3rd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to health; regulating hospice care providers; 1.3 providing criminal penalties; amending Minnesota 1.4 Statutes 2000, sections 13.381, subdivision 10; 1.5 144A.43, subdivisions 1, 3, 4; 144A.45, subdivisions 1.6 1, 2; 144A.46, subdivisions 3a, 3b, 4; 144A.4605, 1.7 subdivisions 2, 3; 145C.01, subdivision 7; 157.17, 1.8 subdivision 2; 609.7495, subdivision 1; 626.5572, 1.9 subdivision 6; Minnesota Statutes 2001 Supplement, 1.10 section 144A.4605, subdivision 4; proposing coding for 1.11 new law in Minnesota Statutes, chapter 144A; repealing 1.12 Minnesota Statutes 2000, section 144A.48. 1.13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.14 Section 1. Minnesota Statutes 2000, section 13.381, 1.15 subdivision 10, is amended to read: 1.16 Subd. 10. [HOME CARE AND HOSPICE
PROGRAMPROVIDER.] Data 1.17 regarding a home care hospice programprovider under sections 1.18 144A.43 to 144A.48144A.47 are governed by section 144A.45. 1.19 Data regarding a hospice provider under sections 144A.75 to 1.20 144A.755 are governed by sections 144A.752 and 144A.754. 1.21 Sec. 2. Minnesota Statutes 2000, section 144A.43, 1.22 subdivision 1, is amended to read: 1.23 Subdivision 1. [APPLICABILITY.] The definitions in this 1.24 section apply to sections 144.699, subdivision 2, and 144A.43 to 1.25 144A.48144A.47. 1.26 Sec. 3. Minnesota Statutes 2000, section 144A.43, 1.27 subdivision 3, is amended to read: 1.28 Subd. 3. [HOME CARE SERVICE.] "Home care service" means 1.29 any of the following services when delivered in a place of 2.1 residence to a person whose illness, disability, or physical 2.2 condition creates a need for the service: 2.3 (1) nursing services, including the services of a home 2.4 health aide; 2.5 (2) personal care services not included under sections 2.6 148.171 to 148.285; 2.7 (3) physical therapy; 2.8 (4) speech therapy; 2.9 (5) respiratory therapy; 2.10 (6) occupational therapy; 2.11 (7) nutritional services; 2.12 (8) home management services when provided to a person who 2.13 is unable to perform these activities due to illness, 2.14 disability, or physical condition. Home management services 2.15 include at least two of the following services: housekeeping, 2.16 meal preparation, and shopping; 2.17 (9) medical social services; 2.18 (10) the provision of medical supplies and equipment when 2.19 accompanied by the provision of a home care service; and 2.20 (11) the provision of a hospice program as specified in2.21 section 144A.48; and2.22 (12)other similar medical services and health-related 2.23 support services identified by the commissioner in rule. 2.24 "Home care service" does not include the following 2.25 activities conducted by the commissioner of health or a board of 2.26 health as defined in section 145A.02, subdivision 2: 2.27 communicable disease investigations or testing; administering or 2.28 monitoring a prescribed therapy necessary to control or prevent 2.29 a communicable disease; or the monitoring of an individual's 2.30 compliance with a health directive as defined in section 2.31 144.4172, subdivision 6. 2.32 Sec. 4. Minnesota Statutes 2000, section 144A.43, 2.33 subdivision 4, is amended to read: 2.34 Subd. 4. [HOME CARE PROVIDER.] "Home care provider" means 2.35 an individual, organization, association, corporation, unit of 2.36 government, or other entity that is regularly engaged in the 3.1 delivery, directly or by contractual arrangement, of home care 3.2 services for a fee. At least one home care service must be 3.3 provided directly, although additional home care services may be 3.4 provided by contractual arrangements. "Home care provider"3.5 includes a hospice program defined in section 144A.48."Home 3.6 care provider" does not include: 3.7 (1) any home care or nursing services conducted by and for 3.8 the adherents of any recognized church or religious denomination 3.9 for the purpose of providing care and services for those who 3.10 depend upon spiritual means, through prayer alone, for healing; 3.11 (2) an individual who only provides services to a relative; 3.12 (3) an individual not connected with a home care provider 3.13 who provides assistance with home management services or 3.14 personal care needs if the assistance is provided primarily as a 3.15 contribution and not as a business; 3.16 (4) an individual not connected with a home care provider 3.17 who shares housing with and provides primarily housekeeping or 3.18 homemaking services to an elderly or disabled person in return 3.19 for free or reduced-cost housing; 3.20 (5) an individual or agency providing home-delivered meal 3.21 services; 3.22 (6) an agency providing senior companion services and other 3.23 older American volunteer programs established under the Domestic 3.24 Volunteer Service Act of 1973, Public Law Number 98-288; 3.25 (7) an employee of a nursing home licensed under this 3.26 chapter or an employee of a boarding care home licensed under 3.27 sections 144.50 to 144.56 who responds to occasional emergency 3.28 calls from individuals residing in a residential setting that is 3.29 attached to or located on property contiguous to the nursing 3.30 home or boarding care home; 3.31 (8) a member of a professional corporation organized under 3.32 chapter 319B that does not regularly offer or provide home care 3.33 services as defined in subdivision 3; 3.34 (9) the following organizations established to provide 3.35 medical or surgical services that do not regularly offer or 3.36 provide home care services as defined in subdivision 3: a 4.1 business trust organized under sections 318.01 to 318.04, a 4.2 nonprofit corporation organized under chapter 317A, a 4.3 partnership organized under chapter 323, or any other entity 4.4 determined by the commissioner; 4.5 (10) an individual or agency that provides medical supplies 4.6 or durable medical equipment, except when the provision of 4.7 supplies or equipment is accompanied by a home care service; 4.8 (11) an individual licensed under chapter 147; or 4.9 (12) an individual who provides home care services to a 4.10 person with a developmental disability who lives in a place of 4.11 residence with a family, foster family, or primary caregiver. 4.12 Sec. 5. Minnesota Statutes 2000, section 144A.45, 4.13 subdivision 1, is amended to read: 4.14 Subdivision 1. [RULES.] The commissioner shall adopt rules 4.15 for the regulation of home care providers pursuant to sections 4.16 144A.43 to 144A.48144A.47. The rules shall include the 4.17 following: 4.18 (a) provisions to assure, to the extent possible, the 4.19 health, safety and well-being, and appropriate treatment of 4.20 persons who receive home care services; 4.21 (b) requirements that home care providers furnish the 4.22 commissioner with specified information necessary to implement 4.23 sections 144A.43 to 144A.48144A.47; 4.24 (c) standards of training of home care provider personnel, 4.25 which may vary according to the nature of the services provided 4.26 or the health status of the consumer; 4.27 (d) standards for medication management which may vary 4.28 according to the nature of the services provided, the setting in 4.29 which the services are provided, or the status of the consumer. 4.30 Medication management includes the central storage, handling, 4.31 distribution, and administration of medications; 4.32 (e) standards for supervision of home care services 4.33 requiring supervision by a registered nurse or other appropriate 4.34 health care professional which must occur on site at least every 4.35 62 days, or more frequently if indicated by a clinical 4.36 assessment, and in accordance with sections 148.171 to 148.285 5.1 and rules adopted thereunder; 5.2 (f) standards for client evaluation or assessment which may 5.3 vary according to the nature of the services provided or the 5.4 status of the consumer; 5.5 (g) requirements for the involvement of a consumer's 5.6 physician, the documentation of physicians' orders, if required, 5.7 and the consumer's treatment plan, and the maintenance of 5.8 accurate, current clinical records; 5.9 (h) the establishment of different classes of licenses for 5.10 different types of providers and different standards and 5.11 requirements for different kinds of home care services; and 5.12 (i) operating procedures required to implement the home 5.13 care bill of rights. 5.14 Sec. 6. Minnesota Statutes 2000, section 144A.45, 5.15 subdivision 2, is amended to read: 5.16 Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner 5.17 shall: 5.18 (1) evaluate, monitor, and license home care providers in 5.19 accordance with sections 144A.45 to 144A.48144A.47; 5.20 (2) inspect the office and records of a provider during 5.21 regular business hours without advance notice to the home care 5.22 provider; 5.23 (3) with the consent of the consumer, visit the home where 5.24 services are being provided; 5.25 (4) issue correction orders and assess civil penalties in 5.26 accordance with section 144.653, subdivisions 5 to 8, for 5.27 violations of sections 144A.43 to 144A.48144A.47 or the rules 5.28 adopted under those sections; and 5.29 (5) take other action reasonably required to accomplish the 5.30 purposes of sections 144A.43 to 144A.48144A.47. 5.31 (b) In the exercise of the authority granted in sections 5.32 144A.43 to 144A.48144A.47, the commissioner shall comply with 5.33 the applicable requirements of section 144.122, the Government 5.34 Data Practices Act, and the Administrative Procedure Act. 5.35 Sec. 7. Minnesota Statutes 2000, section 144A.46, 5.36 subdivision 3a, is amended to read: 6.1 Subd. 3a. [INJUNCTIVE RELIEF.] In addition to any other 6.2 remedy provided by law, the commissioner may bring an action in 6.3 district court to enjoin a person who is involved in the 6.4 management, operation, or control of a home care provider, or an 6.5 employee of the home care provider from illegally engaging in 6.6 activities regulated by sections 144A.43 to 144A.48144A.47. 6.7 The commissioner may bring an action under this subdivision in 6.8 the district court in Ramsey county or in the district in which 6.9 a home care provider is providing services. The court may grant 6.10 a temporary restraining order in the proceeding if continued 6.11 activity by the person who is involved in the management, 6.12 operation, or control of a home care provider, or by an employee 6.13 of the home care provider, would create an imminent risk of harm 6.14 to a recipient of home care services. 6.15 Sec. 8. Minnesota Statutes 2000, section 144A.46, 6.16 subdivision 3b, is amended to read: 6.17 Subd. 3b. [SUBPOENA.] In matters pending before the 6.18 commissioner under sections 144A.43 to 144A.48144A.47, the 6.19 commissioner may issue subpoenas and compel the attendance of 6.20 witnesses and the production of all necessary papers, books, 6.21 records, documents, and other evidentiary material. If a person 6.22 fails or refuses to comply with a subpoena or order of the 6.23 commissioner to appear or testify regarding any matter about 6.24 which the person may be lawfully questioned or to produce any 6.25 papers, books, records, documents, or evidentiary materials in 6.26 the matter to be heard, the commissioner may apply to the 6.27 district court in any district, and the court shall order the 6.28 person to comply with the commissioner's order or subpoena. The 6.29 commissioner of health may administer oaths to witnesses, or 6.30 take their affirmation. Depositions may be taken in or outside 6.31 the state in the manner provided by law for the taking of 6.32 depositions in civil actions. A subpoena or other process or 6.33 paper may be served upon a named person anywhere within the 6.34 state by an officer authorized to serve subpoenas in civil 6.35 actions, with the same fees and mileage and in the same manner 6.36 as prescribed by law for process issued out of a district 7.1 court. A person subpoenaed under this subdivision shall receive 7.2 the same fees, mileage, and other costs that are paid in 7.3 proceedings in district court. 7.4 Sec. 9. Minnesota Statutes 2000, section 144A.46, 7.5 subdivision 4, is amended to read: 7.6 Subd. 4. [RELATION TO OTHER REGULATORY PROGRAMS.] In the 7.7 exercise of the authority granted under sections 144A.43 to 7.8 144A.48144A.47, the commissioner shall not duplicate or replace 7.9 standards and requirements imposed under another state 7.10 regulatory program. The commissioner shall not impose 7.11 additional training or education requirements upon members of a 7.12 licensed or registered occupation or profession, except as 7.13 necessary to address or prevent problems that are unique to the 7.14 delivery of services in the home or to enforce and protect the 7.15 rights of consumers listed in section 144A.44. The commissioner 7.16 of health shall not require a home care provider certified under 7.17 the Medicare program to comply with a rule adopted under section 7.18 144A.45 if the home care provider is required to comply with any 7.19 equivalent federal law or regulation relating to the same 7.20 subject matter. The commissioner of health shall specify in the 7.21 rules those provisions that are not applicable to certified home 7.22 care providers. To the extent possible, the commissioner shall 7.23 coordinate the inspections required under sections 144A.45 7.24 to 144A.48144A.47 with the health facility licensure 7.25 inspections required under sections 144.50 to 144.58 or 144A.10 7.26 when the health care facility is also licensed under the 7.27 provisions of Laws 1987, chapter 378. 7.28 Sec. 10. Minnesota Statutes 2000, section 144A.4605, 7.29 subdivision 2, is amended to read: 7.30 Subd. 2. [ASSISTED LIVING HOME CARE LICENSE ESTABLISHED.] 7.31 A home care provider license category entitled assisted living 7.32 home care provider is hereby established. A home care provider 7.33 may obtain an assisted living license if the program meets the 7.34 following requirements: 7.35 (a) nursing services, delegated nursing services, other 7.36 services performed by unlicensed personnel, or central storage 8.1 of medications under the assisted living license are provided 8.2 solely for residents of one or more housing with services 8.3 establishments registered under chapter 144D; 8.4 (b) unlicensed personnel perform home health aide and home 8.5 care aide tasks identified in Minnesota Rules, parts 4668.0100, 8.6 subparts 1 and 2, and 4668.0110, subpart 1. Qualifications to 8.7 perform these tasks shall be established in accordance with 8.8 subdivision 3; 8.9 (c) periodic supervision of unlicensed personnel is 8.10 provided as required by rule; 8.11 (d) notwithstanding Minnesota Rules, part 4668.0160, 8.12 subpart 6, item D, client records shall include: 8.13 (1) daily records or a weekly summary of home care services 8.14 provided; 8.15 (2) documentation each time medications are administered to 8.16 a client; and 8.17 (3) documentation on the day of occurrence of any 8.18 significant change in the client's status or any significant 8.19 incident, such as a fall or refusal to take medications. 8.20 All entries must be signed by the staff providing the 8.21 services and entered into the record no later than two weeks 8.22 after the end of the service day, except as specified in clauses 8.23 (2) and (3); 8.24 (e) medication and treatment orders, if any, are included 8.25 in the client record and are renewed at least every 12 months, 8.26 or more frequently when indicated by a clinical assessment; 8.27 (f) the central storage of medications in a housing with 8.28 services establishment registered under chapter 144D is managed 8.29 under a system that is established by a registered nurse and 8.30 addresses the control of medications, handling of medications, 8.31 medication containers, medication records, and disposition of 8.32 medications; and 8.33 (g) in other respects meets the requirements established by 8.34 rules adopted under sections 144A.45 to 144A.48144A.47. 8.35 Sec. 11. Minnesota Statutes 2000, section 144A.4605, 8.36 subdivision 3, is amended to read: 9.1 Subd. 3. [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.] 9.2 (a) Unlicensed personnel must: 9.3 (1) satisfy the training or competency requirements 9.4 established by rule under sections 144A.45 to 144A.48144A.47; 9.5 or 9.6 (2) be trained or determined competent by a registered 9.7 nurse in each task identified under Minnesota Rules, part 9.8 4668.0100, subparts 1 and 2, when offered to clients in a 9.9 housing with services establishment as described in paragraphs 9.10 (b) to (e). 9.11 (b) Training for tasks identified under Minnesota Rules, 9.12 part 4668.0100, subparts 1 and 2, shall use a curriculum which 9.13 meets the requirements in Minnesota Rules, part 4668.0130. 9.14 (c) Competency evaluations for tasks identified under 9.15 Minnesota Rules, part 4668.0100, subparts 1 and 2, must be 9.16 completed and documented by a registered nurse. 9.17 (d) Unlicensed personnel performing tasks identified under 9.18 Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be 9.19 trained or demonstrate competency in the following topics: 9.20 (1) an overview of sections 144A.43 to 144A.48144A.47 and 9.21 rules adopted thereunder; 9.22 (2) recognition and handling of emergencies and use of 9.23 emergency services; 9.24 (3) reporting the maltreatment of vulnerable minors or 9.25 adults under sections 626.556 and 626.557; 9.26 (4) home care bill of rights; 9.27 (5) handling of clients' complaints and reporting of 9.28 complaints to the office of health facility complaints; 9.29 (6) services of the ombudsman for older Minnesotans; 9.30 (7) observation, reporting, and documentation of client 9.31 status and of the care or services provided; 9.32 (8) basic infection control; 9.33 (9) maintenance of a clean, safe, and healthy environment; 9.34 (10) communication skills; 9.35 (11) basic elements of body functioning and changes in body 9.36 function that must be reported to an appropriate health care 10.1 professional; and 10.2 (12) physical, emotional, and developmental needs of 10.3 clients, and ways to work with clients who have problems in 10.4 these areas, including respect for the client, the client's 10.5 property, and the client's family. 10.6 (e) Unlicensed personnel who administer medications must 10.7 comply with rules relating to the administration of medications 10.8 in Minnesota Rules, part 4668.0100, subpart 2, except that 10.9 unlicensed personnel need not comply with the requirements of 10.10 Minnesota Rules, part 4668.0100, subpart 5. 10.11 Sec. 12. Minnesota Statutes 2001 Supplement, section 10.12 144A.4605, subdivision 4, is amended to read: 10.13 Subd. 4. [LICENSE REQUIRED.] (a) A housing with services 10.14 establishment registered under chapter 144D that is required to 10.15 obtain a home care license must obtain an assisted living home 10.16 care license according to this section or a class A or class E 10.17 license according to rule. A housing with services 10.18 establishment that obtains a class E license under this 10.19 subdivision remains subject to the payment limitations in 10.20 sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915, 10.21 subdivision 3, paragraph (g). 10.22 (b) A board and lodging establishment registered for 10.23 special services as of December 31, 1996, and also registered as 10.24 a housing with services establishment under chapter 144D, must 10.25 deliver home care services according to sections 144A.43 to 10.26 144A.48144A.47, and may apply for a waiver from requirements 10.27 under Minnesota Rules, parts 4668.0002 to 4668.0240, to operate 10.28 a licensed agency under the standards of section 157.17. Such 10.29 waivers as may be granted by the department will expire upon 10.30 promulgation of home care rules implementing section 144A.4605. 10.31 (c) An adult foster care provider licensed by the 10.32 department of human services and registered under chapter 144D 10.33 may continue to provide health-related services under its foster 10.34 care license until the promulgation of home care rules 10.35 implementing this section. 10.36 (d) An assisted living home care provider licensed under 11.1 this section must comply with the disclosure provisions of 11.2 section 325F.72 to the extent they are applicable. 11.3 Sec. 13. [144A.75] [DEFINITIONS.] 11.4 Subdivision 1. [APPLICABILITY.] For the purposes of 11.5 sections 144A.75 to 144A.756, the following terms have the 11.6 meanings given them. 11.7 Subd. 2. [COMMISSIONER.] "Commissioner" means the 11.8 commissioner of health. 11.9 Subd. 3. [CORE SERVICES.] "Core services" means physician 11.10 services, registered nursing services, medical social services, 11.11 and counseling services. A hospice must ensure that at least 11.12 two core services are regularly provided directly by hospice 11.13 employees. A hospice provider may use contracted staff if 11.14 necessary to supplement hospice employees in order to meet the 11.15 needs of patients during peak patient loads or under 11.16 extraordinary circumstances. 11.17 Subd. 4. [COUNSELING SERVICES.] "Counseling services" 11.18 includes bereavement counseling provided after the patient's 11.19 death and spiritual and other counseling services for the 11.20 individual and the family while enrolled in hospice care. 11.21 Bereavement services must be provided according to a plan of 11.22 care that reflects the needs of the family for up to one year 11.23 following the death of the patient. 11.24 Subd. 5. [HOSPICE PROVIDER.] "Hospice provider" means an 11.25 individual, organization, association, corporation, unit of 11.26 government, or other entity that is regularly engaged in the 11.27 delivery, directly or by contractual arrangement, of hospice 11.28 services for a fee to terminally ill hospice patients. A 11.29 hospice must provide all core services. 11.30 Subd. 6. [HOSPICE PATIENT.] "Hospice patient" means an 11.31 individual who has been diagnosed as terminally ill, with a 11.32 probable life expectancy of under one year, as documented by the 11.33 individual's attending physician and hospice medical director, 11.34 who alone or, when unable, through the individual's family has 11.35 voluntarily consented to and received admission to a hospice 11.36 provider. 12.1 Subd. 7. [HOSPICE PATIENT'S FAMILY.] "Hospice patient's 12.2 family" means relatives of the hospice patient, the hospice 12.3 patient's guardian or primary caregiver, or persons identified 12.4 by the hospice patient as having significant personal ties. 12.5 Subd. 8. [HOSPICE SERVICES; HOSPICE CARE.] "Hospice 12.6 services" or "hospice care" means palliative and supportive care 12.7 and other services provided by an interdisciplinary team under 12.8 the direction of an identifiable hospice administration to 12.9 terminally ill hospice patients and their families to meet the 12.10 physical, nutritional, emotional, social, spiritual, and special 12.11 needs experienced during the final stages of illness, dying, and 12.12 bereavement. These services are provided through a centrally 12.13 coordinated program that ensures continuity and consistency of 12.14 home and inpatient care that is provided directly or through an 12.15 agreement. 12.16 Subd. 9. [INTERDISCIPLINARY TEAM.] "Interdisciplinary team" 12.17 means a group of qualified individuals with expertise in meeting 12.18 the special needs of hospice patients and their families, 12.19 including, at a minimum, those individuals who are providers of 12.20 core services. 12.21 Subd. 10. [MEDICAL DIRECTOR.] "Medical director" means a 12.22 licensed physician who is knowledgeable about palliative 12.23 medicine and assumes overall responsibility for the medical 12.24 component of the hospice care program. 12.25 Subd. 11. [OTHER SERVICES.] "Other services" means 12.26 physical therapy, occupational therapy, speech therapy, 12.27 nutritional counseling, and volunteers. 12.28 Subd. 12. [PALLIATIVE CARE.] "Palliative care" means the 12.29 total active care of patients whose disease is not responsive to 12.30 curative treatment. Control of pain, of other symptoms, and of 12.31 psychological, social, and spiritual problems is paramount. The 12.32 goal of palliative care is the achievement of the best quality 12.33 of life for patients and their families. 12.34 Subd. 13. [RESIDENTIAL HOSPICE FACILITY.] "Residential 12.35 hospice facility" means a facility that resembles a 12.36 single-family home located in a residential area that directly 13.1 provides 24-hour residential and support services in a home-like 13.2 setting for hospice patients as an integral part of the 13.3 continuum of home care provided by a hospice and that houses: 13.4 (1) no more than eight hospice patients; or 13.5 (2) at least nine and no more than 12 hospice patients with 13.6 the approval of the local governing authority, notwithstanding 13.7 section 462.357, subdivision 8. 13.8 Subd. 14. [VOLUNTEER SERVICES.] "Volunteer services" means 13.9 services by volunteers who provide a personal presence that 13.10 augments a variety of professional and nonprofessional services 13.11 available to the hospice patient, the hospice patient's family, 13.12 and the hospice provider. 13.13 Sec. 14. [144A.751] [HOSPICE BILL OF RIGHTS.] 13.14 Subdivision 1. [STATEMENT OF RIGHTS.] An individual who 13.15 receives hospice care and the individual's family have the right 13.16 to: 13.17 (1) receive written information about rights in advance of 13.18 receiving hospice care or during the initial evaluation visit 13.19 before the initiation of hospice care, including what to do if 13.20 rights are violated; 13.21 (2) receive care and services according to a suitable 13.22 hospice plan of care and subject to accepted hospice care 13.23 standards and to take an active part in creating and changing 13.24 the plan and evaluating care and services; 13.25 (3) be told in advance of receiving care about the services 13.26 that will be provided, the disciplines that will furnish care, 13.27 the frequency of visits proposed to be furnished, other choices 13.28 that are available, and the consequence of these choices, 13.29 including the consequences of refusing these services; 13.30 (4) be told in advance, whenever possible, of any change in 13.31 the hospice plan of care and to take an active part in any 13.32 change; 13.33 (5) refuse services or treatment; 13.34 (6) know, in advance, any limits to the services available 13.35 from a provider, and the provider's grounds for a termination of 13.36 services; 14.1 (7) know in advance of receiving care whether the services 14.2 are covered by health insurance, medical assistance, or other 14.3 health programs, the charges for services that will not be 14.4 covered by Medicare, and the charges that the individual may 14.5 have to pay; 14.6 (8) know what the charges are for services, no matter who 14.7 will be paying the bill; 14.8 (9) know that there may be other services available in the 14.9 community, including other end of life services and other 14.10 hospice providers, and know where to go for information about 14.11 these services; 14.12 (10) choose freely among available providers and change 14.13 providers after services have begun, within the limits of health 14.14 insurance, medical assistance, or other health programs; 14.15 (11) have personal, financial, and medical information kept 14.16 private and be advised of the provider's policies and procedures 14.17 regarding disclosure of such information; 14.18 (12) be allowed access to records and written information 14.19 from records according to section 144.335; 14.20 (13) be served by people who are properly trained and 14.21 competent to perform their duties; 14.22 (14) be treated with courtesy and respect and to have the 14.23 patient's property treated with respect; 14.24 (15) be free from physical and verbal abuse; 14.25 (16) reasonable, advance notice of changes in services or 14.26 charges, including at least ten days' advance notice of the 14.27 termination of a service by a provider, except in cases where: 14.28 (i) the recipient of services engages in conduct that 14.29 alters the conditions of employment as specified in the 14.30 employment contract between the hospice provider and the 14.31 individual providing hospice services, or creates an abusive or 14.32 unsafe work environment for the individual providing home care 14.33 services; or 14.34 (ii) an emergency for the informal caregiver or a 14.35 significant change in the recipient's condition has resulted in 14.36 service needs that exceed the current service provider agreement 15.1 and that cannot be safely met by the hospice provider; 15.2 (17) a coordinated transfer when there will be a change in 15.3 the provider of services; 15.4 (18) voice grievances regarding treatment or care that is, 15.5 or fails to be, furnished, or regarding the lack of courtesy or 15.6 respect to the patient or the patient's property; 15.7 (19) know how to contact an individual associated with the 15.8 provider who is responsible for handling problems and to have 15.9 the provider investigate and attempt to resolve the grievance or 15.10 complaint; 15.11 (20) know the name and address of the state or county 15.12 agency to contact for additional information or assistance; 15.13 (21) assert these rights personally, or have them asserted 15.14 by the hospice patient's family when the patient has been judged 15.15 incompetent, without retaliation; and 15.16 (22) have pain and symptoms managed to the patient's 15.17 desired level of comfort. 15.18 Subd. 2. [INTERPRETATION AND ENFORCEMENT OF RIGHTS.] The 15.19 rights under this section are established for the benefit of 15.20 individuals who receive hospice care. A hospice provider may 15.21 not require a person to surrender these rights as a condition of 15.22 receiving hospice care. A guardian or conservator or, when 15.23 there is no guardian or conservator, a designated person, may 15.24 seek to enforce these rights. This statement of rights does not 15.25 replace or diminish other rights and liberties that may exist 15.26 relative to persons receiving hospice care, persons providing 15.27 hospice care, or hospice providers licensed under section 15.28 144A.753. 15.29 Subd. 3. [DISCLOSURE.] A copy of these rights must be 15.30 provided to an individual at the time hospice care is 15.31 initiated. The copy shall contain the address and telephone 15.32 number of the office of health facility complaints and the 15.33 office of the ombudsman for older Minnesotans and a brief 15.34 statement describing how to file a complaint with these 15.35 offices. Information about how to contact the office of the 15.36 ombudsman for older Minnesotans shall be included in notices of 16.1 change in client fees and in notices where hospice providers 16.2 initiate transfer or discontinuation of services. 16.3 Sec. 15. [144A.752] [REGULATION OF HOSPICE CARE.] 16.4 Subdivision 1. [RULES.] The commissioner shall adopt rules 16.5 for the regulation of hospice providers according to sections 16.6 144A.75 to 144A.755. The rules shall include the following: 16.7 (1) provisions to ensure, to the extent possible, the 16.8 health, safety, well-being, and appropriate treatment of persons 16.9 who receive hospice care; 16.10 (2) requirements that hospice providers furnish the 16.11 commissioner with specified information necessary to implement 16.12 sections 144A.75 to 144A.755; 16.13 (3) standards of training of hospice provider personnel; 16.14 (4) standards for medication management, which may vary 16.15 according to the nature of the hospice care provided, the 16.16 setting in which the hospice care is provided, or the status of 16.17 the patient; 16.18 (5) standards for hospice patient and hospice patient's 16.19 family evaluation or assessment, which may vary according to the 16.20 nature of the hospice care provided or the status of the 16.21 patient; and 16.22 (6) requirements for the involvement of a patient's 16.23 physician; documentation of physicians' orders, if required, and 16.24 the patient's hospice plan of care; and maintenance of accurate, 16.25 current clinical records. 16.26 Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner 16.27 shall: 16.28 (1) evaluate, monitor, and license hospice providers 16.29 according to sections 144A.75 to 144A.755; 16.30 (2) inspect the office and records of a hospice provider 16.31 during regular business hours without advance notice to the 16.32 hospice provider; 16.33 (3) with the consent of the patient, visit the home where 16.34 services are being provided; 16.35 (4) issue correction orders and assess civil penalties 16.36 according to section 144.653, subdivisions 5 to 8, for 17.1 violations of sections 144A.75 to 144A.755 or rules adopted 17.2 thereunder; and 17.3 (5) take other action reasonably required to accomplish the 17.4 purposes of sections 144A.75 to 144A.755. 17.5 (b) In the exercise of the authority granted under this 17.6 section, the commissioner shall comply with the applicable 17.7 requirements of the Government Data Practices Act, the 17.8 Administrative Procedure Act, and other applicable law. 17.9 Subd. 3. [RELATION TO OTHER REGULATORY PROGRAMS.] In the 17.10 exercise of the authority granted under sections 144A.75 to 17.11 144A.755, the commissioner shall not duplicate or replace 17.12 standards and requirements imposed under another regulatory 17.13 program of the state. The commissioner shall not impose 17.14 additional training or education requirements upon members of a 17.15 licensed or registered occupation or profession, except as 17.16 necessary to address or prevent problems that are unique to the 17.17 delivery of hospice care or to enforce and protect the rights of 17.18 patients listed under section 144A.751. The commissioner shall 17.19 not require a hospice care provider certified under the Medicare 17.20 program and surveyed and enforced by the Minnesota department of 17.21 health, to comply with a rule adopted under this section if the 17.22 hospice provider is required to comply with any equivalent 17.23 federal law or regulation relating to the same subject matter. 17.24 The commissioner shall specify in the rules those provisions 17.25 that are not applicable to certified hospice providers. 17.26 Subd. 4. [MEDICAID REIMBURSEMENT.] Certification by the 17.27 federal Medicare program must not be a requirement of Medicaid 17.28 payment for room and board services delivered in a residential 17.29 hospice facility. 17.30 Sec. 16. [144A.753] [LICENSURE.] 17.31 Subdivision 1. [LICENSE REQUIRED; APPLICATION.] (a) A 17.32 hospice provider may not operate in the state without a valid 17.33 license issued by the commissioner. 17.34 (b) Within ten days after receiving an application for a 17.35 license, the commissioner shall acknowledge receipt of the 17.36 application in writing. The acknowledgment must indicate 18.1 whether the application appears to be complete or whether 18.2 additional information is required before the application is 18.3 considered complete. Within 90 days after receiving a complete 18.4 application, the commissioner shall either grant or deny the 18.5 license. If an applicant is not granted or denied a license 18.6 within 90 days after submitting a complete application, the 18.7 license must be deemed granted. An applicant whose license has 18.8 been deemed granted must provide written notice to the 18.9 commissioner before providing hospice care. 18.10 (c) Each application for a hospice provider license, or for 18.11 a renewal of a license, shall be accompanied by a fee as follows: 18.12 (1) for revenues no more than $25,000, $125; 18.13 (2) for revenues greater than $25,000 and no more than 18.14 $100,000, $312.50; 18.15 (3) for revenues greater than $100,000 and no more than 18.16 $250,000, $625; 18.17 (4) for revenues greater than $250,000 and no more than 18.18 $350,000, $937.50; 18.19 (5) for revenues greater than $350,000 and no more than 18.20 $450,000, $1,250; 18.21 (6) for revenues greater than $450,000 and no more than 18.22 $550,000, $1,562.50; 18.23 (7) for revenues greater than $550,000 and no more than 18.24 $650,000, $1,875; 18.25 (8) for revenues greater than $650,000 and no more than 18.26 $750,000, $2,187.50; 18.27 (9) for revenues greater then $750,000 and no more than 18.28 $850,000, $2,500; 18.29 (10) for revenues greater than $850,000 and no more than 18.30 $950,000, $2,812.50; 18.31 (11) for revenues greater than $950,000 and no more than 18.32 $1,100,000, $3,125; 18.33 (12) for revenues greater than $1,100,000 and no more than 18.34 $1,275,000, $3,750; 18.35 (13) for revenues greater than $1,275,000 and no more than 18.36 $1,500,000, $4,375; and 19.1 (14) for revenues greater than $1,500,000, $5,000. 19.2 Subd. 2. [LICENSING REQUIREMENTS.] The commissioner shall 19.3 license hospice providers using the authorities under sections 19.4 144A.75 to 144A.755. To receive a license, a hospice provider 19.5 must: 19.6 (1) provide centrally coordinated core services in the home 19.7 and inpatient settings and make other services available, which 19.8 may be provided by employees or contracted staff; 19.9 (2) require that the medical components of the hospice care 19.10 program be under the direction of a licensed physician who 19.11 serves as medical director; 19.12 (3) require that the palliative care provided to a hospice 19.13 patient be under the direction of a licensed physician; 19.14 (4) utilize an interdisciplinary team that meets regularly 19.15 to develop, implement, and evaluate the hospice provider's plan 19.16 of care for each hospice patient and the patient's family. 19.17 Within 48 hours of admission, a licensee must enter a written 19.18 service agreement with the patient or the patient's responsible 19.19 person describing the cost of services. Services are provided 19.20 in accordance to the plan of care developed by the 19.21 interdisciplinary team. Changes in the services provided which 19.22 do not cause a change in fees do not require a written 19.23 modification of the service plan agreed to by the patient or the 19.24 patient's responsible person; 19.25 (5) provide accessible hospice care, 24 hours a day, seven 19.26 days a week; 19.27 (6) utilize an ongoing system of quality assurance; 19.28 (7) require that volunteer services be provided by 19.29 individuals who have completed a hospice volunteer training 19.30 program and are trained to provide the services required; 19.31 (8) provide a planned program of supportive services and 19.32 bereavement counseling available to patients and families during 19.33 hospice care and the bereavement period following the death of 19.34 the hospice patient; and 19.35 (9) require that inpatient services be provided directly or 19.36 by arrangement in a licensed hospital or nursing home or 20.1 residential hospice. 20.2 Subd. 3. [NOMENCLATURE.] A hospice provider may not 20.3 operate in the state or use the words "hospice," "hospice care," 20.4 "hospice care program," or "hospice provider" without a valid 20.5 license issued by the commissioner. St. Anne Hospice in Winona 20.6 county may continue to use the name "hospice." 20.7 Sec. 17. [144A.754] [ENFORCEMENT.] 20.8 Subdivision 1. [ENFORCEMENT.] (a) The commissioner may 20.9 refuse to grant or renew a license, or may suspend or revoke a 20.10 license, for violation of statutes or rules relating to hospice 20.11 or for conduct detrimental to the welfare of a patient. Prior 20.12 to any suspension, revocation, or refusal to renew a license, 20.13 the hospice provider is entitled to notice and a hearing as 20.14 provided by chapter 14. 20.15 (b) In addition to any other remedy provided by law, the 20.16 commissioner may, without a prior contested case hearing, 20.17 temporarily suspend a license or prohibit delivery of hospice 20.18 care by a provider for not more than 60 days if the commissioner 20.19 determines that the health or safety of a patient is in imminent 20.20 danger, provided: 20.21 (1) advance notice is given to the provider; 20.22 (2) after notice, the provider fails to correct the 20.23 problem; 20.24 (3) the commissioner has reason to believe that other 20.25 administrative remedies are not likely to be effective; and 20.26 (4) there is an opportunity for a contested case hearing 20.27 within the 60 days. 20.28 (c) The process of suspending or revoking a license must 20.29 include a plan for transferring affected patients to other 20.30 providers. 20.31 (d) The owner and managerial officials of a hospice 20.32 provider, the license of which has not been renewed or has been 20.33 revoked because of noncompliance with applicable law, are not 20.34 eligible to apply for and shall not be granted a license for 20.35 five years following the effective date of the nonrenewal or 20.36 revocation. 21.1 (e) The commissioner shall not issue a license to a hospice 21.2 provider if an owner or managerial official includes an 21.3 individual who was an owner or managerial official of a hospice 21.4 provider or other type of licensed home care provider whose 21.5 license was not renewed or was revoked as described in paragraph 21.6 (d) for five years following the effective date of nonrenewal or 21.7 revocation. 21.8 (f) Notwithstanding the provisions of paragraph (a), the 21.9 commissioner shall not renew or shall suspend or revoke the 21.10 license of a hospice provider that includes an individual as an 21.11 owner or managerial official who was an owner or managerial 21.12 official of a hospice provider whose license was not renewed or 21.13 was revoked as described in paragraph (d) for five years 21.14 following the effective date of the nonrenewal or revocation. 21.15 (g) The commissioner shall notify the hospice provider 30 21.16 days in advance of the date of nonrenewal, suspension, or 21.17 revocation of the license. Within ten days after the receipt of 21.18 this notification, the hospice provider may request, in writing, 21.19 that the commissioner stay the nonrenewal, revocation, or 21.20 suspension of the license. The hospice provider shall specify 21.21 the reasons for requesting the stay; the steps that will be 21.22 taken to attain or maintain compliance with the licensure laws; 21.23 any limits on the authority or responsibility of the owners or 21.24 managerial officials whose actions resulted in the notice of 21.25 nonrenewal, revocation, or suspension; and any other information 21.26 to establish that the continuing affiliation with these 21.27 individuals will not jeopardize patient health, safety, or 21.28 well-being. The commissioner shall determine whether the stay 21.29 will be granted within 30 days of receiving the provider's 21.30 request. The commissioner may propose additional restrictions 21.31 or limitations on the provider's license and require that the 21.32 granting of the stay be contingent upon compliance with those 21.33 provisions. The commissioner shall take into consideration the 21.34 following factors when determining whether the stay should be 21.35 granted: 21.36 (1) the threat that continued involvement of the owners and 22.1 managerial officials in the hospice provider poses to patient 22.2 health, safety, and well-being; 22.3 (2) the compliance history of the hospice provider; and 22.4 (3) the appropriateness of any limits suggested by the 22.5 hospice provider. 22.6 (h) If the commissioner grants the stay, the order shall 22.7 include any restrictions or limitations on the provider's 22.8 license. The failure of the provider to comply with any 22.9 restrictions or limitations shall result in the immediate 22.10 removal of the stay and the commissioner shall take immediate 22.11 action to suspend, revoke, or not renew the license. 22.12 (i) The provisions contained in paragraphs (d) and (e) 22.13 apply to any nonrenewal or revocation of a hospice provider 22.14 license occurring after the effective date of the rules adopted 22.15 under section 144A.752. 22.16 (j) For the purposes of this subdivision, owners of a 22.17 hospice provider are those individuals whose ownership interest 22.18 provides sufficient authority or control to affect or change 22.19 decisions related to the operation of the hospice provider. An 22.20 owner includes a sole proprietor, a general partner, or any 22.21 other individual whose individual ownership interest can affect 22.22 the management and direction of the policies of the hospice 22.23 provider. For the purposes of this subdivision, managerial 22.24 officials are those individuals who had the responsibility for 22.25 the ongoing management or direction of the policies, services, 22.26 or employees of the hospice provider relating to the areas of 22.27 noncompliance that led to the license revocation or nonrenewal. 22.28 Subd. 2. [INJUNCTIVE RELIEF.] In addition to any other 22.29 remedy provided by law, the commissioner may bring an action in 22.30 district court to enjoin a person who is involved in the 22.31 management, operation, or control of a hospice provider or an 22.32 employee of the hospice provider from illegally engaging in 22.33 activities regulated under sections 144A.75 to 144A.755. The 22.34 commissioner may bring an action under this subdivision in the 22.35 district court in Ramsey county or in the district in which a 22.36 hospice provider is providing hospice care. The court may grant 23.1 a temporary restraining order in the proceeding if continued 23.2 activity by the person who is involved in the management, 23.3 operation, or control of a hospice provider or an employee of 23.4 the hospice provider would create an imminent risk of harm to a 23.5 recipient of hospice care. 23.6 Subd. 3. [SUBPOENA.] In matters pending before the 23.7 commissioner under sections 144A.75 to 144A.755, the 23.8 commissioner may issue subpoenas and compel the attendance of 23.9 witnesses and the production of all necessary papers, books, 23.10 records, documents, and other evidentiary material. If a person 23.11 fails or refuses to comply with a subpoena or order of the 23.12 commissioner to appear or testify regarding any matter about 23.13 which the person may be lawfully questioned or to produce any 23.14 papers, books, records, documents, or evidentiary materials in 23.15 the matter to be heard, the commissioner may apply to the 23.16 district court in any district and the court shall order the 23.17 person to comply with the commissioner's order or subpoena. The 23.18 commissioner may administer oaths to witnesses or take their 23.19 affirmation. Depositions may be taken in or outside the state 23.20 in the manner provided by law for the taking of depositions in 23.21 civil actions. A subpoena or other process or paper may be 23.22 served upon a named person anywhere within the state by an 23.23 officer authorized to serve subpoenas in civil actions, with the 23.24 same fees and mileage and in the same manner as prescribed by 23.25 law for process issued out of a district court. A person 23.26 subpoenaed under this subdivision shall receive the same fees, 23.27 mileage, and other costs that are paid in proceedings in 23.28 district court. 23.29 Subd. 4. [TIME LIMITS FOR APPEALS.] To appeal the 23.30 assessment of civil penalties under section 144A.752, 23.31 subdivision 2, clause (4), a denial of a waiver or variance, and 23.32 an action against a license under subdivision 1, a hospice 23.33 provider must request a hearing no later than 15 days after the 23.34 provider receives notice of the action. 23.35 Subd. 5. [PRIOR CRIMINAL CONVICTIONS.] (a) Before the 23.36 commissioner issues an initial or renewal license, an owner or 24.1 managerial official is required to complete a background study 24.2 under section 144.057. No person may be involved in the 24.3 management, operation, or control of a hospice provider if the 24.4 person has been disqualified under the provisions of chapter 24.5 245A. Individuals disqualified under these provisions may 24.6 request a reconsideration, and if the disqualification is set 24.7 aside, are then eligible to be involved in the management, 24.8 operation, or control of the provider. For purposes of this 24.9 section, owners of a hospice provider subject to the background 24.10 check requirement are those individuals whose ownership interest 24.11 provides sufficient authority or control to affect or change 24.12 decisions related to the operation of the hospice provider. An 24.13 owner includes a sole proprietor, a general partner, or any 24.14 other individual whose individual ownership interest can affect 24.15 the management and direction of the policies of the hospice 24.16 provider. For the purposes of this section, managerial 24.17 officials subject to the background check requirement are those 24.18 individuals who provide "direct contact" as defined in section 24.19 245A.04 or those individuals who have the responsibility for the 24.20 ongoing management or direction of the policies, services, or 24.21 employees of the hospice provider. Data collected under this 24.22 subdivision are classified as private data under section 13.02, 24.23 subdivision 12. 24.24 (b) Employees, contractors, and volunteers of a hospice 24.25 provider are subject to the background study required by section 24.26 144.057. These individuals shall be disqualified under the 24.27 provisions of chapter 245A. Nothing in this section shall be 24.28 construed to prohibit a hospice provider from requiring 24.29 self-disclosure of criminal conviction information. 24.30 (c) Termination of an employee in good faith reliance on 24.31 information or records obtained under paragraph (a) or (b) 24.32 regarding a confirmed conviction does not subject the hospice 24.33 provider to civil liability or liability for unemployment 24.34 benefits. 24.35 Sec. 18. [144A.755] [INFORMATION AND REFERRAL SERVICES.] 24.36 The commissioner shall ensure that information and referral 25.1 services relating to hospice care are available in all regions 25.2 of the state. The commissioner shall collect and make available 25.3 information about available hospice care, sources of payment, 25.4 providers, and the rights of patients. The commissioner may 25.5 require hospice providers to provide information requested for 25.6 the purposes of this section as a condition of licensure. The 25.7 commissioner may publish and make available: 25.8 (1) general information describing hospice care in the 25.9 state; 25.10 (2) limitations on hours, availability of services, and 25.11 eligibility for third-party payments, applicable to individual 25.12 providers; and 25.13 (3) other information the commissioner determines to be 25.14 appropriate. 25.15 Sec. 19. [144A.756] [PENALTY.] 25.16 A person involved in the management, operation, or control 25.17 of a hospice provider who violates section 144A.753, subdivision 25.18 1, paragraph (a), is guilty of a misdemeanor. This section does 25.19 not apply to a person who had no legal authority to affect or 25.20 change decisions related to the management, operation, or 25.21 control of a hospice provider. 25.22 Sec. 20. Minnesota Statutes 2000, section 145C.01, 25.23 subdivision 7, is amended to read: 25.24 Subd. 7. [HEALTH CARE FACILITY.] "Health care facility" 25.25 means a hospital or other entity licensed under sections 144.50 25.26 to 144.58, a nursing home licensed to serve adults under section 25.27 144A.02, ora home care provider licensed under sections 144A.43 25.28 to 144A.48144A.47, or a hospice provider licensed under 25.29 sections 144A.75 to 144A.755. 25.30 Sec. 21. Minnesota Statutes 2000, section 157.17, 25.31 subdivision 2, is amended to read: 25.32 Subd. 2. [REGISTRATION.] At the time of licensure or 25.33 license renewal, a boarding and lodging establishment or a 25.34 lodging establishment that provides supportive services or 25.35 health supervision services must be registered with the 25.36 commissioner, and must register annually thereafter. The 26.1 registration must include the name, address, and telephone 26.2 number of the establishment, the name of the operator, the types 26.3 of services that are being provided, a description of the 26.4 residents being served, the type and qualifications of staff in 26.5 the facility, and other information that is necessary to 26.6 identify the needs of the residents and the types of services 26.7 that are being provided. The commissioner shall develop and 26.8 furnish to the boarding and lodging establishment or lodging 26.9 establishment the necessary form for submitting the registration. 26.10 Housing with services establishments registered under 26.11 chapter 144D shall be considered registered under this section 26.12 for all purposes except that: 26.13 (1) the establishments shall operate under the requirements 26.14 of chapter 144D; and 26.15 (2) the criminal background check requirements of sections 26.16 299C.66 to 299C.71 apply. The criminal background check 26.17 requirements of section 144.057 apply only to personnel 26.18 providing home care services under sections 144A.43 to 26.19 144A.48144A.47 and personnel providing hospice care under 26.20 sections 144A.75 to 144A.755. 26.21 Sec. 22. Minnesota Statutes 2000, section 609.7495, 26.22 subdivision 1, is amended to read: 26.23 Subdivision 1. [DEFINITIONS.] For the purposes of this 26.24 section, the following terms have the meanings given them. 26.25 (a) "Facility" means any of the following: 26.26 (1) a hospital or other health institution licensed under 26.27 sections 144.50 to 144.56; 26.28 (2) a medical facility as defined in section 144.561; 26.29 (3) an agency, clinic, or office operated under the 26.30 direction of or under contract with the commissioner of health 26.31 or a community health board, as defined in section 145A.02; 26.32 (4) a facility providing counseling regarding options for 26.33 medical services or recovery from an addiction; 26.34 (5) a facility providing emergency shelter services for 26.35 battered women, as defined in section 611A.31, subdivision 3, or 26.36 a facility providing transitional housing for battered women and 27.1 their children; 27.2 (6) a facility as defined in section 626.556, subdivision 27.3 2, paragraph (f); 27.4 (7) a facility as defined in section 626.5572, subdivision 27.5 6, where the services described in that paragraph are provided; 27.6 (8) a place to or from which ambulance service, as defined 27.7 in section 144E.001, is provided or sought to be provided; and 27.8 (9) a hospice programprovider licensed under section 27.9 144A.48144A.753. 27.10 (b) "Aggrieved party" means a person whose access to or 27.11 egress from a facility is obstructed in violation of subdivision 27.12 2, or the facility. 27.13 Sec. 23. Minnesota Statutes 2000, section 626.5572, 27.14 subdivision 6, is amended to read: 27.15 Subd. 6. [FACILITY.] (a) "Facility" means a hospital or 27.16 other entity required to be licensed under sections 144.50 to 27.17 144.58; a nursing home required to be licensed to serve adults 27.18 under section 144A.02; a residential or nonresidential facility 27.19 required to be licensed to serve adults under sections 245A.01 27.20 to 245A.16; a home care provider licensed or required to be 27.21 licensed under section 144A.46; a hospice provider licensed 27.22 under sections 144A.75 to 144A.755; or a person or organization 27.23 that exclusively offers, provides, or arranges for personal care 27.24 assistant services under the medical assistance program as 27.25 authorized under sections 256B.04, subdivision 16, 256B.0625, 27.26 subdivision 19a, and 256B.0627. 27.27 (b) For home care providers and personal care attendants, 27.28 the term "facility" refers to the provider or person or 27.29 organization that exclusively offers, provides, or arranges for 27.30 personal care services, and does not refer to the client's home 27.31 or other location at which services are rendered. 27.32 Sec. 24. [EFFECTIVE DATE.] 27.33 (a) Section 15, subdivision 1, is effective the day 27.34 following final enactment. 27.35 (b) Sections 1 to 23, except section 15, subdivision 1, are 27.36 effective upon adoption of licensure rules. Minnesota Rules, 28.1 chapters 4668 and 4669, govern the licensure of hospices until 28.2 new rules are adopted. With enactment of Minnesota Statutes, 28.3 sections 144A.75 to 144A.756, licensure orders issued to 28.4 licensed hospices under Minnesota Statutes, section 144A.45, and 28.5 Minnesota Rules, chapters 4668 and 4669, shall remain valid and 28.6 shall be subject to the issuance of a penalty assessment for 28.7 failure to correct, under Minnesota Statutes, section 144A.752 28.8 (section 15). 28.9 Sec. 25. [REPEALER.] 28.10 Minnesota Statutes 2000, section 144A.48, is repealed 28.11 effective upon adoption of licensure rules under Minnesota 28.12 Statutes, section 144A.752, subdivision 1.