Minnesota Legislature
HF 614
2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 03/26/2015 04:32pm
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A bill for an act
relating to long-term care; providing for long-term care workforce needs;
providing for employee scholarships and loan forgiveness; modifying nursing
facility rate provisions; appropriating money; amending Minnesota Statutes
2014, sections 144.1501, subdivisions 1, 2, 3; 256B.431, subdivision 36;
256B.441, subdivisions 13, 53, by adding a subdivision; proposing coding for
new law in Minnesota Statutes, chapter 144.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2014, section 144.1501, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
new text begin
(b) "Dental therapist" means an individual who is licensed as a dental therapist
under section 150A.06.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end "Dentist" means an individual who is licensed to practice dentistry.
deleted text begin (c)deleted text end new text begin (d)new text end "Designated rural area" means a city or township that is:
(1) outside the seven-county metropolitan area as defined in section 473.121,
subdivision 2; and
(2) has a population under 15,000.
deleted text begin (d)deleted text end new text begin (e)new text end "Emergency circumstances" means those conditions that make it impossible
for the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.
deleted text begin (e)deleted text end new text begin (f)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (f)deleted text end new text begin (g)new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse
anesthetist, advanced clinical nurse specialist, or physician assistant.
deleted text begin (g)deleted text end new text begin (h)new text end "Nurse" means an individual who has completed training and received
all licensing or certification necessary to perform duties as a licensed practical nurse
or registered nurse.
deleted text begin (h)deleted text end new text begin (i)new text end "Nurse-midwife" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (i)deleted text end new text begin (j)new text end "Nurse practitioner" means a registered nurse who has graduated from a
program of study designed to prepare registered nurses for advanced practice as nurse
practitioners.
deleted text begin (j)deleted text end new text begin (k)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (k)deleted text end new text begin (l)new text end "Physician" means an individual who is licensed to practice medicine in
the areas of family practice, internal medicine, obstetrics and gynecology, pediatrics,
or psychiatry.
deleted text begin (l)deleted text end new text begin (m)new text end "Physician assistant" means a person licensed under chapter 147A.
deleted text begin (m)deleted text end new text begin (n)new text end "Qualified educational loan" means a government, commercial, or foundation
loan for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
deleted text begin (n)deleted text end new text begin (o)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 2.
Minnesota Statutes 2014, section 144.1501, subdivision 2, is amended to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents agreeing to practice in designated rural areas or underserved
urban communities or specializing in the area of pediatric psychiatry;
(2) for midlevel practitioners agreeing to practice in designated rural areas or to
teach at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary
program at the undergraduate level or the equivalent at the graduate level;
(3) for nurses who agree to practice in a Minnesota nursing home or intermediate
care facility for persons with developmental disability or to teach at least 12 credit hours,
or 720 hours per year in the nursing field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with
the Healthcare Education-Industry Partnership, shall determine the health care fields
where the need is the greatest, including, but not limited to, respiratory therapy, clinical
laboratory technology, radiologic technology, and surgical technology;
(5) for pharmacists who agree to practice in designated rural areas; deleted text begin and
deleted text end
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by
the United States Department of Health and Human Services under Code of Federal
Regulations, title 42, section 51, chapter 303deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) for dental therapists agreeing to practice in a Minnesota nursing home or
intermediate care facility for persons with a developmental disability.
new text end
(b) Appropriations made to the account do not cancel and are available until
expended, except that at the end of each biennium, any remaining balance in the account
that is not committed by contract and not needed to fulfill existing commitments shall
cancel to the fund.
Sec. 3.
Minnesota Statutes 2014, section 144.1501, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program,
an individual must:
(1) be a medical or dental resident, a licensed pharmacist or be enrolled in a dentist,
midlevel practitioner, registered nurse, or a licensed practical nurse training program; and
(2) submit an application to the commissioner of health. If fewer applications are
submitted by dental students or residents than there are dentist participant slots available,
the commissioner may consider applications submitted by dental program graduates who
are licensed dentists.new text begin The commissioner may consider applications submitted by nursing
program graduates who are registered nurses or licensed practical nurses.
new text end
(b) An applicant selected to participate must sign a contract to agree to serve a
minimum three-year full-time service obligation according to subdivision 2, which
shall begin no later than March 31 following completion of required trainingnew text begin , with the
exception of a nurse, who must agree to serve a minimum two-year full-time service
obligation according to subdivision 2, which shall begin no later than March 31 following
completion of required trainingnew text end .
Sec. 4.
new text begin
[144.1503] HOME AND COMMUNITY-BASED SERVICES EMPLOYEE
SCHOLARSHIP PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
The home and community-based services employee
scholarship grant program is established for the purpose of assisting qualified provider
applicants to provide employee scholarships for education in nursing and other health
care fields.
new text end
new text begin Subd. 2. new text end
new text begin Provision of grants. new text end
new text begin
The commissioner shall make grants available
to qualified providers of older adult services. Grants must be used by home and
community-based service providers to recruit and train staff in their settings through the
establishment of an employee scholarship fund within the setting.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Eligible providers must primarily provide services to
individuals who are 65 years of age and older in home and community-based settings,
including housing with services establishments, adult day centers, and home care agencies.
Qualifying providers must have an established home and community-based services
employee scholarship program, as specified in subdivision 4. Providers that receive
funding under this section must use the funds to award scholarships to employees who
work an average of at least 16 hours per week for the provider.
new text end
new text begin Subd. 4. new text end
new text begin
Home and community-based services employee scholarship program.
new text end
new text begin
Each qualifying provider under this section must have an established home and
community-based services employee scholarship program. Providers may establish
criteria by which funds are distributed among employees. At a minimum, the scholarship
program must cover employee costs related to a course of study that is expected to lead to
career advancement with the provider or in the field of long-term care, including home
care, care of persons with disabilities, or nursing.
new text end
new text begin Subd. 5. new text end
new text begin Participating providers. new text end
new text begin
The commissioner shall publish a request
for proposals in the State Register by August 15, 2015, specifying provider eligibility
requirements, provider selection criteria, program specifics, funding mechanism, and
methods of evaluation. The commissioner must publish additional requests for proposals
by August 15 of each year in which funding is appropriated for this purpose.
new text end
new text begin Subd. 6. new text end
new text begin Reporting requirements. new text end
new text begin
Participating providers shall report to the
commissioner on a schedule determined by the commissioner and on a form supplied by
the commissioner no later than October 1, 2017. The report shall include the amount spent;
number of employees who received scholarships; and, for each scholarship recipient,
the name of the recipient, the amount awarded, the educational institution attended, the
nature of the educational program, and the expected or actual program completion date.
The commissioner shall require providers to repay all of the funds awarded under this
section if the report required under this subdivision is not filed according to the schedule
determined by the commissioner.
new text end
Sec. 5.
Minnesota Statutes 2014, section 256B.431, subdivision 36, is amended to read:
Subd. 36.
Employee scholarship costs and training in English as a second
language.
(a) For the period between July 1, 2001, and June 30, 2003, the commissioner
shall provide to each nursing facility reimbursed under this section, section 256B.434, or
any other section, a scholarship per diem of 25 cents to the total operating payment ratenew text begin .
For the two rate years beginning on or after October 1, 2015, through September 30, 2017,
the commissioner shall allow a scholarship per diem of up to 25 cents for each requesting
facility to be added to the external fixed payment ratenew text end to be used:
(1) for employee scholarships that satisfy the following requirements:
(i) scholarships are available to all employees who work an average of at least deleted text begin 20deleted text end new text begin
tennew text end hours per week at the facility except the administrator, deleted text begin department supervisors, and
registered nursesdeleted text end new text begin and to reimburse student loan expenses for newly hired and recently
graduated registered nurses and licensed practical nurses, and training expenses for
newly hired and recently graduated nursing assistants as defined in section 144A.61,
subdivision 2new text end ; and
(ii) the course of study is expected to lead to career advancement with the facility or
in long-term care, including medical care interpreter services and social work; and
(2) to provide job-related training in English as a second language.
(b) deleted text begin A facility receivingdeleted text end new text begin All facilities may annually requestnew text end a rate adjustment under
this subdivision deleted text begin may submitdeleted text end new text begin by submitting informationnew text end to the commissioner on a schedule
deleted text begin determined by the commissionerdeleted text end and deleted text begin ondeleted text end new text begin innew text end a form supplied by the commissioner deleted text begin a
calculation of the scholarship per diem, including: the amount received from this rate
adjustment; the amount used for training in English as a second language; the number of
persons receiving the training; the name of the person or entity providing the training;
and for each scholarship recipient, the name of the recipient, the amount awarded, the
educational institution attended, the nature of the educational program, the program
completion date, and a determination of the per diem amount of these costs based on
actual resident daysdeleted text end .new text begin The commissioner shall allow a scholarship payment rate equal to
the reported and allowable costs divided by resident days.
new text end
(c) deleted text begin On July 1, 2003, the commissioner shall remove the 25 cent scholarship per diem
from the total operating payment rate of each facility.
deleted text end
deleted text begin (d) For rate years beginning after June 30, 2003, the commissioner shall provide to
each facility the scholarship per diem determined in paragraph (b).deleted text end In calculating the per
diem under paragraph (b), the commissioner shall allow deleted text begin onlydeleted text end costs related to tuition deleted text begin anddeleted text end new text begin ,new text end
direct educational expensesnew text begin , and reasonable costs as defined by the commissioner for child
care costs and transportation expenses related to direct educational expensesnew text end .
new text begin
(d) The rate increase under this subdivision is an optional rate add-on that the facility
must request from the commissioner in a manner prescribed by the commissioner. The
rate increase must be used for scholarships as specified in this subdivision.
new text end
new text begin
(e) Nursing facilities that close beds during a rate year may request to have their
scholarship adjustment under paragraph (b) recalculated by the commissioner for the
remainder of the rate year to reflect the reduction in resident days compared to the cost
report year.
new text end
Sec. 6.
Minnesota Statutes 2014, section 256B.441, subdivision 13, is amended to read:
Subd. 13.
External fixed costs.
"External fixed costs" means costs related to the
nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
section 144.122; until September 30, 2013, long-term care consultation fees under
section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
scholarships under section 256B.431, subdivision 36; new text begin nursing assistant training under
section 144A.611; career ladder rate adjustments under subdivision 65; new text end planned closure
rate adjustments under section 256B.437; or single bed room incentives under section
256B.431, subdivision 42; property taxes and property insurance; and PERA.
Sec. 7.
Minnesota Statutes 2014, section 256B.441, subdivision 53, is amended to read:
Subd. 53.
Calculation of payment rate for external fixed costs.
The commissioner
shall calculate a payment rate for external fixed costs.
(a) For a facility licensed as a nursing home, the portion related to section 256.9657
shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
result of its number of nursing home beds divided by its total number of licensed beds.
(b) The portion related to the licensure fee under section 144.122, paragraph (d),
shall be the amount of the fee divided by actual resident days.
(c) The portion related to scholarships shall be determined under section 256B.431,
subdivision 36.
(d) Until September 30, 2013, the portion related to long-term care consultation shall
be determined according to section 256B.0911, subdivision 6.
(e) The portion related to development and education of resident and family advisory
councils under section 144A.33 shall be $5 divided by 365.
(f) The portion related to planned closure rate adjustments shall be as determined
under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
be included in the payment rate for external fixed costs beginning October 1, 2016.
Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.
(g) The portions related to property insurance, real estate taxes, special assessments,
and payments made in lieu of real estate taxes directly identified or allocated to the nursing
facility shall be the actual amounts divided by actual resident days.
(h) The portion related to the Public Employees Retirement Association shall be
actual costs divided by resident days.
(i) The single bed room incentives shall be as determined under section 256B.431,
subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
no longer be included in the payment rate for external fixed costs beginning October 1,
2016. Single bed room incentives that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.
(j) new text begin The portion related to the nursing assistant training costs under section 144A.611
shall be actual costs divided by resident days.
new text end
new text begin
(k) The portion related to career ladder rate adjustments shall be determined under
subdivision 65.
new text end
new text begin (l) new text end The payment rate for external fixed costs shall be the sum of the amounts in
paragraphs (a) to deleted text begin (i)deleted text end new text begin (k)new text end .
Sec. 8.
Minnesota Statutes 2014, section 256B.441, is amended by adding a
subdivision to read:
new text begin Subd. 65. new text end
new text begin Career ladder rate adjustment. new text end
new text begin
(a) Effective beginning January 1, 2016,
the commissioner shall make available rate adjustments for nursing facilities to implement
career ladder wage increases for participants in leadership or apprenticeship programs.
These rate adjustments shall be added to the external fixed portion of the rate and must be
used for the wage increases and associated costs, including the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, and workers' compensation
provided to employees who are participating in, or have completed, leadership training or
an apprenticeship program approved by either the commissioner of labor and industry
or the commissioner of human services.
new text end
new text begin
(b) Nursing facilities must apply to the commissioner on the forms and according to
the timelines specified by the commissioner in order to receive a rate adjustment for the
career ladder wage increases. Applications for each rate year beginning on October 1 are
due by the previous August 31.
new text end
new text begin
(c) Nursing facilities applying for a rate adjustment for leadership training or
apprenticeship programs shall include on the application the estimated number of
employees who will be participating in the leadership training or apprenticeship programs
during the rate year, the wage increase those employees will be paid as a result of their
apprenticeship, and the number of hours they are expected to work during the year for
the increase. The maximum rate increase for apprenticeship programs shall be computed
as the estimated hours times the wage increases divided by the actual resident days from
the most recent statistical and cost report.
new text end
new text begin
(d) If the costs from all proposals exceed the appropriation for this purpose, the
commissioner shall allocate the money appropriated on a pro rata basis to the applying
facilities by reducing the rate adjustment determined for each facility by an equal
percentage.
new text end
new text begin
(e) Participating nursing facilities must submit to the commissioner a report after
the end of the rate year to determine the amount actually spent on wage increases for
leadership training and apprenticeship program participants. The commissioner shall
recoup the difference between actual and expected funding from a nursing facility found
to have spent less than 90 percent of what the facility had expected to spend based on the
rate increase authorized by the commissioner. The commissioner shall adjust the rate
adjustment to reflect the actual cost of wage increases under this subdivision if the actual
cost exceeds the estimated cost.
new text end
Sec. 9. new text begin APPROPRIATION; LONG-TERM CARE GRANT PROGRAM.
new text end
new text begin
(a) $....... in fiscal year 2016 is appropriated from the general fund to the
commissioner of employment and economic development for a grant program to further
the advancement of long-term care careers. Long-term care employers, Minnesota
postsecondary education institutions, and adult training programs may apply to receive
grants for the following purposes:
new text end
new text begin
(1) to provide funding for employees to further education opportunities;
new text end
new text begin
(2) conferences;
new text end
new text begin
(3) to highlight long-term care week;
new text end
new text begin
(4) to provide hiring incentives to attract employees to the long-term care field;
new text end
new text begin
(5) to provide leadership training for staff;
new text end
new text begin
(6) to fund innovative adult training programs that train low-income and
underemployed individuals;
new text end
new text begin
(7) to provide mentorship models;
new text end
new text begin
(8) to fund simulation centers at local community colleges to train employees for
long-term care careers;
new text end
new text begin
(9) to support health care education programming; and
new text end
new text begin
(10) to provide innovative models for employers to implement policies and programs
to attract and retain employees in the long-term care field.
new text end
new text begin
(b) Eligible organizations must apply to the commissioner of employment and
economic development for a grant on the forms and according to the timelines established
by the commissioner. The commissioner shall give preference to long-term care providers,
including nursing facilities, licensed under Minnesota Statutes, chapter 144A, and
providers registered as housing with services establishments under Minnesota Statutes,
chapter 144D.
new text end
new text begin
(c) The commissioner shall publish the grant notice twice per year and make grants
on October 1 and March 1 of each year the long-term care grant program is funded.
new text end
Sec. 10. new text begin APPROPRIATION; LONG-TERM CARE STUDY.
new text end
new text begin
$....... in fiscal year 2016 is appropriated from the general fund to the commissioner
of employment and economic development to study ways in which tax credits or
hiring incentives can benefit long-term care employers to recruit, retain, and provide
career ladders to employees in the long-term care field. The commissioner must
report recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over employment and economic development, health, and
human services policy and finance by February 1, 2016.
new text end
Sec. 11. new text begin APPROPRIATION; WORKFORCE CENTERS.
new text end
new text begin
$....... in fiscal year 2016 is appropriated from the general fund to the commissioner
of employment and economic development for purposes of enhancing or establishing new
programs within Minnesota Workforce Centers to address the shortage of paid caregivers
in senior care settings in Minnesota. Programs may include but are not limited to screening
of potential candidates for caregiving careers, promotion of vacant caregiving positions,
training of potential caregivers, and placement of caregivers in nursing facilities, housing
with services establishments, home care agencies, and adult day centers.
new text end
Sec. 12. new text begin APPROPRIATION; NURSE LOAN FORGIVENESS PROGRAM.
new text end
new text begin
$260,000 in fiscal year 2016 is appropriated from the general fund to the
commissioner of health for the nurse loan forgiveness program under Minnesota Statutes,
section 144.1501. This appropriation is in addition to any previous appropriation for this
purpose and is added to the program's base.
new text end
Sec. 13. new text begin APPROPRIATION; HOME AND COMMUNITY-BASED SERVICES
EMPLOYEE SCHOLARSHIP PROGRAM.
new text end
new text begin
$....... in fiscal year 2016 is appropriated from the general fund to the commissioner
of health for the purposes of the home and community-based services employee
scholarship program under Minnesota Statutes, section 144.1503.
new text end
Sec. 14. new text begin APPROPRIATION; CAREER LADDER RATE ADJUSTMENT.new text end
new text begin
$....... in fiscal year 2016 and $....... in fiscal year 2017 are appropriated from the
general fund to the commissioner of human services to cover the state share of providing
career ladder program rate adjustments under Minnesota Statutes, section 256B.441,
subdivision 65. This appropriation is added to the base for the fiscal 2018-2019 biennium.
new text end