1.1 	A bill for an act
1.2 	relating to health; modifying practice of advanced practice registered nurses;
1.3 	amending Minnesota Statutes 2016, sections 13.83, subdivision 2; 144.651, 
1.4 	subdivision 21; 144A.4791, subdivision 13; 256.975, subdivision 7b; 256B.0575, 
1.5 	subdivision 1; 256B.0595, subdivision 3; 256B.0625, subdivision 2; 259.24, 
1.6 	subdivision 2; Minnesota Statutes 2017 Supplement, sections 245G.22, subdivision 
1.7 	2; 260C.007, subdivision 6.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2016, section 13.83, subdivision 2, is amended to read:
1.10 		Subd. 2.Public data. Unless specifically classified otherwise by state statute or federal 
1.11 	law, the following data created or collected by a medical examiner or coroner on a deceased 
1.12 	individual are public: name of the deceased; date of birth; date of death; address; sex; race; 
1.13 	citizenship; height; weight; hair color; eye color; build; complexion; age, if known, or 
1.14 	approximate age; identifying marks, scars and amputations; a description of the decedent's 
1.15 	clothing; marital status; location of death including name of hospital where applicable; name 
1.16 	of spouse; whether or not the decedent ever served in the armed forces of the United States; 
1.17 	occupation; business; father's name (also birth name, if different); mother's name (also birth 
1.18 	name, if different); birthplace; birthplace of parents; cause of death; causes of cause of 
1.19 	death; whether an autopsy was performed and if so, whether it was conclusive; date and 
1.20 	place of injury, if applicable, including work place; how injury occurred; whether death 
1.21 	was caused by accident, suicide, homicide, or was of undetermined cause; certification of 
1.22 	attendance by physician or advanced practice registered nurse; physician's or advanced 
1.23 	practice registered nurse's name and address; certification by coroner or medical examiner; 
1.24 	name and signature of coroner or medical examiner; type of disposition of body; burial 
2.1 	place name and location, if applicable; date of burial, cremation or removal; funeral home 
2.2 	name and address; and name of local register or funeral director.

2.3 	Sec. 2. Minnesota Statutes 2016, section 144.651, subdivision 21, is amended to read:
2.4 		Subd. 21.Communication privacy. Patients and residents may associate and 
2.5 	communicate privately with persons of their choice and enter and, except as provided by 
2.6 	the Minnesota Commitment Act, leave the facility as they choose. Patients and residents 
2.7 	shall have access, at their expense, to writing instruments, stationery, and postage. Personal 
2.8 	mail shall be sent without interference and received unopened unless medically or 
2.9 	programmatically contraindicated and documented by the physician or advanced practice 
2.10 	registered nurse in the medical record. There shall be access to a telephone where patients 
2.11 	and residents can make and receive calls as well as speak privately. Facilities which are 
2.12 	unable to provide a private area shall make reasonable arrangements to accommodate the 
2.13 	privacy of patients' or residents' calls. Upon admission to a facility where federal law 
2.14 	prohibits unauthorized disclosure of patient or resident identifying information to callers 
2.15 	and visitors, the patient or resident, or the legal guardian or conservator of the patient or 
2.16 	resident, shall be given the opportunity to authorize disclosure of the patient's or resident's 
2.17 	presence in the facility to callers and visitors who may seek to communicate with the patient 
2.18 	or resident. To the extent possible, the legal guardian or conservator of a patient or resident 
2.19 	shall consider the opinions of the patient or resident regarding the disclosure of the patient's 
2.20 	or resident's presence in the facility. This right is limited where medically inadvisable, as 
2.21 	documented by the attending physician or advanced practice registered nurse in a patient's 
2.22 	or resident's care record. Where programmatically limited by a facility abuse prevention 
2.23 	plan pursuant to section 626.557, subdivision 14, paragraph (b), this right shall also be 
2.24 	limited accordingly.

2.25 	Sec. 3. Minnesota Statutes 2016, section 144A.4791, subdivision 13, is amended to read:
2.26 		Subd. 13.Request for discontinuation of life-sustaining treatment. (a) If a client, 
2.27 	family member, or other caregiver of the client requests that an employee or other agent of 
2.28 	the home care provider discontinue a life-sustaining treatment, the employee or agent 
2.29 	receiving the request:
2.30 	(1) shall take no action to discontinue the treatment; and
2.31 	(2) shall promptly inform the supervisor or other agent of the home care provider of the 
2.32 	client's request.
3.1 	(b) Upon being informed of a request for termination of treatment, the home care provider 
3.2 	shall promptly:
3.3 	(1) inform the client that the request will be made known to the physician or advanced 
3.4 	practice registered nurse who ordered the client's treatment;
3.5 	(2) inform the physician or advanced practice registered nurse of the client's request; 
3.6 	and
3.7 	(3) work with the client and the client's physician or advanced practice registered nurse 
3.8 	to comply with the provisions of the Health Care Directive Act in chapter 145C.
3.9 	(c) This section does not require the home care provider to discontinue treatment, except 
3.10 	as may be required by law or court order.
3.11 	(d) This section does not diminish the rights of clients to control their treatments, refuse 
3.12 	services, or terminate their relationships with the home care provider.
3.13 	(e) This section shall be construed in a manner consistent with chapter 145B or 145C, 
3.14 	whichever applies, and declarations made by clients under those chapters.

3.15 	Sec. 4. Minnesota Statutes 2017 Supplement, section 245G.22, subdivision 2, is amended 
3.16 	to read:
3.17 		Subd. 2.Definitions. (a) For purposes of this section, the terms defined in this subdivision 
3.18 	have the meanings given them.
3.19 	(b) "Diversion" means the use of a medication for the treatment of opioid addiction being 
3.20 	diverted from intended use of the medication.
3.21 	(c) "Guest dose" means administration of a medication used for the treatment of opioid 
3.22 	addiction to a person who is not a client of the program that is administering or dispensing 
3.23 	the medication.
3.24 	(d) "Medical director" means a physician licensed to practice medicine in the jurisdiction 
3.25 	that the opioid treatment program is located who assumes responsibility for administering 
3.26 	all medical services performed by the program, either by performing the services directly 
3.27 	or by delegating specific responsibility to (1) authorized program physicians and; (2) 
3.28 	advanced practice registered nurses, when approved by variance by the State Opioid 
3.29 	Treatment Authority under section 254A.03 and the federal Substance Abuse and Mental 
3.30 	Health Services Administration; or (3) health care professionals functioning under the 
3.31 	medical director's direct supervision.
4.1 	(e) "Medication used for the treatment of opioid use disorder" means a medication 
4.2 	approved by the Food and Drug Administration for the treatment of opioid use disorder.
4.3 	(f) "Minnesota health care programs" has the meaning given in section 256B.0636.
4.4 	(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations, 
4.5 	title 42, section 8.12, and includes programs licensed under this chapter.
4.6 	(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605, 
4.7 	subpart 21a.
4.8 	(i) "Unsupervised use" means the use of a medication for the treatment of opioid use 
4.9 	disorder dispensed for use by a client outside of the program setting.

4.10 	Sec. 5. Minnesota Statutes 2016, section 256.975, subdivision 7b, is amended to read:
4.11 		Subd. 7b.Exemptions and emergency admissions. (a) Exemptions from the federal 
4.12 	screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
4.13 	(1) a person who, having entered an acute care facility from a certified nursing facility, 
4.14 	is returning to a certified nursing facility; or
4.15 	(2) a person transferring from one certified nursing facility in Minnesota to another 
4.16 	certified nursing facility in Minnesota.
4.17 	(b) Persons who are exempt from preadmission screening for purposes of level of care 
4.18 	determination include:
4.19 	(1) persons described in paragraph (a);
4.20 	(2) an individual who has a contractual right to have nursing facility care paid for 
4.21 	indefinitely by the Veterans Administration;
4.22 	(3) an individual enrolled in a demonstration project under section 256B.69, subdivision 
4.23 	8, at the time of application to a nursing facility; and
4.24 	(4) an individual currently being served under the alternative care program or under a 
4.25 	home and community-based services waiver authorized under section 1915(c) of the federal 
4.26 	Social Security Act.
4.27 	(c) Persons admitted to a Medicaid-certified nursing facility from the community on an 
4.28 	emergency basis as described in paragraph (d) or from an acute care facility on a nonworking 
4.29 	day must be screened the first working day after admission.
4.30 	(d) Emergency admission to a nursing facility prior to screening is permitted when all 
4.31 	of the following conditions are met:
5.1 	(1) a person is admitted from the community to a certified nursing or certified boarding 
5.2 	care facility during Senior LinkAge Line nonworking hours;
5.3 	(2) a physician or advanced practice registered nurse has determined that delaying 
5.4 	admission until preadmission screening is completed would adversely affect the person's 
5.5 	health and safety;
5.6 	(3) there is a recent precipitating event that precludes the client from living safely in the 
5.7 	community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's 
5.8 	inability to continue to provide care;
5.9 	(4) the attending physician or advanced practice registered nurse has authorized the 
5.10 	emergency placement and has documented the reason that the emergency placement is 
5.11 	recommended; and
5.12 	(5) the Senior LinkAge Line is contacted on the first working day following the 
5.13 	emergency admission.
5.14 	Transfer of a patient from an acute care hospital to a nursing facility is not considered 
5.15 	an emergency except for a person who has received hospital services in the following 
5.16 	situations: hospital admission for observation, care in an emergency room without hospital 
5.17 	admission, or following hospital 24-hour bed care and from whom admission is being sought 
5.18 	on a nonworking day.
5.19 	(e) A nursing facility must provide written information to all persons admitted regarding 
5.20 	the person's right to request and receive long-term care consultation services as defined in 
5.21 	section 256B.0911, subdivision 1a. The information must be provided prior to the person's 
5.22 	discharge from the facility and in a format specified by the commissioner.

5.23 	Sec. 6. Minnesota Statutes 2016, section 256B.0575, subdivision 1, is amended to read:
5.24 		Subdivision 1.Income deductions. When an institutionalized person is determined 
5.25 	eligible for medical assistance, the income that exceeds the deductions in paragraphs (a) 
5.26 	and (b) must be applied to the cost of institutional care.
5.27 	(a) The following amounts must be deducted from the institutionalized person's income 
5.28 	in the following order:
5.29 	(1) the personal needs allowance under section 256B.35 or, for a veteran who does not 
5.30 	have a spouse or child, or a surviving spouse of a veteran having no child, the amount of 
5.31 	an improved pension received from the veteran's administration not exceeding $90 per 
5.32 	month;
6.1 	(2) the personal allowance for disabled individuals under section 256B.36;
6.2 	(3) if the institutionalized person has a legally appointed guardian or conservator, five 
6.3 	percent of the recipient's gross monthly income up to $100 as reimbursement for guardianship 
6.4 	or conservatorship services;
6.5 	(4) a monthly income allowance determined under section 256B.058, subdivision 2, but 
6.6 	only to the extent income of the institutionalized spouse is made available to the community 
6.7 	spouse;
6.8 	(5) a monthly allowance for children under age 18 which, together with the net income 
6.9 	of the children, would provide income equal to the medical assistance standard for families 
6.10 	and children according to section 256B.056, subdivision 4, for a family size that includes 
6.11 	only the minor children. This deduction applies only if the children do not live with the 
6.12 	community spouse and only to the extent that the deduction is not included in the personal 
6.13 	needs allowance under section 256B.35, subdivision 1, as child support garnished under a 
6.14 	court order;
6.15 	(6) a monthly family allowance for other family members, equal to one-third of the 
6.16 	difference between 122 percent of the federal poverty guidelines and the monthly income 
6.17 	for that family member;
6.18 	(7) reparations payments made by the Federal Republic of Germany and reparations 
6.19 	payments made by the Netherlands for victims of Nazi persecution between 1940 and 1945;
6.20 	(8) all other exclusions from income for institutionalized persons as mandated by federal 
6.21 	law; and
6.22 	(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for necessary 
6.23 	medical or remedial care for the institutionalized person that are recognized under state law, 
6.24 	not medical assistance covered expenses, and not subject to payment by a third party.
6.25 	For purposes of clause (6), "other family member" means a person who resides with the 
6.26 	community spouse and who is a minor or dependent child, dependent parent, or dependent 
6.27 	sibling of either spouse. "Dependent" means a person who could be claimed as a dependent 
6.28 	for federal income tax purposes under the Internal Revenue Code.
6.29 	(b) Income shall be allocated to an institutionalized person for a period of up to three 
6.30 	calendar months, in an amount equal to the medical assistance standard for a family size of 
6.31 	one if:
6.32 	(1) a physician or advanced practice registered nurse certifies that the person is expected 
6.33 	to reside in the long-term care facility for three calendar months or less;
7.1 	(2) if the person has expenses of maintaining a residence in the community; and
7.2 	(3) if one of the following circumstances apply:
7.3 	(i) the person was not living together with a spouse or a family member as defined in 
7.4 	paragraph (a) when the person entered a long-term care facility; or
7.5 	(ii) the person and the person's spouse become institutionalized on the same date, in 
7.6 	which case the allocation shall be applied to the income of one of the spouses.
7.7 	For purposes of this paragraph, a person is determined to be residing in a licensed nursing 
7.8 	home, regional treatment center, or medical institution if the person is expected to remain 
7.9 	for a period of one full calendar month or more.

7.10 	Sec. 7. Minnesota Statutes 2016, section 256B.0595, subdivision 3, is amended to read:
7.11 		Subd. 3.Homestead exception to transfer prohibition. (a) An institutionalized person 
7.12 	is not ineligible for long-term care services due to a transfer of assets for less than fair market 
7.13 	value if the asset transferred was a homestead and:
7.14 	(1) title to the homestead was transferred to the individual's:
7.15 	(i) spouse;
7.16 	(ii) child who is under age 21;
7.17 	(iii) blind or permanently and totally disabled child as defined in the Supplemental 
7.18 	Security Income program;
7.19 	(iv) sibling who has equity interest in the home and who was residing in the home for 
7.20 	a period of at least one year immediately before the date of the individual's admission to 
7.21 	the facility; or
7.22 	(v) son or daughter who was residing in the individual's home for a period of at least 
7.23 	two years immediately before the date the individual became an institutionalized person, 
7.24 	and who provided care to the individual that, as certified by the individual's attending 
7.25 	physician or advanced practice registered nurse, permitted the individual to reside at home 
7.26 	rather than receive care in an institution or facility;
7.27 	(2) a satisfactory showing is made that the individual intended to dispose of the homestead 
7.28 	at fair market value or for other valuable consideration; or
7.29 	(3) the local agency grants a waiver of a penalty resulting from a transfer for less than 
7.30 	fair market value because denial of eligibility would cause undue hardship for the individual, 
7.31 	based on imminent threat to the individual's health and well-being. Whenever an applicant 
8.1 	or recipient is denied eligibility because of a transfer for less than fair market value, the 
8.2 	local agency shall notify the applicant or recipient that the applicant or recipient may request 
8.3 	a waiver of the penalty if the denial of eligibility will cause undue hardship. With the written 
8.4 	consent of the individual or the personal representative of the individual, a long-term care 
8.5 	facility in which an individual is residing may file an undue hardship waiver request, on 
8.6 	behalf of the individual who is denied eligibility for long-term care services on or after July 
8.7 	1, 2006, due to a period of ineligibility resulting from a transfer on or after February 8, 
8.8 	2006. In evaluating a waiver, the local agency shall take into account whether the individual 
8.9 	was the victim of financial exploitation, whether the individual has made reasonable efforts 
8.10 	to recover the transferred property or resource, and other factors relevant to a determination 
8.11 	of hardship. If the local agency does not approve a hardship waiver, the local agency shall 
8.12 	issue a written notice to the individual stating the reasons for the denial and the process for 
8.13 	appealing the local agency's decision.
8.14 	(b) When a waiver is granted under paragraph (a), clause (3), a cause of action exists 
8.15 	against the person to whom the homestead was transferred for that portion of long-term 
8.16 	care services provided within:
8.17 	(1) 30 months of a transfer made on or before August 10, 1993;
8.18 	(2) 60 months if the homestead was transferred after August 10, 1993, to a trust or portion 
8.19 	of a trust that is considered a transfer of assets under federal law;
8.20 	(3) 36 months if transferred in any other manner after August 10, 1993, but prior to 
8.21 	February 8, 2006; or
8.22 	(4) 60 months if the homestead was transferred on or after February 8, 2006,
8.23 	or the amount of the uncompensated transfer, whichever is less, together with the costs 
8.24 	incurred due to the action.

8.25 	Sec. 8. Minnesota Statutes 2016, section 256B.0625, subdivision 2, is amended to read:
8.26 		Subd. 2.Skilled and intermediate nursing care. (a) Medical assistance covers skilled 
8.27 	nursing home services and services of intermediate care facilities, including training and 
8.28 	habilitation services, as defined in section 252.41, subdivision 3, for persons with 
8.29 	developmental disabilities who are residing in intermediate care facilities for persons with 
8.30 	developmental disabilities. Medical assistance must not be used to pay the costs of nursing 
8.31 	care provided to a patient in a swing bed as defined in section 144.562, unless (1) the facility 
8.32 	in which the swing bed is located is eligible as a sole community provider, as defined in 
8.33 	Code of Federal Regulations, title 42, section 412.92, or the facility is a public hospital 
9.1 	owned by a governmental entity with 15 or fewer licensed acute care beds; (2) the Centers 
9.2 	for Medicare and Medicaid Services approves the necessary state plan amendments; (3) the 
9.3 	patient was screened as provided by law; (4) the patient no longer requires acute care 
9.4 	services; and (5) no nursing home beds are available within 25 miles of the facility. The 
9.5 	commissioner shall exempt a facility from compliance with the sole community provider 
9.6 	requirement in clause (1) if, as of January 1, 2004, the facility had an agreement with the 
9.7 	commissioner to provide medical assistance swing bed services.
9.8 	(b) Medical assistance also covers up to ten days of nursing care provided to a patient 
9.9 	in a swing bed if: (1) the patient's physician or advanced practice registered nurse certifies 
9.10 	that the patient has a terminal illness or condition that is likely to result in death within 30 
9.11 	days and that moving the patient would not be in the best interests of the patient and patient's 
9.12 	family; (2) no open nursing home beds are available within 25 miles of the facility; and (3) 
9.13 	no open beds are available in any Medicare hospice program within 50 miles of the facility. 
9.14 	The daily medical assistance payment for nursing care for the patient in the swing bed is 
9.15 	the statewide average medical assistance skilled nursing care per diem as computed annually 
9.16 	by the commissioner on July 1 of each year.

9.17 	Sec. 9. Minnesota Statutes 2016, section 259.24, subdivision 2, is amended to read:
9.18 		Subd. 2.Parents, guardian. If an unmarried parent who consents to the adoption of a 
9.19 	child is under 18 years of age, the consent of the minor parent's parents or guardian, if any, 
9.20 	also shall be required; if either or both the parents are disqualified for any of the reasons 
9.21 	enumerated in subdivision 1, the consent of such parent shall be waived, and the consent 
9.22 	of the guardian only shall be sufficient; and, if there be neither parent nor guardian qualified 
9.23 	to give such consent, the consent may be given by the commissioner. The agency overseeing 
9.24 	the adoption proceedings shall ensure that the minor parent is offered the opportunity to 
9.25 	consult with an attorney, a member of the clergy or, a physician, or an advanced practice 
9.26 	registered nurse before consenting to adoption of the child. The advice or opinion of the 
9.27 	attorney, clergy member or, physician, or advanced practice registered nurse shall not be 
9.28 	binding on the minor parent. If the minor parent cannot afford the cost of consulting with 
9.29 	an attorney, a member of the clergy or, a physician, or an advanced practice registered nurse, 
9.30 	the county shall bear that cost.

10.1 	Sec. 10. Minnesota Statutes 2017 Supplement, section 260C.007, subdivision 6, is amended 
10.2 	to read:
10.3 		Subd. 6.Child in need of protection or services. "Child in need of protection or 
10.4 	services" means a child who is in need of protection or services because the child:
10.5 	(1) is abandoned or without parent, guardian, or custodian;
10.6 	(2)(i) has been a victim of physical or sexual abuse as defined in section 626.556, 
10.7 	subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in 
10.8 	subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or 
10.9 	would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or child 
10.10 	abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment as 
10.11 	defined in subdivision 15;
10.12 	(3) is without necessary food, clothing, shelter, education, or other required care for the 
10.13 	child's physical or mental health or morals because the child's parent, guardian, or custodian 
10.14 	is unable or unwilling to provide that care;
10.15 	(4) is without the special care made necessary by a physical, mental, or emotional 
10.16 	condition because the child's parent, guardian, or custodian is unable or unwilling to provide 
10.17 	that care;
10.18 	(5) is medically neglected, which includes, but is not limited to, the withholding of 
10.19 	medically indicated treatment from an infant with a disability with a life-threatening 
10.20 	condition. The term "withholding of medically indicated treatment" means the failure to 
10.21 	respond to the infant's life-threatening conditions by providing treatment, including 
10.22 	appropriate nutrition, hydration, and medication which, in the treating physician's or 
10.23 	physicians' advanced practice registered nurse's reasonable medical judgment, will be most 
10.24 	likely to be effective in ameliorating or correcting all conditions, except that the term does 
10.25 	not include the failure to provide treatment other than appropriate nutrition, hydration, or 
10.26 	medication to an infant when, in the treating physician's or physicians' advanced practice 
10.27 	registered nurse's reasonable medical judgment:
10.28 	(i) the infant is chronically and irreversibly comatose;
10.29 	(ii) the provision of the treatment would merely prolong dying, not be effective in 
10.30 	ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be 
10.31 	futile in terms of the survival of the infant; or
10.32 	(iii) the provision of the treatment would be virtually futile in terms of the survival of 
10.33 	the infant and the treatment itself under the circumstances would be inhumane;
11.1 	(6) is one whose parent, guardian, or other custodian for good cause desires to be relieved 
11.2 	of the child's care and custody, including a child who entered foster care under a voluntary 
11.3 	placement agreement between the parent and the responsible social services agency under 
11.4 	section 260C.227;
11.5 	(7) has been placed for adoption or care in violation of law;
11.6 	(8) is without proper parental care because of the emotional, mental, or physical disability, 
11.7 	or state of immaturity of the child's parent, guardian, or other custodian;
11.8 	(9) is one whose behavior, condition, or environment is such as to be injurious or 
11.9 	dangerous to the child or others. An injurious or dangerous environment may include, but 
11.10 	is not limited to, the exposure of a child to criminal activity in the child's home;
11.11 	(10) is experiencing growth delays, which may be referred to as failure to thrive, that 
11.12 	have been diagnosed by a physician and are due to parental neglect;
11.13 	(11) is a sexually exploited youth;
11.14 	(12) has committed a delinquent act or a juvenile petty offense before becoming ten 
11.15 	years old;
11.16 	(13) is a runaway;
11.17 	(14) is a habitual truant;
11.18 	(15) has been found incompetent to proceed or has been found not guilty by reason of 
11.19 	mental illness or mental deficiency in connection with a delinquency proceeding, a 
11.20 	certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a 
11.21 	proceeding involving a juvenile petty offense; or
11.22 	(16) has a parent whose parental rights to one or more other children were involuntarily 
11.23 	terminated or whose custodial rights to another child have been involuntarily transferred to 
11.24 	a relative and there is a case plan prepared by the responsible social services agency 
11.25 	documenting a compelling reason why filing the termination of parental rights petition under 
11.26 	section 260C.503, subdivision 2, is not in the best interests of the child.