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HF 2746

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 05/23/2018 03:11pm

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A bill for an act
relating to health; modifying practice of advanced practice registered nurses;
modifying the health professionals permitted to authorize prescription eyeglasses
using old lenses or last prescription available; amending Minnesota Statutes 2016,
sections 13.83, subdivision 2; 144.651, subdivision 21; 144A.4791, subdivision
13; 256.975, subdivision 7b; 256B.0575, subdivision 1; 256B.0595, subdivision
3; 256B.0625, subdivision 2; 259.24, subdivision 2; Minnesota Statutes 2017
Supplement, sections 145.7131; 245G.22, subdivision 2; 260C.007, subdivision
6.

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

Section 1.

Minnesota Statutes 2016, section 13.83, subdivision 2, is amended to read:


Subd. 2.

Public data.

Unless specifically classified otherwise by state statute or federal
law, the following data created or collected by a medical examiner or coroner on a deceased
individual are public: name of the deceased; date of birth; date of death; address; sex; race;
citizenship; height; weight; hair color; eye color; build; complexion; age, if known, or
approximate age; identifying marks, scars and amputations; a description of the decedent's
clothing; marital status; location of death including name of hospital where applicable; name
of spouse; whether or not the decedent ever served in the armed forces of the United States;
occupation; business; father's name (also birth name, if different); mother's name (also birth
name, if different); birthplace; birthplace of parents; cause of death; causes of cause of
death; whether an autopsy was performed and if so, whether it was conclusive; date and
place of injury, if applicable, including work place; how injury occurred; whether death
was caused by accident, suicide, homicide, or was of undetermined cause; certification of
attendance by physician or advanced practice registered nurse; physician's or advanced
practice registered nurse's
name and address; certification by coroner or medical examiner;
name and signature of coroner or medical examiner; type of disposition of body; burial
place name and location, if applicable; date of burial, cremation or removal; funeral home
name and address; and name of local register or funeral director.

Sec. 2.

Minnesota Statutes 2016, section 144.651, subdivision 21, is amended to read:


Subd. 21.

Communication privacy.

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

Sec. 3.

Minnesota Statutes 2016, section 144A.4791, subdivision 13, is amended to read:


Subd. 13.

Request for discontinuation of life-sustaining treatment.

(a) If a client,
family member, or other caregiver of the client requests that an employee or other agent of
the home care provider discontinue a life-sustaining treatment, the employee or agent
receiving the request:

(1) shall take no action to discontinue the treatment; and

(2) shall promptly inform the supervisor or other agent of the home care provider of the
client's request.

(b) Upon being informed of a request for termination of treatment, the home care provider
shall promptly:

(1) inform the client that the request will be made known to the physician or advanced
practice registered nurse
who ordered the client's treatment;

(2) inform the physician or advanced practice registered nurse of the client's request;
and

(3) work with the client and the client's physician or advanced practice registered nurse
to comply with the provisions of the Health Care Directive Act in chapter 145C.

(c) This section does not require the home care provider to discontinue treatment, except
as may be required by law or court order.

(d) This section does not diminish the rights of clients to control their treatments, refuse
services, or terminate their relationships with the home care provider.

(e) This section shall be construed in a manner consistent with chapter 145B or 145C,
whichever applies, and declarations made by clients under those chapters.

Sec. 4.

Minnesota Statutes 2017 Supplement, section 145.7131, is amended to read:


145.7131 EXCEPTION TO EYEGLASS PRESCRIPTION EXPIRATION.

Notwithstanding any practice to the contrary, in an emergency situation or in the case
of lost glasses, an optometrist, or physician, advanced practice registered nurse, or physician
assistant
may authorize a new pair of prescription eyeglasses using the prescription from
the old lenses or the last prescription available.

Sec. 5.

Minnesota Statutes 2017 Supplement, section 245G.22, subdivision 2, is amended
to read:


Subd. 2.

Definitions.

(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.

(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.

(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.

(d) "Medical director" means a physician licensed to practice medicine in the jurisdiction
that the opioid treatment program is located who assumes responsibility for administering
all medical services performed by the program, either by performing the services directly
or by delegating specific responsibility to (1) authorized program physicians and ; (2)
advanced practice registered nurses, when approved by variance by the State Opioid
Treatment Authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration; or (3)
health care professionals functioning under the
medical director's direct supervision.

(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.

(f) "Minnesota health care programs" has the meaning given in section 256B.0636.

(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.

(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.

(i) "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.

Sec. 6.

Minnesota Statutes 2016, section 256.975, subdivision 7b, is amended to read:


Subd. 7b.

Exemptions and emergency admissions.

(a) Exemptions from the federal
screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:

(1) a person who, having entered an acute care facility from a certified nursing facility,
is returning to a certified nursing facility; or

(2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota.

(b) Persons who are exempt from preadmission screening for purposes of level of care
determination include:

(1) persons described in paragraph (a);

(2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the Veterans Administration;

(3) an individual enrolled in a demonstration project under section 256B.69, subdivision
8, at the time of application to a nursing facility; and

(4) an individual currently being served under the alternative care program or under a
home and community-based services waiver authorized under section 1915(c) of the federal
Social Security Act.

(c) Persons admitted to a Medicaid-certified nursing facility from the community on an
emergency basis as described in paragraph (d) or from an acute care facility on a nonworking
day must be screened the first working day after admission.

(d) Emergency admission to a nursing facility prior to screening is permitted when all
of the following conditions are met:

(1) a person is admitted from the community to a certified nursing or certified boarding
care facility during Senior LinkAge Line nonworking hours;

(2) a physician or advanced practice registered nurse has determined that delaying
admission until preadmission screening is completed would adversely affect the person's
health and safety;

(3) there is a recent precipitating event that precludes the client from living safely in the
community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
inability to continue to provide care;

(4) the attending physician or advanced practice registered nurse has authorized the
emergency placement and has documented the reason that the emergency placement is
recommended; and

(5) the Senior LinkAge Line is contacted on the first working day following the
emergency admission.

Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care and from whom admission is being sought
on a nonworking day.

(e) A nursing facility must provide written information to all persons admitted regarding
the person's right to request and receive long-term care consultation services as defined in
section 256B.0911, subdivision 1a. The information must be provided prior to the person's
discharge from the facility and in a format specified by the commissioner.

Sec. 7.

Minnesota Statutes 2016, section 256B.0575, subdivision 1, is amended to read:


Subdivision 1.

Income deductions.

When an institutionalized person is determined
eligible for medical assistance, the income that exceeds the deductions in paragraphs (a)
and (b) must be applied to the cost of institutional care.

(a) The following amounts must be deducted from the institutionalized person's income
in the following order:

(1) the personal needs allowance under section 256B.35 or, for a veteran who does not
have a spouse or child, or a surviving spouse of a veteran having no child, the amount of
an improved pension received from the veteran's administration not exceeding $90 per
month;

(2) the personal allowance for disabled individuals under section 256B.36;

(3) if the institutionalized person has a legally appointed guardian or conservator, five
percent of the recipient's gross monthly income up to $100 as reimbursement for guardianship
or conservatorship services;

(4) a monthly income allowance determined under section 256B.058, subdivision 2, but
only to the extent income of the institutionalized spouse is made available to the community
spouse;

(5) a monthly allowance for children under age 18 which, together with the net income
of the children, would provide income equal to the medical assistance standard for families
and children according to section 256B.056, subdivision 4, for a family size that includes
only the minor children. This deduction applies only if the children do not live with the
community spouse and only to the extent that the deduction is not included in the personal
needs allowance under section 256B.35, subdivision 1, as child support garnished under a
court order;

(6) a monthly family allowance for other family members, equal to one-third of the
difference between 122 percent of the federal poverty guidelines and the monthly income
for that family member;

(7) reparations payments made by the Federal Republic of Germany and reparations
payments made by the Netherlands for victims of Nazi persecution between 1940 and 1945;

(8) all other exclusions from income for institutionalized persons as mandated by federal
law; and

(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for necessary
medical or remedial care for the institutionalized person that are recognized under state law,
not medical assistance covered expenses, and not subject to payment by a third party.

For purposes of clause (6), "other family member" means a person who resides with the
community spouse and who is a minor or dependent child, dependent parent, or dependent
sibling of either spouse. "Dependent" means a person who could be claimed as a dependent
for federal income tax purposes under the Internal Revenue Code.

(b) Income shall be allocated to an institutionalized person for a period of up to three
calendar months, in an amount equal to the medical assistance standard for a family size of
one if:

(1) a physician or advanced practice registered nurse certifies that the person is expected
to reside in the long-term care facility for three calendar months or less;

(2) if the person has expenses of maintaining a residence in the community; and

(3) if one of the following circumstances apply:

(i) the person was not living together with a spouse or a family member as defined in
paragraph (a) when the person entered a long-term care facility; or

(ii) the person and the person's spouse become institutionalized on the same date, in
which case the allocation shall be applied to the income of one of the spouses.

For purposes of this paragraph, a person is determined to be residing in a licensed nursing
home, regional treatment center, or medical institution if the person is expected to remain
for a period of one full calendar month or more.

Sec. 8.

Minnesota Statutes 2016, section 256B.0595, subdivision 3, is amended to read:


Subd. 3.

Homestead exception to transfer prohibition.

(a) An institutionalized person
is not ineligible for long-term care services due to a transfer of assets for less than fair market
value if the asset transferred was a homestead and:

(1) title to the homestead was transferred to the individual's:

(i) spouse;

(ii) child who is under age 21;

(iii) blind or permanently and totally disabled child as defined in the Supplemental
Security Income program;

(iv) sibling who has equity interest in the home and who was residing in the home for
a period of at least one year immediately before the date of the individual's admission to
the facility; or

(v) son or daughter who was residing in the individual's home for a period of at least
two years immediately before the date the individual became an institutionalized person,
and who provided care to the individual that, as certified by the individual's attending
physician or advanced practice registered nurse, permitted the individual to reside at home
rather than receive care in an institution or facility;

(2) a satisfactory showing is made that the individual intended to dispose of the homestead
at fair market value or for other valuable consideration; or

(3) the local agency grants a waiver of a penalty resulting from a transfer for less than
fair market value because denial of eligibility would cause undue hardship for the individual,
based on imminent threat to the individual's health and well-being. Whenever an applicant
or recipient is denied eligibility because of a transfer for less than fair market value, the
local agency shall notify the applicant or recipient that the applicant or recipient may request
a waiver of the penalty if the denial of eligibility will cause undue hardship. With the written
consent of the individual or the personal representative of the individual, a long-term care
facility in which an individual is residing may file an undue hardship waiver request, on
behalf of the individual who is denied eligibility for long-term care services on or after July
1, 2006, due to a period of ineligibility resulting from a transfer on or after February 8,
2006. In evaluating a waiver, the local agency shall take into account whether the individual
was the victim of financial exploitation, whether the individual has made reasonable efforts
to recover the transferred property or resource, and other factors relevant to a determination
of hardship. If the local agency does not approve a hardship waiver, the local agency shall
issue a written notice to the individual stating the reasons for the denial and the process for
appealing the local agency's decision.

(b) When a waiver is granted under paragraph (a), clause (3), a cause of action exists
against the person to whom the homestead was transferred for that portion of long-term
care services provided within:

(1) 30 months of a transfer made on or before August 10, 1993;

(2) 60 months if the homestead was transferred after August 10, 1993, to a trust or portion
of a trust that is considered a transfer of assets under federal law;

(3) 36 months if transferred in any other manner after August 10, 1993, but prior to
February 8, 2006; or

(4) 60 months if the homestead was transferred on or after February 8, 2006,

or the amount of the uncompensated transfer, whichever is less, together with the costs
incurred due to the action.

Sec. 9.

Minnesota Statutes 2016, section 256B.0625, subdivision 2, is amended to read:


Subd. 2.

Skilled and intermediate nursing care.

(a) Medical assistance covers skilled
nursing home services and services of intermediate care facilities, including training and
habilitation services, as defined in section 252.41, subdivision 3, for persons with
developmental disabilities who are residing in intermediate care facilities for persons with
developmental disabilities. Medical assistance must not be used to pay the costs of nursing
care provided to a patient in a swing bed as defined in section 144.562, unless (1) the facility
in which the swing bed is located is eligible as a sole community provider, as defined in
Code of Federal Regulations, title 42, section 412.92, or the facility is a public hospital
owned by a governmental entity with 15 or fewer licensed acute care beds; (2) the Centers
for Medicare and Medicaid Services approves the necessary state plan amendments; (3) the
patient was screened as provided by law; (4) the patient no longer requires acute care
services; and (5) no nursing home beds are available within 25 miles of the facility. The
commissioner shall exempt a facility from compliance with the sole community provider
requirement in clause (1) if, as of January 1, 2004, the facility had an agreement with the
commissioner to provide medical assistance swing bed services.

(b) Medical assistance also covers up to ten days of nursing care provided to a patient
in a swing bed if: (1) the patient's physician or advanced practice registered nurse certifies
that the patient has a terminal illness or condition that is likely to result in death within 30
days and that moving the patient would not be in the best interests of the patient and patient's
family; (2) no open nursing home beds are available within 25 miles of the facility; and (3)
no open beds are available in any Medicare hospice program within 50 miles of the facility.
The daily medical assistance payment for nursing care for the patient in the swing bed is
the statewide average medical assistance skilled nursing care per diem as computed annually
by the commissioner on July 1 of each year.

Sec. 10.

Minnesota Statutes 2016, section 259.24, subdivision 2, is amended to read:


Subd. 2.

Parents, guardian.

If an unmarried parent who consents to the adoption of a
child is under 18 years of age, the consent of the minor parent's parents or guardian, if any,
also shall be required; if either or both the parents are disqualified for any of the reasons
enumerated in subdivision 1, the consent of such parent shall be waived, and the consent
of the guardian only shall be sufficient; and, if there be neither parent nor guardian qualified
to give such consent, the consent may be given by the commissioner. The agency overseeing
the adoption proceedings shall ensure that the minor parent is offered the opportunity to
consult with an attorney, a member of the clergy or , a physician, or an advanced practice
registered nurse
before consenting to adoption of the child. The advice or opinion of the
attorney, clergy member or , physician, or advanced practice registered nurse shall not be
binding on the minor parent. If the minor parent cannot afford the cost of consulting with
an attorney, a member of the clergy or , a physician, or an advanced practice registered nurse,
the county shall bear that cost.

Sec. 11.

Minnesota Statutes 2017 Supplement, section 260C.007, subdivision 6, is amended
to read:


Subd. 6.

Child in need of protection or services.

"Child in need of protection or
services" means a child who is in need of protection or services because the child:

(1) is abandoned or without parent, guardian, or custodian;

(2)(i) has been a victim of physical or sexual abuse as defined in section 626.556,
subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in
subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or child
abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment as
defined in subdivision 15;

(3) is without necessary food, clothing, shelter, education, or other required care for the
child's physical or mental health or morals because the child's parent, guardian, or custodian
is unable or unwilling to provide that care;

(4) is without the special care made necessary by a physical, mental, or emotional
condition because the child's parent, guardian, or custodian is unable or unwilling to provide
that care;

(5) is medically neglected, which includes, but is not limited to, the withholding of
medically indicated treatment from an infant with a disability with a life-threatening
condition. The term "withholding of medically indicated treatment" means the failure to
respond to the infant's life-threatening conditions by providing treatment, including
appropriate nutrition, hydration, and medication which, in the treating physician's or
physicians' advanced practice registered nurse's reasonable medical judgment, will be most
likely to be effective in ameliorating or correcting all conditions, except that the term does
not include the failure to provide treatment other than appropriate nutrition, hydration, or
medication to an infant when, in the treating physician's or physicians' advanced practice
registered nurse's
reasonable medical judgment:

(i) the infant is chronically and irreversibly comatose;

(ii) the provision of the treatment would merely prolong dying, not be effective in
ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
futile in terms of the survival of the infant; or

(iii) the provision of the treatment would be virtually futile in terms of the survival of
the infant and the treatment itself under the circumstances would be inhumane;

(6) is one whose parent, guardian, or other custodian for good cause desires to be relieved
of the child's care and custody, including a child who entered foster care under a voluntary
placement agreement between the parent and the responsible social services agency under
section 260C.227;

(7) has been placed for adoption or care in violation of law;

(8) is without proper parental care because of the emotional, mental, or physical disability,
or state of immaturity of the child's parent, guardian, or other custodian;

(9) is one whose behavior, condition, or environment is such as to be injurious or
dangerous to the child or others. An injurious or dangerous environment may include, but
is not limited to, the exposure of a child to criminal activity in the child's home;

(10) is experiencing growth delays, which may be referred to as failure to thrive, that
have been diagnosed by a physician and are due to parental neglect;

(11) is a sexually exploited youth;

(12) has committed a delinquent act or a juvenile petty offense before becoming ten
years old;

(13) is a runaway;

(14) is a habitual truant;

(15) has been found incompetent to proceed or has been found not guilty by reason of
mental illness or mental deficiency in connection with a delinquency proceeding, a
certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
proceeding involving a juvenile petty offense; or

(16) has a parent whose parental rights to one or more other children were involuntarily
terminated or whose custodial rights to another child have been involuntarily transferred to
a relative and there is a case plan prepared by the responsible social services agency
documenting a compelling reason why filing the termination of parental rights petition under
section 260C.503, subdivision 2, is not in the best interests of the child.

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