1.1                          A bill for an act 
  1.2             relating to health; adding provisions for training and 
  1.3             education providers; appropriating money; amending 
  1.4             Minnesota Statutes 1998, section 144A.10, by adding 
  1.5             subdivisions; proposing coding for new law in 
  1.6             Minnesota Statutes, chapter 144A.  
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1998, section 144A.10, is 
  1.9   amended by adding a subdivision to read: 
  1.10     Subd. 1a.  [TRAINING AND EDUCATION FOR NURSING FACILITY 
  1.11  PROVIDERS.] The commissioner of health must establish and 
  1.12  implement a prescribed process and program for providing 
  1.13  training and education to providers licensed by the department 
  1.14  of health, either by itself or in conjunction with the industry 
  1.15  trade associations, before using any new regulatory guideline, 
  1.16  regulation, interpretation, program letter or memorandum, or any 
  1.17  other materials used in surveyor training to survey licensed 
  1.18  providers.  The process should include but is not limited to the 
  1.19  following key components: 
  1.20     (1) establish clear and objective clinical standards 
  1.21  regarding the regulation, interpretation, or guideline in 
  1.22  question.  This must be done in consultation with the long-term 
  1.23  care industry and other appropriate bodies.  The standard 
  1.24  determined should then be applied uniformly to all facilities 
  1.25  licensed by the health department and surveyed consistently 
  1.26  across the state; 
  2.1      (2) facilitate dialogue with appropriate vendors.  If a 
  2.2   medical device or product is involved in the use of a clinical 
  2.3   standard, the health department should encourage discussion to 
  2.4   promote solutions to any known hazards.  The health department 
  2.5   must communicate with relevant product vendors and federal 
  2.6   agencies regarding the hazards that have been identified by the 
  2.7   health department; 
  2.8      (3) facilitate the implementation of immediate revisions to 
  2.9   any course curriculum for nursing assistants and other health 
  2.10  care professionals which reflect any new standard of care 
  2.11  practice that has been adopted or referenced by the health 
  2.12  department concerning the issue in question; 
  2.13     (4) conduct or identify research as appropriate and share 
  2.14  with the long-term care industry; 
  2.15     (5) identify suitable alternative options and share 
  2.16  information about "best practices" identified in the industry; 
  2.17  and 
  2.18     (6) conduct intensive training and retraining of long-term 
  2.19  facility managers, staff, and health department survey 
  2.20  inspectors either jointly or during the same time frame on the 
  2.21  department's new expectations.  
  2.22     Sec. 2.  Minnesota Statutes 1998, section 144A.10, is 
  2.23  amended by adding a subdivision to read: 
  2.24     Subd. 11.  [DATE ON FOLLOW-UP SURVEYS.] (a) If requested 
  2.25  and not prohibited by federal law, the commissioner shall make 
  2.26  available to the nursing home associations and the public 
  2.27  photocopies of statements of deficiencies and related letters 
  2.28  from the department pertaining to federal certification 
  2.29  surveys.  The commissioner may charge for the actual cost of 
  2.30  reproduction of these documents. 
  2.31     (b) The commissioner shall also make available on a 
  2.32  quarterly basis aggregate data for all federal certification 
  2.33  follow-up or resurvey statements of deficiencies related to 
  2.34  surveys that were conducted in the quarter prior to the 
  2.35  immediately preceding quarter.  The data shall include the 
  2.36  number of facilities with deficiencies, the total number of 
  3.1   deficiencies, the number of facilities that did not have any 
  3.2   deficiencies, the number of facilities for which a resurvey or 
  3.3   follow-up survey was not performed, and the average number of 
  3.4   days between the follow-up or resurvey and the exit date of the 
  3.5   preceding survey. 
  3.6      Sec. 3.  Minnesota Statutes 1998, section 144A.10, is 
  3.7   amended by adding a subdivision to read: 
  3.8      Subd. 12.  [NURSE AIDE TRAINING WAIVERS.] Because any 
  3.9   disruption or delay in the training and registration of nurses 
  3.10  aides may reduce access to care in certified facilities, the 
  3.11  commissioner shall grant a waiver for the continuation of an 
  3.12  approved nurse aide training and competency evaluation program 
  3.13  or nurse aide training program or competency evaluation program 
  3.14  conducted by or on the site of any certified nursing facility or 
  3.15  skilled nursing facility that would otherwise lose approval for 
  3.16  the program or programs. 
  3.17     Sec. 4.  Minnesota Statutes 1998, section 144A.10, is 
  3.18  amended by adding a subdivision to read: 
  3.19     Subd. 13.  [IMMEDIATE JEOPARDY.] When conducting survey 
  3.20  certification and enforcement activities related to regular, 
  3.21  expanded, or extended surveys under Code of Federal Regulations, 
  3.22  title 42, part 488, the commissioner may not issue a finding of 
  3.23  immediate jeopardy unless the specific event or omission that 
  3.24  constitutes the violation of the requirements of participation 
  3.25  initially occurred within the 48 hours prior to the survey 
  3.26  team's arrival at the nursing facility or initially occurred 
  3.27  after the survey team's arrival.  The commissioner may not issue 
  3.28  any findings of immediate jeopardy after the conclusion of a 
  3.29  regular, expanded, or extended survey unless the survey team 
  3.30  identified the deficient practice or practices that constitute 
  3.31  immediate jeopardy and the residents at risk prior to the close 
  3.32  of the exit conference. 
  3.33     Sec. 5.  Minnesota Statutes 1998, section 144A.10, is 
  3.34  amended by adding a subdivision to read: 
  3.35     Subd. 14.  [INFORMAL DISPUTE RESOLUTION.] The commissioner 
  3.36  shall respond in writing to a request from a nursing facility 
  4.1   certified under the federal Medicare and Medicaid programs for 
  4.2   an informal dispute resolution, within 30 days of the exit date 
  4.3   of the facility's survey.  The commissioner's response shall 
  4.4   identify the commissioner's decision regarding the continuation 
  4.5   of each deficiency citation challenged by the nursing facility, 
  4.6   as well as a statement of any changes in findings, level of 
  4.7   severity or scope, and proposed remedies or sanctions for each 
  4.8   deficiency citation. 
  4.9      Sec. 6.  [144A.102] [USE OF CIVIL MONEY PENALTIES; WAIVER 
  4.10  FROM STATE AND FEDERAL RULES AND REGULATIONS.] 
  4.11     By January 2000, the commissioner of health shall work with 
  4.12  providers to examine state and federal rules and regulations 
  4.13  governing the provision of care in licensed nursing facilities 
  4.14  and apply for federal waivers and identify necessary changes in 
  4.15  state law to:  
  4.16     (1) allow the use of civil money penalties imposed upon 
  4.17  nursing facilities to abate any deficiencies identified in a 
  4.18  nursing facility's plan of correction; and 
  4.19     (2) stop the accrual of any fine imposed by the health 
  4.20  department when a follow-up inspection survey is not conducted 
  4.21  by the department within the regulatory deadline. 
  4.22     Sec. 7.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
  4.23  REGULATIONS.] 
  4.24     The following nursing care standards apply to facilities 
  4.25  licensed under chapter 144A: 
  4.26     (1) An incontinent resident must be checked and receive 
  4.27  perineal care according to the care plan, based upon the 
  4.28  resident's individualized assessment.  
  4.29     (2) Residents must be positioned in good body alignment.  
  4.30  The position of residents unable to change their own position 
  4.31  must be changed according to the resident's care plan, based 
  4.32  upon the resident's individualized assessment.  
  4.33     Sec. 8.  [APPROPRIATION; RESEARCH, QUALITY IMPROVEMENT 
  4.34  INITIATIVES, LONG-TERM CARE.] 
  4.35     (a) $....... is appropriated from the general fund to the 
  4.36  commissioner of health in fiscal year 1999 to be used for 
  5.1   clinical data collection and research in the areas of resident 
  5.2   and patient falls and physical restraint use, as well as 
  5.3   additional evaluation of clinical indicators specific to quality 
  5.4   of life and the provision of quality nursing care to patients 
  5.5   and residents in hospitals, boarding care homes, and outpatient 
  5.6   surgical centers licensed under Minnesota Statutes, sections 
  5.7   144.50 to 144.58; and nursing homes and home care agencies 
  5.8   licensed under Minnesota Statutes, chapter 144A. 
  5.9      (b) This research will provide separate and aggregate data 
  5.10  on the incidence of falls in health care facilities and the 
  5.11  prevalence of physical restraint used in resident and patient 
  5.12  care practice.  Research will be conducted to determine a 
  5.13  possible correlation between resident falls, the use of physical 
  5.14  restraints and the presence of incontinence, and the level of 
  5.15  decline in a resident or patient's physical functioning.  
  5.16     (c) This appropriation shall also be used for the 
  5.17  development of clinical guidelines specific to the health care 
  5.18  facilities specified in paragraph (a), and the identification 
  5.19  and promotion of standardized resident care practices by 
  5.20  promulgating written standards of care, targeted education, and 
  5.21  ongoing follow-up study.  A follow-up study will monitor 
  5.22  response to critical interventions, provide a basis for risk 
  5.23  adjustment, and be used to develop performance measures and 
  5.24  clinical targets that can be used industry wide to further 
  5.25  support the quality care initiatives of the long-term care 
  5.26  industry and other health care industry providers. 
  5.27     (d) Appropriating funds for quality care initiatives of the 
  5.28  health care industry for data collection and research will 
  5.29  result in the collaborative efforts of the health care industry 
  5.30  and the health department to identify, share, and implement 
  5.31  standards of "best practices" as well as develop innovative, 
  5.32  alternative treatment modalities to restraints and bed rails. 
  5.33     Sec. 9.  [EFFECTIVE DATE.] 
  5.34     Sections 1 to 8 are effective the day following final 
  5.35  enactment.