Sec. 9.

Minnesota Statutes 2018, section 144A.101, subdivision 5, is amended to read:

Subd. 5.

Survey revisits.

The commissioner shall conduct survey revisits deleted text begin within 15
calendar days of the date by which corrections will be completed, as specified by the provider
in its plan of correction, in cases where category 2 or category 3 remedies are in place deleted text end new text begin
consistent with federal requirements new text end . The commissioner may conduct survey revisits by
telephone or written communications for facilities at which the highest scope and severity
score for a violation was level E or lower.

Sec. 10.

Minnesota Statutes 2018, section 144A.43, subdivision 4, is amended to read:

Subd. 4.

Home care provider.

"Home care provider" means an individual, organization,
association, corporation, unit of government, or other entity that is regularly engaged in the
delivery of at least one home care service, directly new text begin and not by contract, new text end in a client's home
for a fee and who has a valid current temporary license or license issued under sections
144A.43 to 144A.482.

Sec. 11.

Minnesota Statutes 2018, section 144A.43, subdivision 26, is amended to read:

Subd. 26.

Revenues.

"Revenues" means all money received by a licensee deleted text begin derived deleted text end from
the provision of home care services, including deleted text begin fees for services and appropriations of public
money for home care services deleted text end new text begin from clients and liable third parties new text end .

Sec. 12.

Minnesota Statutes 2018, section 144A.473, subdivision 1, is amended to read:

Subdivision 1.

Temporary license and renewal of license.

(a) The department shall
review each application to determine the applicant's knowledge of and compliance with
Minnesota home care regulations. Before granting a temporary license or renewing a license,
the commissioner may further evaluate the applicant or licensee by requesting additional
information or documentation or by conducting an on-site survey of the applicant to
determine compliance with sections 144A.43 to 144A.482.

(b) Within 14 calendar days after receiving an application for a license, the commissioner
shall acknowledge receipt of the application in writing. The acknowledgment must indicate
whether the application appears to be complete or whether additional information is required
before the application will be considered complete.

(c) Within deleted text begin 90 deleted text end new text begin 60 new text end days after receiving a complete application, the commissioner shall
issue a temporary license, renew the license, or deny the license.

(d) The commissioner shall issue a license that contains the home care provider's name,
address, license level, expiration date of the license, and unique license number. All licenses
are valid for one year from the date of issuance.

Sec. 13.

Minnesota Statutes 2018, section 144A.473, subdivision 3, is amended to read:

Subd. 3.

Temporary licensee survey.

(a) If the temporary licensee is in substantial
compliance with the survey, the commissioner shall issue either a basic or comprehensive
home care license. If the temporary licensee is not in substantial compliance with the survey,
the commissioner shall not issue a basic or comprehensive license and there will be no
contested hearing right under chapter 14.

(b) If the temporary licensee whose basic or comprehensive license has been denied
disagrees with the conclusions of the commissioner, then the licensee may request a
reconsideration by the commissioner or commissioner's designee. The reconsideration
request process must be conducted internally by the commissioner or commissioner's
designee, and chapter 14 does not apply.

(c) deleted text begin The temporary licensee requesting reconsideration must make the request in writing
and must list and deleted text end new text begin To be considered, the request for reconsideration must:
new text end

new text begin (1) be in writing;
new text end

new text begin (2) be received by the commissioner within 15 calendar days from the date the provider
receives the denial notice;
new text end

new text begin (3) include documents and other evidence to support the request; and
new text end

new text begin (4) new text end describe the reasons why the licensee disagrees with the decision to deny the basic
or comprehensive home care license.

(d) A temporary licensee whose license is denied must comply with the requirements
for notification and transfer of clients in section 144A.475, subdivision 5.

Sec. 14.

Minnesota Statutes 2018, section 144A.474, subdivision 12, is amended to read:

Subd. 12.

Reconsideration.

(a) The commissioner shall make available to home care
providers a correction order reconsideration process. This process may be used to challenge
the correction order issued, including the level and scope described in subdivision 11, and
any fine assessed. During the correction order reconsideration request, the issuance for the
correction orders under reconsideration are not stayed, but the department shall post
information on the website with the correction order that the licensee has requested a
reconsideration and that the review is pending.

(b) A licensed home care provider may request from the commissioner deleted text begin , in writing, deleted text end a
correction order reconsideration regarding any correction order issued to the provider. The
deleted text begin written deleted text end request for reconsideration must new text begin :
new text end

new text begin (1) be in writing;
new text end

new text begin (2) new text end be received by the commissioner within 15 calendar days of the correction order
receipt date deleted text begin . deleted text end new text begin ;
new text end

new text begin (3) list each correction order, level, scope, and fine the provider does not agree with and
an explanation about why they do not agree;
new text end

new text begin (4) include documents and other evidence to support the request; and
new text end

new text begin (5) describe the reasons why the licensee disagrees with the orders, level, scope, or fine.
new text end

The correction order reconsideration shall not be reviewed by any surveyor, investigator,
or supervisor that participated in the writing or reviewing of the correction order being
disputed. The correction order reconsiderations may be conducted in person, by telephone,
by another electronic form, or in writing, as determined by the commissioner. The
commissioner shall respond in writing to the request from a home care provider for a
correction order reconsideration within 60 days of the date the provider requests a
reconsideration. The commissioner's response shall identify the commissioner's decision
regarding each citation challenged by the home care provider.

(c) The findings of a correction order reconsideration process shall be one or more of
the following:

(1) supported in full, the correction order is supported in full, with no deletion of findings
to the citation;

(2) supported in substance, the correction order is supported, but one or more findings
are deleted or modified without any change in the citation;

(3) correction order cited an incorrect home care licensing requirement, the correction
order is amended by changing the correction order to the appropriate statutory reference;

(4) correction order was issued under an incorrect citation, the correction order is amended
to be issued under the more appropriate correction order citation;

(5) the correction order is rescinded;

(6) fine is amended, it is determined that the fine assigned to the correction order was
applied incorrectly; or

(7) the level or scope of the citation is modified based on the reconsideration.

(d) If the correction order findings are changed by the commissioner, the commissioner
shall update the correction order website.

(e) This subdivision does not apply to temporary licensees.

Sec. 15.

Minnesota Statutes 2018, section 144A.4791, subdivision 9, is amended to read:

Subd. 9.

Service plan, implementation, and revisions to service plan.

(a) No later
than 14 days after the initiation of services, a home care provider shall finalize a current
written service plan.

(b) The service plan and any revisions must include a new text begin dated new text end signature or other
authentication by the home care provider and by the client or the client's representative
documenting agreement on the services to be provided. The service plan must be revised,
if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
must provide information to the client about changes to the provider's fee for services and
how to contact the Office of the Ombudsman for Long-Term Care.

(c) The home care provider must implement and provide all services required by the
current service plan.

(d) The service plan and revised service plan must be entered into the client's record,
including notice of a change in a client's fees when applicable.

(e) Staff providing home care services must be informed of the current written service
plan.

(f) The service plan must include:

(1) a description of the home care services to be provided, the fees for services, and the
frequency of each service, according to the client's current review or assessment and client
preferences;

(2) the identification of the staff or categories of staff who will provide the services;

(3) the schedule and methods of monitoring reviews or assessments of the client;

(4) the frequency of sessions of supervision of staff and type of personnel who will
supervise staff; and

(5) a contingency plan that includes:

(i) the action to be taken by the home care provider and by the client or client's
representative if the scheduled service cannot be provided;

(ii) information and a method for a client or client's representative to contact the home
care provider;

(iii) names and contact information of persons the client wishes to have notified in an
emergency or if there is a significant adverse change in the client's condition, including
identification of and information as to who has authority to sign for the client in an
emergency; and

(iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the client under those
chapters.

ARTICLE 3

CASE MIX

Section 1.

Minnesota Statutes 2018, section 144.0724, subdivision 4, is amended to read:

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and electronically
submit to the commissioner of health MDS assessments that conform with the assessment
schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
by the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
The commissioner of health may substitute successor manuals or question and answer
documents published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, to replace or supplement the current version
of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment;

(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;

(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessment;

(4) all quarterly assessments must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment;

(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; deleted text begin and
deleted text end

(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classification deleted text begin . deleted text end new text begin ; and
new text end

new text begin (7) modifications to the most recent assessments of clauses (1) to (6).
new text end

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and

(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2018, section 144.0724, subdivision 8, is amended to read:

Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident, or
resident's representative, or the nursing facility or boarding care home may request that the
commissioner of health reconsider the assigned reimbursement classification new text begin , including any
items changed during the audit process new text end . The request for reconsideration must be submitted
in writing to the commissioner within 30 days of the day the resident or the resident's
representative receives the resident classification notice. The request for reconsideration
must include the name of the resident, the name and address of the facility in which the
resident resides, the reasons for the reconsideration, and documentation supporting the
request. The documentation accompanying the reconsideration request is limited to deleted text begin a copy
of the MDS that determined the classification and other deleted text end documents that would support or
change the MDS findings.

(b) Upon request, the nursing facility must give the resident or the resident's representative
a copy of the assessment form and the other documentation that was given to the
commissioner of health to support the assessment findings. The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information. Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the material within this time, it is subject to the issuance of a correction order
and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections,
any correction order issued under this subdivision must require that the nursing facility
immediately comply with the request for information and that as of the date of the issuance
of the correction order, the facility shall forfeit to the state a $100 fine for the first day of
noncompliance, and an increase in the $100 fine by $50 increments for each day the
noncompliance continues.

(c) In addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
classification notices were distributed to the resident or the resident's representative; and
(iii) a copy of a notice sent to the resident or to the resident's representative. This notice
must inform the resident or the resident's representative that a reconsideration of the resident's
classification is being requested, the reason for the request, that the resident's rate will change
if the request is approved by the commissioner, the extent of the change, that copies of the
facility's request and supporting documentation are available for review, and that the resident
also has the right to request a reconsideration. If the facility fails to provide the required
information listed in item (iii) with the reconsideration request, the commissioner may
request that the facility provide the information within 14 calendar days. The reconsideration
request must be denied if the information is then not provided, and the facility may not
make further reconsideration requests on that specific reimbursement classification.

(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner under paragraphs (a) and (b). If
necessary for evaluating the reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of receiving the request for reconsideration, the
commissioner shall affirm or modify the original resident classification. The original
classification must be modified if the commissioner determines that the assessment resulting
in the classification did not accurately reflect characteristics of the resident at the time of
the assessment. The resident and the nursing facility or boarding care home shall be notified
within five working days after the decision is made. A decision by the commissioner under
this subdivision is the final administrative decision of the agency for the party requesting
reconsideration.

(e) The resident classification established by the commissioner shall be the classification
that applies to the resident while the request for reconsideration is pending. If a request for
reconsideration applies to an assessment used to determine nursing facility level of care
under subdivision 4, paragraph (c), the resident shall continue to be eligible for nursing
facility level of care while the request for reconsideration is pending.

(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.

ARTICLE 4

AUDIOLOGISTS

Section 1.

Minnesota Statutes 2018, section 148.517, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Dispensing audiologist exam requirements. new text end

new text begin Audiologists must submit
documentation of receiving a qualifying score on an examination meeting the requirements
of section 148.515, subdivision 6.
new text end

Sec. 2. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 62J.63, subdivision 3; 62J.692, subdivision 4a; 62Q.72,
subdivision 2; 144A.04, subdivision 10; 144A.10, subdivisions 6b and 11; and 144A.101,
subdivision 3, new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 19-0361

62J.63 CENTER FOR HEALTH CARE PURCHASING IMPROVEMENT.

Subd. 3.

Report.

The commissioner of health must report annually to the legislature and the governor on the operations, activities, and impacts of the center. The report must be posted on the Department of Health website and must be available to the public. The report must include a description of the state's efforts to develop and use more common strategies for health care performance measurement and health care purchasing. The report must also include an assessment of the impacts of these efforts, especially in promoting greater transparency of health care costs and quality, and greater accountability for health care results and improvement.

62J.692 MEDICAL EDUCATION.

Subd. 4a.

Alternative distribution.

If federal approval is not received for the formula described in subdivision 4, paragraphs (a) and (b), 100 percent of available medical education and research funds shall be distributed based on a distribution formula that reflects a summation of two factors:

(1) a public program volume factor, that is determined by the total volume of public program revenue received by each training site as a percentage of all public program revenue received by all training sites in the fund pool; and

(2) a supplemental public program volume factor, that is determined by providing a supplemental payment of 20 percent of each training site's grant to training sites whose public program revenue accounted for at least 0.98 percent of the total public program revenue received by all eligible training sites. Grants to training sites whose public program revenue accounted for less than 0.98 percent of the total public program revenue received by all eligible training sites shall be reduced by an amount equal to the total value of the supplemental payment.

62Q.72 RECORD KEEPING; REPORTING.

Subd. 2.

Reporting.

Each health plan company shall submit to the appropriate commissioner, as part of the company's annual filing, data on the number and type of complaints that are not resolved within 30 days, or 30 business days as provided under section 72A.201, subdivision 4, clause (3), for insurance companies licensed under chapter 60A. The commissioner shall also make this information available to the public upon request.

144A.04 QUALIFICATIONS FOR LICENSE.

Subd. 10.

Assessments for short-stay residents.

Upon federal approval, a nursing home is not required to perform a resident assessment on a resident expected to remain in the facility for 30 days or less. A short-stay resident transferring from a hospital to a nursing home must have a plan of care developed at the hospital before admission to the nursing home. If a short-stay resident remains in the nursing home longer than 30 days, the nursing home must perform the resident assessment in accordance with sections 144.0721 and 144.0722 within 40 days of the resident's admission.

144A.10 INSPECTION; COMMISSIONER OF HEALTH; FINES.

Subd. 6b.

Fines for federal certification deficiencies.

If the commissioner determines that a nursing home or certified boarding care home does not meet a requirement of section 1919(b), (c), or (d), of the Social Security Act, or any regulation adopted under that section of the Social Security Act, the nursing home or certified boarding care home may be assessed a civil fine for each day of noncompliance and until a notice of correction is received by the commissioner under subdivision 7. Money collected because of these fines must be applied to the protection of the health or property of residents of nursing facilities the commissioner finds deficient. A fine for a specific deficiency may not exceed $500 for each day of noncompliance. The commissioner shall adopt rules establishing a schedule of fines.

Subd. 11.

Facilities cited for immediate jeopardy.

(a) The provisions of this subdivision apply to Minnesota nursing facilities:

(1) that received immediate jeopardy citations between April 1, 1998, and January 13, 1999, for violations of regulations governing the use of physical restraints; and

(2) on whose behalf the commissioner recommended to the federal government that fines for these citations not be imposed or be rescinded.

(b) The commissioner:

(1) shall grant all possible waivers for the continuation of an approved nurse aide training program, an approved competency evaluation program, or an approved nurse aide training and competency evaluation program conducted by or on the site of a facility referred to in this subdivision; and

(2) shall notify the Board of Nursing Home Administrators by June 1, 1999, that the commissioner has recommended to the federal government that fines not be imposed on the facilities referred to in this subdivision or that any fines imposed on these facilities for violations of regulations governing use of physical restraints be rescinded.

144A.101 PROCEDURES FOR FEDERALLY REQUIRED SURVEY PROCESS.

Subd. 3.

Surveyor notes.

The commissioner, upon the request of a nursing facility, shall provide the facility with copies of formal surveyor notes taken during the survey, with the exception of interview forms, at the time of the exit conference or at the time the completed statement of deficiency is provided to the facility. The survey notes shall be redacted to protect the confidentiality of individuals providing information to the surveyors. A facility requesting formal surveyor notes must agree to pay the commissioner for the cost of copying and redacting.