SF 2972

2nd Engrossment - 94th Legislature (2025 - 2026)

Posted on 03/20/2026 01:56 p.m.

A bill for an act
relating to health care facilities; regulating nursing staff requirements at nursing
homes and assisted living facilities; regulating for-profit entity acquisitions of
nursing homes and assisted living facilities; amending Minnesota Statutes 2024,
section 144A.04, by adding subdivisions; Minnesota Statutes 2025 Supplement,
sections 145D.40, by adding a subdivision; 145D.41, subdivisions 1, 2, by adding
a subdivision; proposing coding for new law in Minnesota Statutes, chapters 144G;
145D; repealing Minnesota Statutes 2024, section 144A.04, subdivision 7.

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

Section 1.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision
to read:

new text begin Subd. 7b. new text end

new text begin Onsite registered nurse. new text end

new text begin (a) Except when waived under subdivision 7f, a
nursing home must have a registered nurse onsite 24 hours per day. The registered nurse
must be available to provide direct resident care.
new text end

new text begin (b) For any periods when the onsite registered nurse requirements in paragraph (a) are
waived under subdivision 7f, a nursing home must have a registered nurse, licensed nurse
practitioner, physician assistant, or physician available to respond immediately to telephone
calls from a nursing home.
new text end

Sec. 2.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7c. new text end

new text begin Staffing competencies. new text end

new text begin A nursing home must ensure that all nurses have the
specific competencies and skill sets necessary to care for residents' needs, as identified
through resident assessments and described in the service plan. Providing care includes but
is not limited to assessing, evaluating, planning, and implementing resident care plans and
responding to residents' needs.
new text end

Sec. 3.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7d. new text end

new text begin Required staff ratio. new text end

new text begin (a) The minimum staffing standard for nursing personnel
in a nursing home is as specified in this subdivision.
new text end

new text begin (b) A nursing home must provide nursing care to all residents in accordance with each
resident's service plan while also providing a minimum of 3.48 hours per resident per 24
hours for total nurse staffing, including but not limited to a minimum of 0.55 hours per
resident per 24 hours for registered nurses and a minimum of 2.45 hours per resident per
24 hours for nurse aides and licensed nurse practitioners.
new text end

new text begin (c) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty,
productive nursing hours of all nurses and nursing assistants, calculated on the basis of any
given 24-hour period. "Productive nursing hours" means all on-duty hours during which
nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may
be found in Minnesota Rules, part 4655.6400. Not included are vacations, holidays, sick
leave, in-service classroom training, or lunches. Also not included are the nonproductive
nursing hours of the in-service training director. In homes with more than 60 licensed beds,
the hours of the director of nursing are excluded.
new text end

new text begin (d) A nursing home that is issued a notice of noncompliance under section 144A.10,
subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for
each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.
new text end

Sec. 4.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7e. new text end

new text begin Nursing supervision. new text end

new text begin (a) Except when waived under subdivision 7f, a nursing
home must designate a registered nurse to serve as a charge nurse for each shift.
new text end

new text begin (b) Except when waived under subdivision 7f, a nursing home must designate a registered
nurse to serve as the director of nursing on a full-time basis. The director of nursing may
serve as a charge nurse only when a nursing home has an average daily occupancy of 60 or
fewer residents.
new text end

Sec. 5.

Minnesota Statutes 2024, section 144A.04, is amended by adding a subdivision to
read:

new text begin Subd. 7f. new text end

new text begin Exemption process. new text end

new text begin (a) The commissioner shall establish a process for
exemption to the requirements under subdivisions 7b and 7e. A nursing home shall submit
a request for exemption under this subdivision on a form developed and in a manner
established by the commissioner. A requesting nursing home shall provide in writing to the
commissioner the following information at a minimum:
new text end

new text begin (1) the specific requirement from which exemption is sought;
new text end

new text begin (2) a detailed explanation of the physical proximity of the requesting nursing home to
other nursing homes within reasonable distance providing the same services as the requesting
nursing home;
new text end

new text begin (3) the reason the nursing home is unable to comply with the requirement;
new text end

new text begin (4) the reason that compliance with the requirement will impose substantial hardship,
including but not limited to the risk of the nursing home closing and requiring residents to
move; and
new text end

new text begin (5) the reason that a waiver will not significantly harm residents.
new text end

new text begin Following the submission of an exemption request, the commissioner must provide public
notice of the requested exemption and allow a public comment period.
new text end

new text begin (b) The commissioner shall evaluate requests for exemption under this subdivision by
reviewing the application materials and all comments submitted during the public comment
period. As part of the evaluation process, the commissioner may:
new text end

new text begin (1) inspect the nursing home;
new text end

new text begin (2) confer with the nursing home manager or designee;
new text end

new text begin (3) contact residents or their representatives to determine whether they believe a waiver
is in the residents' best interest; and
new text end

new text begin (4) contact individuals who submitted public comment during the public comment period.
new text end

new text begin (c) The commissioner may grant an exemption if the commissioner determines that
compliance with the requirement from which the exemption is sought cannot be accomplished
without substantial hardship to the nursing home and granting an exemption will not
significantly harm residents. The commissioner may not grant an exemption if it will create
an imminent risk of harm to a resident.
new text end

new text begin (d) An exemption granted under this subdivision is in effect for 90 days. After 90 days,
the nursing home may request a renewal of the exemption. After one renewal, the nursing
home must submit a new request for exemption under this subdivision.
new text end

Sec. 6.

new text begin [144G.65] NURSING STAFF REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Onsite registered nurse. new text end

new text begin (a) Except when waived under subdivision 5,
the facility must have a registered nurse onsite 24 hours per day. The registered nurse must
be available to provide direct resident care.
new text end

new text begin (b) For any periods when the onsite registered nurse requirements in paragraph (a) are
waived under subdivision 5, a facility must have a registered nurse, licensed nurse
practitioner, physician assistant, or physician available to respond immediately to telephone
calls from the facility.
new text end

new text begin Subd. 2. new text end

new text begin Staffing competencies. new text end

new text begin The facility must ensure that all nurses have the specific
competencies and skill sets necessary to care for residents' needs, as identified through
resident assessments, and described in the service plan. Providing care includes but is not
limited to assessing, evaluating, planning, and implementing resident care plans and
responding to residents' needs.
new text end

new text begin Subd. 3. new text end

new text begin Required staff ratio. new text end

new text begin (a) The minimum staffing standard for personnel in
assisted living facilities is as specified in this subdivision.
new text end

new text begin (b) A facility must provide nursing care to all residents in accordance with each resident's
service plan while also providing a minimum of 3.48 hours per resident per 24 hours for
total nurse staffing, including but not limited to a minimum of 0.55 hours per resident per
24 hours for registered nurses and a minimum of 2.45 hours per resident per 24 hours for
nurse aides and licensed nurse practitioners per resident per 24 hours.
new text end

new text begin (c) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty,
productive nursing hours of all nurses and nursing assistants, calculated on the basis of any
given 24-hour period. "Productive nursing hours" means all on-duty hours during which
nurses and nursing assistants are engaged in nursing duties. Not included are vacations,
holidays, sick leave, in-service classroom training, or lunches. Also not included are the
nonproductive nursing hours of the in-service training director. In a facility with more than
60 licensed beds, the hours of the director of nursing are excluded.
new text end

new text begin (d) An assisted living facility that is issued a notice of noncompliance for a violation of
this subdivision shall be assessed a civil fine of $300 for each day of noncompliance.
new text end

new text begin Subd. 4. new text end

new text begin Nursing supervision. new text end

new text begin (a) Except when waived under subdivision 5, the facility
must designate a registered nurse to serve as a charge nurse for each shift.
new text end

new text begin (b) Except when waived under subdivision 5, the facility must designate a registered
nurse to serve as the director of nursing on a full-time basis. The director of nursing may
serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer
residents.
new text end

new text begin Subd. 5. new text end

new text begin Exemption process. new text end

new text begin (a) The commissioner shall establish a process for
exemption to the requirements under subdivisions 1 and 4. A facility shall submit a request
for exemption under this subdivision on a form developed and in a manner established by
the commissioner. A requesting facility shall provide in writing to the commissioner the
following information at a minimum:
new text end

new text begin (1) the specific requirement from which exemption is sought;
new text end

new text begin (2) a detailed explanation of the physical proximity of the requesting facility to other
facilities within reasonable distance providing the same services as the requesting facility;
new text end

new text begin (3) the reason the facility is unable to comply with the requirement;
new text end

new text begin (4) the reason that compliance with the requirement will impose substantial hardship,
including but not limited to the risk of the facility closing and requiring residents to move;
and
new text end

new text begin (5) the reason that a waiver will not significantly harm residents.
new text end

new text begin Following the submission of an exemption request, the commissioner must provide public
notice of the requested exemption and allow a public comment period.
new text end

new text begin (b) The commissioner shall evaluate requests for exemption under this subdivision by
reviewing the application materials and all comments submitted during the public comment
period. As part of the evaluation process, the commissioner may:
new text end

new text begin (1) inspect the facility;
new text end

new text begin (2) confer with the facility manager or designee;
new text end

new text begin (3) contact residents or their representatives to determine whether they believe a waiver
is in the residents' best interest; and
new text end

new text begin (4) contact individuals who submitted public comment during the public comment period.
new text end

new text begin (c) The commissioner may grant an exemption if the commissioner determines that
compliance with the requirement from which the exemption is sought cannot be accomplished
without substantial hardship to the facility and granting an exemption will not significantly
harm residents. The commissioner may not grant an exemption if it will create an imminent
risk of harm to a resident.
new text end

new text begin (d) An exemption granted under this subdivision is in effect for 90 days. After 90 days,
the facility may request a renewal of the exemption. After one renewal, the facility must
submit a new request for exemption under this subdivision.
new text end

Sec. 7.

Minnesota Statutes 2025 Supplement, section 145D.40, is amended by adding a
subdivision to read:

new text begin Subd. 5. new text end

new text begin Health care professional. new text end

new text begin "Health care professional" means an individual who
is licensed or registered by the state to provide health care services within the professional's
scope of practice and in accordance with state law.
new text end

Sec. 8.

Minnesota Statutes 2025 Supplement, section 145D.41, subdivision 1, is amended
to read:

Subdivision 1.

Notice.

At least 120 days prior to the transfer of ownership or control of
a nonprofit nursing home or nonprofit assisted living facility to a for-profit entity, the nursing
home or assisted living facility must provide written notice to new text begin the attorney general, new text end the
commissioner of health new text begin , new text end and the commissioner of human services of its intent to transfer
ownership or control to a for-profit entity.

Sec. 9.

Minnesota Statutes 2025 Supplement, section 145D.41, subdivision 2, is amended
to read:

Subd. 2.

Information.

Together with the notice, the for-profit entity seeking to acquire
ownership or control of the nonprofit nursing home or nonprofit assisted living facility must
provide to the attorney general, commissioner of health, and commissioner of human services new text begin :
new text end

new text begin (1) new text end the names of each individual with an interest in the for-profit entity and the percentage
of interest each individual holds in the for-profit entity new text begin ;
new text end

new text begin (2) a complete and detailed description of the for-profit entity's corporate structure;
new text end

new text begin (3) the names of each individual holding an interest in, and the percentage of interest
held in, any affiliate, subsidiary, or otherwise related entity that the for-profit entity has a
contract to provide goods or services for the operation or maintenance of the nursing home
or assisted living facility or has a contract for goods and services to be provided to residents,
including any real estate investment trusts if permitted under section 145D.42, subdivision
1;
new text end

new text begin (4) for the previous five years, any filings required to be made to any federal or state
agency;
new text end

new text begin (5) the for-profit entity's current balance sheet;
new text end

new text begin (6) all application materials required under section 144A.03 or 144G.12, as applicable;
new text end

new text begin (7) a description of the condition of the buildings the for-profit entity seeks to acquire
or manage, identifying any cooling problems, electric medical devices present, recent exterior
additions and replacements, external building conditions, recent flush toilet breakdowns,
foreclosure status in the previous 12 months, heat risk, heating problems, indoor air quality,
recent interior additions and replacements, and mold, as those terms are defined and described
in Appendix A of the American Housing Survey for the United States: 2023;
new text end

new text begin (8) an affidavit and evidence; and
new text end

new text begin (9) other information required by the attorney general, commissioner of health, and
commissioner of human services new text end .

Sec. 10.

Minnesota Statutes 2025 Supplement, section 145D.41, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Affidavit and evidence. new text end

new text begin In addition to the notice required under subdivision
1, a for-profit entity seeking to acquire ownership or control of a nonprofit nursing home
or nonprofit assisted living facility must submit to the attorney general an affidavit and
evidence sufficient to demonstrate that:
new text end

new text begin (1) the for-profit entity has the financial, managerial, and operational ability to operate
or manage the nursing home or assisted living facility consistent with the requirements of:
(i) for a nursing home, sections 144A.01 to 144A.1888, chapter 256R, and Minnesota Rules,
chapter 4658; or (ii) for an assisted living facility, chapter 144G and Minnesota Rules,
chapter 4659;
new text end

new text begin (2) neither the for-profit entity nor any of its owners, managerial officials, or managers
have committed a crime listed in, or been found civilly liable for an offense listed in, section
144A.03, subdivision 1, clause (13), or 144G.12, subdivision 1, clause (13), as applicable;
new text end

new text begin (3) in the preceding ten years, there have been no judgments and no filed, pending, or
completed public or private litigations, tax liens, written complaints, administrative actions,
or investigations by a government agency against the for-profit entity or any of its owners,
managerial officials, or managers;
new text end

new text begin (4) in the preceding ten years, the for-profit entity has not defaulted in the payment of
money collected for others and has not discharged debts through bankruptcy proceedings;
new text end

new text begin (5) the for-profit entity will invest sufficient capital in the nursing home or assisted living
facility to maintain or improve the facility's infrastructure and staffing;
new text end

new text begin (6)(i) housing costs or costs for services in a nursing home or assisted living facility in
the United States over which the for-profit entity acquired ownership or control have not
increased by more than the increase in the Consumer Price Index for all urban consumers
published by the federal Bureau of Labor Statistics for the 12 months preceding the month
in which the increase became effective; or (ii) if housing costs or costs for services in the
nursing home or assisted living facility increased by more than the increase in the Consumer
Price Index as described in item (i), the increase was justified;
new text end

new text begin (7) within five years after acquiring ownership or control of any other nursing home or
assisted living facility in the United States, the for-profit entity did not sell or otherwise
transfer ownership or control of the nursing home or assisted living facility to another person;
and
new text end

new text begin (8) after acquiring ownership or control of another nursing home in the United States,
that nursing home, with respect to the Centers for Medicare and Medicaid Services rating
system:
new text end

new text begin (i) maintained or improved the nursing home's rating if upon acquisition of ownership
or control the rating was three or more stars; or
new text end

new text begin (ii) improved the nursing home's rating to at least three stars if upon acquisition of
ownership or control the rating was one or two stars.
new text end

Sec. 11.

new text begin [145D.42] PROHIBITED PRACTICES.
new text end

new text begin A for-profit entity that acquires ownership or control of a nonprofit nursing home or
nonprofit assisted living facility is prohibited from:
new text end

new text begin (1) interfering with the professional judgment of a health care professional providing
care in the nursing home or assisted living facility or with a health care professional's
diagnosis or treatment of residents in the nursing home or assisted living facility;
new text end

new text begin (2) providing unequal treatment with regard to charges for housing or services based on
whether the resident pays for housing or services with private funds or through a public
program;
new text end

new text begin (3) engaging in any act, practice, or course of business that would strip an asset from an
acquired nursing home or assisted living facility or that would otherwise undermine the
quality of, safety of, or access to care and services provided by the nursing home or assisted
living facility;
new text end

new text begin (4) engaging in self-dealing;
new text end

new text begin (5) engaging in any acts, practices, or courses of business that result in an adverse impact
on the health, safety, and well-being and quality of care of the residents of the nursing home
or assisted living facility;
new text end

new text begin (6) spending less than 75 percent of the funds received by the nursing home or assisted
living facility from public programs and state appropriations on the direct care of residents;
new text end

new text begin (7) raising resident housing costs beyond the Consumer Price Index for all urban
consumers published by the federal Bureau of Labor Statistics for the 12 months preceding
the month in which the increase became effective unless the for-profit entity can demonstrate
that the increase was justified by legitimate business expenses;
new text end

new text begin (8) allowing a diminution of maintenance or a deterioration in the operations and
infrastructure of the nursing home or assisted living facility that results in unsafe conditions
or violations of building and other relevant codes, diminishes the property value of the
facility, or jeopardizes the health and well-being of the residents; or
new text end

new text begin (9) for a nursing home:
new text end

new text begin (i) failing to improve in the Centers for Medicare and Medicaid Services rating if the
nursing home's current rating is one or two stars; or
new text end

new text begin (ii) allowing a decline in the Centers for Medicare and Medicaid Services rating if the
nursing home's current rating is at least three stars.
new text end

Sec. 12. new text begin ATTORNEY GENERAL ENFORCEMENT.
new text end

new text begin A violation of Minnesota Statutes, section 145D.42, is an unfair and unconscionable
practice in violation of Minnesota Statutes, section 325F.69, subdivision 1. The attorney
general may enforce this section under Minnesota Statutes, section 8.31.
new text end

Sec. 13. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2024, section 144A.04, subdivision 7, new text end new text begin is repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: S2972-2

144A.04 QUALIFICATIONS FOR LICENSE.

Subd. 7.

Minimum nursing staff requirement.

The minimum staffing standard for nursing personnel in certified nursing homes is as specified in this subdivision.

(a) The minimum number of hours of nursing personnel to be provided in a nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized resident day. Upon transition to the 34 group, RUG-III resident classification system, the 0.95 hours per standardized resident day shall no longer apply.

(b) For purposes of this subdivision, "hours of nursing personnel" means the paid, on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the basis of any given 24-hour period. "Productive nursing hours" means all on-duty hours during which nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may be found in Minnesota Rules, part 4655.6400. Not included are vacations, holidays, sick leave, in-service classroom training, or lunches. Also not included are the nonproductive nursing hours of the in-service training director. In homes with more than 60 licensed beds, the hours of the director of nursing are excluded. "Standardized resident day" means the sum of the number of residents in each case mix class multiplied by the case mix weight for that resident class, as found in Minnesota Rules, part 9549.0059, subpart 2, calculated on the basis of a facility's census for any given day. For the purpose of determining a facility's census, the commissioner of health shall exclude the resident days claimed by the facility for resident therapeutic leave or bed hold days.

(c) Calculation of nursing hours per standardized resident day is performed by dividing total hours of nursing personnel for a given period by the total of standardized resident days for that same period.

(d) A nursing home that is issued a notice of noncompliance under section 144A.10, subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.