1.1                          A bill for an act 
  1.2             relating to health; requiring the commissioner to 
  1.3             develop procedures for the nursing home survey 
  1.4             process; amending Laws 1999, chapter 245, article 3, 
  1.5             section 45; repealing Minnesota Statutes 1998, section 
  1.6             144A.103; Minnesota Rules, part 4658.0515. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  [DEVELOPMENT AND IMPLEMENTATION OF ALTERNATIVE 
  1.9   SURVEY PROCESS AND PROCEDURES FOR THE NURSING HOME SURVEY 
  1.10  PROCESS.] 
  1.11     (a) By January 1, 2001, the commissioner of health, in 
  1.12  consultation with the long-term care ombudsman, nursing home 
  1.13  consumer and advocacy groups, nursing home provider 
  1.14  organizations, and other health care professionals shall examine 
  1.15  state and federal rules and regulations governing the provision 
  1.16  of care in nursing facilities in order to develop and implement 
  1.17  alternative procedures for the nursing home survey process.  The 
  1.18  commissioner shall pursue changes to federal law necessary to 
  1.19  accomplish this process.  The commissioner shall apply for any 
  1.20  necessary federal waivers or approval. 
  1.21     (b) The commissioner, in consultation with the groups in 
  1.22  paragraph (a), shall define and describe alternative procedures 
  1.23  for the nursing home survey process and obtain necessary 
  1.24  approval from the United States Health Care Financing 
  1.25  Administration for a Medicaid waiver.  If a federal waiver is 
  1.26  required, the commissioner of health shall submit the waiver 
  2.1   request no later than May 15, 2000.  The commissioner shall 
  2.2   pursue any necessary federal law changes by July 1, 2000. 
  2.3      (c) The commissioner shall take into consideration the 
  2.4   following factors in developing alternative procedures for the 
  2.5   nursing home survey process.  The alternative procedures for the 
  2.6   nursing home survey process shall: 
  2.7      (1) reward skilled nursing facilities with very good 
  2.8   performance with extended intervals between full surveys based 
  2.9   on criteria to be established; 
  2.10     (2) use other existing or new mechanisms to provide 
  2.11  objective assessments of quality and to measure quality 
  2.12  improvement; 
  2.13     (3) provide for frequent collaborative interaction of 
  2.14  facility staff and surveyors versus a punitive approach; 
  2.15     (4) use department resources more effectively and 
  2.16  efficiently in targeting problem areas; and 
  2.17     (5) upon implementation of the alternative survey process, 
  2.18  work in conjunction with industry stakeholders to evaluate the 
  2.19  qualitative benefits and effectiveness of the new process. 
  2.20     Sec. 2.  Laws 1999, chapter 245, article 3, section 45, is 
  2.21  amended to read: 
  2.22     Sec. 45.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
  2.23  REGULATIONS.] 
  2.24     (a) Notwithstanding the provisions of Minnesota Rules, part 
  2.25  4658.0520, an incontinent resident must be checked according to 
  2.26  a specific time interval written in the resident's care 
  2.27  plan.  ~~The resident's attending physician must authorize in~~ 
  2.28  ~~writing any interval longer than two hours.~~ 
  2.29     (b) This section expires July 1, 2001. 
  2.30     Sec. 3.  [DEFENSIVE DOCUMENTATION.] 
  2.31     The commissioner of health, in consultation with the 
  2.32  nursing home industry, consumers, and advocates, shall work 
  2.33  together to develop a proposal to resolve the issue of defensive 
  2.34  documentation in nursing facilities. 
  2.35     Sec. 4.  [FEDERAL WAIVER REQUEST.] 
  2.36     The commissioner of health shall seek a waiver from the 
  3.1   Health Care Financing Administration and the federal government 
  3.2   to decrease the amount of paperwork facilities must complete 
  3.3   when a stay in a nursing facility is less than 30 days. 
  3.4      Sec. 5.  [REGULATIONS THAT IMPEDE DIRECT CARE OF 
  3.5   RESIDENTS.] 
  3.6      The commissioners of health and human services, in 
  3.7   consultation with trade groups, consumers, advocates, and 
  3.8   families, shall work together to develop a proposal to decrease 
  3.9   regulations that impede direct care of residents in nursing 
  3.10  facilities. 
  3.11     Sec. 6.  [REPEALER.] 
  3.12     Minnesota Statutes 1998, section 144A.103, is repealed.  
  3.13  Minnesota Rules, part 4658.0515, is repealed.