HF 744

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; requiring the Department
of Human Services to increase nursing facility and
community services payment rates; appropriating money;
amending Minnesota Statutes 2004, sections 256B.431,
by adding a subdivision; proposing coding for new law
in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2004, section 256B.431, is
amended by adding a subdivision to read:

new text begin Subd. 40. new text end

new text begin Nursing facility rate increase for july 1, 2005
and july 1, 2006. new text end

new text begin (a) For each of the rate years beginning July
1, 2005, and July 1, 2006, the commissioner shall provide to
each nursing facility reimbursed under this section or section
256B.434 an adjustment equal to 3.0 percent of the total
operating payment rate.
new text end

new text begin (b) Money resulting from the rate adjustment under
paragraph (a) must be used to:
new text end

new text begin (1) increase wages and benefits and pay associated costs
for employees except management fees, the administrator, and
central office staff; or
new text end

new text begin (2) add staff, other than administrative personnel, above
the facility's average staff complement for the previous year.
new text end

new text begin (c) Money received by a facility as a result of the rate
adjustment provided in paragraph (a), which must be used as
provided in paragraph (b), must be used only for wage, benefit,
and staff increases implemented on or after July 1, 2005, and
must not be used for increases implemented prior to that date.
new text end

new text begin (d) Nursing facilities may apply for the portions of the
rate adjustment under paragraph (a), which must be used as
provided in paragraph (b). The application must be made to the
commissioner and contain a plan by which the nursing facility
will distribute the funds according to paragraph (b). For
nursing facilities in which the employees are represented by an
exclusive bargaining representative, an agreement negotiated and
agreed to by the employer and the exclusive bargaining
representative constitutes the plan. A negotiated agreement may
constitute the plan only if the agreement is finalized after the
date of enactment of all increases for the rate year and signed
by both parties prior to submission to the commissioner. The
commissioner shall review the plan to ensure that the rate
adjustments are used as provided in paragraph (b). To be
eligible, a facility must submit its distribution plan by
December 31, 2005. If a facility's distribution plan is
effective after July 1, 2005, the portion of the rate
adjustments, which must be used as provided in paragraph (b),
are effective the same date as the facility's plan.
new text end

new text begin (e) A copy of the approved distribution plan must be made
available to all employees by giving each employee a copy or by
posting a copy in an area of the nursing facility to which all
employees have access. If an employee does not receive the wage
and benefit adjustment described in the facility's approved plan
and is unable to resolve the problem with the facility's
management or through the employee's union representative, the
employee may contact the commissioner at an address or telephone
number provided by the commissioner and included in the approved
plan.
new text end

new text begin (f) Notwithstanding section 256B.48, subdivision 1,
paragraph (a), upon the request of a nursing facility, the
commissioner may authorize the facility to raise per diem rates
for private-pay residents on July 1 by the amount anticipated to
be required upon implementation of the rate adjustments
allowable under paragraph (a). The commissioner shall require
any amounts collected under this paragraph, which must be used
as provided in paragraph (b), to be placed in an escrow account
established for this purpose with a financial institution that
provides deposit insurance until the medical assistance rate is
finalized. The commissioner shall conduct audits as necessary
to ensure that:
new text end

new text begin (1) the amounts collected are retained in escrow until
medical assistance rates are increased to reflect the rate
adjustment; and
new text end

new text begin (2) any amounts collected from private-pay residents in
excess of the final medical assistance rate are repaid to the
private-pay residents with interest at the rate used by the
commissioner of revenue for the late payment of taxes and in
effect on the date the distribution plan is approved by the
commissioner of human services.
new text end

Sec. 2.

new text begin [256B.4351] ASSESSMENT FOR HEALTH INSURANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Nursing facility assessment. new text end

new text begin (a)
Effective July 1, 2005, each nursing facility with rates set
under sections 256B.431 and 256B.435 shall pay to the
commissioner, on a monthly basis, an assessment of ten cents per
staff hour worked each month, according to the payment procedure
established by the commissioner.
new text end

new text begin (b) Nursing facilities are exempt from the assessment in
paragraph (a) if they:
new text end

new text begin (1) provide health coverage that is actuarially equivalent
to a qualified number two plan under section 62E.06;
new text end

new text begin (2) pay for at least 80 percent of the cost of
employee-only coverage; and
new text end

new text begin (3) have a participation rate of at least 70 percent of
employees.
new text end

new text begin Subd. 2. new text end

new text begin Health insurance purchasing pool account. new text end

new text begin The
commissioner shall establish a health insurance purchasing pool
account in the general fund and shall deposit all payments
received under this section into that account.
new text end

new text begin Subd. 3. new text end

new text begin Rate increase. new text end

new text begin Effective July 1, 2005, the
commissioner shall increase rates of all nursing facilities
reimbursed under sections 256B.431 and 256B.435 by an amount
equal to the assessment paid under subdivision 1. For
facilities meeting the criteria in subdivision 1, paragraph (b),
the commissioner shall increase reimbursement rates by an amount
equal to the assessment that would have been paid had the
facilities not been exempt.
new text end

Sec. 3.

new text begin [256B.4352] NURSING FACILITY HEALTH INSURANCE
BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human
services shall appoint a ten-member nursing facility health
insurance board, consisting of five representatives of nursing
facility operators and five representatives of nursing facility
employees. The commissioner shall provide technical support to
the board. The board is governed by section 15.0575.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin The board shall:
new text end

new text begin (1) design a self-insured health insurance purchasing pool
that meets the criteria in subdivision 3;
new text end

new text begin (2) develop a timeline and plan for implementation of the
purchasing pool; and
new text end

new text begin (3) upon a legislative approval, implement and administer
the purchasing pool.
new text end

new text begin Subd. 3. new text end

new text begin Design of purchasing pool. new text end

new text begin The design for the
health insurance purchasing pool must:
new text end

new text begin (1) describe the health insurance coverage to be provided,
the estimated cost of coverage to employees, and any
cost-sharing requirements;
new text end

new text begin (2) specify eligibility requirements for employees and
nursing facilities;
new text end

new text begin (3) specify the minimum levels of employer contributions
toward the cost of health coverage;
new text end

new text begin (4) require nursing facilities purchasing coverage through
the pool to remain members of the pool for a specified minimum
time period;
new text end

new text begin (5) provide subsidies for the employee share of health
insurance premiums; and
new text end

new text begin (6) specify how the funds provided through the assessment
established under section 256B.436 will be allocated between a
reserve fund and premium subsidies for employees.
new text end

Subd. 4.

Report to legislature.

new text begin The board shall present
a report to the legislature by December 15, 2005, on the design,
implementation, and administration of a health insurance
purchasing pool for nursing facility employees.
new text end

Sec. 4. new text begin COMMUNITY SERVICES PROVIDER RATE INCREASES.
new text end

new text begin (a) The commissioner of human services shall increase
reimbursement rates by 3.0 percent for each of the rate years
beginning July 1, 2005, and July 1, 2006, effective for services
rendered on or after that date.
new text end

new text begin (b) The 3.0 percent annual rate increases described in this
section must be provided to:
new text end

new text begin (1) home and community-based waivered services for persons
with mental retardation or related conditions under Minnesota
Statutes, section 256B.501;
new text end

new text begin (2) home and community-based waivered services for the
elderly under Minnesota Statutes, section 256B.0915;
new text end

new text begin (3) waivered services under community alternatives for
disabled individuals under Minnesota Statutes, section 256B.49;
new text end

new text begin (4) community alternative care waivered services under
Minnesota Statutes, section 256B.49;
new text end

new text begin (5) traumatic brain injury waivered services under
Minnesota Statutes, section 256B.49;
new text end

new text begin (6) nursing services and home health services under
Minnesota Statutes, section 256B.0625, subdivision 6a;
new text end

new text begin (7) personal care services and nursing supervision of
personal care services under Minnesota Statutes, section
256B.0625, subdivision 19a;
new text end

new text begin (8) private duty nursing services under Minnesota Statutes,
section 256B.0625, subdivision 7;
new text end

new text begin (9) day training and habilitation services for adults with
mental retardation or related conditions under Minnesota
Statutes, sections 252.40 to 252.46;
new text end

new text begin (10) alternative care services under Minnesota Statutes,
section 256B.0913;
new text end

new text begin (11) adult residential program grants under Minnesota
Rules, parts 9535.2000 to 9535.3000;
new text end

new text begin (12) adult and family community support grants under
Minnesota Rules, parts 9535.1700 to 9535.1760;
new text end

new text begin (13) the group residential housing supplementary service
rate under Minnesota Statutes, section 256I.05, subdivision 1a;
new text end

new text begin (14) adult mental health integrated fund grants under
Minnesota Statutes, section 245.4661;
new text end

new text begin (15) semi-independent living services under Minnesota
Statutes, section 252.275, including SILS funding under county
social services grants formerly funded under Minnesota Statutes,
chapter 256I;
new text end

new text begin (16) community support services for deaf and
hard-of-hearing adults with mental illness who use or wish to
use sign language as their primary means of communication; and
new text end

new text begin (17) living skills training programs for persons with
intractable epilepsy who need assistance in the transition to
independent living.
new text end

new text begin (c) Providers that receive a rate increase under this
section shall use the additional revenue to:
new text end

new text begin (1) increase wages and benefits and pay associated costs
for employees except management fees, the administrator, and
central office staff; or
new text end

new text begin (2) add staff, other than administrative personnel, above
the provider's average staff complement for the previous year.
new text end

new text begin (d) For public employees, the portion of this increase
reserved to increase wages and benefits for certain staff is
available and pay rates shall be increased only to the extent
that they comply with laws governing public employees collective
bargaining. Money received by a provider for pay increases
under this section may be used only for increases implemented on
or after the first day of the state fiscal year in which the
increase is available and must not be used for increases
implemented prior to that date.
new text end

new text begin (e) A copy of the provider's plan for complying with
paragraph (c) must be made available to all employees by giving
each employee a copy or by posting a copy in an area of the
provider's operation to which all employees have access. If an
employee does not receive the adjustment described in the plan
and is unable to resolve the problem with the provider, the
employee may contact the employee's union representative. If
the employee is not covered by a collective bargaining
agreement, the employee may contact the commissioner at a
telephone number provided by the commissioner and included in
the provider's plan.
new text end

Sec. 5. new text begin REPORTING OF STATISTICAL AND COST INFORMATION.
new text end

new text begin (a) Nursing facilities shall annually file a statistical
and cost report on or before December 15 for the reporting
period ending September 30.
new text end

new text begin (b) Nursing facilities shall provide the information to the
commissioner in no lesser detail than the information required
on the form established by Minnesota Statutes, section 256B.440.
new text end

new text begin (c) The commissioner may reject a report filed by the
nursing facility under this section if the commissioner
determines that the report has been filed in a form that is
incomplete or inaccurate. If a report is rejected or is not
submitted in a timely manner, the commissioner shall reduce
payments to a nursing facility to 85 percent of amounts due
until the information is completely and accurately filed. The
reinstatement of withheld payments shall be retroactive for no
more than 90 days. A nursing facility whose report is rejected
shall be given a notice of the rejection, the reasons for the
rejection, and an opportunity to correct the report prior to any
payment reduction. A nursing facility that does not submit a
report shall be given a prior written notice of the payment
reduction.
new text end

new text begin (d) The commissioner may determine, in consultation with
stakeholders, additional items to be reported.
new text end

Sec. 6. new text begin NURSING HOURS AND RATES.
new text end

new text begin (a) On July 1, 2005, the required minimum nursing hours in
nursing facilities licensed in Minnesota shall be increased to
4.1 per resident per day.
new text end

new text begin (b) The minimum staffing ratios are 2.8 hours per resident
day of certified nursing assistant (CNA) care and 1.3 hours per
resident day of care by an LPN or RN, of which 0.75 is provided
by an RN.
new text end

new text begin (c) Staffing must be adjusted upward to meet residents'
higher care needs.
new text end

new text begin (d) Nursing facility payment rates must be reasonable and
adequate to meet the costs that must be incurred by efficiently
and economically operated facilities to conform with the
requirements established in paragraphs (a), (b), and (c).
new text end

Sec. 7. new text begin NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.
new text end

new text begin (a) The commissioner of health, in consultation with
long-term care consumers, advocates, unions, and trade
associations, shall review the content of the current curriculum
for the training of nursing assistants and home health aides.
new text end

new text begin (b) This review will identify how changes in the current
training can improve students' caregiving skills, job
satisfaction, and motivation to work in long-term care settings.
These topics shall include, but not be limited to, working with
challenging behaviors and terminal illnesses; improving
communications with residents, families, and other employees;
and understanding techniques for stress management and how
stress in personal life can impact performance in the work
setting. The review will also assess how the curriculum can be
improved to address more effectively the issues of cultural
diversity among employees and cultural issues in employees'
relationships with residents and clients.
new text end

new text begin (c) By January 1, 2006, the commissioner shall submit the
recommendations for updating the curriculum to the chairs of the
legislative committees having jurisdiction over health care
policy. The recommendations shall include implementation
timelines and cost estimates for curriculum development and
implementation.
new text end

Sec. 8. new text begin LONG-TERM CARE SYSTEM PLANNING AND REDESIGN.
new text end

new text begin (a) The commissioner of human services in consultation and
coordination with the commissioner of health shall create a
long-term care task force to develop a plan to reduce nursing
facility bed capacity. The goal is to develop a smaller,
well-supported nursing home system while utilizing a variety of
diverse services in the community. The task force shall address
the following areas:
new text end

new text begin (1) develop explicit policy decisions for the future use of
nursing homes for short-term and chronic care;
new text end

new text begin (2) define specific steps to protect consumers from
problems accessing nursing homes, community services, and
extended hospitalization; and
new text end

new text begin (3) develop a plan to utilize savings to fund facility and
community care workforce development.
new text end

new text begin (b) The commissioner shall issue a report to the chairs of
the legislative committees having jurisdiction over health care
policy by December 15, 2007.
new text end

Sec. 9. new text begin APPROPRIATIONS.
new text end

new text begin $....... is appropriated in fiscal years 2006 and 2007 from
the general fund to the commissioner of human services for the
purposes of sections 1 to 8.
new text end