SF 2261

as introduced - 92nd Legislature (2021 - 2022) Posted on 07/30/2021 11:26am

A bill for an act
relating to health; changing certain health department provisions; amending
Minnesota Statutes 2020, sections 62J.497, subdivisions 1, 3; 62J.63, subdivisions
1, 2; 144.0724, subdivisions 1, 2, 3a, 4, 5, 7, 8, 9, 12; 145.893, subdivision 1;
145.894; 145.897; 256.98, subdivision 1; Laws 2020, Seventh Special Session
chapter 1, article 6, section 12, subdivision 4; repealing Minnesota Statutes 2020,
sections 144.0721, subdivision 1; 144.0722; 144.693.

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

Section 1.

Minnesota Statutes 2020, section 62J.497, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of this section, the following terms have
the meanings given.

(b) "Backward compatible" means that the newer version of a data transmission standard
would retain, at a minimum, the full functionality of the versions previously adopted, and
would permit the successful completion of the applicable transactions with entities that
continue to use the older versions.

(c) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 30.
Dispensing does not include the direct administering of a controlled substance to a patient
by a licensed health care professional.

(d) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.

(e) "Electronic media" has the meaning given under Code of Federal Regulations, title
45, part 160.103.

(f) "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.

(g) "Electronic prescription drug program" means a program that provides for
e-prescribing.

(h) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.

(i) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.

(j) "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.

(k) "NCPDP" means the National Council for Prescription Drug Programs, Inc.

(l) "NCPDP Formulary and Benefits Standard" means the new text begin most recent version of the new text end
National Council for Prescription Drug Programs Formulary and Benefits Standard deleted text begin ,
Implementation Guide, Version 1, Release 0, October 2005 deleted text end new text begin or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare
Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act and regulations
adopted under it. The standards shall be implemented according to the Centers for Medicare
and Medicaid Services schedule for compliance new text end .

(m) "NCPDP SCRIPT Standard" means the new text begin most recent version of the new text end National Council
for Prescription Drug Programs deleted text begin Prescriber/Pharmacist Interface deleted text end SCRIPT Standard,
deleted text begin Implementation Guide Version 8, Release 1 (Version 8.1), October 2005, deleted text end or the most recent
standard adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
regulations adopted under it. The standards shall be implemented according to the Centers
for Medicare and Medicaid Services schedule for compliance. deleted text begin Subsequently released versions
of the NCPDP SCRIPT Standard may be used, provided that the new version of the standard
is backward compatible to the current version adopted by the Centers for Medicare and
Medicaid Services.
deleted text end

(n) "Pharmacy" has the meaning given in section 151.01, subdivision 2.

(o) "Prescriber" means a licensed health care practitioner, other than a veterinarian, as
defined in section 151.01, subdivision 23.

(p) "Prescription-related information" means information regarding eligibility for drug
benefits, medication history, or related health or drug information.

(q) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.

Sec. 2.

Minnesota Statutes 2020, section 62J.497, subdivision 3, is amended to read:

Subd. 3.

Standards for electronic prescribing.

(a) Prescribers and dispensers must use
the NCPDP SCRIPT Standard for the communication of a prescription or prescription-related
information. deleted text begin The NCPDP SCRIPT Standard shall be used to conduct the following
transactions:
deleted text end

deleted text begin (1) get message transaction;
deleted text end

deleted text begin (2) status response transaction;
deleted text end

deleted text begin (3) error response transaction;
deleted text end

deleted text begin (4) new prescription transaction;
deleted text end

deleted text begin (5) prescription change request transaction;
deleted text end

deleted text begin (6) prescription change response transaction;
deleted text end

deleted text begin (7) refill prescription request transaction;
deleted text end

deleted text begin (8) refill prescription response transaction;
deleted text end

deleted text begin (9) verification transaction;
deleted text end

deleted text begin (10) password change transaction;
deleted text end

deleted text begin (11) cancel prescription request transaction; and
deleted text end

deleted text begin (12) cancel prescription response transaction.
deleted text end

(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP SCRIPT
Standard for communicating and transmitting medication history information.

(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and benefit
information.

(d) Providers, group purchasers, prescribers, and dispensers must use the national provider
identifier to identify a health care provider in e-prescribing or prescription-related transactions
when a health care provider's identifier is required.

(e) Providers, group purchasers, prescribers, and dispensers must communicate eligibility
information and conduct health care eligibility benefit inquiry and response transactions
according to the requirements of section 62J.536.

Sec. 3.

Minnesota Statutes 2020, section 62J.63, subdivision 1, is amended to read:

Subdivision 1.

Establishment; administration.

The commissioner of health shall
deleted text begin establish and administer the Center for Health Care Purchasing Improvement as an
administrative unit within the Department of Health. The Center for Health Care Purchasing
Improvement shall deleted text end support the state in its efforts to be a more prudent and efficient purchaser
of quality health care services deleted text begin . The center shall deleted text end new text begin , new text end aid the state in developing and using more
common strategies and approaches for health care performance measurement and health
care purchasing deleted text begin . The common strategies and approaches shall deleted text end new text begin , new text end promote greater transparency
of health care costs and quality deleted text begin , deleted text end and greater accountability for health care results and
improvement deleted text begin . The center shall also deleted text end new text begin , and new text end identify barriers to more efficient, effective, quality
health care and options for overcoming the barriers.

Sec. 4.

Minnesota Statutes 2020, section 62J.63, subdivision 2, is amended to read:

Subd. 2.

Staffing; duties; scope.

deleted text begin (a) deleted text end The commissioner of health may deleted text begin appoint a director,
and up to three additional senior-level staff or codirectors, and other staff as needed who
are under the direction of the commissioner. The staff of the center are in the unclassified
service. deleted text end new text begin :
new text end

deleted text begin (b) With the authorization of the commissioner of health, and in consultation or
interagency agreement with the appropriate commissioners of state agencies, the director,
or codirectors, may:
deleted text end

deleted text begin (1) initiate projects to develop plan designs for state health care purchasing;
deleted text end

deleted text begin (2) deleted text end new text begin (1) new text end require reports or surveys to evaluate the performance of current health care
purchasing new text begin or administrative simplication new text end strategies;

deleted text begin (3) deleted text end new text begin (2) new text end calculate fiscal impacts, including net savings and return on investment, of health
care purchasing strategies and initiatives;

deleted text begin (4) conduct policy audits of state programs to measure conformity to state statute or
other purchasing initiatives or objectives;
deleted text end

deleted text begin (5) deleted text end new text begin (3) new text end support the Administrative Uniformity Committee under deleted text begin section deleted text end new text begin sections new text end 62J.50
new text begin and 62J.536 new text end and other relevant groups or activities to advance agreement on health care
administrative process streamlining;

deleted text begin (6) consult with the Health Economics Unit of the Department of Health regarding
reports and assessments of the health care marketplace;
deleted text end

deleted text begin (7) consult with the Department of Commerce regarding health care regulatory issues
and legislative initiatives;
deleted text end

deleted text begin (8) work with appropriate Department of Human Services staff and the Centers for
Medicare and Medicaid Services to address federal requirements and conformity issues for
health care purchasing;
deleted text end

deleted text begin (9) assist the Minnesota Comprehensive Health Association in health care purchasing
strategies;
deleted text end

deleted text begin (10) convene medical directors of agencies engaged in health care purchasing for advice,
collaboration, and exploring possible synergies;
deleted text end

deleted text begin (11) deleted text end new text begin (4) new text end contact and participate with other relevant health care task forces, study activities,
and similar efforts with regard to health care performance measurement and
performance-based purchasing; and

deleted text begin (12) deleted text end new text begin (5) new text end assist in seeking external funding through appropriate grants or other funding
opportunities and may administer grants and externally funded projects.

Sec. 5.

Minnesota Statutes 2020, section 144.0724, subdivision 1, is amended to read:

Subdivision 1.

Resident reimbursement case mix classifications.

The commissioner
of health shall establish resident reimbursement new text begin case mix new text end classifications based upon the
assessments of residents of nursing homes and boarding care homes conducted under this
section and according to section 256R.17.

Sec. 6.

Minnesota Statutes 2020, section 144.0724, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For purposes of this section, the following terms have the meanings
given.

(a) "Assessment reference date" or "ARD" means the specific end point for look-back
periods in the MDS assessment process. This look-back period is also called the observation
or assessment period.

(b) "Case mix index" means the weighting factors assigned to the RUG-IV classifications.

(c) "Index maximization" means classifying a resident who could be assigned to more
than one category, to the category with the highest case mix index.

(d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,
and functional status elements, that include common definitions and coding categories
specified by the Centers for Medicare and Medicaid Services and designated by the
deleted text begin Minnesota deleted text end Department of Health.

(e) "Representative" means a person who is the resident's guardian or conservator, the
person authorized to pay the nursing home expenses of the resident, a representative of the
Office of Ombudsman for Long-Term Care whose assistance has been requested, or any
other individual designated by the resident.

(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
facility's residents according to their clinical and functional status identified in data supplied
by the facility's Minimum Data Set.

(g) "Activities of daily living" deleted text begin means grooming, deleted text end new text begin includes: personal hygiene, new text end dressing,
bathing, transferring, new text begin bed new text end mobility, deleted text begin positioning, deleted text end new text begin locomotion, new text end eating, and toileting.

(h) "Nursing facility level of care determination" means the assessment process that
results in a determination of a resident's or prospective resident's need for nursing facility
level of care as established in subdivision 11 for purposes of medical assistance payment
of long-term care services for:

(1) nursing facility services under section 256B.434 or chapter 256R;

(2) elderly waiver services under chapter 256S;

(3) CADI and BI waiver services under section 256B.49; and

(4) state payment of alternative care services under section 256B.0913.

Sec. 7.

Minnesota Statutes 2020, section 144.0724, subdivision 3a, is amended to read:

Subd. 3a.

Resident reimbursement new text begin case mix new text end classifications beginning January 1,
2012.

(a) Beginning January 1, 2012, resident reimbursement new text begin case mix new text end classifications shall
be based on the Minimum Data Set, version 3.0 assessment instrument, or its successor
version mandated by the Centers for Medicare and Medicaid Services that nursing facilities
are required to complete for all residents. The commissioner of health shall establish resident
classifications according to the RUG-IV, 48 group, resource utilization groups. Resident
classification must be established based on the individual items on the Minimum Data Set,
which must be completed according to the Long Term Care Facility Resident Assessment
Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare
and Medicaid Services.

(b) Each resident must be classified based on the information from the Minimum Data
Set according to general categories deleted text begin as defined in the Case Mix Classification Manual for
Nursing Facilities deleted text end issued by the Minnesota Department of Health.

Sec. 8.

Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and electronically
submit to the deleted text begin commissioner of health deleted text end new text begin federal data base new text end MDS assessments that conform with
the assessment schedule defined by deleted text begin Code of Federal Regulations, title 42, section 483.20,
and published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, in the Long Term Care Assessment Instrument User's
Manual, version 3.0, and subsequent updates when issued by the Centers for Medicare and
Medicaid Services deleted text end new text begin Long-Term Care Facility Resident Assessment Instrument User's Manual
Version 3.0 or its successor issued by the Centers for Medicare and Medicaid Services new text end . The
commissioner of health may substitute successor manuals or question and answer documents
published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, to replace or supplement the current version of the manual
or document.

(b) The new text begin OBRA new text end assessments used to determine a case mix classification for reimbursement
include the following:

(1) deleted text begin a new deleted text end new text begin an new text end admission assessment;

(2) an annual assessment deleted text begin which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment deleted text end ;

(3) a significant change in status assessment deleted text begin must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessment deleted text end ;

(4) all quarterly assessments deleted text begin must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment deleted text end ;

(5) deleted text begin any deleted text end significant correction to a prior comprehensive assessment, if the new text begin corrected new text end
assessment deleted text begin being corrected deleted text end is the current deleted text begin one deleted text end new text begin assessment new text end being used for deleted text begin RUG classification deleted text end new text begin
payment new text end ; deleted text begin and
deleted text end

(6) deleted text begin any deleted text end significant correction to a prior quarterly assessment, if the new text begin corrected new text end assessment
deleted text begin being corrected deleted text end is the current deleted text begin one deleted text end new text begin assessment new text end being used for deleted text begin RUG classification. deleted text end new text begin payment;
and
new text end

new text begin (7) modifications to the most recent assessments in clauses (1) to (6).
new text end

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and

(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.

Sec. 9.

Minnesota Statutes 2020, section 144.0724, subdivision 5, is amended to read:

Subd. 5.

Short stays.

(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or less deleted text begin . deleted text end new text begin , unless the
resident is admitted and discharged from the facility on the same day, in which case the
admission assessment is not required. When an admission assessment is not submitted, the
case mix classification will be the rate with a case mix index of 1.0.
new text end

(b) Notwithstanding the admission assessment requirements of paragraph (a), a facility
may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents
who stay 14 days or less in lieu of submitting an admission assessment. Facilities shall make
this election annually.

(c) Nursing facilities must elect one of the options described in paragraphs (a) and (b)
by reporting to the commissioner of health, as prescribed by the commissioner. The election
is effective on July 1 each year.

Sec. 10.

Minnesota Statutes 2020, section 144.0724, subdivision 7, is amended to read:

Subd. 7.

Notice of resident reimbursement new text begin case mix new text end classification.

(a) The
commissioner of health shall provide to a nursing facility a notice for each resident of the
deleted text begin reimbursement deleted text end classification established under subdivision 1. The notice must inform the
resident of the new text begin case mix new text end classification deleted text begin that was deleted text end assigned, the opportunity to review the
documentation supporting the classification, the opportunity to obtain clarification from the
commissioner, and the opportunity to request a reconsideration of the classification and the
address and telephone number of the Office of Ombudsman for Long-Term Care. The
commissioner must transmit the notice of resident classification by electronic means to the
nursing facility. deleted text begin A deleted text end new text begin The new text end nursing facility is responsible for the distribution of the notice to
each resident deleted text begin , to the person responsible for the payment of the resident's nursing home
expenses, or to another person designated by the resident deleted text end new text begin or the resident's representative new text end .
This notice must be distributed within three deleted text begin working deleted text end new text begin business new text end days after the facility's receipt
deleted text begin of the electronic file of notice of case mix classifications from the commissioner of health deleted text end .

(b) If a facility submits a deleted text begin modification to the most recent assessment used to establish
a case mix classification conducted under subdivision 3 that results deleted text end new text begin modifying assessment
resulting new text end in a change deleted text begin in deleted text end new text begin of the new text end case mix classification, the facility deleted text begin shall give deleted text end new text begin must provide
a new text end written notice to the resident or the resident's representative deleted text begin about deleted text end new text begin regarding new text end the item new text begin or
items new text end that deleted text begin was deleted text end new text begin were new text end modified and the reason for the deleted text begin modification deleted text end new text begin modifications new text end . The notice
deleted text begin of modified assessment may deleted text end new text begin must new text end be provided deleted text begin at the same time that the resident or resident's
representative is provided the resident's modified notice of classification deleted text end new text begin within three business
days of the resident classification notice new text end .

Sec. 11.

Minnesota Statutes 2020, section 144.0724, subdivision 8, is amended to read:

Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident, or
resident's representative, or the nursing facility new text begin , new text end or deleted text begin boarding deleted text end new text begin board and new text end care home may
request that the commissioner of health reconsider the assigned reimbursement new text begin case mix new text end
classification new text begin and any item or items changed during the audit process new text end . The request for
reconsideration must be submitted in writing to the commissioner deleted text begin within 30 days of the day
the resident or the resident's representative receives the resident classification notice deleted text end new text begin of
health new text end .

new text begin (b) For reconsideration requests initiated by the resident or the resident's representative:
new text end

new text begin (1) The resident or the resident's representative must submit in writing a reconsideration
request to the facility administrator within 30 days of receipt of the resident classification
notice. new text end The new text begin written new text end request deleted text begin for reconsideration deleted text end must include the deleted text begin name of the resident, the
name and address of the facility in which the resident resides, the deleted text end reasons for the
reconsideration deleted text begin , and documentation supporting the deleted text end request. deleted text begin The documentation accompanying
the reconsideration request is limited to a copy of the MDS that determined the classification
and other documents that would support or change the MDS findings.
deleted text end

new text begin (2) Within three business days of receiving the reconsideration request, the nursing
facility must submit to the commissioner of health a completed reconsideration request
form, a copy of the resident's or resident's representative's written request, and all supporting
documentation used to complete the assessment being considered. If the facility fails to
provide the required information, the reconsideration will be completed with the information
submitted and the facility cannot make further reconsideration requests on this classification.
new text end

deleted text begin (b) deleted text end new text begin (3) new text end Upon new text begin written new text end request new text begin and within three business days new text end , the nursing facility must
give the resident or the resident's representative a copy of the assessment deleted text begin form deleted text end new text begin being
reconsidered new text end and deleted text begin the other deleted text end new text begin all supporting new text end documentation deleted text begin that was given to the commissioner
of health deleted text end new text begin used new text end to deleted text begin support deleted text end new text begin complete new text end the assessment deleted text begin findings deleted text end . deleted text begin The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information. deleted text end Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the deleted text begin material deleted text end new text begin required documents new text end within this time, it is subject to the issuance of
a correction order and penalty assessment under sections 144.653 and 144A.10.
Notwithstanding those sections, any correction order issued under this subdivision must
require that the nursing facility immediately comply with the request for information and
that as of the date of the issuance of the correction order, the facility shall forfeit to the state
a $100 fine for the first day of noncompliance, and an increase in the $100 fine by $50
increments for each day the noncompliance continues.

(c) deleted text begin in addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
deleted text end deleted text begin classification notices were distributed to the resident or the resident's representative; and
(iii) deleted text end new text begin For reconsideration requests initiated by the facility:
new text end

new text begin (1) The facility is required to inform the resident or the resident's representative in writing
that a reconsideration of the resident's case mix classification is being requested. The notice
must inform the resident or the resident's representative:
new text end

new text begin (i) of the date and reason for the reconsideration request;
new text end

new text begin (ii) of the potential for a classification and subsequent rate change;
new text end

new text begin (iii) of the extent of the potential rate change;
new text end

new text begin (iv) that copies of the request and supporting documentation are available for review;
and
new text end

new text begin (v) that the resident or the resident's representative has the right to request a
reconsideration.
new text end

new text begin (2) Within 30 days of receipt of the audit exit report or resident classification notice, the
facility must submit to the commissioner of health a completed reconsideration request
form, all supporting documentation used to complete the assessment being reconsidered,
and new text end a copy of deleted text begin a deleted text end new text begin the new text end notice deleted text begin sent to deleted text end new text begin informing new text end the resident or deleted text begin to deleted text end the resident's representative deleted text begin .
This notice must inform the resident or the resident's representative deleted text end that a reconsideration
of the resident's classification is being requested deleted text begin , the reason for the request, that the resident's
rate will change if the request is approved by the commissioner, the extent of the change,
that copies of the facility's request and supporting documentation are available for review,
and that the resident also has the right to request a reconsideration deleted text end .

new text begin (3) new text end If the facility fails to provide the required information deleted text begin listed in item (iii) with the
reconsideration request, the commissioner may request that the facility provide the
information within 14 calendar days. deleted text end new text begin , new text end the reconsideration request deleted text begin must deleted text end new text begin may new text end be denied deleted text begin if the
information is then not provided, deleted text end and the facility may not make further reconsideration
requests on deleted text begin that specific reimbursement deleted text end new text begin this new text end classification.

(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner new text begin of health new text end under paragraphs (a) deleted text begin and
(b) deleted text end new text begin to (c) new text end . If necessary for evaluating the reconsideration request, the commissioner may
conduct on-site reviews. Within 15 deleted text begin working deleted text end new text begin business new text end days of receiving the request for
reconsideration, the commissioner shall affirm or modify the original resident classification.
The original classification must be modified if the commissioner determines that the
assessment resulting in the classification did not accurately reflect characteristics of the
resident at the time of the assessment. deleted text begin The resident and the nursing facility or boarding care
home shall be notified within five working days after the decision is made. deleted text end new text begin The commissioner
must transmit the reconsideration classification notice by electronic means to the nursing
facility. The nursing facility is responsible for the distribution of the notice to the resident
or the resident's representative. The notice must be distributed by the nursing facility within
three business days after receipt. new text end A decision by the commissioner under this subdivision is
the final administrative decision of the agency for the party requesting reconsideration.

(e) The deleted text begin resident deleted text end new text begin case mix new text end classification established by the commissioner shall be the
classification deleted text begin that deleted text end new text begin which new text end applies to the resident while the request for reconsideration is
pending. If a request for reconsideration applies to an assessment used to determine nursing
facility level of care under subdivision 4, paragraph (c), the resident shall continue to be
eligible for nursing facility level of care while the request for reconsideration is pending.

(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.

Sec. 12.

Minnesota Statutes 2020, section 144.0724, subdivision 9, is amended to read:

Subd. 9.

Audit authority.

(a) The commissioner shall audit the accuracy of resident
assessments performed under section 256R.17 through any of the following: desk audits;
on-site review of residents and their records; and interviews with staff, residents, or residents'
families. The commissioner shall reclassify a resident if the commissioner determines that
the resident was incorrectly classified.

(b) The commissioner is authorized to conduct on-site audits on an unannounced basis.

(c) A facility must grant the commissioner access to examine the medical records relating
to the resident assessments selected for audit under this subdivision. The commissioner may
also observe and speak to facility staff and residents.

(d) The commissioner shall consider documentation under the time frames for coding
items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment
Instrument User's Manual published by the Centers for Medicare and Medicaid Services.

(e) The commissioner shall develop an audit selection procedure that includes the
following factors:

(1) Each facility shall be audited annually. If a facility has two successive audits in which
the percentage of change is five percent or less and the facility has not been the subject of
a special audit in the past 36 months, the facility may be audited biannually. A stratified
sample of 15 percent, with a minimum of ten assessments, of the most current assessments
shall be selected for audit. If more than 20 percent of the RUG-IV classifications are changed
as a result of the audit, the audit shall be expanded to a second 15 percent sample, with a
minimum of ten assessments. If the total change between the first and second samples is
35 percent or greater, the commissioner may expand the audit to all of the remaining
assessments.

(2) If a facility qualifies for an expanded audit, the commissioner may audit the facility
again within six months. If a facility has two expanded audits within a 24-month period,
that facility will be audited at least every six months for the next 18 months.

(3) The commissioner may conduct special audits if the commissioner determines that
circumstances exist that could alter or affect the validity of case mix classifications of
residents. These circumstances include, but are not limited to, the following:

(i) frequent changes in the administration or management of the facility;

(ii) an unusually high percentage of residents in a specific case mix classification;

(iii) a high frequency in the number of reconsideration requests received from a facility;

(iv) frequent adjustments of case mix classifications as the result of reconsiderations or
audits;

(v) a criminal indictment alleging provider fraud;

(vi) other similar factors that relate to a facility's ability to conduct accurate assessments;

(vii) an atypical pattern of scoring minimum data set items;

(viii) nonsubmission of assessments;

(ix) late submission of assessments; or

(x) a previous history of audit changes of 35 percent or greater.

(f) deleted text begin Within 15 working days of completing the audit process, the commissioner shall
make available electronically the results of the audit to the facility. If the results of the audit
reflect a change in the resident's case mix classification, a case mix classification notice
will be made available electronically to the facility, using the procedure in subdivision 7,
paragraph (a). The notice must contain the resident's classification and a statement informing
the resident, the resident's authorized representative, and the facility of their right to review
the commissioner's documents supporting the classification and to request a reconsideration
of the classification. This notice must also include the address and telephone number of the
Office of Ombudsman for Long-Term Care. deleted text end new text begin If the audit results in a case mix classification
change, the commissioner must transmit the audit classification notice by electronic means
to the nursing facility within 15 business days of completing an audit. The nursing facility
is responsible for distribution of the notice to each resident or the resident's representative.
This notice must be distributed by the nursing facility within three business days after
receipt. The notice must inform the resident of the case mix classification assigned, the
opportunity to review the documentation supporting the classification, the opportunity to
obtain clarification from the commissioner, the opportunity to request a reconsideration of
the classification, and the address and telephone number of the Office of Ombudsman for
Long-Term Care.
new text end

Sec. 13.

Minnesota Statutes 2020, section 144.0724, subdivision 12, is amended to read:

Subd. 12.

Appeal of nursing facility level of care determination.

(a) A resident or
prospective resident whose level of care determination results in a denial of long-term care
services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
paragraph (h), clause (9).

(b) The commissioner of human services shall ensure that notice of changes in eligibility
due to a nursing facility level of care determination is provided to each affected recipient
or the recipient's guardian at least 30 days before the effective date of the change. The notice
shall include the following information:

(1) how to obtain further information on the changes;

(2) how to receive assistance in obtaining other services;

(3) a list of community resources; and

(4) appeal rights.

deleted text begin A recipient who meets the criteria in section 256B.0922, subdivision 2, paragraph (a), clauses
(1) and (2), may request continued services pending appeal within the time period allowed
to request an appeal under section 256.045, subdivision 3, paragraph (i). This paragraph is
in effect for appeals filed between January 1, 2015, and December 31, 2016.
deleted text end

Sec. 14.

Minnesota Statutes 2020, section 145.893, subdivision 1, is amended to read:

Subdivision 1.

deleted text begin Vouchers deleted text end new text begin Food benefits new text end .

An eligible individual shall receive deleted text begin vouchers deleted text end new text begin
food benefits new text end for the purchase of specified nutritional supplements in type and quantity
approved by the commissioner. Alternate forms of delivery may be developed by the
commissioner in appropriate cases.

Sec. 15.

Minnesota Statutes 2020, section 145.894, is amended to read:

145.894 STATE COMMISSIONER OF HEALTH; DUTIES, RESPONSIBILITIES.

The commissioner of health shall:

(1) develop a comprehensive state plan for the delivery of nutritional supplements to
pregnant and lactating women, infants, and children;

(2) contract with existing local public or private nonprofit organizations for the
administration of the nutritional supplement program;

(3) develop and implement a public education program promoting the provisions of
sections 145.891 to 145.897, and provide for the delivery of individual and family nutrition
education and counseling at project sites. The education programs must include a campaign
to promote breast feeding;

(4) develop in cooperation with other agencies and vendors a uniform state voucher
system for the delivery of nutritional supplements;

(5) authorize local health agencies to issue deleted text begin vouchers bimonthly deleted text end new text begin food benefits trimonthly new text end
to some or all eligible individuals served by the agency, provided the agency demonstrates
that the federal minimum requirements for providing nutrition education will continue to
be met and that the quality of nutrition education and health services provided by the agency
will not be adversely impacted;

(6) investigate and implement a system to reduce the cost of nutritional supplements
and maintain ongoing negotiations with nonparticipating manufacturers and suppliers to
maximize cost savings;

(7) develop, analyze, and evaluate the health aspects of the nutritional supplement
program and establish nutritional guidelines for the program;

(8) apply for, administer, and annually expend at least 99 percent of available federal
or private funds;

(9) aggressively market services to eligible individuals by conducting ongoing outreach
activities and by coordinating with and providing marketing materials and technical assistance
to local human services and community service agencies and nonprofit service providers;

(10) determine, on July 1 of each year, the number of pregnant women participating in
each special supplemental food program for women, infants, and children (WIC) and, deleted text begin in
1986, 1987, and 1988, deleted text end at the commissioner's discretion, designate a different food program
deliverer if the current deliverer fails to increase the participation of pregnant women in the
program by at least ten percent over the previous year's participation rate;

(11) promulgate all rules necessary to carry out the provisions of sections 145.891 to
145.897; and

(12) ensure that any state appropriation to supplement the federal program is spent
consistent with federal requirements.

Sec. 16.

Minnesota Statutes 2020, section 145.897, is amended to read:

145.897 deleted text begin VOUCHERS deleted text end new text begin FOOD BENEFITS new text end .

deleted text begin Vouchers deleted text end new text begin Food benefits new text end issued pursuant to sections 145.891 to 145.897 shall be only
for the purchase of those foods determined by the deleted text begin commissioner deleted text end new text begin United States Department
of Agriculture new text end to be desirable nutritional supplements for pregnant and lactating women,
infants and children. deleted text begin These foods shall include, but not be limited to, iron fortified infant
formula, vegetable or fruit juices, cereal, milk, cheese, and eggs.
deleted text end

Sec. 17.

Minnesota Statutes 2020, section 256.98, subdivision 1, is amended to read:

Subdivision 1.

Wrongfully obtaining assistance.

new text begin (a) new text end A person who commits any of the
following acts or omissions with intent to defeat the purposes of sections 145.891 to 145.897,
the MFIP program formerly codified in sections 256.031 to 256.0361, the AFDC program
formerly codified in sections 256.72 to 256.871, chapter 256B, 256D, 256I, 256J, 256K, or
256L, child care assistance programs, and emergency assistance programs under section
256D.06, is guilty of theft and shall be sentenced under section 609.52, subdivision 3, clauses
(1) to (5):

(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a
willfully false statement or representation, by intentional concealment of any material fact,
or by impersonation or other fraudulent device, assistance or the continued receipt of
assistance, to include child care assistance or deleted text begin vouchers deleted text end new text begin food benefits new text end produced according
to sections 145.891 to 145.897 and MinnesotaCare services according to sections 256.9365,
256.94, and 256L.01 to 256L.15, to which the person is not entitled or assistance greater
than that to which the person is entitled;

(2) knowingly aids or abets in buying or in any way disposing of the property of a
recipient or applicant of assistance without the consent of the county agency; or

(3) obtains or attempts to obtain, alone or in collusion with others, the receipt of payments
to which the individual is not entitled as a provider of subsidized child care, or by furnishing
or concurring in a willfully false claim for child care assistance.

new text begin (b) new text end The continued receipt of assistance to which the person is not entitled or greater than
that to which the person is entitled as a result of any of the acts, failure to act, or concealment
described in this subdivision shall be deemed to be continuing offenses from the date that
the first act or failure to act occurred.

Sec. 18.

Laws 2020, Seventh Special Session chapter 1, article 6, section 12, subdivision
4, is amended to read:

Subd. 4.

Housing with services establishment registration; conversion to an assisted
living facility license.

(a) Housing with services establishments registered under chapter
144D, providing home care services according to chapter 144A to at least one resident, and
intending to provide assisted living services on or after August 1, 2021, must submit an
application for an assisted living facility license in accordance with section 144G.12 no
later than June 1, 2021. The commissioner shall consider the application in accordance with
section deleted text begin 144G.16 deleted text end new text begin 144G.15 new text end .

(b) Notwithstanding the housing with services contract requirements identified in section
144D.04, any existing housing with services establishment registered under chapter 144D
that does not intend to convert its registration to an assisted living facility license under this
chapter must provide written notice to its residents at least 60 days before the expiration of
its registration, or no later than May 31, 2021, whichever is earlier. The notice must:

(1) state that the housing with services establishment does not intend to convert to an
assisted living facility;

(2) include the date when the housing with services establishment will no longer provide
housing with services;

(3) include the name, e-mail address, and phone number of the individual associated
with the housing with services establishment that the recipient of home care services may
contact to discuss the notice;

(4) include the contact information consisting of the phone number, e-mail address,
mailing address, and website for the Office of Ombudsman for Long-Term Care and the
Office of Ombudsman for Mental Health and Developmental Disabilities; and

(5) for residents who receive home and community-based waiver services under section
256B.49 and chapter 256S, also be provided to the resident's case manager at the same time
that it is provided to the resident.

(c) A housing with services registrant that obtains an assisted living facility license, but
does so under a different business name as a result of reincorporation, and continues to
provide services to the recipient, is not subject to the 60-day notice required under paragraph
(b). However, the provider must otherwise provide notice to the recipient as required under
sections 144D.04 and 144D.045, as applicable, and section 144D.09.

(d) All registered housing with services establishments providing assisted living under
sections 144G.01 to 144G.07 prior to August 1, 2021, must have an assisted living facility
license under this chapter.

(e) Effective August 1, 2021, any housing with services establishment registered under
chapter 144D that has not converted its registration to an assisted living facility license
under this chapter is prohibited from providing assisted living services.

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 begin REPEALER.
new text end

new text begin Minnesota Statutes 2020, sections 144.0721, subdivision 1; 144.0722; and 144.693, new text end new text begin are
repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 21-00175

144.0721 ASSESSMENTS OF CARE AND SERVICES TO NURSING HOME RESIDENTS.

Subdivision 1.

Appropriateness and quality.

Until the date of implementation of the revised case mix system based on the minimum data set, the commissioner of health shall assess the appropriateness and quality of care and services furnished to private paying residents in nursing homes and boarding care homes that are certified for participation in the medical assistance program under United States Code, title 42, sections 1396-1396p. These assessments shall be conducted until the date of implementation of the revised case mix system with the exception of provisions requiring recommendations for changes in the level of care provided to the private paying residents.

144.0722 RESIDENT REIMBURSEMENT CLASSIFICATIONS.

Subdivision 1.

Resident reimbursement classifications.

The commissioner of health shall establish resident reimbursement classifications based upon the assessments of residents of nursing homes and boarding care homes conducted under section 144.0721, or under rules established by the commissioner of human services under chapter 256R. The reimbursement classifications established by the commissioner must conform to the rules established by the commissioner of human services.

Subd. 2.

Notice of resident reimbursement classification.

The commissioner of health shall notify each resident, and the nursing home or boarding care home in which the resident resides, of the reimbursement classification established under subdivision 1. The notice must inform the resident of the classification that was assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the commissioner, and the opportunity to request a reconsideration of the classification. The notice of resident classification must be sent by first-class mail. The individual resident notices may be sent to the resident's nursing home or boarding care home for distribution to the resident. The nursing home or boarding care home is responsible for the distribution of the notice to each resident, to the person responsible for the payment of the resident's nursing home expenses, or to another person designated by the resident. This notice must be distributed within three working days after the facility's receipt of the notices from the department.

Subd. 2a.

Semiannual assessment by nursing facilities.

Notwithstanding Minnesota Rules, part 9549.0059, subpart 2, item B, the individual dependencies items 21 to 24 and 28 are required to be completed in accordance with the Facility Manual for Completing Case Mix Requests for Classification, July 1987, issued by the Minnesota Department of Health.

Subd. 3.

Request for reconsideration.

The resident or the nursing home or boarding care home may request that the commissioner reconsider the assigned reimbursement classification. The request for reconsideration must be submitted in writing to the commissioner within 30 days of the receipt of the notice of resident classification. For reconsideration requests submitted by or on behalf of the resident, the time period for submission of the request begins as of the date the resident or the resident's representative receives the classification notice. The request for reconsideration must include the name of the resident, the name and address of the facility in which the resident resides, the reasons for the reconsideration, the requested classification changes, and documentation supporting the requested classification. The documentation accompanying the reconsideration request is limited to documentation establishing that the needs of the resident at the time of the assessment resulting in the disputed classification justify a change of classification.

Subd. 3a.

Access to information.

Upon written request, the nursing home or boarding care home must give the resident or the resident's representative a copy of the assessment form and the other documentation that was given to the department to support the assessment findings. The nursing home or boarding care home shall also provide access to and a copy of other information from the resident's record that has been requested by or on behalf of the resident to support a resident's reconsideration request. A copy of any requested material must be provided within three working days of receipt of a written request for the information. If a facility fails to provide the material within this time, it is subject to the issuance of a correction order and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order issued under this subdivision must require that the facility immediately comply with the request for information and that as of the date of the issuance of the correction order, the facility shall forfeit to the state a $100 fine the first day of noncompliance, and an increase in the $100 fine by $50 increments for each day the noncompliance continues. For the purposes of this section, "representative" includes the resident's guardian or conservator, the person authorized to pay the nursing home expenses of the resident, a representative of the nursing home ombudsman's office whose assistance has been requested, or any other individual designated by the resident.

Subd. 3b.

Facility's request for reconsideration.

In addition to the information required in subdivision 3, a reconsideration request from a nursing home or boarding care home must contain the following information: the date the resident reimbursement classification notices were received by the facility; the date the classification notices were distributed to the resident or the resident's representative; and a copy of a notice sent to the resident or to the resident's representative. This notice must tell the resident or the resident's representative that a reconsideration of the resident's classification is being requested, the reason for the request, that the resident's rate will change if the request is approved by the department and the extent of the change, that copies of the facility's request and supporting documentation are available for review, and that the resident also has the right to request a reconsideration. If the facility fails to provide this information with the reconsideration request, the request must be denied, and the facility may not make further reconsideration requests on that specific reimbursement classification.

Subd. 4.

Reconsideration.

The commissioner's reconsideration must be made by individuals not involved in reviewing the assessment that established the disputed classification. The reconsideration must be based upon the initial assessment and upon the information provided to the commissioner under subdivision 3. If necessary for evaluating the reconsideration request, the commissioner may conduct on-site reviews. In its discretion, the commissioner may review the reimbursement classifications assigned to all residents in the facility. Within 15 working days of receiving the request for reconsideration, the commissioner shall affirm or modify the original resident classification. The original classification must be modified if the commissioner determines that the assessment resulting in the classification did not accurately reflect the needs of the resident at the time of the assessment. The resident and the nursing home or boarding care home shall be notified within five working days after the decision is made. The commissioner's decision under this subdivision is the final administrative decision of the agency.

Subd. 5.

Audit authority.

The Department of Health may audit assessments of nursing home and boarding care home residents. These audits may be in addition to the assessments completed by the department under section 144.0721. The audits may be conducted at the facility, and the department may conduct the audits on an unannounced basis.

144.693 MEDICAL MALPRACTICE CLAIMS; REPORTS.

Subdivision 1.

Insurers' reports to commissioner.

On or before September 1, 1976, and on or before March 1 and September 1 of each year thereafter, each insurer providing professional liability insurance to one or more hospitals, outpatient surgery centers, or health maintenance organizations, shall submit to the state commissioner of health a report listing by facility or organization all claims which have been closed by or filed with the insurer during the period ending December 31 of the previous year or June 30 of the current year. The report shall contain, but not be limited to, the following information:

(1) the total number of claims made against each facility or organization which were filed or closed during the reporting period;

(2) the date each new claim was filed with the insurer;

(3) the allegations contained in each claim filed during the reporting period;

(4) the disposition and closing date of each claim closed during the reporting period;

(5) the dollar amount of the award or settlement for each claim closed during the reporting period; and

(6) any other information the commissioner of health may, by rule, require.

Any hospital, outpatient surgery center, or health maintenance organization which is self insured shall be considered to be an insurer for the purposes of this section and shall comply with the reporting provisions of this section.

A report from an insurer submitted pursuant to this section is private data, as defined in section 13.02, subdivision 12, accessible to the facility or organization which is the subject of the data, and to its authorized agents. Any data relating to patient records which is reported to the state commissioner of health pursuant to this section shall be reported in the form of summary data, as defined in section 13.02, subdivision 19.

Subd. 2.

Report to legislature.

The state commissioner of health shall collect and review the data reported pursuant to subdivision 1. On December 1, 1976, and on January 2 of each year thereafter, the state commissioner of health shall report to the legislature the findings related to the incidence and size of malpractice claims against hospitals, outpatient surgery centers, and health maintenance organizations, and shall make any appropriate recommendations to reduce the incidence and size of the claims. Data published by the state commissioner of health pursuant to this subdivision with respect to malpractice claims information shall be summary data within the meaning of section 13.02, subdivision 19.

Subd. 3.

Access to insurers' records.

The state commissioner of health shall have access to the records of any insurer relating to malpractice claims made against hospitals, outpatient surgery centers, and health maintenance organizations in years prior to 1976 if the commissioner determines the records are necessary to fulfill the duties of the commissioner under Laws 1976, chapter 325.