1.1                          A bill for an act
  1.2             relating to health; establishing minimum staffing 
  1.3             standards for nursing facilities; requiring facilities 
  1.4             to post information on staffing standards; requiring 
  1.5             studies; appropriating money; proposing coding for new 
  1.6             law in Minnesota Statutes, chapter 144A. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  [144A.041] [STAFFING STANDARDS FOR NURSING 
  1.9   FACILITIES.] 
  1.10     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.11  section, the following definitions apply: 
  1.12     (a) "Day shift" means that division of the day used by a 
  1.13  nursing facility for purposes of employee staffing consisting of 
  1.14  eight hours commencing between 6:00 a.m. and 8:00 a.m. 
  1.15     (b) "Evening shift" means that division of the day used by 
  1.16  a nursing facility for purposes of employee staffing consisting 
  1.17  of eight hours commencing between 2:00 p.m. and 4:00 p.m. 
  1.18     (c) "Licensed nurse" means a registered nurse (RN) or a 
  1.19  licensed practical nurse (LPN). 
  1.20     (d) "Night shift" means that division of the day used by a 
  1.21  nursing facility for purposes of employee staffing consisting of 
  1.22  eight hours commencing between 10:00 p.m. and 12:00 a.m. 
  1.23     (e) "Nursing staff" means, for purposes of the ratios 
  1.24  within this section, only certified nurse aides and licensed 
  1.25  nurses who are employed as direct caregivers. 
  1.26     Subd. 2.  [MINIMUM STAFFING STANDARDS.] (a) The 
  2.1   commissioner of health shall not issue or renew a license of a 
  2.2   nursing facility unless the facility employs nursing personnel 
  2.3   sufficient in number to provide continuous 24-hour nursing care 
  2.4   and services sufficient to meet the needs of each resident in 
  2.5   the nursing facility. 
  2.6      (b) A nursing facility shall maintain: 
  2.7      (1) a full-time RN director of nursing, except as provided 
  2.8   in section 144A.04, subdivisions 5 and 7a; 
  2.9      (2) a full-time RN assistant director of nursing in 
  2.10  facilities of 100 beds or more; 
  2.11     (3) a full-time director of in-service education in 
  2.12  facilities of 100 beds or more; and 
  2.13     (4) an RN nursing supervisor on duty at all times (24 hours 
  2.14  per day, seven days per week). 
  2.15     (c) A nursing facility shall maintain a ratio of certified 
  2.16  nurse aides to residents of no less than: 
  2.17     (1) one to ten on the day shift; 
  2.18     (2) one to 12 on the evening shift; and 
  2.19     (3) one to 17 on the night shift. 
  2.20     (d) A nursing facility shall maintain a ratio of licensed 
  2.21  nurses to residents of no less than: 
  2.22     (1) one to 15 on the day shift; 
  2.23     (2) one to 25 on the evening shift; and 
  2.24     (3) one to 35 on the night shift. 
  2.25     (e) The requirements and ratios specified in paragraphs 
  2.26  (b), (c), and (d) are minimum standards only.  Nursing 
  2.27  facilities must employ additional staff if needed to ensure 
  2.28  quality resident care. 
  2.29     (f) No employee who provides services such as food 
  2.30  preparation, housekeeping, laundry, or maintenance services 
  2.31  shall be counted in determining the ratios in paragraphs (c) and 
  2.32  (d). 
  2.33     Subd. 3.  [ACTIVITIES STAFFING.] (a) All nursing facilities 
  2.34  licensed for 30 beds or more shall have a full-time activities 
  2.35  director. 
  2.36     (b) All nursing facilities licensed for fewer than 30 beds 
  3.1   shall have, at a minimum, a part-time activities director. 
  3.2      Subd. 4.  [NUTRITION AND DIETETICS STAFFING.] A nursing 
  3.3   facility must at all times provide a level of staffing adequate 
  3.4   to meet the care needs of each resident.  The level of staffing 
  3.5   must, at a minimum, include: 
  3.6      (1) a food service manager with a bachelor of science or 
  3.7   associate degree in food service management or a related field 
  3.8   or a registered dietetic technician (DTR) or certified dietary 
  3.9   manager (CDM); and 
  3.10     (2) a registered dietician (RD) or a certified 
  3.11  dietician/nutritionist (CDN) on a full-time, part-time, or 
  3.12  consultant basis. 
  3.13     Subd. 5.  [DISCLOSURE; PUBLIC RIGHT TO STAFFING 
  3.14  INFORMATION.] (a) A nursing facility shall post, for each wing 
  3.15  or floor of the facility and for each shift, the current number 
  3.16  of licensed and unlicensed nursing staff directly responsible 
  3.17  for resident care and the current ratios of residents to staff, 
  3.18  which show separately the number of residents to licensed 
  3.19  nursing staff and the number of residents to unlicensed nursing 
  3.20  staff.  A facility may only consider time actually worked by 
  3.21  nursing staff in the calculations of ratios and may not consider 
  3.22  time scheduled but not actually worked.  The information posted 
  3.23  must be in the form of average daily staffing ratios for the 
  3.24  most recent reporting period. 
  3.25     (b) The information must be displayed on a uniform form 
  3.26  supplied by the commissioner of health.  The posted information 
  3.27  must be visible and accessible to all residents, residents' 
  3.28  families, caregivers, and potential consumers in each facility.  
  3.29  A poster provided by the commissioner of health that describes 
  3.30  the minimum staffing standards and ratios specified in 
  3.31  subdivisions 2 and 3 must be posted in the same vicinity as the 
  3.32  uniform form. 
  3.33     Subd. 6.  [PROTECTED COMMUNICATIONS.] No nursing facility 
  3.34  may retaliate or take adverse action against any employee for 
  3.35  communicating with local, state, or federal authorities 
  3.36  regarding nursing facility deficiencies.  Communication related 
  4.1   to nursing facility deficiencies is protected under section 
  4.2   181.932.  Communication related to nursing facility deficiencies 
  4.3   includes an allegation regarding violations of laws, statutes, 
  4.4   or regulations regarding the health and safety of residents or 
  4.5   fraud or misrepresentation regarding such laws and regulations. 
  4.6      Subd. 7.  [ASSESSMENT OF STAFFING RATIOS AND 
  4.7   STANDARDS.] Every five years, beginning in calendar year 2006, 
  4.8   the commissioner of health, in consultation with an advisory 
  4.9   committee comprised of representatives of consumers, nursing 
  4.10  facility employees, and the nursing facility industry, shall 
  4.11  conduct a study to assess whether the staffing ratios and 
  4.12  standards specified in this section are sufficient to meet 
  4.13  resident needs.  The commissioner shall report findings and 
  4.14  recommendations to the legislature by December 1 of the year in 
  4.15  which the study is required. 
  4.16     Sec. 2.  [ADDITIONAL STAFFING REQUIREMENTS FOR RESIDENTS 
  4.17  WITH HIGHER ACUITY.] 
  4.18     The commissioner of health, in consultation with the 
  4.19  commissioner of human services, shall contract with experts in 
  4.20  the field of nursing staffing research and long-term care to 
  4.21  develop a methodology for determining appropriate levels of 
  4.22  staffing based on acuity.  The commissioner of health shall 
  4.23  present recommendations to the legislature by December 1, 2004. 
  4.24     Sec. 3.  [APPROPRIATION.] 
  4.25     $....... is appropriated from the general fund to the 
  4.26  commissioner of human services for the biennium ending June 30, 
  4.27  2003, to provide funding to nursing facilities to comply with 
  4.28  section 1. 
  4.29     Sec. 4.  [EFFECTIVE DATE.] 
  4.30     Sections 1 and 2 are effective July 1, 2003.