SF 2643

as introduced - 88th Legislature (2013 - 2014) Posted on 05/02/2014 08:36am

A bill for an act
relating to health; changing provisions for adequate care requirement; requiring
a report; amending Minnesota Statutes 2012, sections 144A.04, subdivision 7;
256B.434, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2012, section 144A.04, subdivision 7, is amended to read:

Subd. 7.

deleted text begin Minimum nursing staff deleted text end new text begin Adequate care new text end requirement.

deleted text begin Notwithstanding
the provisions of Minnesota Rules, part 4655.5600, the minimum staffing standard for
nursing personnel in certified nursing homes is as follows:
deleted text end

deleted text begin (a) The minimum number of hours of nursing personnel to be provided in a nursing
home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized
resident day. Upon transition to the 34 group, RUG-III resident classification system, the
0.95 hours per standardized resident day shall no longer apply.
deleted text end

deleted text begin (b) For purposes of this subdivision, "hours of nursing personnel" means the paid,
on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the
basis of any given 24-hour period. "Productive nursing hours" means all on-duty hours
during which nurses and nursing assistants are engaged in nursing duties. Examples
of nursing duties may be found in Minnesota Rules, parts 4655.5900, 4655.6100, and
4655.6400. Not included are vacations, holidays, sick leave, in-service classroom training,
or lunches. Also not included are the nonproductive nursing hours of the in-service
training director. In homes with more than 60 licensed beds, the hours of the director
of nursing are excluded. "Standardized resident day" means the sum of the number of
residents in each case mix class multiplied by the case mix weight for that resident class,
as found in Minnesota Rules, part 9549.0059, subpart 2, calculated on the basis of a
facility's census for any given day. For the purpose of determining a facility's census, the
commissioner of health shall exclude the resident days claimed by the facility for resident
therapeutic leave or bed hold days.
deleted text end

deleted text begin (c) Calculation of nursing hours per standardized resident day is performed by
dividing total hours of nursing personnel for a given period by the total of standardized
resident days for that same period.
deleted text end

deleted text begin (d) A nursing home that is issued a notice of noncompliance under section 144A.10,
subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for
each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.
deleted text end

new text begin (a) Beginning January 1, 2015, the adequate care standard for productive, direct
hands-on care nursing personnel in licensed nursing homes shall be the greater of four
hours per standardized resident day.
new text end

new text begin (b) Beginning January 1, 2015, the adequate care standard for productive, direct
hands-on care nursing personnel in licensed nursing homes shall be four hours per
standardized day.
new text end

new text begin (c) For purposes of this subdivision, "productive hours of nursing personnel" means
the hours of all nurses, nursing assistants, and therapeutic medication aides providing
on-duty, direct hands-on resident care, or other direct hands-on care nursing duties,
calculated on the basis of each 24-hour period. The hours not included in productive hours
of nursing personnel include but are not limited to: vacations, supplemental holiday pay,
sick leave, in-service classroom training, supplemental holiday pay, the hours of in-service
training director, the assistant director of nursing, the minimum data set nurse, and nursing
hours separately reimbursed under section 256B.431, subdivision 2e.
new text end

new text begin (d) For purposes of this subdivision, "standardized resident day" means the sum of
the number of residents in each case mix class multiplied by the case mix weight for
that resident class, as published by the department, calculated on the basis of a facility's
census each day. Changes of RUG class assignment shall not take effect until receipt of
notification from the commissioner of health. For the purpose of determining a facility's
census, the commissioner of health shall exclude the resident days claimed by the facility
for resident therapeutic leave or bed hold days.
new text end

new text begin (e) Calculation of productive nursing hours per resident day is performed by dividing
total productive hours of nursing personnel for each day by the number of residents on that
day. Calculation of productive nursing hours per standardized resident day is performed
by dividing total productive hours of nursing personnel for each day by the total of
standardized resident days for that day. Licensed nursing homes shall prepare monthly
reports to the commissioner according to instructions and on forms provided by the
commissioner. The filed reports are public documents and shall be posted in a prominent
location at each nursing home site for review by patients, visitors, and staff. Copies must
be provided to the facility's staff collective bargaining representative upon request.
new text end

new text begin (f) A nursing home with one or more instance in which the adequate care standard is
not met shall be issued a notice of noncompliance under section 144A.10, subdivision 5,
for a violation of this subdivision, and beginning April 15, 2015, shall be assessed a civil
fine according to clauses (1) to (3), subject to section 144A.10, subdivisions 7 and 8. For:
new text end

new text begin (1) the first occurrence of noncompliance in each six-month period, the fine shall
be $250;
new text end

new text begin (2) each of the second and third occurrence in each six-month period, the fine shall
be $500; and
new text end

new text begin (3) each occurrence over three occurrences in each six-month period, the fine shall
be $1,000. An "occurrence of noncompliance" means either a day during which the actual
staffing levels fall below the standard required in paragraph (a) or (b). An occurrence
in which data reported under paragraph (e) are determined by the commissioner to be
materially inaccurate.
new text end

new text begin (g) The commissioner may allow exceptions to the definition of nursing staff to
include other direct care staff, waive notices of noncompliance, and waive fines under
extraordinary circumstances at the sole discretion of the commissioner.
new text end

new text begin (h) Fines collected under this subdivision shall be deposited in a special revenue
account and shall be used by the commissioner for grants for education and training
of direct care staff.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2012, section 256B.434, is amended by adding a
subdivision to read:

new text begin Subd. 22. new text end

new text begin Nursing facility rate increases. new text end

new text begin Beginning January 1, 2015, nursing
facilities may apply to the commissioner and the commissioner shall allow rate increases
to nursing facilities to cover the costs of complying with the standards in section 144A.04.
Applications shall be submitted to the commissioner in a manner determined by the
commissioner. In determining allowable rate increases, the commissioner shall consider:
new text end

new text begin (1) the standards in section 144A.04, subdivision 7;
new text end

new text begin (2) actual productive hours of direct care, average hourly cost of employed staff, and
resident days by RUGs classification reported on a facility's most recent annual statistical
and cost report under section 256B.441; and
new text end

new text begin (3) the facility's statement of the number of hours, by discipline, that are required
to be added to achieve adequate care in order to ensure compliance, not to exceed the
difference between the adequate care standard and previous levels by more than 20 percent.
new text end

new text begin EFFECTIVE DATE. new text end

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