SF 1079

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

A bill for an act
relating to health; providing an exception to the
moratorium on nursing home beds by allowing
relicensure and recertification of beds placed on
layaway; amending Minnesota Statutes 2004, section
144A.071, subdivision 4a.

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

Section 1.

Minnesota Statutes 2004, section 144A.071,
subdivision 4a, is amended to read:

Subd. 4a.

Exceptions for replacement beds.

It is in the
best interest of the state to ensure that nursing homes and
boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain
construction projects. Facilities should be maintained in
condition to satisfy the physical and emotional needs of
residents while allowing the state to maintain control over
nursing home expenditure growth.

The commissioner of health in coordination with the
commissioner of human services, may approve the renovation,
replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:

(a) to license or certify beds in a new facility
constructed to replace a facility or to make repairs in an
existing facility that was destroyed or damaged after June 30,
1987, by fire, lightning, or other hazard provided:

(i) destruction was not caused by the intentional act of or
at the direction of a controlling person of the facility;

(ii) at the time the facility was destroyed or damaged the
controlling persons of the facility maintained insurance
coverage for the type of hazard that occurred in an amount that
a reasonable person would conclude was adequate;

(iii) the net proceeds from an insurance settlement for the
damages caused by the hazard are applied to the cost of the new
facility or repairs;

(iv) the new facility is constructed on the same site as
the destroyed facility or on another site subject to the
restrictions in section 144A.073, subdivision 5;

(v) the number of licensed and certified beds in the new
facility does not exceed the number of licensed and certified
beds in the destroyed facility; and

(vi) the commissioner determines that the replacement beds
are needed to prevent an inadequate supply of beds.

Project construction costs incurred for repairs authorized under
this clause shall not be considered in the dollar threshold
amount defined in subdivision 2;

(b) to license or certify beds that are moved from one
location to another within a nursing home facility, provided the
total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $1,000,000;

(c) to license or certify beds in a project recommended for
approval under section 144A.073;

(d) to license or certify beds that are moved from an
existing state nursing home to a different state facility,
provided there is no net increase in the number of state nursing
home beds;

(e) to certify and license as nursing home beds boarding
care beds in a certified boarding care facility if the beds meet
the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section
144A.073, and if the cost of any remodeling of the facility does
not exceed $1,000,000. If boarding care beds are licensed as
nursing home beds, the number of boarding care beds in the
facility must not increase beyond the number remaining at the
time of the upgrade in licensure. The provisions contained in
section 144A.073 regarding the upgrading of the facilities do
not apply to facilities that satisfy these requirements;

(f) to license and certify up to 40 beds transferred from
an existing facility owned and operated by the Amherst H. Wilder
Foundation in the city of St. Paul to a new unit at the same
location as the existing facility that will serve persons with
Alzheimer's disease and other related disorders. The transfer
of beds may occur gradually or in stages, provided the total
number of beds transferred does not exceed 40. At the time of
licensure and certification of a bed or beds in the new unit,
the commissioner of health shall delicense and decertify the
same number of beds in the existing facility. As a condition of
receiving a license or certification under this clause, the
facility must make a written commitment to the commissioner of
human services that it will not seek to receive an increase in
its property-related payment rate as a result of the transfers
allowed under this paragraph;

(g) to license and certify nursing home beds to replace
currently licensed and certified boarding care beds which may be
located either in a remodeled or renovated boarding care or
nursing home facility or in a remodeled, renovated, newly
constructed, or replacement nursing home facility within the
identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located,
provided that the number of boarding care beds in the facility
or complex are decreased by the number to be licensed as nursing
home beds and further provided that, if the total costs of new
construction, replacement, remodeling, or renovation exceed ten
percent of the appraised value of the facility or $200,000,
whichever is less, the facility makes a written commitment to
the commissioner of human services that it will not seek to
receive an increase in its property-related payment rate by
reason of the new construction, replacement, remodeling, or
renovation. The provisions contained in section 144A.073
regarding the upgrading of facilities do not apply to facilities
that satisfy these requirements;

(h) to license as a nursing home and certify as a nursing
facility a facility that is licensed as a boarding care facility
but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the
commissioner of health that licensing the facility as a nursing
home and certifying the facility as a nursing facility will
result in a net annual savings to the state general fund of
$200,000 or more;

(i) to certify, after September 30, 1992, and prior to July
1, 1993, existing nursing home beds in a facility that was
licensed and in operation prior to January 1, 1992;

(j) to license and certify new nursing home beds to replace
beds in a facility acquired by the Minneapolis Community
Development Agency as part of redevelopment activities in a city
of the first class, provided the new facility is located within
three miles of the site of the old facility. Operating and
property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434;

(k) to license and certify up to 20 new nursing home beds
in a community-operated hospital and attached convalescent and
nursing care facility with 40 beds on April 21, 1991, that
suspended operation of the hospital in April 1986. The
commissioner of human services shall provide the facility with
the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its
existing 40 beds;

(l) to license or certify beds in renovation, replacement,
or upgrading projects as defined in section 144A.073,
subdivision 1, so long as the cumulative total costs of the
facility's remodeling projects do not exceed $1,000,000;

(m) to license and certify beds that are moved from one
location to another for the purposes of converting up to five
four-bed wards to single or double occupancy rooms in a nursing
home that, as of January 1, 1993, was county-owned and had a
licensed capacity of 115 beds;

(n) to allow a facility that on April 16, 1993, was a
106-bed licensed and certified nursing facility located in
Minneapolis to layaway all of its licensed and certified nursing
home beds. These beds may be relicensed and recertified in a
newly constructed teaching nursing home facility affiliated with
a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency
committee on long-term care planning. The beds on layaway
status shall have the same status as voluntarily delicensed and
decertified beds, except that beds on layaway status remain
subject to the surcharge in section 256.9657. This layaway
provision expires July 1, 1998;

(o) to allow a project which will be completed in
conjunction with an approved moratorium exception project for a
nursing home in southern Cass County and which is directly
related to that portion of the facility that must be repaired,
renovated, or replaced, to correct an emergency plumbing problem
for which a state correction order has been issued and which
must be corrected by August 31, 1993;

(p) to allow a facility that on April 16, 1993, was a
368-bed licensed and certified nursing facility located in
Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified
beds by converting three-bed wards to single or double
occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on
layaway status remain subject to the surcharge in section
256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per
bed reactivation fee. In addition, at any time within three
years of the effective date of the layaway, the beds on layaway
status may be:

(1) relicensed and recertified upon relocation and
reactivation of some or all of the beds to an existing licensed
and certified facility or facilities located in Pine River,
Brainerd, or International Falls; provided that the total
project construction costs related to the relocation of beds
from layaway status for any facility receiving relocated beds
may not exceed the dollar threshold provided in subdivision 2
unless the construction project has been approved through the
moratorium exception process under section 144A.073;

(2) relicensed and recertified, upon reactivation of some
or all of the beds within the facility which placed the beds in
layaway status, if the commissioner has determined a need for
the reactivation of the beds on layaway status.

The property-related payment rate of a facility placing
beds on layaway status must be adjusted by the incremental
change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph
(c). The property-related payment rate for a facility
relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification
became effective. Any beds remaining on layaway status more
than three years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified;

(q) to license and certify beds in a renovation and
remodeling project to convert 12 four-bed wards into 24 two-bed
rooms, expand space, and add improvements in a nursing home
that, as of January 1, 1994, met the following conditions: the
nursing home was located in Ramsey County; had a licensed
capacity of 154 beds; and had been ranked among the top 15
applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process;

(r) to license and certify up to 117 beds that are
relocated from a licensed and certified 138-bed nursing facility
located in St. Paul to a hospital with 130 licensed hospital
beds located in South St. Paul, provided that the nursing
facility and hospital are owned by the same or a related
organization and that prior to the date the relocation is
completed the hospital ceases operation of its inpatient
hospital services at that hospital. After relocation, the
nursing facility's status under section 256B.431, subdivision
2j, shall be the same as it was prior to relocation. The
nursing facility's property-related payment rate resulting from
the project authorized in this paragraph shall become effective
no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting
from this project, the allowable appraised value of the nursing
facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed
$2,490,000;

(s) to license and certify two beds in a facility to
replace beds that were voluntarily delicensed and decertified on
June 28, 1991;

(t) to allow 16 licensed and certified beds located on July
1, 1994, in a 142-bed nursing home and 21-bed boarding care home
facility in Minneapolis, notwithstanding the licensure and
certification after July 1, 1995, of the Minneapolis facility as
a 147-bed nursing home facility after completion of a
construction project approved in 1993 under section 144A.073, to
be laid away upon 30 days' prior written notice to the
commissioner. Beds on layaway status shall have the same status
as voluntarily delicensed or decertified beds except that they
shall remain subject to the surcharge in section 256.9657. The
16 beds on layaway status may be relicensed as nursing home beds
and recertified at any time within five years of the effective
date of the layaway upon relocation of some or all of the beds
to a licensed and certified facility located in Watertown,
provided that the total project construction costs related to
the relocation of beds from layaway status for the Watertown
facility may not exceed the dollar threshold provided in
subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073.

The property-related payment rate of the facility placing
beds on layaway status must be adjusted by the incremental
change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph
(c). The property-related payment rate for the facility
relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification
became effective. Any beds remaining on layaway status more
than five years after the date the layaway status became
effective must be removed from layaway status and immediately
delicensed and decertified;

(u) to license and certify beds that are moved within an
existing area of a facility or to a newly constructed addition
which is built for the purpose of eliminating three- and
four-bed rooms and adding space for dining, lounge areas,
bathing rooms, and ancillary service areas in a nursing home
that, as of January 1, 1995, was located in Fridley and had a
licensed capacity of 129 beds;

(v) to relocate 36 beds in Crow Wing County and four beds
from Hennepin County to a 160-bed facility in Crow Wing County,
provided all the affected beds are under common ownership;

(w) to license and certify a total replacement project of
up to 49 beds located in Norman County that are relocated from a
nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment
rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of Minnesota Rules,
part 9549.0057, and the reimbursement provisions of section
256B.431, except that subdivision 26, paragraphs (a) and (b),
shall not apply until the second rate year after the settle-up
cost report is filed. Property-related reimbursement rates
shall be determined under section 256B.431, taking into account
any federal or state flood-related loans or grants provided to
the facility;

(x) to license and certify a total replacement project of
up to 129 beds located in Polk County that are relocated from a
nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment
rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of Minnesota Rules,
part 9549.0057, and the reimbursement provisions of section
256B.431, except that subdivision 26, paragraphs (a) and (b),
shall not apply until the second rate year after the settle-up
cost report is filed. Property-related reimbursement rates
shall be determined under section 256B.431, taking into account
any federal or state flood-related loans or grants provided to
the facility;

(y) to license and certify beds in a renovation and
remodeling project to convert 13 three-bed wards into 13 two-bed
rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met
the following conditions: the nursing home was located in
Ramsey County, was not owned by a hospital corporation, had a
licensed capacity of 64 beds, and had been ranked among the top
15 applicants by the 1993 moratorium exceptions advisory review
panel. The total project construction cost estimate for this
project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process;

(z) to license and certify up to 150 nursing home beds to
replace an existing 285 bed nursing facility located in St.
Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at
the existing site. The reduction in the licensed capacity of
the existing facility shall occur during the construction
project as beds are taken out of service due to the construction
process. Prior to the start of the construction process, the
facility shall provide written information to the commissioner
of health describing the process for bed reduction, plans for
the relocation of residents, and the estimated construction
schedule. The relocation of residents shall be in accordance
with the provisions of law and rule;

(aa) to allow the commissioner of human services to license
an additional 36 beds to provide residential services for the
physically handicapped under Minnesota Rules, parts 9570.2000 to
9570.3400, in a 198-bed nursing home located in Red Wing,
provided that the total number of licensed and certified beds at
the facility does not increase;

(bb) to license and certify a new facility in St. Louis
county with 44 beds constructed to replace an existing facility
in St. Louis County with 31 beds, which has resident rooms on
two separate floors and an antiquated elevator that creates
safety concerns for residents and prevents nonambulatory
residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;

(cc) to license and certify four beds in a 16-bed certified
boarding care home in Minneapolis to replace beds that were
voluntarily delicensed and decertified on or before March 31,
1992. The licensure and certification is conditional upon the
facility periodically assessing and adjusting its resident mix
and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of
human services shall retain the authority to audit the facility
at any time and shall require the facility to comply with any
requirements necessary to prevent an institution for mental
disease declaration, including delicensure and decertification
of beds, if necessary;

(dd) to license and certify 72 beds in an existing facility
in Mille Lacs County with 80 beds as part of a renovation
project. The renovation must include construction of an
addition to accommodate ten residents with beginning and
midstage dementia in a self-contained living unit; creation of
three resident households where dining, activities, and support
spaces are located near resident living quarters; designation of
four beds for rehabilitation in a self-contained area;
designation of 30 private rooms; and other improvements;

(ee) to license and certify beds in a facility that has
undergone replacement or remodeling as part of a planned closure
under section 256B.437;

(ff) to license and certify a total replacement project of
up to 124 beds located in Wilkin County that are in need of
relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility
shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the
reimbursement provisions of section 256B.431, except that
section 256B.431, subdivision 26, paragraphs (a) and (b), shall
not apply until the second rate year after the settle-up cost
report is filed. Property-related reimbursement rates shall be
determined under section 256B.431, taking into account any
federal or state flood-related loans or grants provided to the
facility;

(gg) to allow the commissioner of human services to license
an additional nine beds to provide residential services for the
physically handicapped under Minnesota Rules, parts 9570.2000 to
9570.3400, in a 240-bed nursing home located in Duluth, provided
that the total number of licensed and certified beds at the
facility does not increase;

(hh) to license and certify up to 120 new nursing facility
beds to replace beds in a facility in Anoka County, which was
licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility
and is in Anoka County. Operating and property rates shall be
determined and allowed under section 256B.431 and Minnesota
Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or
256B.435. The provisions of section 256B.431, subdivision 26,
paragraphs (a) and (b), do not apply until the second rate year
following settle-up; deleted text begin or
deleted text end

(ii) to transfer up to 98 beds of a 129-licensed bed
facility located in Anoka County that, as of March 25, 2001, is
in the active process of closing, to a 122-licensed bed
nonprofit nursing facility located in the city of Columbia
Heights or its affiliate. The transfer is effective when the
receiving facility notifies the commissioner in writing of the
number of beds accepted. The commissioner shall place all
transferred beds on layaway status held in the name of the
receiving facility. The layaway adjustment provisions of
section 256B.431, subdivision 30, do not apply to this layaway.
The receiving facility may only remove the beds from layaway for
recertification and relicensure at the receiving facility's
current site, or at a newly constructed facility located in
Anoka County. The receiving facility must receive statutory
authorization before removing these beds from layaway status new text begin ; or
new text end

new text begin (jj) to remove from layaway status up to 60 of the 98 beds
placed in layaway status in paragraph (ii), and relicense and
recertify these beds in stages in a newly constructed nursing
facility in Ramsey located on a long-term care campus that
provides a continuum of housing and health care options and
services, ranging from independent living to skilled nursing
services. The beds must be relicensed and recertified in two
stages. The beds must be relicensed and recertified prior to
June 30, 2009 new text end .