SF 4006

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/17/2022 10:54am

A bill for an act
relating to health; requiring hospital core staffing plans; creating a presumption
of workers' compensation eligibility for licensed registered nurses providing direct
care in hospitals who receive a diagnosis of post-traumatic stress disorder;
modifying the health professional education loan forgiveness program; establishing
the hospital nursing education loan forgiveness program; appropriating money;
amending Minnesota Statutes 2020, sections 144.1501, subdivision 4; 144.55,
subdivision 6; 144.653, subdivision 5; 144.7055; 144.7067, by adding a subdivision;
144A.53, subdivision 2; 256R.02, subdivision 22; Minnesota Statutes 2021
Supplement, sections 144.1501, subdivision 3; 176.011, subdivision 15; proposing
coding for new law in Minnesota Statutes, chapter 144.

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

Section 1. new text begin TITLE.
new text end

new text begin This act shall be known as the "Keeping Nurses at the Bedside Act."
new text end

Sec. 2.

Minnesota Statutes 2021 Supplement, 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 training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, alcohol and drug counselor, pharmacist, public health nurse, midlevel
practitioner, registered nurse, or a licensed practical nurse. The commissioner may also
consider applications submitted by graduates in eligible professions who are licensed and
in practice; and

(2) submit an application to the commissioner of health.

(b) new text begin Except as specified in paragraph (c), new text end 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
training, 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 training.

new text begin (c) An applicant selected to participate who is a nurse and who agrees to teach according
to subdivision 2, paragraph (a), clause (3), must sign a contract to agree to teach for a
minimum of two years.
new text end

Sec. 3.

Minnesota Statutes 2020, section 144.1501, subdivision 4, is amended to read:

Subd. 4.

Loan forgiveness.

new text begin (a) new text end The commissioner of health may select applicants each
year for participation in the loan forgiveness program, within the limits of available funding.
In considering applications, the commissioner shall give preference to applicants who
document diverse cultural competencies. The commissioner shall distribute available funds
for loan forgiveness proportionally among the eligible professions according to the vacancy
rate for each profession in the required geographic area, facility type, teaching area, patient
group, or specialty type specified in subdivision 2. The commissioner shall allocate funds
for physician loan forgiveness so that 75 percent of the funds available are used for rural
physician loan forgiveness and 25 percent of the funds available are used for underserved
urban communities and pediatric psychiatry loan forgiveness. If the commissioner does not
receive enough qualified applicants each year to use the entire allocation of funds for any
eligible profession, the remaining funds may be allocated proportionally among the other
eligible professions according to the vacancy rate for each profession in the required
geographic area, patient group, or facility type specified in subdivision 2. Applicants are
responsible for securing their own qualified educational loans. The commissioner shall
select participants based on their suitability for practice serving the required geographic
area or facility type specified in subdivision 2, as indicated by experience or training. The
commissioner shall give preference to applicants closest to completing their training. new text begin Except
as specified in paragraph (b), new text end for each year that a participant meets the service obligation
required under subdivision 3, up to a maximum of four years, the commissioner shall make
annual disbursements directly to the participant equivalent to 15 percent of the average
educational debt for indebted graduates in their profession in the year closest to the applicant's
selection for which information is available, not to exceed the balance of the participant's
qualifying educational loans. Before receiving loan repayment disbursements and as
requested, the participant must complete and return to the commissioner a confirmation of
practice form provided by the commissioner verifying that the participant is practicing as
required under subdivisions 2 and 3. The participant must provide the commissioner with
verification that the full amount of loan repayment disbursement received by the participant
has been applied toward the designated loans. After each disbursement, verification must
be received by the commissioner and approved before the next loan repayment disbursement
is made. Participants who move their practice remain eligible for loan repayment as long
as they practice as required under subdivision 2.

new text begin (b) For each year that a participant who is a nurse and who has agreed to teach according
to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner
shall make annual disbursements directly to the participant equivalent to 15 percent of the
average annual educational debt for indebted graduates in the nursing profession in the year
closest to the participant's selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
new text end

Sec. 4.

new text begin [144.1507] HOSPITAL NURSING EDUCATION LOAN FORGIVENESS
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
apply.
new text end

new text begin (b) "Nurse" means an individual who is licensed as a registered nurse and who is
providing direct patient care in a nonprofit hospital setting.
new text end

new text begin (c) "PSLF program" means the federal Public Service Loan Forgiveness program
established under Code of Federal Regulations, title 34, section 685.219.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible to participate in the hospital nursing education
loan forgiveness program, a nurse must be:
new text end

new text begin (1) enrolled in the PSLF program;
new text end

new text begin (2) employed full time as a registered nurse by a nonprofit hospital that is an eligible
employer under the PSLF program; and
new text end

new text begin (3) providing direct care to patients at the nonprofit hospital.
new text end

new text begin (b) An applicant must submit to the commissioner of health:
new text end

new text begin (1) a completed application on forms provided by the commissioner;
new text end

new text begin (2) proof that the applicant is enrolled in the PSLF program; and
new text end

new text begin (3) confirmation that the applicant is employed full time as a registered nurse by a
nonprofit hospital and is providing direct patient care.
new text end

new text begin (c) The applicant selected to participate must sign a contract to agree to continue to
provide direct patient care as a registered nurse at a nonprofit hospital for the repayment
period of the participant's eligible loan under the PSLF program.
new text end

new text begin Subd. 3. new text end

new text begin Loan forgiveness. new text end

new text begin (a) The commissioner of health shall select applicants each
year for participation in the hospital nursing education loan forgiveness program, within
limits of available funding. Applicants are responsible for applying for and maintaining
eligibility for the PSLF program.
new text end

new text begin (b) For each year that a participant meets the eligibility requirements described in
subdivision 2, the commissioner shall make an annual disbursement directly to the participant
in an amount equal to the minimum loan payments required to be paid by the participant
under the participant's repayment plan established for the participant under the PSLF program
for the previous loan year. Before receiving the annual loan repayment disbursement, the
participant must complete and return to the commissioner a confirmation of practice form
provided by the commissioner, verifying that the participant continues to meet the eligibility
requirements under subdivision 2.
new text end

new text begin (c) The participant must provide the commissioner with verification that the full amount
of loan repayment disbursement received by the participant has been applied toward the
loan for which forgiveness is sought under the PSLF program.
new text end

new text begin Subd. 4. new text end

new text begin Penalty for nonfulfillment. new text end

new text begin If a participant does not fulfill the required
minimum commitment of service as required under subdivision 2, or the secretary of
education determines that the participant does not meet eligibility requirements for the PSLF
program, the commissioner shall collect from the participant the total amount paid to the
participant under the hospital nursing education loan forgiveness program plus interest at
a rate established according to section 270C.40. The commissioner shall deposit the money
collected in the health care access fund to be credited to the health professional education
loan forgiveness program account established in section 144.1501, subdivision 2. The
commissioner shall allow waivers of all or part of the money owed to the commissioner as
a result of a nonfulfillment penalty if emergency circumstances prevent fulfillment of the
service commitment or if the PSLF program is discontinued before the participant's service
commitment is fulfilled.
new text end

Sec. 5.

Minnesota Statutes 2020, section 144.55, subdivision 6, is amended to read:

Subd. 6.

Suspension, revocation, and refusal to renew.

(a) The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the following grounds:

(1) violation of any of the provisions of sections 144.50 to 144.56 or the rules or standards
issued pursuant thereto, or Minnesota Rules, chapters 4650 and 4675;

(2) permitting, aiding, or abetting the commission of any illegal act in the institution;

(3) conduct or practices detrimental to the welfare of the patient; deleted text begin or
deleted text end

(4) obtaining or attempting to obtain a license by fraud or misrepresentation; deleted text begin or
deleted text end

(5) with respect to hospitals and outpatient surgical centers, if the commissioner
determines that there is a pattern of conduct that one or more physicians or advanced practice
registered nurses who have a "financial or economic interest," as defined in section 144.6521,
subdivision 3, in the hospital or outpatient surgical center, have not provided the notice and
disclosure of the financial or economic interest required by section 144.6521 deleted text begin . deleted text end new text begin ; or
new text end

new text begin (6) with respect to hospitals, if, after a recommendation from the director of the Office
of Health Facility Complaints, the commissioner determines that there is a pattern of the
hospital failing to comply with the hospital's core staffing plans as required under sections
144.7051 to 144.7059.
new text end

(b) The commissioner shall not renew a license for a boarding care bed in a resident
room with more than four beds.

Sec. 6.

Minnesota Statutes 2020, section 144.653, subdivision 5, is amended to read:

Subd. 5.

Correction orders.

Whenever a duly authorized representative of the state
commissioner of health finds upon inspection of a facility required to be licensed under the
provisions of sections 144.50 to 144.58 that the licensee of such facility is not in compliance
with sections 144.411 to 144.417, 144.50 to 144.58, 144.651, new text begin 144.7051 to 144.7059, new text end or
626.557, or the applicable rules promulgated under those sections, a correction order shall
be issued to the licensee. The correction order shall state the deficiency, cite the specific
rule violated, and specify the time allowed for correction.

Sec. 7.

new text begin [144.7051] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For the purposes of sections 144.7051 to 144.7059, the
terms defined in this section have the meanings given them.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Daily staffing schedule. new text end

new text begin "Daily staffing schedule" means the actual number
of full-time equivalent nonmanagerial care staff assigned to an inpatient care unit and
providing care in that unit during a 24-hour period and the actual number of patients assigned
to each direct care registered nurse present and providing care in the unit.
new text end

new text begin Subd. 4. new text end

new text begin Direct care registered nurse. new text end

new text begin "Direct care registered nurse" means a registered
nurse as defined in section 148.171, subdivision 20, who is nonsupervisory and
nonmanagerial and who directly provides nursing care to patients more than 60 percent of
the time.
new text end

new text begin Subd. 5. new text end

new text begin Hospital. new text end

new text begin "Hospital" means any setting that is licensed under this chapter as a
hospital.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 8.

new text begin [144.7053] HOSPITAL NURSE STAFFING COMMITTEES.
new text end

new text begin Subdivision 1. new text end

new text begin Hospital nurse staffing committee required. new text end

new text begin Each hospital must establish
and maintain a functioning hospital nurse staffing committee. A hospital may assign the
functions and duties of a hospital nurse staffing committee to an existing committee provided
the existing committee meets the membership requirements applicable to a hospital nurse
staffing committee.
new text end

new text begin Subd. 2. new text end

new text begin Committee membership. new text end

new text begin (a) At least 60 percent of the committee's membership
must be direct care registered nurses. Direct care registered nurses who are members of a
collective bargaining unit shall be appointed or elected to the committee according to the
guidelines of the applicable collective bargaining agreement. If there is no collective
bargaining agreement, direct care registered nurses shall be elected to the committee by
direct care registered nurses employed by the hospital.
new text end

new text begin (b) The hospital shall appoint no more than 40 percent of the committee's membership.
new text end

new text begin Subd. 3. new text end

new text begin Compensation. new text end

new text begin A hospital must treat participation in committee meetings by
any hospital employee as scheduled work time and compensate each committee member at
the employee's existing rate of pay. A hospital must relieve all direct care registered nurse
members of the hospital nurse staffing committee of other work duties during the times at
which the committee meets.
new text end

new text begin Subd. 4. new text end

new text begin Meeting frequency. new text end

new text begin Each hospital nurse staffing committee must meet at least
quarterly.
new text end

new text begin Subd. 5. new text end

new text begin Committee duties. new text end

new text begin (a) Each hospital nurse staffing committee shall create,
implement, continuously evaluate, and update as needed evidence-based written core staffing
plans to guide the creation of daily staffing schedules for each inpatient care unit of the
hospital.
new text end

new text begin (b) Each hospital nurse staffing committee must:
new text end

new text begin (1) establish a secure and anonymous method for any hospital employee or patient to
submit directly to the committee any concerns related to safe staffing;
new text end

new text begin (2) review each concern related to safe staffing submitted directly to the committee;
new text end

new text begin (3) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 5;
new text end

new text begin (4) review each concern for safe staffing form forwarded to the committee by the
commissioner;
new text end

new text begin (5) conduct a trend analysis of the data related to all reported concerns regarding safe
staffing;
new text end

new text begin (6) develop a mechanism for tracking and analyzing staffing trends within the hospital;
new text end

new text begin (7) submit to the Office of Health Facility Complaints a nurse staffing report;
new text end

new text begin (8) assist the commissioner in conducting surveys of nonmanagerial care staff by
facilitating and encouraging participation in the surveys of a representative sample of direct
care registered nurses employed by the hospital; and
new text end

new text begin (9) record in the committee minutes for each meeting a summary of the discussions and
recommendations of the committee. Each committee must maintain the minutes, records,
and distributed materials for five years.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 9.

Minnesota Statutes 2020, section 144.7055, is amended to read:

144.7055 new text begin HOSPITAL CORE new text end STAFFING PLAN deleted text begin REPORTS deleted text end .

Subdivision 1.

Definitions.

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

deleted text begin (b) deleted text end new text begin (a) new text end "Core staffing plan" means deleted text begin the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit deleted text end new text begin
a plan described in subdivision 2 new text end .

deleted text begin (c) deleted text end new text begin (b) new text end "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
and other health care workers, which may include but is not limited to nursing assistants,
nursing aides, patient care technicians, and patient care assistants, who perform
nonmanagerial direct patient care functions for more than 50 percent of their scheduled
hours on a given patient care unit.

deleted text begin (d) deleted text end new text begin (c) new text end "Inpatient care unit" new text begin or "unit" new text end means a designated inpatient area for assigning
patients and staff for which a deleted text begin distinct staffing plan deleted text end new text begin daily staffing schedule new text end exists and that
operates 24 hours per day, seven days per week in a hospital setting. Inpatient care unit does
not include any hospital-based clinic, long-term care facility, or outpatient hospital
department.

deleted text begin (e) deleted text end new text begin (d) new text end "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.

deleted text begin (f) "Patient acuity tool" means a system for measuring an individual patient's need for
nursing care. This includes utilizing a professional registered nursing assessment of patient
condition to assess staffing need.
deleted text end

Subd. 2.

Hospital new text begin core new text end staffing deleted text begin report deleted text end new text begin plans new text end .

(a) The deleted text begin chief nursing executive or nursing
designee deleted text end new text begin hospital nurse staffing committee new text end of every deleted text begin reporting deleted text end hospital deleted text begin in Minnesota under
section 144.50 will deleted text end new text begin must new text end develop a core staffing plan for each deleted text begin patient deleted text end new text begin inpatient new text end care unit.

(b) Core staffing plans deleted text begin shall deleted text end new text begin must new text end specify new text begin all of the following:
new text end

new text begin (1) new text end the new text begin projected number of new text end full-time equivalent deleted text begin for deleted text end new text begin nonmanagerial care staff that will
be assigned in a 24-hour period to new text end each deleted text begin patient deleted text end new text begin inpatient new text end care unit deleted text begin for each 24-hour period. deleted text end new text begin ;
new text end

new text begin (2) the maximum number of patients on each inpatient care unit for whom a direct care
nurse can typically safely care;
new text end

new text begin (3) criteria for determining when circumstances exist on each inpatient care unit such
that a direct care nurse cannot safely care for the typical number of patients and when
assigning a lower number of patients to each nurse on the inpatient unit would be appropriate;
new text end

new text begin (4) a procedure for each inpatient care unit to make shift-to-shift adjustments in staffing
levels when such adjustments are required by patient acuity and nursing intensity in the
unit;
new text end

new text begin (5) a contingency plan for each inpatient unit to safely address circumstances in which
patient care needs unexpectedly exceed the staffing resources provided for in a daily staffing
schedule. A contingency plan must include a method to quickly identify for each daily
staffing schedule additional direct care registered nurses who are available to provide direct
care on the inpatient care unit; and
new text end

new text begin (6) strategies to enable direct care registered nurses to take breaks to which they are
entitled under law or under an applicable collective bargaining agreement.
new text end

(c) new text begin Core staffing plans must ensure that:
new text end

new text begin (1) the person creating a daily staffing schedule has sufficiently detailed information to
create a daily staffing schedule that meets the requirements of the plan;
new text end

new text begin (2) daily staffing nurse schedules do not rely on assigning individual nonmanagerial
care staff to work overtime hours in excess of 16 hours in a 24-hour period or to work
consecutive 24-hour periods requiring 16 or more hours;
new text end

new text begin (3) a direct care registered nurse is not required or expected to perform functions outside
the nurse's professional license;
new text end

new text begin (4) light duty direct care registered nurses are given appropriate assignments; and
new text end

new text begin (5) daily staffing schedules do not interfere with applicable collective bargaining
agreements.
new text end

new text begin Subd. 2a. new text end

new text begin Development of hospital core staffing plans. new text end

new text begin (a) new text end Prior to deleted text begin submitting deleted text end new text begin
completing or updating new text end the core staffing plan, deleted text begin as required in subdivision 3, hospitals shall deleted text end new text begin
a hospital nurse staffing committee must new text end consult with representatives of the hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel about
the core staffing plan and the expected average number of patients upon which the new text begin core new text end
staffing plan is based.

new text begin (b) When developing a core staffing plan, a hospital nurse staffing committee must
consider all of the following:
new text end

new text begin (1) the individual needs and expected census of each inpatient care unit;
new text end

new text begin (2) unit-specific patient acuity, including fall risk and behaviors requiring intervention,
such as physical aggression toward self or others or destruction of property;
new text end

new text begin (3) unit-specific demands on direct care registered nurses' time, including:
new text end

new text begin (i) frequency of admissions, discharges, and transfers;
new text end

new text begin (ii) frequency and complexity of patient evaluations and assessments;
new text end

new text begin (iii) frequency and complexity of nursing care planning;
new text end

new text begin (iv) planning for patient discharge;
new text end

new text begin (v) assessing for patient referral;
new text end

new text begin (vi) patient education; and
new text end

new text begin (vii) implementing infectious disease protocols;
new text end

new text begin (4) the architecture and geography of the inpatient care unit, including the placement of
patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
new text end

new text begin (5) mechanisms and procedures to provide for one-to-one patient observation for patients
on psychiatric or other units;
new text end

new text begin (6) the stress under which direct care nurses are placed when required to work extreme
amounts of overtime, such as shifts in excess of 12 hours or multiple consecutive double
shifts;
new text end

new text begin (7) the need for specialized equipment and technology on the unit;
new text end

new text begin (8) other special characteristics of the unit or community patient population, including
age, cultural and linguistic diversity and needs, functional ability, communication skills,
and other relevant social and socioeconomic factors;
new text end

new text begin (9) the skill mix of personnel other than direct care registered nurses providing or
supporting direct patient care on the unit;
new text end

new text begin (10) mechanisms and procedures for identifying additional registered nurses who are
available for direct patient care when patients' unexpected needs exceed the planned workload
for direct care staff; and
new text end

new text begin (11) demands on direct care registered nurses' time not directly related to providing
direct care on a unit, such as involvement in quality improvement activities, professional
development, service to the hospital, including serving on the hospital nurse staffing
committee, and service to the profession.
new text end

Subd. 3.

Standard electronic reporting deleted text begin developed deleted text end new text begin of core staffing plans new text end .

deleted text begin (a) Hospitals deleted text end new text begin
Each hospital new text end must submit the core staffing plans new text begin approved by the hospital's nurse staffing
committee new text end to the Minnesota Hospital Association deleted text begin by January 1, 2014 deleted text end . The Minnesota
Hospital Association shall include each deleted text begin reporting deleted text end hospital's core staffing deleted text begin plan deleted text end new text begin plans new text end on the
Minnesota Hospital Association's Minnesota Hospital Quality Report website deleted text begin by April 1,
2014 deleted text end . new text begin Hospitals shall submit to the Minnesota Hospital Association new text end any substantial deleted text begin changes deleted text end new text begin
updates new text end to deleted text begin the deleted text end new text begin a new text end core staffing plan deleted text begin shall be updated deleted text end within 30 days new text begin of the approval of the
updates by the hospital's nurse staffing committee or of amendment through arbitration.
The Minnesota Hospital Association shall update the Minnesota Hospital Quality Report
website with the updated core staffing plans within 30 days of receipt of the updated plan new text end .

new text begin Subd. 4. new text end

new text begin Standard electronic reporting of direct patient care report. new text end

deleted text begin (b) deleted text end The Minnesota
Hospital Association shall include on its website for each reporting hospital on a quarterly
basis the actual direct patient care hours per patient and per unit. Hospitals must submit the
direct patient care report to the Minnesota Hospital Association deleted text begin by July 1, 2014, and deleted text end quarterly
deleted text begin thereafter deleted text end .

new text begin Subd. 5. new text end

new text begin Standard electronic reporting of licensing actions. new text end

new text begin The Minnesota Hospital
Association shall include on its website for public inspection a list prepared by the reporting
hospital of any civil penalties, administrative actions, license suspensions, or license
revocations imposed by the commissioner for violations of a requirement under sections
144.7051 to 144.7059.
new text end

new text begin Subd. 6. new text end

new text begin Mandatory submission of core staffing plan to commissioner. new text end

new text begin Each hospital
must submit the core staffing plans and any updates to the commissioner on the same
schedule described in subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 10.

new text begin [144.7056] IMPLEMENTATION OF HOSPITAL CORE STAFFING PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Plan implementation required. new text end

new text begin A hospital must implement the core
staffing plans approved by a majority vote of the hospital nurse staffing committee.
new text end

new text begin Subd. 2. new text end

new text begin Public posting of core staffing plans. new text end

new text begin A hospital must post the core staffing
plan for the inpatient care unit in a public area on the unit.
new text end

new text begin Subd. 3. new text end

new text begin Public posting of compliance with plan. new text end

new text begin For each publicly posted core staffing
plan, a hospital must post a notice stating whether the current staffing on the unit complies
with the hospital's core staffing plan for that unit. The public notice of compliance must
include a list of the number of nonmanagerial care staff working on the unit during the
current shift and the number of patients assigned to each direct care registered nurse working
on the unit during the current shift. The list must enumerate the nonmanagerial care staff
by health care worker type. The public notice of compliance must be posted immediately
adjacent to the publicly posted core staffing plan.
new text end

new text begin Subd. 4. new text end

new text begin Public distribution of core staffing plan and notice of compliance. new text end

new text begin (a) A
hospital must include with the posted materials described in subdivisions 2 and 3 a statement
that individual copies of the posted materials are available upon request to any patient on
the unit or to any visitor of a patient on the unit. The statement must include specific
instructions for obtaining copies of the posted materials.
new text end

new text begin (b) A hospital must, within four hours after the request, provide individual copies of all
the posted materials described in subdivisions 2 and 3 to any patient on the unit or to any
visitor of a patient on the unit who requests the materials.
new text end

new text begin Subd. 5. new text end

new text begin Documentation of compliance. new text end

new text begin Each hospital must document compliance with
its core nursing plans and maintain records demonstrating compliance for each inpatient
care unit for five years. Each hospital must provide to its nurse staffing committee access
to all documentation required under this subdivision.
new text end

new text begin Subd. 6. new text end

new text begin Dispute resolution. new text end

new text begin (a) If hospital management objects to a core staffing plan
approved by a majority vote of the hospital nurse staffing committee, the hospital may elect
to attempt to amend the core staffing plan through arbitration. The arbitration process must
include testimony on the potential impact of changes to the core staffing plan from a
representative of the Minnesota Department of Health who has experience with licensing
and compliance survey inspections of health care facilities and from a representative of the
Board of Nursing with expertise in nurse licensure who can describe the circumstances
under which a nurse's license can be put at risk when a nurse accepts a patient assignment
that the nurse believes is unsafe.
new text end

new text begin (b) During an ongoing dispute resolution process, a hospital must continue to implement
the core staffing plan as written and approved by the hospital nurse staffing committee.
new text end

new text begin (c) If the dispute resolution process results in an amendment to the core staffing plan,
the hospital must implement the amended core staffing plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2024.
new text end

Sec. 11.

new text begin [144.7057] ENFORCEMENT OF COMPLIANCE WITH HOSPITAL CORE
STAFFING PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Failure to submit nurse staffing reports. new text end

new text begin If a hospital fails to submit
to the commissioner a substantially complete nurse staffing report within 60 days of the
end of a quarter, the Office of Health Facility Complaints shall impose a fine of $5,000.
new text end

new text begin Subd. 2. new text end

new text begin Receipt of reports of unsafe staffing conditions. new text end

new text begin (a) The commissioner must
maintain a secure online portal for the submission by hospital employees of anonymous
reports of unsafe staffing conditions in any hospital.
new text end

new text begin (b) Upon receipt of a report of unsafe staffing conditions, the commissioner shall forward
the report to the Office of Health Facility Complaints for investigation, to the hospital nurse
staffing committee of the hospital that is the subject of the report, and to any collective
bargaining agent representing the licensed registered nurses employed by the hospital that
is the subject of the report.
new text end

new text begin Subd. 3. new text end

new text begin Investigation of reports of unsafe staffing conditions. new text end

new text begin (a) The director of the
Office of Health Facility Complaints shall investigate under section 144A.53 all reports of
unsafe staffing conditions. If the director determines that an inpatient care unit identified
in a complaint was not in compliance with its core staffing plan on the date identified in the
complaint or is not in compliance during an on-site investigation, the director must issue a
correction order under section 144.653.
new text end

new text begin (b) If upon reinspection the director finds that the hospital has not corrected deficiencies
specified in the correction order, a notice of noncompliance with a correction order shall
be issued stating all deficiencies not corrected. Notwithstanding section 144.653, subdivision
6, unless a hearing is requested under section 144.653, subdivision 8, the hospital shall
forfeit to the state, within 15 days after receipt by the hospital of a notice of noncompliance
with a correction order, $1,000 for each inpatient care unit out of compliance with its core
staffing plan for that unit.
new text end

new text begin (c) If after a second reinspection the director finds that the hospital has not brought an
inpatient care unit into compliance with its core staffing plan, the hospital must forfeit to
the state $5,000 per day since the previous reinspection for each inpatient care unit that
remains out of compliance with its core staffing plan.
new text end

new text begin (d) If after a third reinspection the director finds that the hospital has not brought an
inpatient care unit into compliance with its core staffing plan, the director shall recommend
to the commissioner that the commissioner suspend the license of the hospital under section
144.55.
new text end

new text begin (e) All forfeitures under this section shall be paid into the general fund.
new text end

new text begin Subd. 4. new text end

new text begin Investigations arising from nurse staffing reports. new text end

new text begin If, upon review of quarterly
nurse staffing reports submitted to the Office of Health Facility Complaints under section
144.7058, the director determines that there is a pattern of the hospital failing to comply
with the hospital's core staffing plans, the director may open an investigation. An
investigation under this subdivision is subject to the requirements of subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 12.

new text begin [144.7058] HOSPITAL NURSE STAFFING COMMITTEE REPORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Nurse staffing report required. new text end

new text begin Each hospital nurse staffing committee
must submit quarterly nurse staffing reports to the Office of Health Facility Complaints.
Reports must be submitted within 60 days of the end of the quarter.
new text end

new text begin Subd. 2. new text end

new text begin Nurse staffing report. new text end

new text begin Nurse staffing reports submitted to the Office of Health
Facility Complaints by a hospital nurse staffing committee must:
new text end

new text begin (1) identify any suspected incidents of the hospital failing during the reporting quarter
to meet the standards of one of its core staffing plans;
new text end

new text begin (2) identify problems of insufficient staffing, including but not limited to inappropriate
number of direct care registered nurses scheduled in a unit, inappropriate number of direct
care registered nurses present and delivering care in a unit, inappropriately experienced
direct care registered nurses scheduled for a particular unit, inappropriately experienced
direct care registered nurses present and delivering care in a unit, inability for nurse
supervisors to adjust daily nursing schedules for increased patient acuity or nursing intensity
in a unit, and chronically unfilled direct care positions within the hospital;
new text end

new text begin (3) identify any units that pose a risk to patient safety due to inadequate staffing;
new text end

new text begin (4) propose solutions to solve insufficient staffing;
new text end

new text begin (5) propose solutions to reduce risks to patient safety in inadequately staffed units; and
new text end

new text begin (6) describe staffing trends within the hospital.
new text end

new text begin Subd. 3. new text end

new text begin Public posting of nurse staffing reports. new text end

new text begin The Office of Health Facility
Complaints shall include on its website each quarterly nurse staffing report submitted to
the office under subdivision 1.
new text end

new text begin Subd. 4. new text end

new text begin Public posting of licensing actions. new text end

new text begin The Office of Health Facility Complaints
shall include on its website for public inspection a list prepared by the reporting hospital of
any civil penalties, administrative actions, license suspensions, or license revocations
imposed by the commissioner for violations of a requirement under sections 144.7051 to
144.7059.
new text end

new text begin Subd. 5. new text end

new text begin Standardized reporting. new text end

new text begin The commissioner shall develop and provide to each
hospital nurse staffing committee a uniform format or standard form the committee must
use to comply with the nurse staffing reporting requirements under this section. The format
or form developed by the commissioner must present the reported information in a manner
allowing patients and the public to clearly understand and compare staffing patterns and
actual levels of staffing across reporting hospitals. The commissioner must include in the
uniform format or on the standardized form space to allow the reporting hospital to include
a description of additional resources available to support unit-level patient care and a
description of the hospital.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2024.
new text end

Sec. 13.

new text begin [144.7059] RETALIATION PROHIBITED.
new text end

new text begin A hospital or the Board of Nursing may not retaliate against or discipline a direct care
registered nurse, either formally or informally, for:
new text end

new text begin (1) challenging the process by which a hospital nurse staffing committee is formed or
conducts its business;
new text end

new text begin (2) challenging a core staffing plan approved by a hospital nurse staffing committee;
new text end

new text begin (3) objecting to or submitting a grievance related to a patient assignment that leads to a
direct care registered nurse violating medical restrictions recommended by the nurse's
medical provider; or
new text end

new text begin (4) submitting a report of unsafe staffing conditions.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 14.

Minnesota Statutes 2020, section 144.7067, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Duty to analyze hospital staffing. new text end

new text begin The commissioner shall:
new text end

new text begin (1) analyze adverse event reports, nurse staffing reports submitted to the Office of Health
Facility Complaints under section 144.7058, and reports of unsafe staffing conditions
submitted to the Office of Health Facility Complaints under section 144.7057 to determine
correlations between demonstrable understaffing and adverse events and to identify patterns
of systemic understaffing in hospitals;
new text end

new text begin (2) communicate to individual hospitals the commissioner's conclusions, if any, regarding
a correlation between adverse events reported in the hospital and understaffing demonstrated
by submitted nurse staffing reports or investigations by the director of the Office of Health
Facility Complaints;
new text end

new text begin (3) communicate with relevant hospitals any recommendations for corrective action
resulting from the commissioner's analysis conducted under clause (1); and
new text end

new text begin (4) publish an annual report:
new text end

new text begin (i) describing, by hospital, correlations between adverse events and demonstrable
understaffing;
new text end

new text begin (ii) outlining, in aggregate, corrective action plans and the findings of root cause analyses
regarding understaffing in hospitals; and
new text end

new text begin (iii) making recommendations for modifications of the regulation of care provided in
hospitals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end

Sec. 15.

Minnesota Statutes 2020, section 144A.53, subdivision 2, is amended to read:

Subd. 2.

Complaints.

(a) The director may receive a complaint from any source
concerning an action of an administrative agency, a health care provider, a home care
provider, a residential care home, or a health facility. The director may require a complainant
to pursue other remedies or channels of complaint open to the complainant before accepting
or investigating the complaint. Investigators are required to interview at least one family
member of the vulnerable adult identified in the complaint. If the vulnerable adult is directing
his or her own care and does not want the investigator to contact the family, this information
must be documented in the investigative file.

(b) The director shall keep written records of all complaints and any action upon them.
After completing an investigation of a complaint, the director shall inform the complainant,
the administrative agency having jurisdiction over the subject matter, the health care provider,
the home care provider, the residential care home, and the health facility of the action taken.
Complainants must be provided a copy of the public report upon completion of the
investigation.

new text begin (c) Notwithstanding paragraph (a), for complaints arising from a report of unsafe staffing
conditions in a hospital under section 144.7057, the director must not require a complainant
to pursue other remedies or channels of complaint open to the complainant before accepting
or investigating the complaint and investigators are not required to interview at least one
family member of a vulnerable adult identified in the complaint. Within 30 days of receipt
of a report of unsafe staffing conditions in a hospital under section 144.7057, the director
must conduct an on-site complaint investigation to determine if the inpatient care unit
identified in the complaint was in compliance with its core staffing plan on the date identified
in the complaint and whether the unit is in compliance during the on-site investigation.
new text end

Sec. 16.

Minnesota Statutes 2021 Supplement, section 176.011, subdivision 15, is amended
to read:

Subd. 15.

Occupational disease.

(a) "Occupational disease" means a mental impairment
as defined in paragraph (d) or physical disease arising out of and in the course of employment
peculiar to the occupation in which the employee is engaged and due to causes in excess of
the hazards ordinary of employment and shall include undulant fever. Physical stimulus
resulting in mental injury and mental stimulus resulting in physical injury shall remain
compensable. Mental impairment is not considered a disease if it results from a disciplinary
action, work evaluation, job transfer, layoff, demotion, promotion, termination, retirement,
or similar action taken in good faith by the employer. Ordinary diseases of life to which the
general public is equally exposed outside of employment are not compensable, except where
the diseases follow as an incident of an occupational disease, or where the exposure peculiar
to the occupation makes the disease an occupational disease hazard. A disease arises out of
the employment only if there be a direct causal connection between the conditions under
which the work is performed and if the occupational disease follows as a natural incident
of the work as a result of the exposure occasioned by the nature of the employment. An
employer is not liable for compensation for any occupational disease which cannot be traced
to the employment as a direct and proximate cause and is not recognized as a hazard
characteristic of and peculiar to the trade, occupation, process, or employment or which
results from a hazard to which the worker would have been equally exposed outside of the
employment.

(b) If immediately preceding the date of disablement or death, an employee was employed
on active duty with an organized fire or police department of any municipality, as a member
of the Minnesota State Patrol, conservation officer service, state crime bureau, as a forest
officer by the Department of Natural Resources, correctional officer or security counselor
employed by the state or a political subdivision at a corrections, detention, or secure treatment
facility, or sheriff or full-time deputy sheriff of any county, and the disease is that of
myocarditis, coronary sclerosis, pneumonia or its sequel, and at the time of employment
such employee was given a thorough physical examination by a licensed doctor of medicine,
and a written report thereof has been made and filed with such organized fire or police
department, with the Minnesota State Patrol, conservation officer service, state crime bureau,
Department of Natural Resources, Department of Corrections, or sheriff's department of
any county, which examination and report negatived any evidence of myocarditis, coronary
sclerosis, pneumonia or its sequel, the disease is presumptively an occupational disease and
shall be presumed to have been due to the nature of employment. If immediately preceding
the date of disablement or death, any individual who by nature of their position provides
emergency medical care, or an employee who was employed as a licensed police officer
under section 626.84, subdivision 1; firefighter; paramedic; correctional officer or security
counselor employed by the state or a political subdivision at a corrections, detention, or
secure treatment facility; emergency medical technician; or licensed nurse providing
emergency medical care; and who contracts an infectious or communicable disease to which
the employee was exposed in the course of employment outside of a hospital, then the
disease is presumptively an occupational disease and shall be presumed to have been due
to the nature of employment and the presumption may be rebutted by substantial factors
brought by the employer or insurer. Any substantial factors which shall be used to rebut
this presumption and which are known to the employer or insurer at the time of the denial
of liability shall be communicated to the employee on the denial of liability.

(c) A firefighter on active duty with an organized fire department who is unable to
perform duties in the department by reason of a disabling cancer of a type caused by exposure
to heat, radiation, or a known or suspected carcinogen, as defined by the International
Agency for Research on Cancer, and the carcinogen is reasonably linked to the disabling
cancer, is presumed to have an occupational disease under paragraph (a). If a firefighter
who enters the service after August 1, 1988, is examined by a physician prior to being hired
and the examination discloses the existence of a cancer of a type described in this paragraph,
the firefighter is not entitled to the presumption unless a subsequent medical determination
is made that the firefighter no longer has the cancer.

(d) For the purposes of this chapter, "mental impairment" means a diagnosis of
post-traumatic stress disorder by a licensed psychiatrist or psychologist. For the purposes
of this chapter, "post-traumatic stress disorder" means the condition as described in the most
recently published edition of the Diagnostic and Statistical Manual of Mental Disorders by
the American Psychiatric Association. For purposes of section 79.34, subdivision 2, one or
more compensable mental impairment claims arising out of a single event or occurrence
shall constitute a single loss occurrence.

(e) If, preceding the date of disablement or death, an employee who was employed on
active duty as: a licensed police officer; a firefighter; a paramedic; an emergency medical
technician; a licensed nurse employed to provide emergency medical services outside of a
medical facility; new text begin a licensed registered nurse employed to provide direct care in a licensed
hospital; new text end a public safety dispatcher; a correctional officer or security counselor employed
by the state or a political subdivision at a corrections, detention, or secure treatment facility;
a sheriff or full-time deputy sheriff of any county; or a member of the Minnesota State Patrol
is diagnosed with a mental impairment as defined in paragraph (d), and had not been
diagnosed with the mental impairment previously, then the mental impairment is
presumptively an occupational disease and shall be presumed to have been due to the nature
of employment. This presumption may be rebutted by substantial factors brought by the
employer or insurer. Any substantial factors that are used to rebut this presumption and that
are known to the employer or insurer at the time of the denial of liability shall be
communicated to the employee on the denial of liability. The mental impairment is not
considered an occupational disease if it results from a disciplinary action, work evaluation,
job transfer, layoff, demotion, promotion, termination, retirement, or similar action taken
in good faith by the employer.

(f) Notwithstanding paragraph (a) and the rebuttable presumption for infectious or
communicable diseases in paragraph (b), an employee who contracts COVID-19 is presumed
to have an occupational disease arising out of and in the course of employment if the
employee satisfies the requirements of clauses (1) and (2).

(1) The employee was employed as a licensed peace officer under section 626.84,
subdivision 1; firefighter; paramedic; nurse or health care worker, correctional officer, or
security counselor employed by the state or a political subdivision at a corrections, detention,
or secure treatment facility; emergency medical technician; a health care provider, nurse,
or assistive employee employed in a health care, home care, or long-term care setting, with
direct COVID-19 patient care or ancillary work in COVID-19 patient units; and workers
required to provide child care to first responders and health care workers under Executive
Order 20-02 and Executive Order 20-19.

(2) The employee's contraction of COVID-19 must be confirmed by a positive laboratory
test or, if a laboratory test was not available for the employee, as diagnosed and documented
by the employee's licensed physician, licensed physician's assistant, or licensed advanced
practice registered nurse (APRN), based on the employee's symptoms. A copy of the positive
laboratory test or the written documentation of the physician's, physician assistant's, or
APRN's diagnosis shall be provided to the employer or insurer.

(3) Once the employee has satisfied the requirements of clauses (1) and (2), the
presumption shall only be rebutted if the employer or insurer shows the employment was
not a direct cause of the disease. A denial of liability under this paragraph must meet the
requirements for a denial under section 176.221, subdivision 1.

(4) The date of injury for an employee who has contracted COVID-19 under this
paragraph shall be the date that the employee was unable to work due to a diagnosis of
COVID-19, or due to symptoms that were later diagnosed as COVID-19, whichever occurred
first.

(5) An employee who has contracted COVID-19 but who is not entitled to the
presumption under this paragraph is not precluded from claiming an occupational disease
as provided in other paragraphs of this subdivision or from claiming a personal injury under
subdivision 16.

(6) The commissioner shall provide a detailed report on COVID-19 workers'
compensation claims under this paragraph to the Workers' Compensation Advisory Council,
and chairs and ranking minority members of the house of representatives and senate
committees with jurisdiction over workers' compensation, by January 15, 2021.

Sec. 17.

Minnesota Statutes 2020, section 256R.02, subdivision 22, is amended to read:

Subd. 22.

Fringe benefit costs.

"Fringe benefit costs" means the costs for group life,
dental, workers' compensation, short- and long-term disability, long-term care insurance,
accident insurance, supplemental insurance, legal assistance insurance, profit sharing, new text begin child
care costs, new text end health insurance costs not covered under subdivision 18, including costs associated
with part-time employee family members or retirees, and pension and retirement plan
contributions, except for the Public Employees Retirement Association costs.

Sec. 18. new text begin DIRECTION TO THE COMMISSIONER OF HEALTH; EXPANSION OF
THE NURSING WORKFORCE REPORT.
new text end

new text begin The commissioner of health shall expand the commissioner's existing license renewal
questionnaires authorized under Minnesota Statutes, sections 144.051 and 144.052, to
include the collection, analysis, and reporting of data on the following topics:
new text end

new text begin (1) Minnesota's supply of active licensed registered nurses;
new text end

new text begin (2) trends in Minnesota regarding retention by hospitals of licensed registered nurses;
new text end

new text begin (3) reasons licensed registered nurses are leaving direct care positions at hospitals; and
new text end

new text begin (4) reasons licensed registered nurses are choosing not to renew their licenses and leaving
the profession.
new text end

Sec. 19. new text begin INITIAL IMPLEMENTATION OF THE KEEPING NURSES AT THE
BEDSIDE ACT.
new text end

new text begin (a) By July 1, 2024, each hospital must establish and convene a hospital nurse staffing
committee as described under Minnesota Statutes, section 144.7053.
new text end

new text begin (b) By October 1, 2024, each hospital must implement core staffing plans developed by
its hospital nurse staffing committee and satisfy the plan posting requirements under
Minnesota Statutes, section 144.7056.
new text end

new text begin (c) By October 1, 2024, each hospital must submit to the Office of Health Facility
Complaints core staffing plans meeting the requirements of Minnesota Statutes, section
144.7055. The commissioner of health must not renew the hospital license of any hospital
that does not submit its core staffing plans by October 1, 2024, until the hospital submits
the plan.
new text end

new text begin (d) By October 1, 2024, the commissioner of health must develop and deploy a secure
online portal for the submission by hospital employees of anonymous reports of unsafe
staffing conditions. The commissioner must model the report form available through the
portal on the Minnesota Nurses Association's concern for unsafe staffing form.
new text end

new text begin (e) By December 31, 2024, the commissioner of health must provide electronic access
to the uniform format or standard form for nurse staffing reporting described under Minnesota
Statutes, section 144.7058, subdivision 5.
new text end

Sec. 20. new text begin APPROPRIATION; LOAN FORGIVENESS FOR NURSING
INSTRUCTORS.
new text end

new text begin Notwithstanding the priorities and distribution requirements under Minnesota Statutes,
section 144.1501, $50,000 in fiscal year 2023 is appropriated from the general fund to the
commissioner of health for the health professional education loan forgiveness program
under Minnesota Statutes, section 144.1501, to be distributed in accordance with the program
to eligible nurses who have agreed to teach in accordance with Minnesota Statutes, section
144.1501, subdivision 2. This is a onetime appropriation and is available until June 30,
2024.
new text end

Sec. 21. new text begin APPROPRIATION; HOSPITAL NURSING LOAN FORGIVENESS.
new text end

new text begin $....... in fiscal year 2023 is appropriated from the general fund to the commissioner of
health for the hospital nursing education loan forgiveness program under Minnesota Statutes,
section 144.1507.
new text end

Sec. 22. new text begin APPROPRIATION; UNSAFE HOSPITAL NURSE STAFFING
REPORTING PORTAL.
new text end

new text begin $....... in fiscal year 2023 is appropriated from the general fund to the commissioner of
health for the development and implementation of an online portal for the submission by
hospital employees of anonymous reports of unsafe staffing conditions in licensed hospitals.
This is a onetime appropriation and is available until June 30, 2025.
new text end

Sec. 23. new text begin APPROPRIATION; OFFICE OF HEALTH FACILITY COMPLAINTS
INVESTIGATIVE DUTIES.
new text end

new text begin $....... in fiscal year 2023 is appropriated from the general fund to the commissioner of
health for the investigative duties described in Minnesota Statutes, section 144A.53,
subdivision 2, paragraph (c). The general fund base for this appropriation is $....... in fiscal
year 2024 and $....... in fiscal year 2025.
new text end

Sec. 24. new text begin APPROPRIATION; IMPROVING MENTAL HEALTH OF HEALTH
CARE WORKERS.
new text end

new text begin $1,000,000 in fiscal year 2023 is appropriated from the general fund to the commissioner
of health for competitive grants to hospitals, community health centers, rural health clinics,
and medical professional associations to establish or enhance evidence-based or
evidence-informed programs dedicated to improving the mental health of health care
professionals. The general fund base for this appropriation is $1,000,000 in fiscal year 2024
and $1,000,000 in fiscal year 2025.
new text end

Sec. 25. new text begin APPROPRIATION; PREVENTION OF VIOLENCE IN HEALTH CARE.
new text end

new text begin $50,000 in fiscal year 2023 is appropriated to the commissioner of health to continue
the prevention of violence in health care programs and to create violence prevention resources
for hospitals and other health care providers to use to train their staff on violence prevention.
The general fund base for this appropriation is $50,000 in fiscal year 2024 and $50,000 in
fiscal year 2025.
new text end

Sec. 26. new text begin APPROPRIATION; HOSPITAL STAFFING STUDY.
new text end

new text begin $....... in fiscal year 2023 is appropriated to the commissioner of health for the hospital
staffing study authorized under Minnesota Statutes, section 144.7067, subdivision 4. The
general fund base for this appropriation is $....... in fiscal year 2024 and $....... in fiscal year
2025.
new text end

Sec. 27. new text begin REVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes, section 144.7055, the revisor shall renumber paragraphs (b) to
(e) alphabetically as individual subdivisions under Minnesota Statutes, section 144.7051.
The revisor shall make any necessary changes to sentence structure for this renumbering
while preserving the meaning of the text. The revisor shall also make necessary
cross-reference changes in Minnesota Statutes and Minnesota Rules consistent with the
renumbering.
new text end