SF 448

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; modifying regulatory requirements 
  1.3             and standards for nursing facilities; amending 
  1.4             Minnesota Statutes 2002, sections 144A.04, subdivision 
  1.5             3, by adding a subdivision; 144A.10, by adding a 
  1.6             subdivision; 256B.434, subdivision 10; repealing 
  1.7             Minnesota Statutes 2002, sections 256B.0915, 
  1.8             subdivision 7; 256B.439; 256B.69, subdivision 6a. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2002, section 144A.04, 
  1.11  subdivision 3, is amended to read: 
  1.12     Subd. 3.  [STANDARDS.] (a) The facility must meet the 
  1.13  minimum health, sanitation, safety and comfort standards 
  1.14  prescribed by the rules of the commissioner of health with 
  1.15  respect to the construction, equipment, maintenance and 
  1.16  operation of a nursing home, except as provided in paragraph 
  1.17  (b).  The commissioner of health may temporarily waive 
  1.18  compliance with one or more of the standards if the commissioner 
  1.19  determines that: 
  1.20     (a) (1) temporary noncompliance with the standard will not 
  1.21  create an imminent risk of harm to a nursing home resident; and 
  1.22     (b) (2) a controlling person on behalf of all other 
  1.23  controlling persons: 
  1.24     (1) (i) has entered into a contract to obtain the materials 
  1.25  or labor necessary to meet the standard set by the commissioner 
  1.26  of health, but the supplier or other contractor has failed to 
  1.27  perform the terms of the contract and the inability of the 
  2.1   nursing home to meet the standard is due solely to that failure; 
  2.2   or 
  2.3      (2) (ii) is otherwise making a diligent good faith effort 
  2.4   to meet the standard. 
  2.5      The commissioner shall make available to other nursing 
  2.6   homes information on facility-specific waivers that are 
  2.7   granted.  The commissioner shall, upon the request of a 
  2.8   facility, extend a waiver granted to a specific facility to 
  2.9   other similarly situated facilities, if the commissioner 
  2.10  determines that these facilities also satisfy clauses (1) and 
  2.11  (2) and any other terms and conditions of the waiver.  
  2.12     The commissioner of health shall allow, by rule, a nursing 
  2.13  home to provide fewer hours of nursing care to intermediate care 
  2.14  residents of a nursing home than required by the present rules 
  2.15  of the commissioner if the commissioner determines that the 
  2.16  needs of the residents of the home will be adequately met by a 
  2.17  lesser amount of nursing care. 
  2.18     (b) Notwithstanding paragraph (a), the commissioner shall 
  2.19  deem facilities that are certified as medical assistance or 
  2.20  Medicare providers as meeting the minimum health, sanitation, 
  2.21  safety, and comfort standards prescribed by rule with respect to 
  2.22  the maintenance and operation of a nursing home.  A facility 
  2.23  that qualifies for deemed status under this paragraph must still 
  2.24  meet the commissioner's standards as prescribed by rule with 
  2.25  respect to the construction and equipment of a nursing home. 
  2.26     (c) A facility is not required to seek a waiver under 
  2.27  paragraph (a) when responding to resident-specific requests, if 
  2.28  the facility has discussed health and safety concerns with the 
  2.29  resident and the resident request and discussion of health and 
  2.30  safety concerns are documented in the resident's patient record. 
  2.31     Sec. 2.  Minnesota Statutes 2002, section 144A.04, is 
  2.32  amended by adding a subdivision to read: 
  2.33     Subd. 11.  [INCONTINENT RESIDENTS.] Notwithstanding 
  2.34  Minnesota Rules, part 4658.0520, an incontinent resident must be 
  2.35  checked according to a specific time interval written in the 
  2.36  resident's care plan.  The resident's attending physician must 
  3.1   authorize in writing any interval longer than two hours unless 
  3.2   the resident, if competent, or a family member or legally 
  3.3   appointed conservator, guardian, or health care agent of a 
  3.4   resident who is not competent, agrees in writing to waive 
  3.5   physician involvement in determining this interval. 
  3.6      [EFFECTIVE DATE.] This section is effective July 1, 2003. 
  3.7      Sec. 3.  Minnesota Statutes 2002, section 144A.10, is 
  3.8   amended by adding a subdivision to read: 
  3.9      Subd. 16.  [INDEPENDENT INFORMAL DISPUTE RESOLUTION.] (a) 
  3.10  Notwithstanding subdivision 15, a facility certified under the 
  3.11  federal Medicare or Medicaid programs may request from the 
  3.12  commissioner, in writing, an independent informal dispute 
  3.13  resolution process regarding any deficiency citation issued to 
  3.14  the facility.  The facility must specify in its written request 
  3.15  each deficiency citation that it disputes.  The commissioner 
  3.16  shall provide a hearing under sections 14.57 to 14.62 and the 
  3.17  rules adopted by the office of administrative hearings governing 
  3.18  contested cases, except that upon the written request of the 
  3.19  facility, the parties must submit the issues raised to 
  3.20  arbitration by an administrative law judge. 
  3.21     (b) Upon receipt of a written request for an arbitration 
  3.22  proceeding, the commissioner shall file with the office of 
  3.23  administrative hearings a request for the appointment of an 
  3.24  arbitrator and simultaneously serve the facility with notice of 
  3.25  the request.  The arbitrator for the dispute shall be an 
  3.26  administrative law judge appointed by the office of 
  3.27  administrative hearings.  The disclosure provisions of section 
  3.28  572.10 and the notice provisions of section 572.12 apply.  The 
  3.29  facility and the commissioner have the right to be represented 
  3.30  by an attorney. 
  3.31     (c) The commissioner and the facility may present written 
  3.32  evidence, depositions, and oral statements and arguments at the 
  3.33  arbitration proceeding.  Oral statements and arguments may be 
  3.34  made by telephone. 
  3.35     (d) Within ten working days of the close of the arbitration 
  3.36  proceeding, the administrative law judge shall issue findings 
  4.1   regarding each of the deficiencies in dispute.  An 
  4.2   administrative law judge shall not increase the severity or 
  4.3   scope assigned to a deficiency.  The findings shall be one or 
  4.4   more of the following: 
  4.5      (1) Supported in full.  The citation is supported in full, 
  4.6   with no deletion of findings and no change in the scope or 
  4.7   severity assigned to the deficiency citation. 
  4.8      (2) Supported in substance.  The citation is supported, but 
  4.9   one or more findings are deleted without any change in the scope 
  4.10  or severity assigned to the deficiency. 
  4.11     (3) Deficient practice cited under wrong requirement of 
  4.12  participation.  The citation is amended by moving it to the 
  4.13  correct requirement of participation. 
  4.14     (4) Scope not supported.  The citation is amended through a 
  4.15  decrease in the scope assigned to the citation. 
  4.16     (5) Severity not supported.  The citation is amended 
  4.17  through a decrease in the severity assigned to the citation. 
  4.18     (6) No deficient practice.  The citation is deleted because 
  4.19  the findings did not support the citation or the negative 
  4.20  resident outcome was unavoidable. 
  4.21     (e) The commissioner shall reimburse the office of 
  4.22  administrative hearings for the costs incurred by that office 
  4.23  for the arbitration proceeding.  The facility shall reimburse 
  4.24  the commissioner for the proportion of the costs that represent 
  4.25  the sum of deficiency citations supported in full under 
  4.26  paragraph (d), clause (1), or in substance under paragraph (d), 
  4.27  clause (2), divided by the total number of deficiencies 
  4.28  disputed.  A deficiency citation for which the administrative 
  4.29  law judge's sole finding is that the deficient practice was 
  4.30  cited under the wrong requirements of participation shall not be 
  4.31  counted in the numerator or denominator in the calculation of 
  4.32  the proportion of costs. 
  4.33     Sec. 4.  Minnesota Statutes 2002, section 256B.434, 
  4.34  subdivision 10, is amended to read: 
  4.35     Subd. 10.  [EXEMPTIONS.] (a) To the extent permitted by 
  4.36  federal law, (1) a facility that has entered into a contract 
  5.1   under this section is not required to file a cost report, as 
  5.2   defined in Minnesota Rules, part 9549.0020, subpart 13, for any 
  5.3   year after the base year that is the basis for the calculation 
  5.4   of the contract payment rate for the first rate year of the 
  5.5   alternative payment demonstration project contract; and (2) a 
  5.6   facility under contract is not subject to audits of historical 
  5.7   costs or revenues, or paybacks or retroactive adjustments based 
  5.8   on these costs or revenues, except audits, paybacks, or 
  5.9   adjustments relating to the cost report that is the basis for 
  5.10  calculation of the first rate year under the contract. 
  5.11     (b) A facility that is under contract with the commissioner 
  5.12  under this section is not subject to the moratorium on licensure 
  5.13  or certification of new nursing home beds in section 144A.071, 
  5.14  unless the project results in a net increase in bed capacity or 
  5.15  involves relocation of beds from one site to another.  Contract 
  5.16  payment rates must not be adjusted to reflect any additional 
  5.17  costs that a nursing facility incurs as a result of a 
  5.18  construction project undertaken under this paragraph.  In 
  5.19  addition, as a condition of entering into a contract under this 
  5.20  section, a nursing facility must agree that any future medical 
  5.21  assistance payments for nursing facility services will not 
  5.22  reflect any additional costs attributable to the sale of a 
  5.23  nursing facility under this section and to construction 
  5.24  undertaken under this paragraph that otherwise would not be 
  5.25  authorized under the moratorium in section 144A.073.  Nothing in 
  5.26  this section prevents a nursing facility participating in the 
  5.27  alternative payment demonstration project under this section 
  5.28  from seeking approval of an exception to the moratorium through 
  5.29  the process established in section 144A.073, and if approved the 
  5.30  facility's rates shall be adjusted to reflect the cost of the 
  5.31  project.  Nothing in this section prevents a nursing facility 
  5.32  participating in the alternative payment demonstration project 
  5.33  from seeking legislative approval of an exception to the 
  5.34  moratorium under section 144A.071, and, if enacted, the 
  5.35  facility's rates shall be adjusted to reflect the cost of the 
  5.36  project. 
  6.1      (c) Notwithstanding section 256B.48, subdivision 6, 
  6.2   paragraphs (c), (d), and (e), and pursuant to any terms and 
  6.3   conditions contained in the facility's contract, a nursing 
  6.4   facility that is under contract with the commissioner under this 
  6.5   section is in compliance with section 256B.48, subdivision 6, 
  6.6   paragraph (b), if the facility is Medicare certified. 
  6.7      (d) Notwithstanding paragraph (a), if by April 1, 1996, the 
  6.8   health care financing administration has not approved a required 
  6.9   waiver, or the Centers for Medicare and Medicaid Services 
  6.10  otherwise requires cost reports to be filed prior to the 
  6.11  waiver's approval, the commissioner shall require a cost report 
  6.12  for the rate year. 
  6.13     (e) A facility that is under contract with the commissioner 
  6.14  under this section shall be allowed to change therapy 
  6.15  arrangements from an unrelated vendor to a related vendor during 
  6.16  the term of the contract.  The commissioner may develop 
  6.17  reasonable requirements designed to prevent an increase in 
  6.18  therapy utilization for residents enrolled in the medical 
  6.19  assistance program. 
  6.20     (f) The commissioner shall not require contracts entered 
  6.21  into on or after July 1, 2003, to contain facility-specific 
  6.22  quality improvement plans. 
  6.23     [EFFECTIVE DATE.] This section is effective July 1, 2003. 
  6.24     Sec. 5.  [ADVISORY COMMITTEE ON DEEMED STATUS.] 
  6.25     The commissioner of health shall establish an advisory 
  6.26  committee to examine and make recommendations to the 
  6.27  commissioner on quality of care issues related to the granting 
  6.28  of deemed status under Minnesota Statutes, section 144A.04, 
  6.29  subdivision 3, paragraph (b), for nursing facilities.  
  6.30  Membership of the committee must include, but is not limited to, 
  6.31  representatives of the nursing home industry, representatives of 
  6.32  nursing home residents, and health care providers.  The 
  6.33  committee is governed by Minnesota Statutes, section 15.059, 
  6.34  except that members do not receive per diems and the committee 
  6.35  expires June 30, 2005. 
  6.36     Sec. 6.  [REPEALER.] 
  7.1      Subdivision 1.  [LONG-TERM CARE QUALITY 
  7.2   PROFILES.] Minnesota Statutes 2002, section 256B.439, is 
  7.3   repealed. 
  7.4      Subd. 2.  [PMAP NURSING HOME SERVICES.] Minnesota Statutes 
  7.5   2002, sections 256B.0915; subdivision 7; and 256B.69, 
  7.6   subdivision 6a, are repealed. 
  7.7      [EFFECTIVE DATE.] This section is effective July 1, 2003.