Office of the Revisor of Statutes
Minnesota Session Laws - 1983, Regular Session
Key: (1) language to be deleted (2) new language
Laws of Minnesota 1983
CHAPTER 199--S.F.No. 695
An act relating to public welfare; requiring new
procedures for determining nursing home payment rates;
requiring a moratorium on certification or welfare
licensure of new beds with certain exceptions;
providing for an interagency board for quality
assurance; appropriating money; amending Minnesota
Statutes 1982, sections 144A.10, subdivisions 4, 6,
and by adding a subdivision; 256B.091, subdivisions 1,
2, 4, and 8; 256B.41; 256B.47; and 256B.48; proposing
new law coded in Minnesota Statutes 1982, chapters
144A and 256B; repealing Minnesota Statutes 1982,
sections 256B.42; 256B.43; 256B.44; 256B.45; and
256B.46; and 12 MCAR 2.049.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. [144A.071] [MORATORIUM ON CERTIFICATION OF
NURSING HOME BEDS.]
Subdivision 1. [FINDINGS.] The legislature finds that
medical assistance expenditures are increasing at a much faster
rate than the state's ability to pay them; that reimbursement
for nursing home care and ancillary services comprises over half
of medical assistance costs, and, therefore, controlling
expenditures for nursing home care is essential to prudent
management of the state's budget; that construction of new
nursing homes, the addition of more nursing home beds to the
state's long-term care resources, and increased conversion of
beds to skilled nursing facility bed status inhibits the ability
to control expenditures; that Minnesota already leads the nation
in nursing home expenditures per capita, has the fifth highest
number of beds per capita elderly, and that private paying
individuals and medical assistance recipients have equivalent
access to nursing home care; and that in the absence of a
moratorium the increased numbers of nursing homes and nursing
home beds will consume resources that would otherwise be
available to develop a comprehensive long-term care system that
includes a continuum of care. Unless action is taken, this
expansion of bed capacity and changes of beds to a higher
classification of care are likely to accelerate with the repeal
of the certificate of need program effective March 15, 1984. The
legislature also finds that Minnesota's dependence on
institutional care for elderly persons is due in part to the
dearth of alternative services in the home and community.
The legislature declares that a moratorium on medical
assistance certification of new nursing home beds and on changes
in certification to a higher level of care is necessary to
control nursing home expenditure growth and enable the state to
meet the needs of its elderly by providing high quality services
in the most appropriate manner along a continuum of care.
Subd. 2. [MORATORIUM.] Notwithstanding the provisions of
the Certificate of Need Act, sections 145.832 to 145.845, or any
other law to the contrary, the commissioner of health, in
coordination with the commissioner of public welfare, shall deny
each request by a nursing home or boarding care home, except an
intermediate care facility for the mentally retarded, for
addition of new certified beds or for a change or changes in the
certification status of existing beds except as provided in
subdivision 3. The total number of certified beds in the state
in the skilled level and in the intermediate levels of care
shall remain at or decrease from the number of beds certified at
each level of care on the effective date of this section, except
as allowed under subdivision 3. "Certified bed" means a nursing
home bed or a boarding care bed certified by the commissioner of
health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq.
The commissioner of public welfare, in coordination with
the commissioner of health, shall deny any request to issue a
license under sections 245.781 to 245.812 and 252.28 to a
nursing home or boarding care home, if that license would result
in an increase in the medical assistance reimbursement amount.
Subd. 3. [EXCEPTIONS.] The commissioner of health, in
coordination with the commissioner of welfare, may approve the
addition of a new certified bed or change in the certification
status of an existing bed under the following conditions:
(a) To replace a bed decertified after the effective date
of this section or to address an extreme hardship situation, in
a particular county that, together with all contiguous Minnesota
counties, has fewer nursing home beds per 1,000 elderly than the
number that is ten percent higher than the national average of
nursing home beds per 1,000 elderly individuals. For the
purposes of this section, the national average of nursing home
beds shall be the most recent figure that can be supplied by the
federal health care financing administration and the number of
elderly in the county or the nation shall be determined by the
most recent federal census or the most recent estimate of the
state demographer as of July 1, of each year of persons age 65
and older, whichever is the most recent at the time of the
request for replacement. In allowing replacement of a
decertified bed, the commissioners shall ensure that the number
of added or recertified beds does not exceed the total number of
decertified beds in the state in that level of care. An extreme
hardship situation can only be found after the county documents
the existence of unmet medical needs that cannot be addressed by
any other alternatives;
(b) To certify a new bed in a facility that commenced
construction before the effective date of this section. For the
purposes of this section, "commenced construction" means that
all of the following conditions were met: the final working
drawings and specifications were approved by the commissioner of
health; the construction contracts were let; a timely
construction schedule was developed, stipulating dates for
beginning, achieving various stages, and completing
construction; and all zoning and building permits were secured;
(c) To certify beds in a new nursing home that is needed in
order to meet the special dietary needs of its residents, if:
the nursing home proves to the commissioner's satisfaction that
the needs of its residents cannot otherwise be met; elements of
the special diet are not available through most food
distributors; and proper preparation of the special diet
requires incurring various operating expenses, including extra
food preparation or serving items, not incurred to a similar
extent by most nursing homes; or
(d) When the change in certification status results in a
decrease in the reimbursement amount.
Subd. 4. [MONITORING.] The commissioner of health, in
coordination with the commissioner of public welfare, shall
implement mechanisms to monitor and analyze the effect of the
moratorium in the different geographic areas of the state. The
commissioner of health shall submit to the legislature, no later
than January 15, 1984, and annually thereafter, an assessment of
the impact of the moratorium by geographic area, with particular
attention to service deficits or problems and a corrective
action plan.
Subd. 5. [REPORT.] The commissioner of energy, planning,
and development, in consultation with the commissioners of
health and public welfare, shall report to the senate health and
human services committee and the house health and welfare
committee by January 15, 1986 and biennially thereafter
regarding:
projections on the number of elderly Minnesota residents
including medical assistance recipients;
the number of residents most at risk for nursing home
placement;
the needs for long-term care and alternative home and
noninstitutional services;
availability of and access to alternative services by
geographic region; and
the necessity or desirability of continuing, modifying, or
repealing the moratorium in relation to the availability and
development of the continuum of long-term care services.
Sec. 2. Minnesota Statutes 1982, section 144A.10,
subdivision 4, is amended to read:
Subd. 4. [CORRECTION ORDERS.] Whenever a duly authorized
representative of the commissioner of health finds upon
inspection of a nursing home, that the facility or a controlling
person or an employee of the facility is not in compliance with
sections 144.651, 144A.01 to 144A.17, or 626.557 or the rules
promulgated thereunder, a correction order shall be issued to
the facility. The correction order shall state the deficiency,
cite the specific rule or statute violated, state the suggested
method of correction, and specify the time allowed for
correction. The commissioner of health by rule shall establish
a schedule of allowable time periods for correction of nursing
home deficiencies. If the commissioner finds that the nursing
home had uncorrected violations and that two or more of the
uncorrected violations create a risk to resident care, safety,
or rights, the commissioner shall notify the commissioner of
public welfare who shall review reimbursement to the nursing
home to determine the extent to which the state has paid for
substandard care.
Sec. 3. Minnesota Statutes 1982, section 144A.10,
subdivision 6, is amended to read:
Subd. 6. [FINES.] A nursing home which is issued a notice
of noncompliance with a correction order shall be assessed a
civil fine in accordance with a schedule of fines promulgated by
rule of established by the commissioner of health before
December 1, 1983. In establishing the schedule of fines, the
commissioner shall consider the potential for harm presented to
any resident as a result of noncompliance with each statute or
rule. The fine shall be assessed for each day the facility
remains in noncompliance and until a notice of correction is
received by the commissioner of health in accordance with
subdivision 7. No fine for a specific violation may exceed $250
$500 per day of noncompliance.
Sec. 4. Minnesota Statutes 1982, section 144A.10, is
amended by adding a subdivision to read:
Subd. 6a. [SCHEDULE OF FINES.] The commissioner of health
shall propose for adoption the schedule of fines by publishing
it in the State Register and allowing a period of 60 days from
the publication date for interested persons to submit written
comments on the schedule. Within 60 days after the close of the
comment period, and after considering any comments received, the
commissioner shall adopt the schedule in final form.
The schedule of fines is exempt from the definition of
"rule" in section 14.02, subdivision 4, and has the force and
effect of law upon compliance with section 14.38, subdivision
7. The effective date of the schedule of fines is five days
after publication, as provided in section 14.38, subdivision 8.
The provisions of any rule establishing a schedule of fines for
noncompliance with correction orders issued to nursing homes
remain effective with respect to nursing homes until repealed,
modified, or superseded by the schedule established in
accordance with this subdivision.
Sec. 5. [144A.31] [INTERAGENCY BOARD FOR QUALITY
ASSURANCE.]
Subdivision 1. [INTERAGENCY BOARD.] The commissioners of
health and public welfare shall establish, by July 1, 1983, an
interagency board of employees of their respective departments
who are knowledgeable and employed in the areas of long-term
care, geriatric care, long-term care facility inspection, or
quality of care assurance. The number of interagency board
members shall not exceed seven; three members each to represent
the commissioners of health and public welfare and one member to
represent the commissioner of public safety in the enforcement
of fire and safety standards in nursing homes. The commissioner
of public welfare or a designee shall chair and convene the
board. The board may utilize the expertise and time of other
individuals employed by either department as needed. The board
may recommend that the commissioners contract for services as
needed. The board shall meet as often as necessary to
accomplish its duties, but at least monthly. The board shall
establish procedures, including public hearings, for allowing
regular opportunities for input from residents, nursing homes,
and other interested persons.
Subd. 2. [INSPECTIONS.] No later than January 1, 1984, the
board shall develop and recommend implementation and enforcement
of an effective system to ensure quality of care in each nursing
home in the state. Quality of care includes evaluating, using
the resident's care plan, whether the resident's ability to
function is optimized and should not be measured solely by the
number or amount of services provided.
The board shall assist the commissioner of health in
ensuring that inspections and reinspections of nursing homes are
conducted with a frequency and in a manner calculated to most
effectively and appropriately fulfill its quality assurance
responsibilities and achieve the greatest benefit to nursing
home residents. The commissioner of health shall require a
higher frequency and extent of inspections with respect to those
nursing homes that present the most serious concerns with
respect to resident health, treatment, comfort, safety, and
well-being. These concerns include but are not limited to:
complaints about care, safety, or rights; situations where
previous inspections or reinspections have resulted in
correction orders related to care, safety, or rights; instances
of frequent change in administration in excess of normal
turnover rates; and situations where persons involved in
ownership or administration of the nursing home have been
convicted of engaging in criminal activity. A nursing home that
presents none of these concerns or any other concern or
condition established by the board that poses a risk to resident
care, safety, or rights shall be inspected once every two years
for compliance with key requirements as determined by the board.
The board shall develop and recommend to the commissioners
mechanisms beyond the inspection process to protect resident
care, safety, and rights, including but not limited to
coordination with the office of health facility complaints and
the nursing home ombudsman program.
Subd. 3. [METHODS FOR DETERMINING RESIDENT CARE NEEDS.]
The board shall develop and recommend to the commissioners
definitions for levels of care and methods for determining
resident care needs for implementation on July 1, 1985 in order
to adjust payments for resident care based on the mix of
resident needs in a nursing home. The methods for determining
resident care needs shall include assessments of ability to
perform activities of daily living and assessments of medical
and therapeutic needs.
Subd. 4. [ENFORCEMENT.] The board shall develop and
recommend for implementation effective methods of enforcing
quality of care standards. When it deems necessary, and when
all other methods of enforcement are not appropriate, the board
shall recommend to the commissioner of health closure of all or
part of a nursing home and revocation of the license. The board
shall develop, and the commissioner of public welfare shall
implement, a resident relocation plan that instructs the county
in which the nursing home is located of procedures to ensure
that the needs of residents in nursing homes about to be closed
are met. The county shall ensure placement in swing beds in
hospitals, placement in unoccupied beds in other nursing homes,
utilization of home health care on a temporary basis, foster
care placement, or other appropriate alternative care. In
preparing for relocation, the board shall ensure that residents
and their families or guardians are involved in planning the
relocation.
Subd. 5. [REPORTS.] The board shall prepare a report and
the commissioners of health and public welfare shall deliver
this report to the legislature no later than January 15, 1984,
on the board's proposals and progress on implementation of the
methods required under subdivisions 2, 3, and 4. The
commissioners shall recommend changes in or additions to
legislation necessary or desirable to fulfill their
responsibilities. The board shall prepare an annual report and
the commissioners shall deliver this report annually to the
legislature, beginning in January, 1985, on the implementation
and enforcement of the provisions of this section.
Subd. 6. [DATA.] The interagency board may have access to
data from the commissioners of health, public welfare, and
public safety for carrying out its duties under this section.
The commissioner of health and the commissioner of public
welfare may each have access to data on persons, including data
on vendors of services, from the other to carry out the purposes
of this section. If the interagency board, the commissioner of
health, or the commissioner of public welfare receives data on
persons, including data on vendors of services, that is
collected, maintained, used or disseminated in an investigation,
authorized by statute and relating to enforcement of rules or
law, the board or the commissioner shall not disclose that
information except:
(a) pursuant to section 13.05;
(b) pursuant to statute or valid court order; or
(c) to a party named in a civil or criminal proceeding,
administrative or judicial, for preparation of defense.
Data described in this subdivision is classified as public
data upon its submission to a hearing examiner or court in an
administrative or judicial proceeding.
Sec. 6. Minnesota Statutes 1982, section 256B.091,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE.] It is the purpose of this
section to prevent inappropriate nursing home or boarding care
home placement by establishing a program of preadmission
screening teams for all medical assistance recipients and any
individual who would become eligible for medical assistance
within 90 180 days of admission to a licensed nursing home or
boarding care home participating in the program. Further, it is
the purpose of this section and the program to gain further
information about how to contain costs associated with
inappropriate nursing home or boarding care home admissions.
The commissioners of public welfare and health shall seek to
maximize use of available federal and state funds and establish
the broadest program possible within the appropriation
available. The commissioner of public welfare shall promulgate
temporary rules in order to implement this section by September
1, 1980.
Sec. 7. Minnesota Statutes 1982, section 256B.091,
subdivision 2, is amended to read:
Subd. 2. [SCREENING TEAMS; ESTABLISHMENT.] Each county
agency designated by the commissioner of public welfare to
participate in the program shall contract with the local board
of health organized under section 145.911 to 145.922 or other
public or nonprofit agency to establish a screening team to
assess, prior to admission to a nursing home or a boarding care
home licensed under section 144A.02 or sections 144.50 to
144.56, that is certified for medical assistance as a skilled
nursing facility, intermediate care facility level I, or
intermediate care facility level II, the health and social needs
of medical assistance recipients and individuals who would
become eligible for medical assistance within 90 180 days of
nursing home or boarding care home admission. Each local
screening team shall be composed of a public health nurse from
the local public health nursing service and a social worker from
the local community welfare agency. Each screening team shall
have a physician available for consultation and shall utilize
individuals' attending physicians' physical assessment forms, if
any, in assessing needs. The individual's physician shall be
included on the screening team if the physician chooses to
participate. If the individual is being discharged from an
acute care facility, a discharge planner from that facility may
be present, at the facility's request, during the screening
team's assessment of the individual and may participate in
discussions but not in making the screening team's
recommendations under subdivision 3, clause (e). If the
assessment procedure or screening team recommendation results in
a delay of the individual's discharge from the acute care
facility, the facility shall not be denied medical assistance
reimbursement or incur any other financial or regulatory penalty
of the medical assistance program that would otherwise be caused
by the individual's extended length of stay; 50 percent of the
cost of this reimbursement or financial or regulatory penalty
shall be paid by the state and 50 percent shall be paid by the
county. Other personnel as deemed appropriate by the county
agency may be included on the team. The county agency may
contract with an acute care facility to have the facility's
discharge planners perform the functions of a screening team
with regard to individuals discharged from the facility and in
those cases the discharge planners may participate in making
recommendations under subdivision 3, clause (e). No member of a
screening team shall have a direct or indirect financial or
self-serving interest in a nursing home or noninstitutional
referral such that it would not be possible for the member to
consider each case objectively.
Sec. 8. Minnesota Statutes 1982, section 256B.091,
subdivision 4, is amended to read:
Subd. 4. [SCREENING OF PERSONS.] Prior to nursing home or
boarding care home admission, screening teams shall assess the
needs of all persons receiving medical assistance and of all
persons who would be eligible for medical assistance within 90
180 days of admission to a nursing home or boarding care home,
except patients transferred from other nursing homes or patients
who, having entered acute care facilities from nursing homes,
are returning to nursing home care. Any other interested person
may be assessed by a screening team upon payment of a fee based
upon a sliding fee scale.
Sec. 9. Minnesota Statutes 1982, section 256B.091,
subdivision 8, is amended to read:
Subd. 8. [ALTERNATIVE CARE GRANTS.] The commissioner shall
provide grants to counties participating in the program to pay
costs of providing alternative care to individuals screened
under subdivision 4. Payment is available under this
subdivision only for individuals (1) for whom the screening team
would recommend nursing home admission if alternative care were
not available; (2) who are receiving medical assistance or who
would be eligible for medical assistance within 90 180 days of
admission to a nursing home; and (3) who need services that are
not available at that time in the county through other public
assistance.
Grants may be used for payment of costs of providing
services such as, but not limited to, foster care for elderly
persons, day care whether or not offered through a nursing home,
nutritional counseling, or medical social services, which
services are provided by a licensed health care provider, a home
health service eligible for reimbursement under Titles XVIII and
XIX of the federal Social Security Act, or by persons employed
by or contracted with by the county board or the local welfare
agency. The county agency shall ensure that a plan of care is
established for each individual in accordance with subdivision
3, clause (e)(2). The plan shall include any services
prescribed by the individual's attending physician as necessary
and follow up services as necessary. The county agency shall
provide documentation to the commissioner verifying that the
individual's alternative care is not available at that time
through any other public assistance or service program and shall
provide documentation in each individual's plan of care that the
most cost effective alternatives available have been offered to
the individual. Grants to counties under this subdivision are
subject to audit by the commissioner for fiscal and utilization
control.
The commissioner shall establish a sliding fee schedule for
requiring payment for the cost of providing services under this
subdivision to persons who are eligible for the services but who
are not yet eligible for medical assistance. The sliding fee
schedule is not subject to chapter 14 but the commissioner shall
publish the schedule and any later changes in the State Register
and allow a period of 20 working days from the publication date
for interested persons to comment before adopting the sliding
fee schedule in final forms.
The commissioner shall apply for a waiver for federal
financial participation to expand the availability of services
under this subdivision. The commissioner shall provide grants
to counties from the nonfederal share, unless the commissioner
obtains a federal waiver for medical assistance payments, of
medical assistance appropriations. The state expenditures for
this section shall not exceed $1,800,000 for the biennium ending
June 30, 1983. A county agency may use grant money to
supplement but not supplant services available through other
public assistance or service programs and shall not use grant
money to establish new programs for which public money is
available through sources other than grants provided under this
subdivision. A county agency shall not use grant money to
provide care under this subdivision to an individual if the
anticipated cost of providing this care would exceed the average
payment, as determined by the commissioner, for the level of
nursing home care that the recipient would receive if placed in
a nursing home. The nonfederal share may be used to pay up to
90 percent of the start-up and service delivery costs of
providing care under this subdivision. Each county agency that
receives a grant shall pay 10 percent of the costs.
The commissioner shall promulgate temporary rules in
accordance with sections 14.29 to 14.36, to establish required
documentation and reporting of care delivered.
Sec. 10. Minnesota Statutes 1982, section 256B.41, is
amended to read:
256B.41 [INTENT.]
Subdivision 1. [AUTHORITY.] The state agency commissioner
shall by rule establish a formula, by rule, procedures for
establishing payment determining rates for care of residents of
nursing homes which qualify as vendors of medical assistance,
and for implementing the provisions of sections 256B.41,
256B.47, 256B.48, and sections 11, 12, 15, and 16. The
procedures shall be based on methods and standards that the
commissioner finds are adequate to provide for the costs that
must be incurred for the care of residents in efficiently and
economically operated nursing homes and shall specify the costs
that are allowable for establishing payment rates through
medical assistance.
Subd. 2. [FEDERAL REQUIREMENTS.] It is the intent of the
legislature to establish certain limitations on the state agency
in setting standards for nursing home rate setting for the care
of recipients of medical assistance pursuant to this chapter. It
is not the intent of the legislature to repeal or change any
existing or future rule promulgated by the state agency relating
to the setting of rates for nursing homes unless the rule is
clearly in conflict with sections 256B.41 to 256B.48. If any
provision of sections 256B.41 to, 256B.47, and 256B.48 and
sections 11, 12, 15, and 16, is determined by the United States
government to be in conflict with existing or future
requirements of the United States government with respect to
federal participation in medical assistance, the federal
requirements shall prevail.
Sec. 11. [256B.421] [DEFINITIONS.]
Subdivision 1. [SCOPE.] For the purposes of sections
256B.41, 256B.47, 256B.48, and sections 11, 12, 15, and 16, the
following terms and phrases shall have the meaning given to them.
Subd. 2. [ACTUAL ALLOWABLE HISTORICAL OPERATING COST PER
DIEM.] "Actual allowable historical operating cost per diem"
means the per diem payment for actual costs, including operating
costs, allowed by the commissioner for the most recent reporting
year.
Subd. 3. [COMMISSIONER.] "Commissioner" means the
commissioner of public welfare.
Subd. 4. [FINAL RATE.] "Final rate" means the rate
established after any adjustment by the commissioner, including
but not limited to adjustments resulting from cost report
reviews and field audits.
Subd. 5. [GENERAL AND ADMINISTRATIVE COSTS.] "General and
administrative costs" means all allowable costs for
administering the facility, including but not limited to:
salaries of administrators, assistant administrators, medical
directors, accounting personnel, data processing personnel, and
all clerical personnel; board of directors fees; business office
functions and supplies; travel; telephone and telegraph;
advertising; licenses and permits; membership dues and
subscriptions; postage; insurance, except as included as a
fringe benefit under subdivision 14; professional services such
as legal, accounting and data processing services; central or
home office costs; management fees; management consultants;
employee training, for any top management personnel and for
other than direct resident care related personnel; and business
meetings and seminars. These costs shall be included in general
and administrative costs in total, without direct or indirect
allocation to other cost categories.
In a nursing home of 60 or fewer beds, part of an
administrator's salary may be allocated to other cost categories
to the extent justified in records kept by the nursing home.
Central or home office costs representing services of required
consultants in areas including, but not limited to, dietary,
pharmacy, social services, or activities may be allocated to the
appropriate department, but only if those costs are directly
identified by the nursing home.
Subd. 6. [HISTORICAL OPERATING COSTS.] "Historical
operating costs" means the allowable operating costs incurred by
the facility during the reporting year immediately preceding the
rate year for which the payment rate becomes effective, after
the commissioner has reviewed those costs and determined them to
be allowable costs under the medical assistance program, and
after the commissioner has applied appropriate limitations such
as the limit on administrative costs.
Subd. 7. [NURSING HOME.] "Nursing home" means a facility
licensed under chapter 144A or a boarding care facility licensed
under sections 144.50 to 144.56.
Subd. 8. [OPERATING COSTS.] "Operating costs" means the
day-to-day costs of operating the facility in compliance with
licensure and certification standards. Operating cost
categories are: nursing, including nurses and nursing
assistants training; dietary; laundry and linen; housekeeping;
plant operation and maintenance; other care-related services;
general and administration; payroll taxes; real estate taxes and
actual special assessments paid; and fringe benefits, including
clerical training.
Subd. 9. [PAYMENT RATE.] "Payment rate" means the rate
determined under section 12.
Subd. 10. [PRIVATE PAYING RESIDENT.] "Private paying
resident" means a nursing home resident who is not a medical
assistance recipient and whose payment rate is not established
by another third party, including the veterans administration or
medicare.
Subd. 11. [RATE YEAR.] "Rate year" means the fiscal year
for which a payment rate determined under section 12 is
effective, from July 1 to the next June 30.
Subd. 12. [REPORTING YEAR.] "Reporting year" means the
period from October 1 to September 30, immediately preceding the
rate year, for which the nursing home submits reports required
under section 256B.48, subdivision 2.
Subd. 13. [ACTUAL RESIDENT DAY.] "Actual resident day"
means a billable, countable day as defined by the commissioner.
Subd. 14. [FRINGE BENEFITS.] "Fringe benefits" means
workers' compensation insurance, group health or dental
insurance, group life insurance, retirement benefits or plans,
and uniform allowances.
Subd. 15. [PAYROLL TAXES.] "Payroll taxes" means the
employer's share of FICA taxes, governmentally required
retirement contributions, and state and federal unemployment
compensation taxes.
Sec. 12. [256B.431] [RATE DETERMINATION.]
Subdivision 1. [IN GENERAL.] The commissioner shall
determine prospective payment rates for resident care costs. In
determining the rates, the commissioner shall group nursing
homes according to different levels of care and geographic
location until July 1, 1985, and after that date, mix of
resident needs, and geographic location, as defined by the
commissioner. The commissioner shall consider the use of the
standard metropolitan statistical areas when developing groups
by geographic location. Until groups are established according
to mix of resident needs, the commissioner shall group all
convalescent and nursing care units attached to hospitals into
one group for purposes of determining reimbursement for
operating costs. On or before June 15, 1983, the commissioner
shall mail notices to each nursing home of the rates to be
effective from July 1 of that year to June 30 of the following
year. In subsequent years, the commissioner shall provide
notice to each nursing home on or before May 1 of the rates
effective for the following rate year. If a statute enacted
after May 1 affects the rates, the commissioner shall provide a
revised notice to each nursing home as soon as possible.
The commissioner shall establish, by rule, limitations on
compensation recognized in the historical base for top
management personnel. The commissioner shall also establish, by
rule, limitations on allowable nursing hours for each level of
care for the rate years beginning July 1, 1983 and July 1, 1984.
Subd. 2. [OPERATING COSTS.] (a) The commissioner shall
establish, by rule, procedures for determining per diem
reimbursement for operating costs based on actual resident days.
The commissioner shall disallow any portion of the general and
administration cost category, exclusive of fringe benefits and
payroll taxes, that exceeds
10 percent for nursing homes with more than 100 certified
beds in total,
12 percent for nursing homes with fewer than 101 but more
than 40 certified beds in total,
14 percent for nursing homes with 40 or fewer certified
beds in total, and
15 percent for convalescent and nursing care units attached
to hospitals for the rate year beginning July 1, 1983,
of the expenditures in all operating cost categories except
fringe benefits, payroll taxes, and general and administration.
(b) For the rate year beginning July 1, 1983, and ending
June 30, 1984, the prospective operating cost payment rate for
each nursing home shall be determined by the commissioner based
on the allowed historical operating costs as reported in the
most recent cost report received by December 31, 1982 and
audited by March 1, 1983, and may be subsequently adjusted to
reflect the costs allowed. To determine the allowed historical
operating cost, the commissioner shall update the historical per
diem shown in those cost reports to June 30, 1983, using a nine
percent annual rate of increase after applying the general and
administrative cost limitation described in paragraph (a). The
commissioner shall calculate the 60th percentile of actual
allowable historical operating cost per diems for each group of
nursing homes established under subdivision 1.
(1) Within each group, each nursing home whose actual
allowable historical operating cost per diem as determined under
this paragraph (b) is above the 60th percentile shall receive
the 60th percentile increased by six percent plus 80 percent of
the difference between its actual allowable operating cost per
diem and the 60th percentile.
(2) Within each group, each nursing home whose actual
allowable historical operating cost per diem is at or below the
60th percentile shall receive that actual allowable historical
operating cost per diem increased by six percent.
For the rate year beginning July 1, 1984, and ending June
30, 1985, the prospective operating cost payment rate for each
nursing home shall be determined by the commissioner based on
actual allowable historical operating costs incurred during the
reporting year preceding the rate year. The commissioner shall
analyze and evaluate each nursing home's report of allowable
operating costs incurred by the nursing home during the
reporting year immediately preceding the rate year. The actual
allowable historical operating costs, after the commissioner's
analysis and evaluation, shall be added together and divided by
the number of actual resident days to compute the actual
allowable historical operating cost per diem. The commissioner
shall calculate the 60th percentile of actual allowable
historical operating cost per diems for each group of nursing
homes established under subdivision 1.
(3) Within each group, each nursing home whose actual
allowable historical operating cost per diem is above the 60th
percentile of payment rates shall receive the 60th percentile
increased at an annual rate of six percent plus 75 percent of
the difference between its actual allowable historical operating
cost per diem and the 60th percentile.
(4) Within each group, each nursing home whose actual
allowable historical operating cost per diem is at or below the
60th percentile shall receive that actual allowable historical
operating cost per diem increased at an annual rate of six
percent.
(c) For subsequent years, the commissioner shall:
(1) Contract with an econometric firm with recognized
expertise in and access to national economic change indices that
can be applied to the appropriate cost categories when
determining the operating cost payment rate;
(2) Establish the 60th percentile of actual allowable
historical operating cost per diems for each group of nursing
homes established under subdivision 1 based on cost reports of
allowable operating costs in the previous reporting year. The
commissioner shall analyze and evaluate each nursing home's
report of allowable operating costs incurred by the nursing home
during the reporting year immediately preceding the rate year
for which the payment rate becomes effective. The allowable
historical operating costs, after the commissioner's analysis
and evaluation, shall be added together and divided by the
actual number of resident days in order to compute the actual
allowable historical operating cost per diem;
(3) Establish a composite index for each group by
determining the weighted average of all economic change
indicators applied to the operating cost categories in that
group.
(4) Within each group, each nursing home shall receive the
60th percentile increased by the composite index calculated in
paragraph (c)(3). The historical base for determining the
prospective payment rate shall not exceed the operating cost
payment rates during that reporting year.
The commissioner shall include the reported actual real
estate tax liability of each proprietary nursing home as an
operating cost of that nursing home. The commissioner shall
include a reported actual special assessment for each nursing
home as an operating cost of that nursing home. Total real
estate tax liability and actual special assessments paid for
each nursing home (i) shall be divided by actual resident days
in order to compute the operating cost payment rate for this
operating cost category, but (ii) shall not be used to compute
the 60th percentile.
(d) The commissioner shall allow the nursing home to keep,
as an efficiency incentive, the difference between the nursing
home's operating cost payment rate established for that rate
year and the actual historical operating costs incurred for that
rate year, if the latter amount is smaller. If a nursing home's
actual historic operating costs are greater than the prospective
payment rate for that rate year, there shall be no retroactive
cost settle-up. If an annual cost report or field audit
indicates that the expenditures for direct resident care have
been reduced in amounts large enough to indicate a possible
detrimental effect on the quality of care, the commissioner
shall notify the commissioner of health and the interagency
board for quality assurance. If a field audit reveals that
unallowable expenditures have been included in the nursing
home's historical operating costs, the commissioner shall
disallow the expenditures and recover the entire overpayment.
The commissioner shall establish, by rule, procedures for
assessing an interest charge at the rate determined for unpaid
taxes or penalties under section 270.75 on any outstanding
balance resulting from an overpayment or underpayment.
(e) The commissioner may negotiate, with a nursing home
that is eligible to receive medical assistance payments, a
payment rate of up to 125 percent of the allowed payment rate to
be paid for a period of up to three months for individuals who
have been hospitalized for more than 100 days, who have
extensive care needs based on nursing hours actually provided or
mental or physical disability, or need for respite care for a
specified and limited time period, and based on an assessment of
the nursing home's resident mix as determined by the
commissioner of health. The payment rate negotiated and paid
pursuant to this paragraph is specifically exempt from the
definition of "rule" and the rule-making procedures required by
chapter 14 and section 16.
(f) Until groups are established according to mix of
resident care needs, nursing homes licensed on June 1, 1983 by
the commissioner to provide residential services for the
physically handicapped and nursing homes that have an average
length of stay of less than 180 days shall not be included in
the calculation of the 60th percentile of any group. For rate
year beginning July 1, 1983 and July 1, 1984, each of these
nursing homes shall receive their actual allowed historical
operating cost per diem increased by six percent. The
commissioner shall also apply to these nursing homes the
percentage limitation on the general and administrative cost
category as provided in subdivision 2, paragraph (a).
Subd. 3. [PROPERTY-RELATED COSTS.] For rate years
beginning July 1, 1983 and July 1, 1984, property-related costs
shall be reimbursed to each nursing home at the level recognized
in the most recent cost report received by December 31, 1982 and
audited by March 1, 1983, and may be subsequently adjusted to
reflect the costs recognized in the final rate for that cost
report, adjusted for rate limitations in effect before the
effective date of this section. Property-related costs
include: depreciation, interest, earnings or investment
allowance, lease, or rental payments. No adjustments shall be
made as a result of sales or reorganizations of provider
entities.
Adjustments for the cost of repairs, replacements,
renewals, betterments, or improvements to existing buildings,
and building service equipment shall be allowed if:
(i) The cost incurred is reasonable, necessary, and
ordinary;
(ii) The net cost is greater than $5,000. "Net cost" means
the actual cost, minus proceeds from insurance, salvage, or
disposal;
(iii) The nursing home's property-related costs per diem is
equal to or less than the average property-related costs per
diem within its group; and
(iv) The adjustment is shown in depreciation schedules
submitted to and approved by the commissioner.
Annual per diem shall be computed by dividing total
property-related costs by 96 percent of the nursing home's
licensed capacity days for nursing homes with more than 60 beds
and 94 percent of the nursing home's licensed capacity days for
nursing homes with 60 or fewer beds. For a nursing home whose
residents' average length of stay is 180 days or less, the
commissioner may waive the 96 or 94 percent factor and divide
the nursing home's property-related costs by the actual resident
days to compute the nursing home's annual property-related per
diem. The commissioner shall promulgate temporary and permanent
rules to recapture excess depreciation upon sale of a nursing
home.
For rate years beginning on or after July 1, 1985, the
commissioner, by permanent rule, shall reimburse nursing home
providers that are vendors in the medical assistance program for
the rental use of their property. The "rent" is the amount of
periodic payment which a renter might expect to pay for the
right to the agreed use of the real estate and the depreciable
equipment as it exists. "Real estate" means land improvements,
buildings, and attached fixtures used directly for resident
care. "Depreciable equipment" means the standard moveable
resident care equipment and support service equipment generally
used in long-term care facilities.
In developing the method for determining payment rates for
the rental use of nursing homes, the commissioner shall consider
factors designed to:
(i) simplify the administrative procedures for determining
payment rates for property-related costs;
(ii) minimize discretionary or appealable decisions;
(iii) eliminate any incentives to sell nursing homes;
(iv) recognize legitimate costs of preserving and replacing
property;
(v) recognize the existing costs of outstanding
indebtedness allowable under the statutes and rules in effect on
May 1, 1983;
(vi) address the current value of, if used directly for
patient care, land improvements, buildings, attached fixtures,
and equipment;
(vii) establish an investment per bed limitation;
(viii) reward efficient management of capital assets;
(ix) provide equitable treatment of facilities;
(x) consider a variable rate; and
(xi) phase in implementation of the rental reimbursement
method.
No later than January 1, 1984, the commissioner shall
report to the legislature on any further action necessary or
desirable in order to implement the purposes and provisions of
this subdivision.
Subd. 4. [SPECIAL RATES.] A newly constructed nursing home
or one with a capacity increase of 50 percent or more may, upon
written application to the commissioner, receive an interim
payment rate for reimbursement for property-related costs
calculated pursuant to the statutes and rules in effect on May
1, 1983 and for operating costs negotiated by the commissioner
based upon the 60th percentile established for the appropriate
group under subdivision 2, paragraph (b) to be effective from
the first day a medical assistance recipient resides in the home
or for the added beds. For newly constructed nursing homes
which are not included in the calculation of the 60th percentile
for any group, subdivision 2(f), the commissioner shall
establish by rule procedures for determining interim operating
cost payment rates and interim property-related cost payment
rates. The interim payment rate shall not be in effect for more
than 17 months. The commissioner shall establish, by temporary
and permanent rules, procedures for determining the interim rate
and for making a retroactive cost settle-up after the first year
of operation; the cost settled operating cost per diem shall not
exceed 110 percent of the 60th percentile established for the
appropriate group. The commissioner shall establish by rule
procedures for determining payment rates for nursing homes which
provide care under a lesser care level than the level for which
the nursing home is certified.
Subd. 5. [ADJUSTMENTS.] When resolution of appeals or
on-site field audits of the records of nursing homes within a
group result in adjustments to the 60th percentile of the
payment rates within the group in any reporting year, the 60th
percentile established for the following rate year for that
group shall be increased or decreased by the adjustment amount.
Sec. 13. Minnesota Statutes 1982, section 256B.47, is
amended to read:
256B.47 [RATE LIMITS NONALLOWABLE COSTS; NOTICE OF
INCREASES TO PRIVATE PAYING RESIDENTS.]
Subdivision 1. [NONALLOWABLE COSTS.] The state agency
shall by rule establish separate overall limitations on the
costs for items which directly relate to the provision of
patient care to residents of nursing homes and those which do
not directly relate to the provision of care. The state agency
may also by rule, establish limitations for specific cost
categories which do not directly relate to the provision of
patient care. The state agency shall reimburse nursing homes
for the costs of nursing care in excess of any state agency
limits on hours of nursing care if the commissioner of health
issues a correction order pursuant to section 144A.10,
subdivision 4, directing the nursing home to provide the
additional nursing care. All costs determined otherwise
allowable shall be subject to these limitations.
Subd. 2. The following costs shall not be recognized as
allowable to the extent that these costs cannot be demonstrated
by the nursing home to the state agency to be directly related
to the provision of patient care: (1) political contributions;
(2) salaries or expenses of a lobbyist, as defined in section
10A.01, subdivision 11, for lobbying activities; (3) advertising
designed to encourage potential residents to select a particular
nursing home; (4) assessments levied by the health department
commissioner of health for uncorrected violations; (5) legal and
related fees expenses for unsuccessful challenges to decisions
by state governmental agencies; (6) memberships in sports,
health or similar social clubs or organizations; and (7) costs
incurred for activities directly related to influencing
employees with respect to unionization and (6) dues paid to a
nursing home or hospital association. The state agency shall
promulgate rules establishing standards which shall distinguish
between any patient-care related components and nonpatient-care
related components of these costs, where applicable. For
purposes of these rules, the state agency shall exercise
emergency powers and establish emergency rules pursuant to
section 15.0412, subdivision 5, before September 1, 1977. The
state agency commissioner shall by rule exclude the costs of any
other items which it determines are not directly related to the
provision of patient resident care.
Subd. 3. On or before January 1, 1977 the state agency
shall by rule establish a procedure affording notice of the
approved rate for medical assistance recipients to nursing homes
within 120 days after the close of the fiscal year of the
nursing home.
Subd. 4. 2. [NOTICE TO RESIDENTS.] No increase in nursing
home rates for private paying residents shall be effective
unless the nursing home notifies the resident or person
responsible for payment of the increase in writing 30 days
before the increase takes effect.
A nursing home may adjust its rates without giving the
notice required by this subdivision when the purpose of the rate
adjustment is to: (a) reflect a necessary change in the level
of care provided to a resident; or (b) retroactively or
prospectively equalize private pay rates with rates charged to
medical assistance recipients as required by section 256B.48,
subdivision 1, clause (a) and applicable federal law.
Subd. 5. The commissioner shall promulgate rules no later
than August 1, 1980, to amend the current rules governing
nursing home reimbursement, in accordance with sections 14.01 to
14.70, to allow providers to allocate their resources in order
to provide as many nursing hours as necessary within the total
cost limitations of the per diem already granted. If the state
fails to set rates as required by section 12, the time required
for giving notice is decreased by the number of days by which
the state was late in setting the rates.
Sec. 14. Minnesota Statutes 1982, section 256B.48, is
amended to read:
256B.48 [CONDITIONS FOR PARTICIPATION.]
Subdivision 1. [PROHIBITED PRACTICES.] No A nursing home
shall be is not eligible to receive medical assistance payments
unless it agrees in writing that it will refrain refrains from:
(a) Charging nonmedical assistance residents rates for
similar services which exceed by more than ten percent those
rates which are approved by the state agency for medical
assistance recipients. For nursing homes charging nonmedical
assistance residents rates less than ten percent more than those
rates which are approved by the state agency for medical
assistance recipients, the maximum differential in rates between
nonmedical assistance residents and medical assistance
recipients shall not exceed that differential which was in
effect on April 13, 1976. If a nursing home has exceeded this
differential since April 13, 1976, it shall return the amount
collected in excess of the allowable differential stated by this
subdivision to the nonmedical assistance resident, or that
person's representative, by July 1, 1977. Effective July 1,
1978, no nursing home shall be eligible for medical assistance
if it charges nonmedical assistance recipients Charging private
paying residents rates for similar services which exceed those
which are approved by the state agency for medical assistance
recipients; provided, however, that as determined by the
prospective desk audit rate, except under the following
circumstances: the nursing home may (1) charge nonmedical
assistance private paying residents a higher rate for a private
room, and (2) charge for special services which are not included
in the daily rate if medical assistance patients residents are
charged separately at the same rate for the same services in
addition to the daily rate paid by the state agency
commissioner. A nursing home that charges a private paying
resident a rate in violation of this clause is subject to an
action by the state of Minnesota or any of its subdivisions or
agencies for civil damages. A private paying resident or the
resident's legal representative has a cause of action for civil
damages against a nursing home that charges the resident rates
in violation of this clause. The damages awarded shall include
three times the payments that result from the violation,
together with costs and disbursements, including reasonable
attorneys' fees or their equivalent. A private paying resident
or the resident's legal representative, the state, subdivision
or agency, or a nursing home may request a hearing to determine
the allowed rate or rates at issue in the cause of action.
Within 15 calendar days after receiving a request for such a
hearing, the commissioner shall request assignment of a hearing
examiner under sections 14.48 to 14.56 to conduct the hearing as
soon as possible or according to agreement by the parties. The
hearing examiner shall issue a report within 15 calendar days
following the close of the hearing. The prohibition set forth
in this clause shall not apply to facilities licensed as
boarding care facilities which are not certified as skilled or
intermediate care facilities level I or II for reimbursement
through medical assistance;
(b) Requiring an applicant for admission to the home, or
the guardian or conservator of the applicant, as a condition of
admission, to pay an admission fee any fee or deposit in excess
of $100, loan any money to the nursing home, or promise to leave
all or part of the applicant's estate to the home; and
(c) Requiring any resident of the nursing home to utilize a
vendor of health care services who is a licensed physician or
pharmacist chosen by the nursing home;
(d) Requiring any applicant to the nursing home, or the
applicant's guardian or conservator, as a condition of
admission, to assure that the applicant is neither eligible for
nor will seek public assistance for payment of nursing home care
costs;
(e) Requiring any vendor of medical care as defined by
section 256B.02, subdivision 7, who is reimbursed by medical
assistance under a separate fee schedule, to pay any portion of
his fee to the nursing home except as payment for renting or
leasing space or equipment of the nursing home or purchasing
support services, if those agreements are disclosed to the
commissioner; and
(f) Refusing, for more than 24 hours, to accept a resident
returning to his same bed or a bed certified for the same level
of care, in accordance with a physician's order authorizing
transfer, after receiving inpatient hospital services.
The prohibitions set forth in clause (b) shall not apply to
a retirement home with more than 325 beds including at least 150
licensed nursing home beds and which:
(1) is owned and operated by an organization tax-exempt
under section 290.05, subdivision 1, clause (i); and
(2) at the time of admission places accounts for all of the
applicant's assets which are required to be assigned to the home
in a trust account from which so that only expenses for the cost
of care of the applicant may be deducted charged against the
account; and
(3) agrees in writing at the time of admission to the home
to permit the applicant, or his guardian, or conservator, to
examine the records relating to the individual's trust
applicant's account upon request, and to receive an audited
statement of the expenditures from charged against his
individual account upon request; and
(4) agrees in writing at the time of admission to the home
to permit the applicant to withdraw from the home at any time
and to receive, upon withdrawal, all of the unexpended funds
remaining in the balance of his individual trust account; and
(5) was in compliance with provisions (1) to (4) as of June
30, 1976.
Subd. 2. [REPORTING REQUIREMENTS.] Effective July 1, 1976,
no nursing home shall be eligible to receive medical assistance
payments unless it agrees in writing to:
(a) provide the state agency with its most recent (1)
balance sheet and statement of revenues and expenses as audited
by a certified public accountant licensed by this state or by a
public accountant as defined in section 412.222; (2) statement
of ownership for the nursing home; and (3) a separate audited
balance sheet and statement of revenues and expenses for each
nursing home if more than one nursing home or other business
operation is owned by the same owner; a governmentally owned
nursing home may comply with the auditing requirements of this
clause by submitting an audit report prepared by the state
auditor's office;
(b) Provide the state agency with copies of leases,
purchase agreements and other related documents related to the
lease or purchase of the nursing home; and
(c) Provide to the state agency upon request copies of
leases, purchase agreements, or similar documents for the
purchase or acquisition of equipment, goods and services which
are claimed as allowable costs.
No later than December 31 of each year, a skilled nursing
facility or intermediate care facility, including boarding care
facilities, which receives medical assistance payments or other
reimbursements from the state agency shall:
(a) Provide the state agency with a copy of its audited
financial statements. The audited financial statements must
include a balance sheet, income statement, statement of the rate
or rates charged to private paying residents, statement of
retained earnings, statements of changes in financial position
(cash and working capital methods), notes to the financial
statements, applicable supplemental information, and the
certified public accountant's or licensed public accountant's
opinion. The examination by the certified public accountant or
licensed public accountant shall be conducted in accordance with
generally accepted auditing standards as promulgated and adopted
by the American Institute of Certified Public Accountants;
(b) Provide the state agency with a statement of ownership
for the facility;
(c) Provide the state agency with separate, audited
financial statements as specified in clause (a) for every other
facility owned in whole or part by an individual or entity which
has an ownership interest in the facility;
(d) Upon request, provide the state agency with separate,
audited financial statements as specified in clause (a) for
every organization with which the facility conducts business and
which is owned in whole or in part by an individual or entity
which has an ownership interest in the facility;
(e) Provide the state agency with copies of leases,
purchase agreements, and other documents related to the lease or
purchase of the nursing facility;
(f) Upon request, provide the state agency with copies of
leases, purchase agreements, and other documents related to the
acquisition of equipment, goods, and services which are claimed
as allowable costs; and
(g) Permit access by the state agency to the certified
public accountant's and licensed public accountant's audit
workpapers which support the audited financial statements
required in clauses (a), (c), and (d).
Documents or information provided to the state agency
pursuant to this subdivision shall be public. If the
requirements of clauses (a) to (g) are not met, the
reimbursement rate may be reduced to 80 percent of the rate in
effect on the first day of the fourth calendar month after the
close of the reporting year, and the reduction shall continue
until the requirements are met.
Subd. 3. [INCOMPLETE OR INACCURATE REPORTS.] The state
agency commissioner may reject any annual cost report filed by a
nursing home pursuant to this chapter if it the commissioner
determines that the report or the information required in
subdivision 2, clause (a) has been filed in a form that is
incomplete or inaccurate. In the event that a report is
rejected pursuant to this subdivision, the state agency may make
payments commissioner shall reduce the reimbursement rate to a
nursing home at the to 80 percent of its most recently
established rate determined for its prior fiscal year, or at an
interim rate established by the state agency, until the
information is completely and accurately filed.
Subd. 4. [EXTENSIONS.] The commissioner may grant a 15-day
extension of the reporting deadline to a nursing home for good
cause. To receive such an extension, a nursing home shall
submit a written request by December 1. The commissioner will
notify the nursing home of the decision by December 15.
Subd. 5. [FALSE REPORTS.] If a nursing home knowingly
supplies inaccurate or false information in a required report
that results in an overpayment, the commissioner shall:
(a) immediately adjust the nursing home's payment rate to
recover the entire overpayment within the rate year; or
(b) terminate the commissioner's agreement with the nursing
home; or
(c) prosecute under applicable state or federal law; or
(d) use any combination of the foregoing actions.
Sec. 15. [256B.50] [APPEALS.]
A nursing home may appeal a decision arising from the
application of standards or methods pursuant to sections 10 and
256B.47 if the appeal, if successful, would result in a change
to the nursing home's payment rate. To appeal, the nursing home
shall notify the commissioner of its intent to appeal within 30
days and submit a written appeal request within 60 days of
receiving notice of the payment rate determination or decision.
The appeal request shall specify each disputed item, the reason
for the dispute, an estimate of the dollar amount involved for
each disputed item, the computation that the nursing home
believes is correct, the authority in statute or rule upon which
the nursing home relies for each disputed item, the name and
address of the person or firm with whom contacts may be made
regarding the appeal, and other information required by the
commissioner. The appeal shall be heard by a hearing examiner
according to sections 14.48 to 14.56, or upon agreement by both
parties according to a modified appeals procedure established by
the commissioner and the hearing examiner. In any proceeding
under this section, the appealing party must demonstrate by a
preponderance of the evidence that the commissioner's
determination is incorrect. Regardless of any rate appeal, the
rate established shall be the rate paid and shall remain in
effect until final resolution of the appeal or subsequent desk
or field audit adjustment, notwithstanding any provision of law
or rule to the contrary. To challenge the validity of rules
established by the commissioner pursuant to sections 256B.41,
256B.47, 256B.48, and sections 11, 12, 15, and 16, a nursing
home shall comply with section 14.44.
Sec. 16. [256B.502] [TEMPORARY RULES.]
The commissioners of health and public welfare shall
promulgate temporary and permanent rules necessary to implement
sections 1 to 15 except as otherwise indicated in accordance
with sections 14.01 to 14.38. Temporary rules promulgated by
August 15, 1983 to implement the rate determination provisions
of section 12 are retroactive to and effective as of July 1,
1983. Notwithstanding the provisions of section 14.35,
temporary rules promulgated to implement sections 1 to 15 shall
be effective for up to 360 days after July 1, 1983, and may be
continued in effect for two additional periods of 180 days each
if the commissioner gives notice of continuation of each
additional period by publishing notice in the State Register and
mailing the same notice to all persons registered with the
commissioner to receive notice of rulemaking proceedings in
connection with sections 1 to 15. The temporary rules
promulgated in accordance with this section shall not be
effective 720 days after their effective date without following
the procedures in sections 14.13 to 14.20. The commissioner
shall report to the legislature by January 1, 1985, on likely
groups and shall establish groups of nursing homes based on the
mix of resident care needs, and on geographic area, by July 1,
1985.
Sec. 17. [LEGISLATIVE COMMISSION ON LONG-TERM HEALTH
CARE.]
Subdivision 1. A legislative study commission is created
(a) to monitor the inspection and regulation activities,
including rule developments, of the departments of health and
public welfare with the goal of improving quality of care;
(b) to study and report on alternative long-term care
services, including respite care services, day care services,
and hospice services; and
(c) to study and report on alternatives to medical
assistance funding for providing long term health care services
to the citizens of Minnesota.
The study commission shall consider the use of such
alternatives as private insurance, private annuities, health
maintenance organizations, preferred provider organizations,
medicare, and such other alternatives as the commission may deem
worthy of study.
Subd. 2. The commission shall consist of six members of
the house of representatives appointed by the speaker and six
members of the senate appointed by the subcommittee on
committees.
Subd. 3. The commission shall report its findings and
recommendations to the governor and the legislature not later
than January 1, 1985.
Subd. 4. The commission shall hold meetings and hearings
at the times and places it designates to accomplish the purposes
set forth in this section. It shall select a chairperson and
other officers from its membership as it deems necessary.
Subd. 5. The commission shall make use of existing
legislative facilities and staff of the house and senate
research department and senate counsel, but it may also request
the legislative coordinating commission to supply it with
additional necessary staff, office space, and administrative
services. All additional personnel shall be hired and
supervised by the directors of the house and senate research
departments and senate counsel. The commission shall have full
authority to contract for expert services and opinions relevant
to the purposes of this section. The commission, by a
two-thirds vote of its members, may request the issuance of
subpoenas, including subpoenas duces tecum, requiring the
appearance of persons, production of relevant records, and
giving of relevant testimony.
Sec. 18. [256B.433] [ANCILLARY SERVICES.]
The commissioner shall promulgate rules pursuant to the
Administrative Procedures Act to set the amount and method of
payment for ancillary materials and services provided to
recipients residing in long-term care facilities. Payment for
materials and services may be made to either the nursing home in
the operating cost per diem, to the vendor of ancillary services
pursuant to 12 MCAR 2.047 or to a nursing home pursuant to 12
MCAR 2.047. Payment for the same or similar service to a
recipient shall not be made to both the nursing home and the
vendor. The commissioner shall ensure that charges for
ancillary materials and services are as would be incurred by a
prudent buyer.
Sec. 19. [REPEALER.]
Minnesota Statutes 1982, sections 256B.42; 256B.43; 256B.44;
256B.45; and 256B.46 are repealed effective July 1, 1983. 12
MCAR, section 2.049 is superseded effective on the effective
date of the first temporary rule promulgated to implement
section 12, retroactive to July 1, 1983.
Sec. 20. [APPROPRIATION.]
The approved complement of the department of health
increased by one-half position for the interagency board.
$1,043,520 for fiscal year 1984 and $603,680 for fiscal year
1985 are appropriated from the general fund to the commissioner
of public welfare for the state's costs of implementing sections
1 to 19 for the biennium ending June 30, 1985. $4,376,560 for
fiscal year 1984 and $6,176,462 for fiscal year 1985 is
appropriated from the general fund for the state's costs for
preadmission screening and alternative care grants. Remaining
amounts necessary to fund these areas shall be obtained from
federal and county sources and shall be appropriated for
implementing sections 1 to 18. The approved complement of the
department of public welfare is increased by five and one-half
full-time positions; the one-half full-time position is for the
interagency board.
Sec. 21. [EFFECTIVE DATE.]
Sections 1 to 20 are effective the day following enactment,
for the moratorium and for establishing procedures for
determining payment rates to become effective for the biennium
beginning July 1, 1983, and thereafter. The amendments to
section 256B.48, subdivision 1, apply to causes of action
arising from charges made on or after the effective date of
section 14.
Approved May 22, 1983
Official Publication of the State of Minnesota
Revisor of Statutes