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Minnesota Legislature

Office of the Revisor of Statutes

HF 3308

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 04/12/2018 04:41pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 1st Engrossment

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A bill for an act
relating to health; providing protections for older adults and vulnerable adults;
modifying the health care and home care bills of rights; modifying the regulation
of home care providers; modifying correction order provisions; establishing a
training and operations panel within the Office of Health Facility Complaints;
modifying requirements for reporting maltreatment of vulnerable adults;
establishing working groups; requiring reports; appropriating money; amending
Minnesota Statutes 2016, sections 144.651, subdivision 20; 144A.44, subdivision
1; 144A.473, subdivision 2; 144A.474, subdivisions 2, 8; 144A.53, subdivision
1, by adding subdivisions; 626.557, subdivisions 5, 9c, 9e, 12b, 17; Minnesota
Statutes 2017 Supplement, section 144A.10, subdivision 4.

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

Section 1.

Minnesota Statutes 2016, section 144.651, subdivision 20, is amended to read:


Subd. 20.

Grievances.

Patients and residents shall be encouraged and assisted, throughout
their stay in a facility or their course of treatment, to understand and exercise their rights
as patients, residents, and citizens. Patients and residents may voice grievances deleted text beginanddeleted text endnew text begin,new text end
recommend changes in policies and services to facility staff and others of their choice, new text beginand
otherwise exercise their rights under this section
new text endfree from restraint, interference, coercion,
discrimination, or reprisal, including threat of discharge. Notice of the grievance procedure
of the facility or program, as well as addresses and telephone numbers for the Office of
Health Facility Complaints and the area nursing home ombudsman pursuant to the Older
Americans Act, section 307(a)(12) shall be posted in a conspicuous place.

Every acute care inpatient facility, every residential program as defined in section
253C.01, every nonacute care facility, and every facility employing more than two people
that provides outpatient mental health services shall have a written internal grievance
procedure that, at a minimum, sets forth the process to be followed; specifies time limits,
including time limits for facility response; provides for the patient or resident to have the
assistance of an advocate; requires a written response to written grievances; and provides
for a timely decision by an impartial decision maker if the grievance is not otherwise resolved.
Compliance by hospitals, residential programs as defined in section 253C.01 which are
hospital-based primary treatment programs, and outpatient surgery centers with section
144.691 and compliance by health maintenance organizations with section 62D.11 is deemed
to be compliance with the requirement for a written internal grievance procedure.

Sec. 2.

Minnesota Statutes 2017 Supplement, section 144A.10, subdivision 4, is amended
to read:


Subd. 4.

Correction orders.

Whenever a duly authorized representative of the
commissioner of health finds upon inspection of a nursing home, that the facility or a
controlling person or an employee of the facility is not in compliance with sections 144.411
to 144.417, 144.651, 144.6503, 144A.01 to 144A.155, or 626.557 or the rules promulgated
thereunder, a correction order shall be issued to the facility. The correction order shall state
the deficiency, cite the specific rule or statute violated, state the suggested method of
correction, and deleted text beginspecifydeleted text endnew text begin recommendnew text end the time allowed for correction. new text beginUpon receipt of a
correction order, a facility shall develop and submit to the commissioner a corrective action
plan based on the correction order. The corrective action plan must specify the steps the
facility will take to correct the violation and to prevent such violations in the future, how
the facility will monitor its compliance with the corrective action plan, and when the facility
plans to complete the steps in the corrective action plan. The commissioner is presumed to
accept a corrective action plan unless the commissioner notifies the submitting facility that
the plan is not accepted within 15 calendar days after the plan is submitted to the
commissioner. The commissioner shall monitor the facility's compliance with the corrective
action plan.
new text endIf the commissioner finds that the nursing home had uncorrected or repeated
violations which create a risk to resident care, safety, or rights, the commissioner shall notify
the commissioner of human services.

Sec. 3.

Minnesota Statutes 2016, section 144A.44, subdivision 1, is amended to read:


Subdivision 1.

Statement of rights.

A person who receives home care services has these
rights:

(1) the right to receive written information about rights before receiving services,
including what to do if rights are violated;

(2) the right to receive care and services according to a suitable and up-to-date plan, and
subject to accepted health care, medical or nursing standards, to take an active part in
developing, modifying, and evaluating the plan and services;

(3) the right to be told before receiving services the type and disciplines of staff who
will be providing the services, the frequency of visits proposed to be furnished, other choices
that are available for addressing home care needs, and the potential consequences of refusing
these services;

(4) the right to be told in advance of any recommended changes by the provider in the
service plan and to take an active part in any decisions about changes to the service plan;

(5) the right to refuse services or treatment;

(6) the right to know, before receiving services or during the initial visit, any limits to
the services available from a home care provider;

(7) the right to be told before services are initiated what the provider charges for the
services; to what extent payment may be expected from health insurance, public programs,
or other sources, if known; and what charges the client may be responsible for paying;

(8) the right to know that there may be other services available in the community,
including other home care services and providers, and to know where to find information
about these services;

(9) the right to choose freely among available providers and to change providers after
services have begun, within the limits of health insurance, long-term care insurance, medical
assistance, or other health programs;

(10) the right to have personal, financial, and medical information kept private, and to
be advised of the provider's policies and procedures regarding disclosure of such information;

(11) the right to access the client's own records and written information from those
records in accordance with sections 144.291 to 144.298;

(12) the right to be served by people who are properly trained and competent to perform
their duties;

(13) the right to be treated with courtesy and respect, and to have the client's property
treated with respect;

(14) the right to be free from physical and verbal abuse, neglect, financial exploitation,
and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment
of Minors Act;

(15) the right to reasonable, advance notice of changes in services or charges;

(16) the right to know the provider's reason for termination of services;

(17) the right to at least ten days' advance notice of the termination of a service by a
provider, except in cases where:

(i) the client engages in conduct that significantly alters the terms of the service plan
with the home care provider;

(ii) the client, person who lives with the client, or others create an abusive or unsafe
work environment for the person providing home care services; or

(iii) an emergency or a significant change in the client's condition has resulted in service
needs that exceed the current service plan and that cannot be safely met by the home care
provider;

(18) the right to a coordinated transfer when there will be a change in the provider of
services;

(19) the right to complain about services that are provided, or fail to be provided, and
the lack of courtesy or respect to the client or the client's property;

new text begin (20) the right to recommend changes in policies and services to the home care provider,
provider staff, and others of the person's choice, free from restraint, interference, coercion,
discrimination, or reprisal, including threat of termination of services;
new text end

deleted text begin (20)deleted text endnew text begin (21)new text end the right to know how to contact an individual associated with the home care
provider who is responsible for handling problems and to have the home care provider
investigate and attempt to resolve the grievance or complaint;

deleted text begin (21)deleted text endnew text begin (22)new text end the right to know the name and address of the state or county agency to contact
for additional information or assistance; and

deleted text begin (22)deleted text endnew text begin (23)new text end the right to assert these rights personally, or have them asserted by the client's
representative or by anyone on behalf of the client, without retaliation.

Sec. 4.

Minnesota Statutes 2016, section 144A.473, subdivision 2, is amended to read:


Subd. 2.

Temporary license.

(a) For new license applicants, the commissioner shall
issue a temporary license for either the basic or comprehensive home care level. A temporary
license is effective for up to one year from the date of issuance. Temporary licensees must
comply with sections 144A.43 to 144A.482.

(b) During the temporary license deleted text beginyeardeleted text endnew text begin periodnew text end, the commissioner shall survey the temporary
licensee new text beginwithin 90 days new text endafter the commissioner is notified or has evidence that the temporary
licensee is providing home care services.

(c) Within five days of beginning the provision of services, the temporary licensee must
notify the commissioner that it is serving clients. The notification to the commissioner may
be mailed or e-mailed to the commissioner at the address provided by the commissioner. If
the temporary licensee does not provide home care services during the temporary license
deleted text begin yeardeleted text endnew text begin periodnew text end, then the temporary license expires at the end of the deleted text beginyeardeleted text endnew text begin periodnew text end and the applicant
must reapply for a temporary home care license.

(d) A temporary licensee may request a change in the level of licensure prior to being
surveyed and granted a license by notifying the commissioner in writing and providing
additional documentation or materials required to update or complete the changed temporary
license application. The applicant must pay the difference between the application fees
when changing from the basic level to the comprehensive level of licensure. No refund will
be made if the provider chooses to change the license application to the basic level.

(e) If the temporary licensee notifies the commissioner that the licensee has clients within
45 days prior to the temporary license expiration, the commissioner may extend the temporary
license for up to 60 days in order to allow the commissioner to complete the on-site survey
required under this section and follow-up survey visits.

Sec. 5.

Minnesota Statutes 2016, section 144A.474, subdivision 2, is amended to read:


Subd. 2.

Types of home care surveys.

(a) "Initial full survey" means the survey of a
new temporary licensee conducted after the department is notified or has evidence that the
temporary licensee is providing home care services to determine if the provider is in
compliance with home care requirements. Initial full surveys must be completed within 14
months after the department's issuance of a temporary basic or comprehensive license.

(b)new text begin "Change in ownership survey" means a full survey of a new licensee due to a change
in ownership. Change in ownership surveys must be completed within six months after the
department's issuance of a new license due to a change in ownership.
new text end

new text begin (c)new text end "Core survey" means periodic inspection of home care providers to determine ongoing
compliance with the home care requirements, focusing on the essential health and safety
requirements. Core surveys are available to licensed home care providers who have been
licensed for three years and surveyed at least once in the past three years with the latest
survey having no widespread violations beyond Level 1 as provided in subdivision 11.
Providers must also not have had any substantiated licensing complaints, substantiated
complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
Act, or an enforcement action as authorized in section 144A.475 in the past three years.

(1) The core survey for basic home care providers must review compliance in the
following areas:

(i) reporting of maltreatment;

(ii) orientation to and implementation of the home care bill of rights;

(iii) statement of home care services;

(iv) initial evaluation of clients and initiation of services;

(v) client review and monitoring;

(vi) service plan implementation and changes to the service plan;

(vii) client complaint and investigative process;

(viii) competency of unlicensed personnel; and

(ix) infection control.

(2) For comprehensive home care providers, the core survey must include everything
in the basic core survey plus these areas:

(i) delegation to unlicensed personnel;

(ii) assessment, monitoring, and reassessment of clients; and

(iii) medication, treatment, and therapy management.

deleted text begin (c)deleted text endnew text begin (d)new text end "Full survey" means the periodic inspection of home care providers to determine
ongoing compliance with the home care requirements that cover the core survey areas and
all the legal requirements for home care providers. A full survey is conducted for all
temporary licensees and for providers who do not meet the requirements needed for a core
survey, and when a surveyor identifies unacceptable client health or safety risks during a
core survey. A full survey must include all the tasks identified as part of the core survey
and any additional review deemed necessary by the department, including additional
observation, interviewing, or records review of additional clients and staff.

deleted text begin (d)deleted text endnew text begin (e)new text end "Follow-up surveys" means surveys conducted to determine if a home care
provider has corrected deficient issues and systems identified during a core survey, full
survey, or complaint investigation. Follow-up surveys may be conducted via phone, e-mail,
fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
concluded with an exit conference and written information provided on the process for
requesting a reconsideration of the survey results.

deleted text begin (e)deleted text endnew text begin (f)new text end Upon receiving information alleging that a home care provider has violated or is
currently violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
investigate the complaint according to sections 144A.51 to 144A.54.

Sec. 6.

Minnesota Statutes 2016, section 144A.474, subdivision 8, is amended to read:


Subd. 8.

Correction orders.

(a) A correction order may be issued whenever the
commissioner finds upon survey or during a complaint investigation that a home care
provider, a managerial official, or an employee of the provider is not in compliance with
sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
document areas of noncompliance and the time allowed for correction.

(b) The commissioner shall mail copies of any correction order to the last known address
of the home care provider, or electronically scan the correction order and e-mail it to the
last known home care provider e-mail address, within 30 calendar days after the survey exit
date. A copy of each correction order and copies of any documentation supplied to the
commissioner shall be kept on file by the home care provider, and public documents shall
be made available for viewing by any person upon request. Copies may be kept electronically.

(c) By the correction order date, the home care provider must deleted text begindocument in the provider's
records any action taken to comply with the correction order. The commissioner may request
a copy of this documentation and the home care provider's action to respond to the correction
order in future surveys, upon a complaint investigation, and as otherwise needed
deleted text endnew text begin develop
and submit to the commissioner a corrective action plan based on the correction order. The
corrective action plan must specify the steps the provider will take to comply with the
correction order and how to prevent noncompliance in the future, how the provider will
monitor its compliance with the corrective action plan, and when the provider plans to
complete the steps in the corrective action plan. The commissioner is presumed to accept
a corrective action plan unless the commissioner notifies the submitting home care provider
that the plan is not accepted within 15 calendar days after the plan is submitted to the
commissioner. The commissioner shall monitor the provider's compliance with the corrective
action plan
new text end.

Sec. 7.

Minnesota Statutes 2016, section 144A.53, subdivision 1, is amended to read:


Subdivision 1.

Powers.

The director may:

(a) Promulgate by rule, pursuant to chapter 14, and within the limits set forth in
subdivision 2, the methods by which complaints against health facilities, health care
providers, home care providers, or residential care homes, or administrative agencies are
to be made, reviewed, investigated, and acted upon; provided, however, that a fee may not
be charged for filing a complaint.

(b) Recommend legislation and changes in rules to the state commissioner of health,
governor, administrative agencies or the federal government.

(c) Investigate, upon a complaint or upon initiative of the director, any action or failure
to act by a health care provider, home care provider, residential care home, or a health
facility.

(d) Request and receive access to relevant information, records, incident reports, or
documents in the possession of an administrative agency, a health care provider, a home
care provider, a residential care home, or a health facility, and issue investigative subpoenas
to individuals and facilities for oral information and written information, including privileged
information which the director deems necessary for the discharge of responsibilities. For
purposes of investigation and securing information to determine violations, the director
need not present a release, waiver, or consent of an individual. The identities of patients or
residents must be kept private as defined by section 13.02, subdivision 12.

(e) Enter and inspect, at any time, a health facility or residential care home and be
permitted to interview staff; provided that the director shall not unduly interfere with or
disturb the provision of care and services within the facility or home or the activities of a
patient or resident unless the patient or resident consents.

(f) Issue correction orders and assess civil fines new text beginfor all licensing violations or maltreatment
determinations, including licensing violations or maltreatment determinations identified in
the appeals or review process following final disposition of a maltreatment report or issuance
of a citation for a licensing violation. Correction orders shall be issued and civil penalties
shall be assessed
new text endpursuant to section 144.653 or any other law which provides for the issuance
of correction orders to health facilities or home care provider, or under section 144A.45. A
facility's or home's refusal to cooperate in providing lawfully requested information may
also be grounds for a correction order.

(g) Recommend the certification or decertification of health facilities pursuant to Title
XVIII or XIX of the United States Social Security Act.

(h) Assist patients or residents of health facilities or residential care homes in the
enforcement of their rights under Minnesota law.

(i) Work with administrative agencies, health facilities, home care providers, residential
care homes, and health care providers and organizations representing consumers on programs
designed to provide information about health facilities to the public and to health facility
residents.

Sec. 8.

Minnesota Statutes 2016, section 144A.53, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Safety and quality improvement technical panel. new text end

new text begin The director shall establish
an expert technical panel to examine and make recommendations, on an ongoing basis, on
how to apply proven safety and quality improvement practices and infrastructure to settings
and providers that provide long-term services and supports. The technical panel must include
representation from nonprofit Minnesota-based organizations dedicated to patient safety or
innovation in health care safety and quality, Department of Health staff with expertise in
issues related to adverse health events, the University of Minnesota, organizations
representing long-term care providers and home care providers in Minnesota, national patient
safety experts, and other experts in the safety and quality improvement field. The technical
panel shall periodically provide recommendations to the legislature on legislative changes
needed to promote safety and quality improvement practices in long-term care settings and
with long-term care providers.
new text end

Sec. 9.

Minnesota Statutes 2016, section 144A.53, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Training and operations panel. new text end

new text begin (a) The director shall establish a training and
operations panel within the Office of Health Facility Complaints to examine and make
recommendations, on an ongoing basis, on continual improvements to the operation of the
office. The training and operations panel shall be composed of office staff, including
investigators and intake and triage staff, one or more representatives of the commissioner's
office, and employees from any other divisions in the Department of Health with relevant
knowledge or expertise. The training and operations panel may also consult with employees
from other agencies in state government with relevant knowledge or expertise.
new text end

new text begin (b) The training and operations panel shall examine and make recommendations to the
director and the commissioner regarding introducing or refining office systems, procedures,
and staff training in order to improve office and staff efficiency; enhance communications
between the office, health care facilities, home care providers, and residents or clients; and
provide for appropriate, effective protection for vulnerable adults through rigorous
investigations and enforcement of laws. Panel duties include but are not limited to:
new text end

new text begin (1) developing the office's training processes to adequately prepare and support
investigators in performing their duties;
new text end

new text begin (2) developing clear, consistent internal policies for conducting investigations as required
by federal law, including policies to ensure staff meet the deadlines in state and federal laws
for triaging, investigating, and making final dispositions of cases involving maltreatment,
and procedures for notifying the vulnerable adult, reporter, and facility of any delays in
investigations; communicating these policies to staff in a clear, timely manner; and
developing procedures to evaluate and modify these internal policies on an ongoing basis;
new text end

new text begin (3) developing and refining quality control measures for the intake and triage processes,
through such practices as reviewing a random sample of the triage decisions made in case
reports or auditing a random sample of the case files to ensure the proper information is
being collected, the files are being properly maintained, and consistent triage and
investigations determinations are being made;
new text end

new text begin (4) developing and maintaining systems and procedures to accurately determine the
situations in which the office has jurisdiction over a maltreatment allegation;
new text end

new text begin (5) developing and maintaining audit procedures for investigations, to ensure investigators
obtain and document information necessary to support decisions;
new text end

new text begin (6) developing and maintaining procedures to, following a maltreatment determination,
clearly communicate the appeal or review rights of all parties upon final disposition;
new text end

new text begin (7) continuously upgrading the information on and utility of the office's Web site through
such steps as providing clear, detailed information about the appeal or review rights of
vulnerable adults, alleged perpetrators, and providers and facilities; and
new text end

new text begin (8) publishing, in coordination with other areas at the Department of Health and in the
manner that does not duplicate information already published by the Department of Health,
the public portions of all investigation memoranda prepared by the commissioner of health
in the past three years under section 626.557, subdivision 12b, and the public portions of
all final orders in the past three years related to licensing violations under this chapter. These
memoranda and orders must be published in a manner that allows consumers to search
memoranda and orders by facility or provider name and by the physical location of the
facility or provider.
new text end

Sec. 10.

Minnesota Statutes 2016, section 626.557, subdivision 5, is amended to read:


Subd. 5.

Immunity; protection for reporters.

(a) A person who makes a good faith
report is immune from any civil or criminal liability that might otherwise result from making
the report, or from participating in the investigation, or for failure to comply fully with the
reporting obligation under section 609.234 or 626.557, subdivision 7.

(b) A person employed by a lead investigative agency or a state licensing agency who
is conducting or supervising an investigation or enforcing the law in compliance with this
section or any related rule or provision of law is immune from any civil or criminal liability
that might otherwise result from the person's actions, if the person is acting in good faith
and exercising due care.

(c) A person who knows or has reason to know a report has been made to a common
entry point and who in good faith participates in an investigation of alleged maltreatment
is immune from civil or criminal liability that otherwise might result from making the report,
or from failure to comply with the reporting obligation or from participating in the
investigation.

(d) The identity of any reporter may not be disclosed, except as provided in deleted text beginsubdivisiondeleted text endnew text begin
subdivisions 9c and
new text end 12b.

(e) For purposes of this subdivision, "person" includes a natural person or any form of
a business or legal entity.

Sec. 11.

Minnesota Statutes 2016, section 626.557, subdivision 9c, is amended to read:


Subd. 9c.

Lead investigative agency; notifications, dispositions, determinations.

(a)
deleted text begin Upon request of the reporter,deleted text end The lead investigative agency shall notify the reporter that it
has received the report, and provide information on the initial disposition of the report within
five business days of receipt of the report, provided that the notification will not endanger
the vulnerable adult or hamper the investigation. new text beginIf a vulnerable adult who is the subject of
the report, or the vulnerable adult's guardian or health care agent, so inquires, the lead
investigative agency shall disclose to the person who inquired whether the lead investigative
agency has received a report from a facility regarding maltreatment of the vulnerable adult.
new text end

(b) Upon conclusion of every investigation it conducts, the lead investigative agency
shall make a final disposition as defined in section 626.5572, subdivision 8.

(c) When determining whether the facility or individual is the responsible party for
substantiated maltreatment or whether both the facility and the individual are responsible
for substantiated maltreatment, the lead investigative agency shall consider at least the
following mitigating factors:

(1) whether the actions of the facility or the individual caregivers were in accordance
with, and followed the terms of, an erroneous physician order, prescription, resident care
plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible
for the issuance of the erroneous order, prescription, plan, or directive or knows or should
have known of the errors and took no reasonable measures to correct the defect before
administering care;

(2) the comparative responsibility between the facility, other caregivers, and requirements
placed upon the employee, including but not limited to, the facility's compliance with related
regulatory standards and factors such as the adequacy of facility policies and procedures,
the adequacy of facility training, the adequacy of an individual's participation in the training,
the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a
consideration of the scope of the individual employee's authority; and

(3) whether the facility or individual followed professional standards in exercising
professional judgment.

(d) When substantiated maltreatment is determined to have been committed by an
individual who is also the facility license holder, both the individual and the facility must
be determined responsible for the maltreatment, and both the background study
disqualification standards under section 245C.15, subdivision 4, and the licensing actions
under section 245A.06 or 245A.07 apply.

(e) The lead investigative agency shall complete its final disposition within 60 calendar
days. If the lead investigative agency is unable to complete its final disposition within 60
calendar days, the lead investigative agency shall notify the following persons provided
that the notification will not endanger the vulnerable adult or hamper the investigation: (1)
the vulnerable adult or the vulnerable adult's guardian or health care agent, when known,
if the lead investigative agency knows them to be aware of the investigation; deleted text beginanddeleted text end (2) the
facility, where applicablenew text begin; and (3) the reporternew text end. The notice shall contain the reason for the
delay and the projected completion date. If the lead investigative agency is unable to complete
its final disposition by a subsequent projected completion date, the lead investigative agency
shall again notify the vulnerable adult or the vulnerable adult's guardian or health care agent,
when known if the lead investigative agency knows them to be aware of the investigationdeleted text begin,
and
deleted text endnew text begin;new text end the facility, where applicablenew text begin; and the reporternew text end, of the reason for the delay and the
revised projected completion date provided that the notification will not endanger the
vulnerable adult or hamper the investigation. The lead investigative agency must notify the
health care agent of the vulnerable adult only if the health care agent's authority to make
health care decisions for the vulnerable adult is currently effective under section 145C.06
and not suspended under section 524.5-310 and the investigation relates to a duty assigned
to the health care agent by the principal. A lead investigative agency's inability to complete
the final disposition within 60 calendar days or by any projected completion date does not
invalidate the final disposition.

(f) Within ten calendar days of completing the final disposition, the lead investigative
agency shall provide a copy of the public investigation memorandum under subdivision
12b, paragraph (b), clause (1), when required to be completed under this section, to the
following persons: (1) the vulnerable adult, or the vulnerable adult's guardian or health care
agent, if known, unless the lead investigative agency knows that the notification would
endanger the well-being of the vulnerable adult; (2) the reporter, deleted text beginif the reporter requested
notification when making the report,
deleted text end provided this notification would not endanger the
well-being of the vulnerable adult; (3) the alleged perpetrator, if known; (4) the facility;
and (5) the ombudsman for long-term care, or the ombudsman for mental health and
developmental disabilities, as appropriate.

(g) If, as a result of a reconsideration, review, or hearing, the lead investigative agency
changes the final disposition, or if a final disposition is changed on appeal, the lead
investigative agency shall notify the parties specified in paragraph (f).

(h) The lead investigative agency shall notify the vulnerable adult who is the subject of
the report or the vulnerable adult's guardian or health care agent, if known, and any person
or facility determined to have maltreated a vulnerable adult, of their appeal or review rights
under this section or section 256.021.

(i) The lead investigative agency shall routinely provide investigation memoranda for
substantiated reports to the appropriate licensing boards. These reports must include the
names of substantiated perpetrators. The lead investigative agency may not provide
investigative memoranda for inconclusive or false reports to the appropriate licensing boards
unless the lead investigative agency's investigation gives reason to believe that there may
have been a violation of the applicable professional practice laws. If the investigation
memorandum is provided to a licensing board, the subject of the investigation memorandum
shall be notified and receive a summary of the investigative findings.

(j) In order to avoid duplication, licensing boards shall consider the findings of the lead
investigative agency in their investigations if they choose to investigate. This does not
preclude licensing boards from considering other information.

(k) The lead investigative agency must provide to the commissioner of human services
its final dispositions, including the names of all substantiated perpetrators. The commissioner
of human services shall establish records to retain the names of substantiated perpetrators.

Sec. 12.

Minnesota Statutes 2016, section 626.557, subdivision 9e, is amended to read:


Subd. 9e.

Education requirements.

(a) The commissioners of health, human services,
and public safety shall cooperate in the development of a joint program for education of
lead investigative agency investigators in the appropriate techniques for investigation of
complaints of maltreatment. This program must be developed by July 1, 1996. The program
must include but need not be limited to the following areas: (1) information collection and
preservation; (2) analysis of facts; (3) levels of evidence; (4) conclusions based on evidence;
(5) interviewing skills, including specialized training to interview people with unique needs;
(6) report writing; (7) coordination and referral to other necessary agencies such as law
enforcement and judicial agencies; (8) human relations and cultural diversity; (9) the
dynamics of adult abuse and neglect within family systems and the appropriate methods
for interviewing relatives in the course of the assessment or investigation; (10) the protective
social services that are available to protect alleged victims from further abuse, neglect, or
financial exploitation; (11) the methods by which lead investigative agency investigators
and law enforcement workers cooperate in conducting assessments and investigations in
order to avoid duplication of efforts; and (12) data practices laws and procedures, including
provisions for sharing data.

(b) The commissioner of human services shall conduct an outreach campaign to promote
the common entry point for reporting vulnerable adult maltreatment. This campaign shall
use the Internet and other means of communication.

(c) The commissioners of health, human services, and public safety shall offer at least
annual education to others on the requirements of this section, on how this section is
implemented, and investigation techniques.

(d) The commissioner of human services, in coordination with the commissioner of
public safety shall provide training for the common entry point staff as required in this
subdivision and the program courses described in this subdivision, at least four times per
year. At a minimum, the training shall be held twice annually in the seven-county
metropolitan area and twice annually outside the seven-county metropolitan area. The
commissioners shall give priority in the program areas cited in paragraph (a) to persons
currently performing assessments and investigations pursuant to this section.

(e) The commissioner of public safety shall notify in writing law enforcement personnel
of any new requirements under this section. The commissioner of public safety shall conduct
regional training for law enforcement personnel regarding their responsibility under this
section.

(f) Each lead investigative agency investigator must complete the education program
specified by this subdivision within the first 12 months of work as a lead investigative
agency investigator.

A lead investigative agency investigator employed when these requirements take effect
must complete the program within the first year after training is available or as soon as
training is available.

All lead investigative agency investigators having responsibility for investigation duties
under this section must receive a minimum of eight hours of continuing education or
in-service training each year specific to their duties under this section.

new text begin (g) The commissioners of health and human services shall develop and maintain written
guidance materials for facilities that explain and illustrate the reporting requirements under
this section, and the reporting requirements under Code of Federal Regulations, title 42,
section 483.12(c) for facilities subject to those requirements.
new text end

Sec. 13.

Minnesota Statutes 2016, section 626.557, subdivision 12b, is amended to read:


Subd. 12b.

Data management.

(a) In performing any of the duties of this section as a
lead investigative agency, the county social service agency shall maintain appropriate
records. Data collected by the county social service agency under this section are welfare
data under section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data
under this paragraph that are inactive investigative data on an individual who is a vendor
of services are private data on individuals, as defined in section 13.02. The identity of the
reporter may only be disclosed as provided in paragraph (c).

Data maintained by the common entry point are confidential data on individuals or
protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, the
common entry point shall maintain data for three calendar years after date of receipt and
then destroy the data unless otherwise directed by federal requirements.

(b) The commissioners of health and human services shall prepare an investigation
memorandum for each report alleging maltreatment investigated under this section. County
social service agencies must maintain private data on individuals but are not required to
prepare an investigation memorandum. During an investigation by the commissioner of
health or the commissioner of human services, data collected under this section are
confidential data on individuals or protected nonpublic data as defined in section 13.02.
Upon completion of the investigation, the data are classified as provided in clauses (1) to
(3) and paragraph (c).

(1) The investigation memorandum must contain the following data, which are public:

(i) the name of the facility investigated;

(ii) a statement of the nature of the alleged maltreatment;

(iii) pertinent information obtained from medical or other records reviewed;

(iv) the identity of the investigator;

(v) a summary of the investigation's findings;

(vi) statement of whether the report was found to be substantiated, inconclusive, false,
or that no determination will be made;

(vii) a statement of any action taken by the facility;

(viii) a statement of any action taken by the lead investigative agency; and

(ix) when a lead investigative agency's determination has substantiated maltreatment, a
statement of whether an individual, individuals, or a facility were responsible for the
substantiated maltreatment, if known.

The investigation memorandum must be written in a manner which protects the identity
of the reporter and of the vulnerable adult and may not contain the names or, to the extent
possible, data on individuals or private data listed in clause (2).

(2) Data on individuals collected and maintained in the investigation memorandum are
private data, including:

(i) the name of the vulnerable adult;

(ii) the identity of the individual alleged to be the perpetrator;

(iii) the identity of the individual substantiated as the perpetrator; and

(iv) the identity of all individuals interviewed as part of the investigation.

(3) Other data on individuals maintained as part of an investigation under this section
are private data on individuals upon completion of the investigation.

(c) After the assessment or investigation is completed, the name of the reporter must be
confidential. The subject of the report may compel disclosure of the name of the reporter
only with the consent of the reporter or upon a written finding by a court that the report was
false and there is evidence that the report was made in bad faith. This subdivision does not
alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except
that where the identity of the reporter is relevant to a criminal prosecution, the district court
shall do an in-camera review prior to determining whether to order disclosure of the identity
of the reporter.

(d) Notwithstanding section 138.163, data maintained under this section by the
commissioners of health and human services must be maintained under the following
schedule and then destroyed unless otherwise directed by federal requirements:

(1) data from reports determined to be false, maintained for three years after the finding
was made;

(2) data from reports determined to be inconclusive, maintained for four years after the
finding was made;

(3) data from reports determined to be substantiated, maintained for seven years after
the finding was made; and

(4) data from reports which were not investigated by a lead investigative agency and for
which there is no final disposition, maintained for three years from the date of the report.

(e) The commissioners of health and human services shall annually publish on their Web
sites the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigation under this section,
and the resolution of those investigations. On a biennial basis, the commissioners of health
and human services shall jointly report the following information to the legislature and the
governor:

(1) the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigations under this section,
the resolution of those investigations, and which of the two lead agencies was responsible;

(2) trends about types of substantiated maltreatment found in the reporting period;

(3) deleted text beginif there are upward trends for types of maltreatment substantiated,deleted text end recommendations
for new text beginpreventing, new text endaddressingnew text begin,new text end and responding to deleted text beginthemdeleted text endnew text begin substantiated maltreatmentnew text end;

(4) efforts undertaken or recommended to improve the protection of vulnerable adults;

(5) whether and where backlogs of cases result in a failure to conform with statutory
time frames and recommendations for reducing backlogs if applicable;

(6) recommended changes to statutes affecting the protection of vulnerable adults; and

(7) any other information that is relevant to the report trends and findings.

(f) Each lead investigative agency must have a record retention policy.

(g) Lead investigative agencies, prosecuting authorities, and law enforcement agencies
may exchange not public data, as defined in section 13.02, if the agency or authority
requesting the data determines that the data are pertinent and necessary to the requesting
agency in initiating, furthering, or completing an investigation under this section. Data
collected under this section must be made available to prosecuting authorities and law
enforcement officials, local county agencies, and licensing agencies investigating the alleged
maltreatment under this section. The lead investigative agency shall exchange not public
data with the vulnerable adult maltreatment review panel established in section 256.021 if
the data are pertinent and necessary for a review requested under that section.
Notwithstanding section 138.17, upon completion of the review, not public data received
by the review panel must be destroyed.

(h) Each lead investigative agency shall keep records of the length of time it takes to
complete its investigations.

(i) A lead investigative agency may notify other affected parties and their authorized
representative if the lead investigative agency has reason to believe maltreatment has occurred
and determines the information will safeguard the well-being of the affected parties or dispel
widespread rumor or unrest in the affected facility.

(j) Under any notification provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a lead investigative agency may
not provide any notice unless the vulnerable adult has consented to disclosure in a manner
which conforms to federal requirements.

Sec. 14.

Minnesota Statutes 2016, section 626.557, subdivision 17, is amended to read:


Subd. 17.

Retaliation prohibited.

(a) A facility or person shall not retaliate against any
person who reports in good faith suspected maltreatment pursuant to this section, or against
a vulnerable adult with respect to whom a report is made, because of the report.

(b) In addition to any remedies allowed under sections 181.931 to 181.935, any facility
or person which retaliates against any person because of a report of suspected maltreatment
is liable to that person for actual damages, punitive damages up to $10,000, and attorney
fees.

(c) There shall be a rebuttable presumption that any adverse action, as defined below,
within 90 days of a report, is retaliatory. For purposes of this clause, the term "adverse
action" refers to action taken by a facility or person involved in a report against the person
making the report or the person with respect to whom the report was made because of the
report, and includes, but is not limited to:

(1) discharge or transfer from the facility;

(2) discharge from or termination of employment;

(3) demotion or reduction in remuneration for services;

(4) restriction or prohibition of access to the facility or its residents; or

(5) any restriction of rights set forth in section 144.651new text begin, 144A.44, or 144A.441new text end.

Sec. 15. new text beginREPORT; SAFETY AND QUALITY IMPROVEMENT PRACTICES.
new text end

new text begin By January 15, 2019, the safety and quality improvement technical panel established
under Minnesota Statutes, section 144A.53, subdivision 5, shall provide recommendations
to the legislature on legislative changes needed to promote safety and quality improvement
practices in long-term care settings and with long-term care providers. The recommendations
must address:
new text end

new text begin (1) how to implement a system for adverse health events reporting, learning, and
prevention in long-term care settings and with long-term care providers; and
new text end

new text begin (2) interim actions to improve systems for the timely analysis of reports and complaints
submitted to the Office of Health Facility Complaints to identify common themes and key
prevention opportunities, and to disseminate key findings to providers across the state for
the purposes of shared learning and prevention.
new text end

Sec. 16. new text beginREPORT; PROGRESS IN MEETING INVESTIGATION DEADLINES.
new text end

new text begin By September 15, 2018, March 15, 2019, and September 15, 2019, the commissioner
of health shall report to the chairs and ranking minority members of the legislative committees
with jurisdiction over health care or aging and long-term care, regarding steps taken by the
commissioner to improve compliance of the Office of Health Facility Complaints with
deadlines in state and federal law for triaging, investigating, and making final dispositions
of cases alleging maltreatment of vulnerable adults. In the reports under this section, the
commissioner must provide data on the office's compliance with deadlines in state and
federal law, and a plan to improve timeliness in any areas in which it is noncompliant.
new text end

Sec. 17. new text beginREPORT AND RECOMMENDATIONS; IMMEDIATE PENALTIES FOR
SERIOUS VIOLATIONS OF STATE LAW.
new text end

new text begin The commissioner of health shall develop a proposal and draft legislation to allow the
commissioner to impose immediate penalties on long-term care facilities and providers for
serious violations of state law. The proposal and draft legislation must determine what
actions constitute a serious violation of state law and specify appropriate penalties for each
category of serious violation. The commissioner shall develop this proposal in consultation
with representatives of long-term care facilities, representatives of home care providers,
and elder justice advocates. The proposal and draft legislation must be submitted to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health care or aging and long-term care by January 15, 2019.
new text end

Sec. 18. new text beginASSISTED LIVING AND DEMENTIA CARE LICENSING WORKING
GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; membership. new text end

new text begin (a) An assisted living and dementia care
licensing working group is established.
new text end

new text begin (b) The commissioner of health shall appoint the following members of the working
group:
new text end

new text begin (1) four providers from the senior housing with services profession;
new text end

new text begin (2) two persons who reside in senior housing with services establishments, or family
members of persons who reside in senior housing with services establishments;
new text end

new text begin (3) one representative from the Home Care and Assisted Living Advisory Council;
new text end

new text begin (4) one representative of a health plan company;
new text end

new text begin (5) one representative from Care Providers of Minnesota;
new text end

new text begin (6) one representative from LeadingAge Minnesota;
new text end

new text begin (7) one representative from the Alzheimer's Association;
new text end

new text begin (8) one representative from the area agencies on aging;
new text end

new text begin (9) one federal compliance official; and
new text end

new text begin (10) one representative from the Minnesota Home Care Association.
new text end

new text begin (c) The following individuals shall also be members of the working group:
new text end

new text begin (1) the commissioner of health or a designee;
new text end

new text begin (2) the commissioner of human services or a designee;
new text end

new text begin (3) the ombudsman for long-term care or a designee; and
new text end

new text begin (4) one member of the Minnesota Board of Aging, selected by the board.
new text end

new text begin (d) The appointing authorities under this subdivision must complete their appointments
no later than July 1, 2018.
new text end

new text begin Subd. 2. new text end

new text begin Duties; recommendations. new text end

new text begin The assisted living and dementia care licensing
working group shall consider and make recommendations on a new regulatory framework
for assisted living and dementia care. In developing the licensing framework, the working
group must address at least the following:
new text end

new text begin (1) the appropriate level of regulation, including licensure, registration, or certification;
new text end

new text begin (2) coordination of care;
new text end

new text begin (3) the scope of care to be provided, and limits on acuity levels of residents;
new text end

new text begin (4) consumer rights;
new text end

new text begin (5) staff training and qualifications;
new text end

new text begin (6) options for the engagement of seniors and their families;
new text end

new text begin (7) notices and financial requirements; and
new text end

new text begin (8) compliance with federal Medicaid waiver requirements for home and
community-based services settings.
new text end

new text begin Subd. 3. new text end

new text begin Meetings. new text end

new text begin The commissioner of health or a designee shall convene the first
meeting of the working group no later than August 1, 2018. The members of the working
group shall elect a chair from among the group's members at the first meeting, and the
commissioner of health or a designee shall serve as the working group's chair until a chair
is elected. Meetings of the working group shall be open to the public.
new text end

new text begin Subd. 4. new text end

new text begin Compensation. new text end

new text begin Members of the working group shall serve without compensation
or reimbursement for expenses.
new text end

new text begin Subd. 5. new text end

new text begin Administrative support. new text end

new text begin The commissioner of health shall provide
administrative support for the working group and arrange meeting space.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By January 15, 2019, the working group must submit a report with
findings, recommendations, and draft legislation to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires January 16, 2019, or the day after the
working group submits the report required under subdivision 6, whichever is earlier.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 19. new text beginDEMENTIA CARE CERTIFICATION WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; membership. new text end

new text begin (a) A dementia care certification working
group is established.
new text end

new text begin (b) The commissioner of health shall appoint the following members of the working
group:
new text end

new text begin (1) one caregiver of a person who has been diagnosed with Alzheimer's disease or other
dementia;
new text end

new text begin (2) two providers from the senior housing with services profession;
new text end

new text begin (3) two geriatricians, one of whom serves a diverse or underserved community;
new text end

new text begin (4) one psychologist who specializes in dementia care;
new text end

new text begin (5) one representative of the Alzheimer's Association;
new text end

new text begin (6) one representative from Care Providers of Minnesota;
new text end

new text begin (7) one representative from LeadingAge Minnesota; and
new text end

new text begin (8) one representative from the Minnesota Home Care Association.
new text end

new text begin (c) The following individuals shall also be members of the working group:
new text end

new text begin (1) the commissioner of health or a designee;
new text end

new text begin (2) the commissioner of human services or a designee;
new text end

new text begin (3) the ombudsman for long-term care or a designee;
new text end

new text begin (4) one member of the Minnesota Board on Aging, selected by the board; and
new text end

new text begin (5) the executive director of the Minnesota Board on Aging, who shall serve as a
nonvoting member of the working group.
new text end

new text begin (d) The appointing authorities under this subdivision must complete their appointments
no later than July 1, 2018.
new text end

new text begin Subd. 2. new text end

new text begin Duties; recommendations. new text end

new text begin The dementia care certification working group
shall consider and make recommendations regarding the certification of providers offering
dementia care services to clients diagnosed with Alzheimer's disease or other dementias.
The working group must:
new text end

new text begin (1) develop standards in the following areas that nursing homes, boarding care homes,
and housing with services establishments that offer care for clients diagnosed with
Alzheimer's disease or other dementias must meet in order to obtain dementia care
certification: staffing, egress control, access to secured outdoor spaces, specialized therapeutic
activities, and specialized life enrichment programming;
new text end

new text begin (2) develop requirements for disclosing dementia care certification standards to
consumers; and
new text end

new text begin (3) develop mechanisms for enforcing dementia care certification standards.
new text end

new text begin Subd. 3. new text end

new text begin Meetings. new text end

new text begin The commissioner of health or a designee shall convene the first
meeting of the working group no later than August 1, 2018. The members of the working
group shall elect a chair from among the group's members at the first meeting, and the
commissioner of health or a designee shall serve as the working group's chair until a chair
is elected. Meetings of the working group shall be open to the public.
new text end

new text begin Subd. 4. new text end

new text begin Compensation. new text end

new text begin Members of the working group shall serve without compensation
or reimbursement for expenses.
new text end

new text begin Subd. 5. new text end

new text begin Administrative support. new text end

new text begin The commissioner of health shall provide
administrative support for the working group and arrange meeting space.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By January 15, 2019, the working group must submit a report with
findings, recommendations, and draft legislation to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires January 16, 2019, or the day after the
working group submits the report required under subdivision 6, whichever is earlier.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 20. new text beginASSISTED LIVING REPORT CARD WORKING GROUP.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; membership. new text end

new text begin (a) An assisted living report card working
group, tasked with researching and making recommendations on the development of an
assisted living report card, is established.
new text end

new text begin (b) The commissioner of human services shall appoint the following members of the
working group:
new text end

new text begin (1) two persons who reside in senior housing with services establishments;
new text end

new text begin (2) four representatives of the senior housing with services profession;
new text end

new text begin (3) two family members of persons who reside in senior housing with services
establishments;
new text end

new text begin (4) a representative from the Home Care and Assisted Living Advisory Council;
new text end

new text begin (5) a representative from the University of Minnesota with expertise in data and analytics;
new text end

new text begin (6) a representative from Care Providers of Minnesota; and
new text end

new text begin (7) a representative from LeadingAge Minnesota.
new text end

new text begin (c) The following individuals shall also be appointed to the working group:
new text end

new text begin (1) the commissioner of human services or a designee;
new text end

new text begin (2) the commissioner of health or a designee;
new text end

new text begin (3) the ombudsman for long-term care or a designee;
new text end

new text begin (4) one member of the Minnesota Board on Aging, selected by the board; and
new text end

new text begin (5) the executive director of the Minnesota Board on Aging who shall serve on the
working group as a nonvoting member.
new text end

new text begin (d) The appointing authorities under this subdivision must complete their appointments
no later than July 1, 2018.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin The assisted living report card working group shall consider and make
recommendations on the development of an assisted living report card. The quality metrics
considered shall include, but are not limited to:
new text end

new text begin (1) an annual customer satisfaction survey measure using the CoreQ questions for assisted
living residents and family members;
new text end

new text begin (2) a measure utilizing level 3 or 4 citations from Department of Health home care survey
findings and substantiated Office of Health Facility Complaints findings against a home
care provider;
new text end

new text begin (3) a home care staff retention measure; and
new text end

new text begin (4) a measure that scores a provider's staff according to their level of training and
education.
new text end

new text begin Subd. 3. new text end

new text begin Meetings. new text end

new text begin The commissioner of human services or a designee shall convene
the first meeting of the working group no later than August 1, 2018. The members of the
working group shall elect a chair from among the group's members at the first meeting, and
the commissioner of human services or a designee shall serve as the working group's chair
until a chair is elected. Meetings of the working group shall be open to the public.
new text end

new text begin Subd. 4. new text end

new text begin Compensation. new text end

new text begin Members of the working group shall serve without compensation
or reimbursement for expenses.
new text end

new text begin Subd. 5. new text end

new text begin Administrative support. new text end

new text begin The commissioner of human services shall provide
administrative support for the working group and arrange meeting space.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin By January 15, 2019, the working group must submit a report with
findings, recommendations, and draft legislation to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The working group expires January 16, 2019, or the day after the
working group submits the report required in subdivision 6, whichever is earlier.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 21. new text beginAPPROPRIATIONS.
new text end

new text begin (a) $....... in fiscal year 2019 is appropriated from the general fund to the commissioner
of health for purposes of the dementia care certification working group and the assisted
living and dementia care licensing working group.
new text end

new text begin (b) $....... in fiscal year 2019 is appropriated from the general fund to the commissioner
of human services for purposes of the assisted living report card working group.
new text end