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Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

  

                         Laws of Minnesota 1986 

                        CHAPTER 420-S.F.No. 2147 
           An act relating to health and human services; 
          requiring the commissioner of health to monitor 
          transitional care; authorizing use of swing beds by 
          patients transferred from hospitals; requiring 
          transportation services involving the use of a 
          stretcher to meet life support transportation 
          licensing standards; changing the computation of 
          inpatient hospital rates; modifying the preadmission 
          screening program; changing financial statement 
          certification requirements for nursing homes that are 
          phasing out of the medical assistance program; 
          providing for refunds of excess charges; establishing 
          requirements for medical assistance rate appeals 
          procedures for intermediate care facilities; requiring 
          a study of geographic groupings of nursing homes; 
          establishing a task force on long-term care health 
          planning; requiring a refund for private pay 
          residents; amending Minnesota Statutes 1984, sections 
          144.801, subdivision 4; 174.29, subdivision 1; and 
          251.011, subdivision 4; and Minnesota Statutes 1985 
          Supplement, sections 144.562, subdivision 3; 256.969, 
          subdivision 2; 256B.091, subdivisions 2, 4, 5, and 8; 
          256B.48 subdivision 1b and by adding a subdivision; 
          and 256B.501, subdivision 3; proposing coding for new 
          law in Minnesota Statutes, chapter 144. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1985 Supplement, section 
144.562, subdivision 3, is amended to read: 
    Subd. 3.  [APPROVAL OF LICENSE CONDITION.] The commissioner 
of health shall approve a license condition for swing beds if 
the hospital meets all of the criteria of this subdivision: 
    (a) The hospital must meet the eligibility criteria in 
subdivision 2. 
    (b) The hospital must be in compliance with the medicare 
conditions of participation for swing beds under Code of Federal 
Regulations, title 42, section 405.1041. 
    (c) The hospital must agree, in writing, to limit the 
length of stay of a patient receiving services in a swing bed to 
not more than 40 days, or the duration of medicare eligibility, 
unless the commissioner of health approves a greater length of 
stay in an emergency situation.  To determine whether an 
emergency situation exists, the commissioner shall require the 
hospital to provide documentation that continued services in the 
swing bed are required by the patient; that no skilled nursing 
facility beds are available within 25 miles from the patient's 
home, or in some more remote facility of the resident's choice, 
that can provide the appropriate level of services required by 
the patient; and that other alternative services are not 
available to meet the needs of the patient.  If the commissioner 
approves a greater length of stay, the hospital shall develop a 
plan providing for the discharge of the patient upon the 
availability of a nursing home bed or other services that meet 
the needs of the patient.  Permission to extend a patient's 
length of stay must be requested by the hospital at least ten 
days prior to the end of the maximum length of stay. 
    (d) The hospital must agree, in writing, to limit admission 
to a swing bed only to (1) patients who have been hospitalized 
and not yet discharged from the facility, or (2) patients who 
are transferred directly from an acute care hospital.  
    (e) The hospital must agree, in writing, to report to the 
commissioner of health by December 1, 1985, and annually 
thereafter, in a manner required by the commissioner (1) the 
number of patients readmitted to a swing bed within 60 days of a 
patient's discharge from the facility, (2) the hospital's 
charges for care in a swing bed during the reporting period with 
a description of the care provided for the rate charged, and (3) 
the number of beds used by the hospital for transitional care 
and similar subacute inpatient care.  
    (f) The hospital must agree, in writing, to report 
statistical data on the utilization of the swing beds on forms 
supplied by the commissioner.  The data must include the number 
of swing beds, the number of admissions to and discharges from 
swing beds, medicare reimbursed patient days, total patient 
days, and other information required by the commissioner to 
assess the utilization of swing beds. 
    Sec. 2.  [144.564] [MONITORING OF SUBACUTE OR TRANSITIONAL 
CARE SERVICES.] 
    Subdivision 1.  [HOSPITAL DATA.] The commissioner of health 
shall monitor the provision of subacute or transitional care 
services provided in hospitals.  All hospitals providing these 
services must report statistical data on the extent and 
utilization of these services on forms supplied by the 
commissioner.  The data must include the following information:  
the number of admissions to and discharges from subacute or 
transitional care beds, charges for services in these beds, the 
length of stay and total patient days, admission origin and 
discharge destination, and other information required by the 
commissioner to assess the utilization of these services.  For 
purposes of this subdivision, subacute or transitional care 
services is care provided in a hospital bed to patients who have 
been hospitalized and no longer meet established acute care 
criteria, and care provided to patients who are admitted for 
respite care. 
    Subd. 2.  [NURSING HOME DATA.] Nursing homes which provide 
services to individuals whose length of stay in the facility is 
less than 42 days shall report the data required by subdivision 
1 on forms supplied by the commissioner of health.  
     Subd. 3.  [ANNUAL REPORT.] The commissioner shall monitor 
the provision of services described in this section and shall 
report annually to the legislature concerning these services, 
including recommendations on the need for legislation. 
    Sec. 3.  Minnesota Statutes 1984, section 144.801, 
subdivision 4, is amended to read: 
    Subd. 4.  "Life support transportation service" means 
transportation and treatment which is rendered or offered to be 
rendered preliminary to or during transportation to, from, or 
between health care facilities for ill or injured persons, or 
expectant mothers.  The term includes all transportation 
involving the use of a stretcher, unless the person to be 
transported is not likely to require life support transportation 
service and medical treatment during the course of transport. 
    Sec. 4.  Minnesota Statutes 1984, section 174.29, 
subdivision 1, is amended to read: 
    Subdivision 1.  [DEFINITION.] For the purpose of sections 
174.29 to 174.31 "special transportation service" means motor 
vehicle transportation provided on a regular basis by a public 
or private entity or person that is designed exclusively or 
primarily to serve individuals who are elderly, handicapped, or 
disabled and who are unable to use regular means of 
transportation but do not require life support transportation 
service, as defined in section 144.801, subdivision 4.  Special 
transportation service includes but is not limited to service 
provided by specially equipped buses, vans, taxis, and 
volunteers driving private automobiles. 
    Sec. 5.  Minnesota Statutes 1984, section 251.011, 
subdivision 4, is amended to read:  
    Subd. 4.  [OAK TERRACE NURSING HOME.] Any portion or unit 
of Glen Lake Sanatorium not used for the treatment of 
tuberculosis patients may be used by the commissioner of human 
services for the care of geriatric patients, under the name of 
Oak Terrace Nursing Home.  
    The commissioner of administration may lease any portion or 
unit of Oak Terrace Nursing Home for the purpose of providing 
food and shelter for the homeless.  
    Sec. 6.  Minnesota Statutes 1985 Supplement, section 
256.969, subdivision 2, is amended to read: 
    Subd. 2.  [RATES FOR INPATIENT HOSPITALS.] Rates paid to 
inpatient hospitals shall be based on a rate per admission until 
the commissioner can begin to reimburse hospitals for services 
under the medical assistance and general assistance medical care 
programs based upon a diagnostic classification system 
appropriate to the service populations.  On July 1, 1984, the 
commissioner shall begin to utilize to the extent possible 
existing classification systems, including medicare.  The 
commissioner may incorporate the grouping of hospitals with 
similar characteristics for uniform rates upon the development 
and implementation of the diagnostic classification system.  
Prior to implementation of the diagnostic classification system, 
the commissioner shall report the proposed grouping of hospitals 
to the senate health and human services committee and the house 
health and welfare committee.  Effective August 1, 1985, the 
computation of the base year cost per admission and the 
computation of the relative values of the diagnostic categories 
must include identified outlier cases and their weighted costs 
up to the point that they become outlier cases, but must exclude 
costs and days beyond that point.  Claims paid for care provided 
on or after August 1, 1985, may be adjusted to reflect a 
recomputation of rates.  The commissioner shall reconstitute the 
diagnostic categories to reflect actual hospital practices, the 
specific character of specialty hospitals, or to reduce 
variances within the diagnostic categories after notice in the 
state register and a 30 day comment period.  After May 1, 1986, 
acute care hospital billings under the medical assistance and 
general assistance medical care programs must not be submitted 
until the recipient is discharged.  However, the commissioner 
shall establish monthly interim payments with inpatient 
hospitals that have individual patient lengths of stay in excess 
of 30 days regardless of diagnosis-related group.  For purposes 
of establishing interim rates, the commissioner is exempt from 
the requirements of chapter 14.  Medical assistance and general 
assistance medical care reimbursement for treatment of mental 
illness shall be reimbursed based upon diagnosis 
classifications.  The commissioner may selectively contract with 
hospitals for services within the diagnostic classifications 
relating to mental illness and chemical dependency under 
competitive bidding when reasonable geographic access by 
recipients can be assured.  No physician shall be denied the 
privilege of treating a recipient required to utilize a hospital 
under contract with the commissioner, as long as the physician 
meets credentialing standards of the individual hospital. 
    Sec. 7.  Minnesota Statutes 1985 Supplement, section 
256B.091, subdivision 2, is amended to read: 
    Subd. 2.  [SCREENING TEAMS; ESTABLISHMENT.] Each county 
agency designated by the commissioner of human services to 
participate in the program shall contract with the local board 
of health organized under sections 145.911 to 145.922 or other 
public or nonprofit agency to establish a screening team to 
assess the health and social needs of all applicants 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.  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 a 
person who has been screened must be reassessed for purposes of 
assigning a case mix classification because admission to a 
nursing home occurs later than the time allowed by rule 
following the initial screening and assessment, the reassessment 
may be completed by the public health nurse member of the 
screening team.  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. 
    Individuals not eligible for medical assistance who are 
being transferred from a hospital to a nursing home may be 
screened by only one member of the screening team in 
consultation with the other member.  The interagency board for 
quality assurance, with the participation of members of 
screening teams, shall identify other circumstances when it 
would be appropriate for only one member of a screening team to 
conduct the nursing home preadmission screenings.  The committee 
shall report its recommendations to the legislature in January, 
1987. 
    Sec. 8.  Minnesota Statutes 1985 Supplement, 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 applicants, except (1) patients transferred from 
other nursing homes; (2) patients who, having entered acute care 
facilities from nursing homes, are returning to nursing home 
care; (3) persons entering a facility described in section 
256B.431, subdivision 4, paragraph (b); (4) individuals not 
eligible for medical assistance whose length of stay is expected 
to be 30 days or less based on a physician's certification, if 
the facility notifies the screening team upon admission and 
provides an update to the screening team on the 30th day after 
admission; (5) individuals who have a contractual right to have 
their nursing home care paid for indefinitely by the veteran's 
administration; or (4) (6) persons entering a facility conducted 
by and for the adherents of a recognized church or religious 
denomination for the purpose of providing care and services for 
those who depend upon spiritual means, through prayer alone, for 
healing.  The cost for screening persons applicants who are 
receiving medical assistance or who would be eligible for 
medical assistance within 180 days of nursing home or boarding 
care home admission, must be paid by state, federal, and county 
money.  Other persons shall be assessed by a screening team upon 
payment of a fee approved by the commissioner. the medical 
assistance program.  The total screening cost for each county 
for applicants who are not eligible for medical assistance must 
be paid monthly by nursing homes and boarding care homes 
participating in the medical assistance program in the county.  
The monthly amount to be paid by each nursing home and boarding 
care home must be determined by dividing the county's estimate 
of the total annual cost of screenings allowed by the 
commissioner in the county for the following rate year by 12 to 
determine the monthly cost estimate and allocating the monthly 
cost estimate to each nursing home and boarding care home based 
on the number of licensed beds in the nursing home or boarding 
care home.  The monthly cost estimate for each nursing home must 
be submitted to the nursing home and the state by the county no 
later than February 15 of each year for inclusion in the nursing 
home's payment rate on the following rate year.  The 
commissioner shall include the reported annual estimated cost of 
screenings for each nursing home or boarding care home as an 
operating cost of that nursing home in accordance with section 
256B.431, subdivision 2b, clause (g).  For all individuals 
regardless of payment source, if delay-of-screening timelines 
are not met because a county is late in screening an individual 
who meets the delay-of-screening criteria, the county is solely 
responsible for paying the nursing home rate for the resident 
days that exceed the delay-of-screening timelines until the 
screening is completed.  Notwithstanding section 256B.0641, 
overpayments attributable to payment of the screening costs 
under the medical assistance program may not be recovered from a 
facility. 
    Sec. 9.  Minnesota Statutes 1985 Supplement, section 
256B.091, subdivision 5, is amended to read: 
    Subd. 5.  [APPEALS.] Appeals from the screening team's 
recommendation shall be made pursuant to the procedures set 
forth in section 256.045, subdivisions 2 and 3.  An appeal shall 
be automatic if the individual's physician does not agree with 
the recommendation of the screening team.  
    Sec. 10.  Minnesota Statutes 1985 Supplement, 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 and nursing home residents who request a 
screening.  Prior to July of each year, the commissioner shall 
allocate state funds available for alternative care grants to 
each local agency.  This allocation must be made as follows:  
half of the state funds available for alternative care grants 
must be allocated to each county according to the total number 
of adults in that county who are recipients age 65 or older who 
are reported to the department by March 1 of each state fiscal 
year and half of the state funds available for alternative care 
grants must be allocated to a county according to that county's 
number of medicare enrollments age 65 or older for the most 
recent statistical report.  Payment is available under this 
subdivision only for individuals (1) for whom the screening team 
would recommend nursing home admission or continued stay if 
alternative care were not available; (2) who are receiving 
medical assistance or who would be eligible for medical 
assistance within 180 days of admission to a nursing home; (3) 
who need services that are not available at that time in the 
county through other public assistance; and (4) who are age 65 
or older. 
    The commissioner shall establish by rule, in accordance 
with chapter 14, procedures for determining grant reallocations, 
limits on the rates for payment of approved services, including 
screenings, and submittal and approval of a biennial county plan 
for the administration of the preadmission screening and 
alternative care grants program.  Grants may be used for payment 
of costs of providing care-related supplies, equipment, and 
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), and that a client's service needs and 
eligibility is reassessed at least every six months.  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 and to the commissioner that the most 
cost effective alternatives available have been offered to the 
individual and that the individual was free to choose among 
available qualified providers, both public and private.  The 
county agency shall document to the commissioner that the agency 
made reasonable efforts to inform potential providers of the 
anticipated need for services under the alternative care grants 
program and that the agency allowed potential providers an 
opportunity to be selected to contract with the county board.  
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.  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 ten percent of the costs. 
    The commissioner shall promulgate emergency rules in 
accordance with sections 14.29 to 14.36, to establish required 
documentation and reporting of care delivered. 
    Sec. 11.  Minnesota Statutes 1985 Supplement, section 
256B.48, subdivision 1b, is amended to read:  
    Subd. 1b.  [EXCEPTION.] Notwithstanding any agreement 
between a nursing home and the department of human services or 
the provisions of this section or section 256B.411, other than 
subdivision 1a of this section, the commissioner may authorize 
continued medical assistance payments to a nursing home which 
ceased intake of medical assistance recipients prior to July 1, 
1983, and which charges private paying residents rates that 
exceed those permitted by subdivision 1, paragraph (a), for (i) 
residents who resided in the nursing home before July 1, 1983, 
or (ii) residents for whom the commissioner or any predecessors 
of the commissioner granted a permanent individual waiver prior 
to October 1, 1983.  Nursing homes seeking continued medical 
assistance payments under this subdivision shall make the 
reports required under subdivision 2, except that on or after 
December 31, 1985, the financial statements required need not be 
audited by or contain the opinion of a certified public 
accountant or licensed public accountant, but need only be 
reviewed by a certified public accountant or licensed public 
accountant.  In the event that the state is determined by the 
federal government to be no longer eligible for the federal 
share of medical assistance payments made to a nursing home 
under this subdivision, the commissioner may cease medical 
assistance payments, under this subdivision, to that nursing 
home. 
    Sec. 12.  Minnesota Statutes 1985 Supplement, section 
256B.48, is amended by adding a subdivision to read: 
    Subd. 7.  [REFUND OF EXCESS CHARGES.] Any nursing home 
which has charged a resident a rate for a case-mix 
classification upon admission which is in excess of the rate for 
the case-mix classification established by the commissioner of 
health and effective on the date of admission, must refund the 
amount of charge in excess of the rate for the case-mix 
classification established by the commissioner of health and 
effective on the date of admission.  Refunds must be credited to 
the next monthly billing or refunded within 15 days of receipt 
of the classification notice from the department of health.  
Failure to refund the excess charge shall be considered to be a 
violation of this section. 
    Sec. 13.  Minnesota Statutes 1985 Supplement, section 
256B.501, subdivision 3, is amended to read: 
    Subd. 3.  [RATES FOR INTERMEDIATE CARE FACILITIES FOR 
PERSONS WITH MENTAL RETARDATION OR RELATED CONDITIONS.] The 
commissioner shall establish, by rule, procedures for 
determining rates for care of residents of intermediate care 
facilities for persons with mental retardation or related 
conditions.  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 facilities.  In developing 
the procedures, the commissioner shall include: 
    (a) cost containment measures that assure efficient and 
prudent management of capital assets and operating cost 
increases which do not exceed increases in other sections of the 
economy;  
    (b) limits on the amounts of reimbursement for property, 
general and administration, and new facilities;  
    (c) requirements to ensure that the accounting practices of 
the facilities conform to generally accepted accounting 
principles; and 
    (d) incentives to reward accumulation of equity; and 
    (e) appeals procedures that satisfy the requirements of 
section 256B.50 for appeals of decisions arising from the 
application of standards or methods pursuant to Minnesota Rules, 
parts 9510.0500 to 9510.0890, 9553.0010 to 9553.0080, and 12 
MCAR 2.05301 to 2.05315 (temporary).  
    In establishing rules and procedures for setting rates for 
care of residents in intermediate care facilities for persons 
with mental retardation or related conditions, the commissioner 
shall consider the recommendations contained in the February 11, 
1983, Report of the Legislative Auditor on Community Residential 
Programs for the Mentally Retarded and the recommendations 
contained in the 1982 Report of the Department of Public Welfare 
Rule 52 Task Force.  Rates paid to supervised living facilities 
for rate years beginning during the fiscal biennium ending June 
30, 1985, shall not exceed the final rate allowed the facility 
for the previous rate year by more than five percent.  
    Sec. 14.  [GEOGRAPHIC GROUPINGS STUDY.] 
    By February 1, 1987, the director of the state planning 
agency, in consultation with the commissioner of human services, 
shall report to the legislature on the appropriateness of 
current geographic groupings for reimbursement of nursing home 
operating costs.  The report shall contain recommendations for 
legislative action which address the following:  nursing home 
input prices and regional variation in costs; and alternative 
methods for recognizing regional variations in the cost of doing 
business including approaches used by other states with 
comparable nursing home reimbursement systems. 
    Sec. 15.  [TASK FORCE ON LONG-TERM CARE HEALTH PLANNING.] 
    Subdivision 1.  [CREATION.] There is created a task force 
on long-term care health planning.  The nine-member task force 
appointed by the governor shall include:  two members from the 
legislative commission on long-term care; two representatives 
from the Minnesota nursing home trade associations; two members 
from long-term care consumer groups, and one representative each 
of the commissioners of health and human services.  The director 
of the state planning agency or a designee shall chair and 
convene the task force. 
    Subd. 2.  [DUTIES.] The task force on long-term care health 
planning shall conduct a study and report to the legislative 
commission on long-term care and to the legislature by January 
15, 1987.  In the study and report, the task force shall: 
    (1) propose a statewide plan for orderly and rational 
development of additional long-term care facilities; 
    (2) examine the need to amend the moratorium law to permit 
replacement or reconfiguration of beds provided no new beds are 
added to the system unless necessary; 
    (3) examine current classification of the intermediate care 
facilities class two (ICF II) as to the possibility of 
reclassification or upgrading; and 
    (4) address the need to modernize and renovate long-term 
care facilities built in 1950 to 1960 to improve energy 
efficiency and the quality of life in those older facilities. 
    Subd. 3.  [TASK FORCE EXPIRATION DATE.] The task force on 
long-term care health planning expires January 15, 1987. 
    Sec. 16.  [REFUND REQUIRED.] 
    Any current or previous nursing home provider obligated 
pursuant to a written agreement or otherwise to refund to a 
private paying resident, the resident's legal representative, or 
the resident's successor in interest, excess charges made in 
violation of section 256B.48, subdivision 1, clause (a), since 
July 1, 1976, shall refund the excess charges plus interest to 
the private paying resident, the resident's legal 
representative, or the resident's successor in interest before 
July 1, 1986.  Unless otherwise specified in a written agreement 
with the commissioner of human services, the amount of excess 
charges to be refunded shall be equal to the difference between 
the prospective desk audit rate, before appeal resolutions, 
established by the commissioner and the actual amount charged to 
each private paying resident.  The interest refunded shall be 
equal to the greater of the actual interest earned by the 
provider or six percent per annum.  However, where a current or 
previous nursing home provider has notified a resident, the 
resident's legal representative, or the resident's successor in 
interest, that the resident is due a refund and the refund is 
unclaimed, or if the resident, the resident's legal 
representative, or the resident's successor in interest cannot 
be located, the provider is exempt from any cause of action for 
civil damages.  A private paying resident, the resident's legal 
representative, or the resident's successor in interest, has a 
cause of action for civil damages against the current or 
previous nursing home provider for the provider's failure to 
refund the excess charges and interest owing in violation of 
this section.  The damages shall be three times the excess 
charges and interest payment that results from the violation, 
together with costs and disbursements, including reasonable 
attorney's fees or their equivalent.  For prospective desk audit 
rates established prior to July 1, 1983, which are under appeal 
as of March 1, 1986, the provider must refund:  (1) at the 
prospective desk audit rate; or (2) at the amount not in dispute 
with notice that an additional refund based on the rate after 
appeal may be forthcoming upon resolution of an appeal.  Any 
nursing home withholding all or part of a refund based on its 
pending rate appeal shall, by July 1, 1986, submit to the 
commissioner for each appeal a specification of 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, unless the above information has already 
been submitted to the commissioner.  Any amounts still owing the 
resident, the resident's legal representative, or the resident's 
successor in interest, after the appeal is settled must be 
refunded within 30 days of the resolution of the appeal.  
Interest shall continue on the amount not immediately refunded, 
and shall be equal to the greater of the actual interest earned 
by the provider or six percent per annum. 
    Sec. 17.  [TRANSFER.] 
    $880,000 is transferred from the preadmission screening and 
alternative care grants account to the medical assistance 
account. 
    Sec. 18.  [EFFECTIVE DATE.] 
    Sections 3, 4, 6 to 13, and 16 are effective the day 
following enactment.  Section 1 is effective May 1, 1986, and 
sections 2, 5, 14, 15, and 17 are effective July 1, 1986. 
    Approved March 24, 1986