Minnesota Session Laws - 1987, Regular Session

  

                         Laws of Minnesota 1987 

                         CHAPTER 378-S.F.No. 51 
           An act relating to health; requiring licensure of home 
          care providers and hospice programs; providing a home 
          care bill of rights; providing a complaint procedure 
          for home care clients; appropriating money; amending 
          Minnesota Statutes 1986, sections 144.335, subdivision 
          1; 144.699, subdivision 2; 144A.51, subdivision 6, and 
          by adding a subdivision; 144A.52, subdivision 3; 
          144A.53; 144A.54, subdivision 1; 256B.04, by adding a 
          subdivision; 364.09; and 626.557, subdivision 2; 
          proposing coding for new law in Minnesota Statutes, 
          chapter 144A.  
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1986, section 144.335, 
subdivision 1, is amended to read: 
    Subdivision 1.  [DEFINITIONS.] For the purposes of this 
section, the following terms have the meanings given them: 
    (a) "Patient" means a natural person who has received 
health care services from a provider for treatment of a medical, 
psychiatric or mental condition, or a person the patient 
designates in writing as a representative.  Except for minors 
who have received health care services pursuant to sections 
144.341 to 144.347, in the case of a minor, "patient" includes a 
parent or guardian, or a person acting as a parent or guardian 
in the absence of a parent or guardian. 
    (b) "Provider" means (1) any person who furnishes health 
care services and is licensed to furnish the services pursuant 
to chapters 147, 148, 150A, 151 or 153; (2) a home care provider 
licensed under section 6; and (2) (3) a health care facility 
licensed pursuant to this chapter or chapter 144A. 
    Sec. 2.  Minnesota Statutes 1986, section 144.699, 
subdivision 2, is amended to read:  
    Subd. 2.  [FOSTERING PRICE COMPETITION.] The commissioner 
of health shall:  
    (a) Encourage hospitals, outpatient surgical centers, home 
care providers, and professionals regulated by the health 
related licensing boards as defined in section 214.01, 
subdivision 2, and by the commissioner of health under section 
214.13, to publish prices for procedures and services that are 
representative of the diagnoses and conditions for which 
citizens of this state seek treatment.  
    (b) Analyze and disseminate available price information and 
analyses so as to foster the development of price competition 
among hospitals, outpatient surgical centers, home care 
providers, and health professionals.  
    Sec. 3.  [144A.43] [DEFINITIONS.] 
    Subdivision 1.  [APPLICABILITY.] The definitions in this 
section apply to sections 2 to 8. 
    Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
commissioner of health. 
    Subd. 3.  [HOME CARE SERVICE.] "Home care service" means 
any of the following services when delivered in a place of 
residence to a person whose illness, disability, or physical 
condition creates a need for the service:  
    (1) nursing services, including the services of a home 
health aide;  
    (2) personal care services not included under sections 
148.171 to 148.299; 
    (3) physical therapy; 
    (4) speech therapy; 
    (5) respiratory therapy; 
    (6) occupational therapy; 
    (7) nutritional services; 
     (8) home management services when provided to a person who 
is unable to perform these activities due to illness, 
disability, or physical condition.  Home management services 
include at least two of the following services:  housekeeping, 
meal preparation, laundry, shopping, and other similar services; 
    (9) medical social services; 
    (10) the provision of medical supplies and equipment when 
accompanied by the provision of a home care service; 
    (11) the provision of a hospice program as specified in 
section 8; and 
    (12) other similar medical services and health-related 
support services identified by the commissioner in rule. 
    Subd. 4.  [HOME CARE PROVIDER.] "Home care provider" means 
an individual, organization, association, corporation, unit of 
government, or other entity that is regularly engaged in the 
delivery, directly or by contractual arrangement, of home care 
services for a fee.  At least one home care service must be 
provided directly, although additional home care services may be 
provided by contractual arrangements.  "Home care provider" 
includes a hospice program defined in section 8.  "Home care 
provider" does not include: 
    (1) any home care or nursing services conducted by and for 
the adherents of any 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; 
    (2) an individual who only provides services to a relative; 
    (3) an individual not connected with a home care provider 
who provides assistance with home management services or 
personal care needs if the assistance is provided primarily as a 
contribution and not as a business; 
    (4) an individual not connected with a home care provider 
who shares housing with and provides primarily housekeeping or 
homemaking services to an elderly or disabled person in return 
for free or reduced-cost housing; 
    (5) an individual or agency providing home-delivered meal 
services; 
    (6) an agency providing senior companion services and other 
older American volunteer programs established under the Domestic 
Volunteer Service Act of 1973, Public Law Number 98-288;  
    (7) an individual or agency that only provides chore, 
housekeeping, or child care services which do not involve the 
provision of home care services; 
    (8) an employee of a nursing home licensed under chapter 
144A who provides emergency services to individuals residing in 
an apartment unit attached to the nursing home; 
    (9) a member of a professional corporation organized under 
sections 319A.01 to 319A.22 that does not regularly offer or 
provide home care services as defined in subdivision 3; 
    (10) the following organizations established to provide 
medical or surgical services that do not regularly offer or 
provide home care services as defined in subdivision 3:  a 
business trust organized under sections 318.01 to 318.04, a 
nonprofit corporation organized under chapter 317, a partnership 
organized under chapter 323, or any other entity determined by 
the commissioner; 
    (11) an individual or agency that provides medical supplies 
or durable medical equipment, except when the provision of 
supplies or equipment is accompanied by a home care service; or 
    (12) an individual licensed under chapter 147.  
    Sec. 4.  [144A.44] [HOME CARE BILL OF RIGHTS.] 
    Subdivision 1.  [STATEMENT OF RIGHTS.] A person who 
receives home care services has these rights: 
    (1) the right to receive written information about rights, 
including what to do if rights are violated; 
    (2) the right to receive care and services according to a 
suitable and up-to-date plan, and subject to accepted medical or 
nursing standards, to take an active part in creating and 
changing the plan and evaluating care and services; 
    (3) the right to be told about the services that are being 
provided or suggested, about other choices that are available, 
and about the consequences of these choices including the 
consequences of refusing these services; 
    (4) the right to refuse services or treatment; 
    (5) the right to know, in advance, any limits to the 
services available from a provider, whether the services are 
covered by health insurance, medical assistance, or other health 
programs, and the provider's grounds for a termination of 
services; 
    (6) the right to know what the charges are for services, no 
matter who will be paying the bill; 
    (7) the right to know that there may be other services 
available in the community, including other home care services 
and providers, and to know where to go for information about 
these services; 
    (8) the right to choose freely among available providers 
and to change providers after services have begun, within the 
limits of health insurance, medical assistance, or other health 
programs; 
    (9) the right to have personal, financial, and medical 
information kept private; 
    (10) the right to be allowed access to records and written 
information from records in accordance with section 144.335; 
    (11) the right to be served by people who are properly 
trained and competent to perform their duties; 
    (12) the right to be treated with courtesy and respect; 
    (13) the right to be free from physical and verbal abuse; 
    (14) the right to reasonable notice of changes in services 
or charges; 
    (15) the right to a coordinated transfer when there will be 
a change in the provider of services; 
    (16) the right to know how to contact an individual 
associated with the provider who is responsible for handling 
problems and the name and address of the state or county agency 
to contact for additional information or assistance; and 
    (17) the right to assert these rights without retaliation. 
    Subd. 2.  [INTERPRETATION AND ENFORCEMENT OF RIGHTS.] These 
rights are established for the benefit of persons who receive 
home care services.  "Home care services" means home care 
services as defined in section 3, subdivision 3.  A home care 
provider may not require a person to surrender these rights as a 
condition of receiving services.  A guardian or conservator or, 
when there is no guardian or conservator, a designated person, 
may seek to enforce these rights.  This statement of rights does 
not replace or diminish other rights and liberties that may 
exist relative to persons receiving home care services, persons 
providing home care services, or providers licensed under this 
act.  A copy of these rights must be provided to an individual 
at the time home care services are initiated.  The copy shall 
also contain the address and phone number of the office of 
health facility complaints and a brief statement describing how 
to file a complaint with that office. 
     Sec. 5.  [144A.45] [REGULATION OF HOME CARE SERVICES.] 
    Subdivision 1.  [RULES.] The commissioner shall adopt rules 
for the regulation of home care providers pursuant to sections 3 
to 8 and 14.  The rules shall include the following:  
    (a) provisions to assure, to the extent possible, the 
health, safety and well-being, and appropriate treatment of 
persons who receive home care services;  
    (b) requirements that home care providers furnish the 
commissioner with specified information necessary to implement 
sections 3 to 8 and 14;  
    (c) standards of training of home care provider personnel, 
which may vary according to the nature of the services provided 
or the health status of the consumer; 
    (d) standards of supervision by a registered nurse or other 
appropriate health care professionals of personnel providing 
home care services, which may vary according to the nature of 
the services provided or the health status of the consumer; 
    (e) requirements for the involvement of a consumer's 
physician, the documentation of physicians' orders, if required, 
and the consumer's treatment plan, and the maintenance of 
accurate, current clinical records;  
    (f) the establishment of different classes of licenses for 
different types of providers and different standards and 
requirements for different kinds of home care services; and 
    (g) operating procedures required to implement the home 
care bill of rights. 
    Subd. 2.  [REGULATORY FUNCTIONS.] (a) The commissioner 
shall:  
    (1) evaluate, monitor, and license home care providers in 
accordance with sections 5 to 8 and 14; 
    (2) inspect the office and records of a provider during 
regular business hours, provided that when conducting routine 
office visits or inspections, the commissioner shall provide at 
least 48 hours advance notice to the home care provider; 
    (3) with the consent of the consumer, visit the home where 
services are being provided; 
    (4) issue correction orders and assess civil penalties in 
accordance with section 144.653, subdivisions 5 to 8; and 
    (5) take other action reasonably required to accomplish the 
purposes of sections 3 to 8 and 14. 
    (b) In the exercise of the authority granted in sections 3 
to 8 and 14, the commissioner shall comply with the applicable 
requirements of section 144.122, the government data practices 
act, and the administrative procedure act. 
    Subd. 3.  [ADVISORY TASK FORCE.] The commissioner of health 
shall establish and appoint a home care advisory task force 
consisting of 15 members representing the various kinds of home 
care providers, including a hospice program, health care 
professionals, community health services agencies, and 
consumers.  The appointment, removal, and compensation of 
members is as provided in section 15.059, subdivision 6.  The 
task force shall provide advice and recommendations to the 
commissioner regarding the development of rules required by 
subdivision 1. 
    Sec. 6.  [144A.46] [LICENSURE.] 
    Subdivision 1.  [LICENSE REQUIRED.] (a) A home care 
provider may not operate in the state without a current license 
issued by the commissioner of health. 
    (b) Within ten days after receiving an application for a 
license, the commissioner shall acknowledge receipt of the 
application in writing.  The acknowledgement must indicate 
whether the application appears to be complete or whether 
additional information is required before the application will 
be considered complete.  Within 90 days after receiving a 
complete application, the commissioner shall either grant or 
deny the license.  If an applicant is not granted or denied a 
license within 90 days after submitting a complete application, 
the license must be deemed granted.  An applicant whose license 
has been deemed granted must provide written notice to the 
commissioner before providing a home care service. 
    Subd. 2.  [EXEMPTIONS.] The following individuals or 
organizations are exempt from the requirement to obtain a home 
care provider license: 
    (1) a person who is licensed under sections 148.171 to 
148.285 and who independently provides nursing services in the 
home without any contractual or employment relationship to a 
home care provider or other organization; 
    (2) a personal care assistant who provides services under 
the medical assistance program as authorized under section 
256B.02, subdivision 8, paragraph (17), and section 15; 
      (3) a person or organization that exclusively offers, 
provides, or arranges for personal care assistant services under 
the medical assistance program as authorized under section 
256B.02, subdivision 8, paragraph (17), and section 15; 
    (4) a person who is registered under sections 148.65 to 
148.78 and who independently provides physical therapy services 
in the home without any contractual or employment relationship 
to a home care provider or other organization; 
    (5) a person who provides services to a person with mental 
retardation under a program of semi-independent living services 
regulated by Minnesota Rules, parts 9525.0500 to 9525.0660; or 
    (6) a person who provides services to a person with mental 
retardation under contract with a county to provide home and 
community-based services that are reimbursed under the medical 
assistance program, chapter 256B, and regulated by Minnesota 
Rules, parts 9525.1800 to 9525.1930. 
    An exemption under this subdivision does not excuse the 
individual from complying with applicable provisions of the home 
care bill of rights. 
    Subd. 3.  [ENFORCEMENT.] The commissioner may refuse to 
grant or renew a license, or may suspend or revoke a license, 
for violation of statutes or rules relating to home care 
services or for conduct detrimental to the welfare of the 
consumer.  Prior to any suspension, revocation, or refusal to 
renew a license, the home care provider shall be entitled to 
notice and a hearing as provided by sections 14.57 to 14.70.  In 
addition to any other remedy provided by law, the commissioner 
may, without a prior contested case hearing, temporarily suspend 
a license or prohibit delivery of services by a provider for not 
more than 60 days if the commissioner determines that the health 
or safety of a consumer is in imminent danger, provided (1) 
advance notice is given to the provider; (2) after notice, the 
provider fails to correct the problem; (3) the commissioner has 
reason to believe that other administrative remedies are not 
likely to be effective; and (4) there is an opportunity for a 
contested case hearing within the 60 days.  The process of 
suspending or revoking a license must include a plan for 
transferring affected clients to other providers.  
    Subd. 4.  [RELATION TO OTHER REGULATORY PROGRAMS.] In the 
exercise of the authority granted under sections 3 to 8 and 14, 
the commissioner shall not duplicate or replace standards and 
requirements imposed under another state regulatory program.  
The commissioner shall not impose additional training or 
education requirements upon members of a licensed or registered 
occupation or profession, except as necessary to address or 
prevent problems that are unique to the delivery of services in 
the home or to enforce and protect the rights of consumers 
listed in section 4.  For home care providers certified under 
the Medicare program, the state standards must not be 
inconsistent with the Medicare standards for Medicare services.  
To the extent possible, the commissioner shall coordinate the 
inspections required under sections 5 and 8 with the health 
facility licensure inspections required under sections 144.50 to 
144.58 or 144A.10 when the health care facility is also licensed 
under the provisions of this act. 
    Subd. 5.  [PRIOR CRIMINAL CONVICTIONS.] An applicant for a 
home care provider license shall disclose to the commissioner 
all criminal convictions of persons involved in the management, 
operation, or control of the provider.  A home care provider 
shall require employees of the provider and applicants for 
employment to disclose all criminal convictions.  No person may 
be employed by a home care provider or involved in the 
management, operation, or control of a provider, if the person 
has been convicted of a crime that relates to the provision of 
home care services or to the position, duties, or 
responsibilities undertaken by that person in the operation of 
the home care provider, unless the person can provide sufficient 
evidence of rehabilitation.  The commissioner shall adopt rules 
for determining whether a crime relates to home care services 
and what constitutes sufficient evidence of rehabilitation.  The 
rules must require consideration of the nature and seriousness 
of the crime; the relationship of the crime to the purposes of 
home care licensure and regulation; the relationship of the 
crime to the ability, capacity, and fitness required to perform 
the duties and discharge the responsibilities of the person's 
position; mitigating circumstances or social conditions 
surrounding the commission of the crime; the length of time 
elapsed since the crime was committed; the seriousness of the 
risk to the home care client's person or property; and other 
factors the commissioner considers appropriate.  Data collected 
under this subdivision shall be classified as private data under 
section 13.02, subdivision 12. 
    Sec. 7.  [144A.47] [INFORMATION AND REFERRAL SERVICES.] 
    The commissioner shall ensure that information and referral 
services relating to home care are available in all regions of 
the state.  The commissioner shall collect and make available 
information about available home care services, sources of 
payment, providers, and the rights of consumers.  The 
commissioner may require home care providers to provide 
information requested for the purposes of this section, 
including price information, as a condition of registration or 
licensure.  Specific price information furnished by providers 
under this section is not public data and must not be released 
without the written permission of the agency.  The commissioner 
may publish and make available: 
    (1) general information and a summary of the range of 
prices of home care services in the state; 
    (2) limitations on hours, availability of services, and 
eligibility for third-party payments, applicable to individual 
providers; and 
    (3) other information the commissioner determines to be 
appropriate. 
    Sec. 8.  [144A.48] [HOSPICE PROGRAMS.] 
    Subdivision 1.  [DEFINITIONS.] For the purposes of this 
section, the following terms have the meanings given to them: 
    (1) "Core services" means physician services, registered 
nursing services, medical social services, pastoral care or 
other counseling services, and volunteer services that are 
provided either directly by the hospice program or through a 
service contract or other arrangement; 
    (2) "Hospice patient" means an individual who has been 
diagnosed as terminally ill with a probable life expectancy of 
under one year, as documented by the individual's attending 
physician, and who alone or, when unable, through the hospice 
patient's family has voluntarily consented to and received 
admission to a hospice program; 
    (3) "Hospice patient's family" means relatives of the 
hospice patient, the hospice patient's guardian, primary 
caregivers, or persons identified by the hospice patient as 
having significant personal ties; 
     (4) "Hospice program" means palliative and supportive care 
and other services provided by an interdisciplinary team under 
the direction of an identifiable hospice administration to 
terminally ill hospice patients and their families to meet the 
physical, nutritional, emotional, social, spiritual, and special 
needs experienced during the final stages of illness, dying, and 
bereavement, through a centrally coordinated program that 
ensures continuity and consistency of home and inpatient care 
provided directly or through an agreement; 
    (5) "Interdisciplinary team" means a group of qualified 
individuals with expertise in meeting the special needs of 
hospice patients and their families, including, at a minimum, 
those individuals who are providers of core services; 
    (6) "Palliative care" means care directed at managing the 
symptoms experienced by the hospice patient and intended to 
enhance the quality of life for the hospice patient and the 
patient's family, but not directed at curing the illness; and 
    (7) "Volunteer services" means services by volunteers who 
provide a personal presence that augments a variety of 
professional and nonprofessional services available to the 
hospice patient, the patient's family, and the hospice program.  
    Subd. 2.  [LICENSE REQUIREMENTS.] A hospice program may not 
operate in the state or use the words "hospice" or "hospice 
program" without a current license issued by the commissioner of 
health.  The commissioner shall license hospice programs using 
the powers and authorities contained in sections 3 to 7 and 14.  
In addition a hospice program must provide: 
    (1) centrally coordinated hospice core services in the home 
and inpatient settings; 
    (2) that the medical components of the hospice program are 
under the direction of a licensed physician who serves as 
medical director; 
    (3) that the palliative medical care provided to a hospice 
patient is under the direction of the attending physician; 
    (4) an interdisciplinary team that meets regularly to 
develop, implement, and evaluate the hospice program's plan of 
care for each hospice patient and the patient's family; 
    (5) accessible hospice care, 24 hours a day, seven days a 
week; 
    (6) an ongoing system of quality assurance; 
    (7) that volunteer services are provided by individuals who 
have completed a hospice training program and are qualified to 
provide the services; 
    (8) a planned program of supportive services available to 
patients' families during the bereavement period; and 
    (9) that inpatient services are provided directly or by 
arrangement in a licensed hospital or nursing home. 
    Subd. 3.  [REQUIRED INSPECTIONS.] The commissioner shall 
inspect the hospice program, the home care and the inpatient 
care provided by the hospice program to determine if the 
requirements of sections 5 to 8 are met. 
    Subd. 4.  [RULE AUTHORITY.] The commissioner shall 
promulgate rules to implement the provisions of this section. 
    Subd. 5.  [LICENSE DESIGNATION.] A license issued to a home 
care provider meeting the requirements contained in this section 
shall indicate that the provider is qualified to offer hospice 
care. 
    Sec. 9.  Minnesota Statutes 1986, section 144A.51, 
subdivision 6, is amended to read:  
    Subd. 6.  "Resident" means any resident or patient of a 
health facility or a consumer of services provided by a home 
care provider, or the guardian or conservator of a the resident 
or, patient of a health facility, or consumer, if one has been 
appointed. 
    Sec. 10.  Minnesota Statutes 1986, section 144A.51, is 
amended by adding a subdivision to read:  
    Subd. 7.  "Home care provider" means a home care provider 
as defined in section 3, subdivision 4. 
    Sec. 11.  Minnesota Statutes 1986, section 144A.52, 
subdivision 3, is amended to read: 
    Subd. 3.  The director may delegate to members of the staff 
any of the authority or duties of the director except the duty 
of formally making recommendations to the legislature, 
administrative agencies, health facilities, health care 
providers, home care providers, and the state commissioner of 
health. 
    Sec. 12.  Minnesota Statutes 1986, section 144A.53, is 
amended to read: 
    144A.53 [DIRECTOR; POWERS AND DUTIES.] 
    Subdivision 1.  [POWERS.] The director may: 
    (a) Promulgate by rule, pursuant to chapter 14, and within 
the limits set forth in subdivision 2, the methods by which 
complaints against health facilities, health care providers, 
home care providers, or administrative agencies are to be made, 
reviewed, investigated, and acted upon; provided, however, that 
a fee may not be charged for filing a complaint; 
    (b) Recommend legislation and changes in rules to the state 
commissioner of health, legislature, governor, administrative 
agencies or the federal government; 
    (c) Investigate, upon a complaint or upon initiative of the 
director, any action or failure to act by a health care 
provider, home care provider, or a health facility; 
    (d) Request and receive access to relevant information, 
records, or documents in the possession of an administrative 
agency, a health care provider, a home care provider, or a 
health facility which the director deems necessary for the 
discharge of responsibilities; 
    (e) Enter and inspect, at any time, a health facility; 
provided that the director shall not unduly interfere with or 
disturb the activities of a resident unless the resident 
consents; 
    (f) Issue a correction order pursuant to section 144.653 or 
any other law which provides for the issuance of correction 
orders to health care facilities or home care provider, or under 
section 5; 
    (g) Recommend the certification or decertification of 
health facilities pursuant to Title XVIII or Title XIX of the 
United States Social Security Act; 
    (h) Assist residents of health facilities in the 
enforcement of their rights under Minnesota law; and 
    (i) Work with administrative agencies, health 
facilities, home care providers, and health care providers and 
organizations representing consumers on programs designed to 
provide information about health facilities to the public and to 
health facility residents. 
    Subd. 2.  [COMPLAINTS.] The director may receive a 
complaint from any source concerning an action of an 
administrative agency, a health care provider, a home care 
provider, or a health facility.  The director may require a 
complainant to pursue other remedies or channels of complaint 
open to the complainant before accepting or investigating the 
complaint. 
    The director shall keep written records of all complaints 
and any action upon them.  After completing an investigation of 
a complaint, the director shall inform the complainant, the 
administrative agency having jurisdiction over the subject 
matter, the health care provider, the home care provider, and 
the health facility of the action taken. 
    Subd. 3.  [RECOMMENDATIONS.] If, after duly considering a 
complaint and whatever material the director deems pertinent, 
the director determines that the complaint is valid, the 
director may recommend that an administrative agency, a health 
care provider, a home care provider, or a health facility should:
    (a) Modify or cancel the actions which gave rise to the 
complaint; 
    (b) Alter the practice, rule or decision which gave rise to 
the complaint; 
    (c) Provide more information about the action under 
investigation; or 
    (d) Take any other step which the director considers 
appropriate. 
    If the director requests, the administrative agency, a 
health care provider, a home care provider, or health facility 
shall, within the time specified, inform the director about the 
action taken on a recommendation. 
    Subd. 4.  [REFERRAL OF COMPLAINTS.] If a complaint received 
by the director relates to a matter more properly within the 
jurisdiction of an occupational licensing board or other 
governmental agency, the director shall forward the complaint to 
that agency and shall inform the complaining party of the 
forwarding.  The agency shall promptly act in respect to the 
complaint, and shall inform the complaining party and the 
director of its disposition.  If a governmental agency receives 
a complaint which is more properly within the jurisdiction of 
the director, it shall promptly forward the complaint to the 
director, and shall inform the complaining party of the 
forwarding.  If the director has reason to believe that an 
official or employee of an administrative agency, a home care 
provider, or health facility has acted in a manner warranting 
criminal or disciplinary proceedings, the director shall refer 
the matter to the state commissioner of health, the commissioner 
of human services, an appropriate prosecuting authority, or 
other appropriate agency. 
    Sec. 13.  Minnesota Statutes 1986, section 144A.54, 
subdivision 1, is amended to read: 
    Subdivision 1.  Except as otherwise provided by this 
section, the director may determine the form, frequency, and 
distribution of the conclusions and recommendations.  The 
director shall transmit the conclusions and recommendations to 
the state commissioner of health and the legislature.  Before 
announcing a conclusion or recommendation that expressly or by 
implication criticizes an administrative agency, a health care 
provider, a home care provider, or a health facility, the 
director shall consult with that agency, health care provider, 
home care provider, or facility.  When publishing an opinion 
adverse to an administrative agency, a health care provider, a 
home care provider, or a health facility, the director shall 
include in the publication any statement of reasonable length 
made to the director by that agency, health care provider, home 
care provider, or health facility in defense or explanation of 
the action. 
    Sec. 14.  [144A.49] [TEMPORARY PROCEDURES.] 
    For purposes of this section, "home care providers" shall 
mean the providers described in section 3, subdivision 4, 
including hospice programs described in section 8.  Home care 
providers are exempt from the licensure requirement in section 
6, subdivision 1, until 90 days after the effective date of the 
licensure rules.  Beginning July 1, 1987, no home care provider, 
as defined in section 3, subdivision 4, except a provider exempt 
from licensure under section 6, subdivision 2, may provide home 
care services in this state without registering with the 
commissioner.  A home care provider is registered with the 
commissioner when the commissioner has received in writing the 
provider's name; the name of its parent corporation or 
sponsoring organization, if any; the street address and 
telephone number of its principal place of business; the street 
address and telephone number of its principal place of business 
in Minnesota; the counties in Minnesota in which it may render 
services; the street address and telephone number of all other 
offices in Minnesota; and the name, educational background, and 
ten-year employment history of the person responsible for the 
management of the agency.  A registration fee must be submitted 
with the application for registration.  The fee must be 
established pursuant to section 144.122 and must be based on a 
consideration of the following factors:  the number of clients 
served by the home care provider, the number of employees, the 
number of services offered, and annual revenues of the 
provider.  The registration is effective until 90 days after 
licensure rules are effective.  In order to maintain its 
registration and provide services in Minnesota, a home care 
provider must comply with section 4 and comply with requests for 
information under section 7.  A registered home care provider is 
subject to sections 144A.51 to 144A.54.  Registration under this 
section does not exempt a home care provider from the licensure 
and other requirements later adopted by the commissioner. 
    Within 90 days after the effective date of the licensure 
rules under section 5, the commissioner of health shall issue 
provisional licenses to all home care providers registered with 
the department as of that date.  The provisional license shall 
be valid until superseded by a license issued under section 6 or 
for a period of one year, whichever is shorter.  Applications 
for licensure as a home care provider received on or after the 
effective date of the home care licensure rules, shall be issued 
under section 6, subdivision 1. 
    Sec. 15.  Minnesota Statutes 1986, section 256B.04, is 
amended by adding a subdivision to read: 
    Subd. 16.  [PERSONAL CARE ASSISTANTS.] (a) The commissioner 
shall adopt permanent rules to implement, administer, and 
operate the personal care assistant services program.  The rules 
must incorporate the standards and requirements adopted by the 
commissioner of health under section 5 which are applicable to 
the personal care assistant program.  Limits on the extent of 
personal care assistant services that may be provided to an 
individual must be based on the cost-effectiveness of the 
services in relation to the costs of inpatient hospital care, 
nursing home care, and other available types of care.  The rules 
must provide, at a minimum: 
    (1) that agencies be selected to contract with or employ 
and train staff to provide and supervise the provision of 
personal care services; 
    (2) that agencies employ or contract with a qualified 
applicant that a qualified recipient proposes to the agency as 
the recipient's choice of assistant; 
    (3) that agencies bill the medical assistance program for a 
personal care service by a personal care assistant and visits by 
the registered nurse supervising the personal care assistant; 
    (4) that agencies establish a grievance mechanism; and 
    (5) that agencies have a quality assurance program.  
    (b) For personal care assistants under contract with an 
agency under paragraph (a), the provision of training and 
supervision by the agency does not create an employment 
relationship. 
    Sec. 16.  Minnesota Statutes 1986, section 364.09, is 
amended to read: 
    364.09 [LAW ENFORCEMENT; EXCEPTION EXCEPTIONS.] 
    This chapter shall not apply to the practice of law 
enforcement, to eligibility for a family day care license or, a 
family foster care license, a home care provider license, or to 
eligibility for school bus driver endorsements.  Nothing in this 
section shall be construed to preclude the Minnesota police and 
peace officers training board from recommending policies set 
forth in this chapter to the attorney general for adoption in 
the attorney general's discretion to apply to law enforcement. 
    Sec. 17.  Minnesota Statutes 1986, section 626.557, 
subdivision 2, is amended to read: 
    Subd. 2.  [DEFINITIONS.] As used in this section, the 
following terms have the meanings given them unless the specific 
context indicates otherwise. 
    (a) "Facility" means a hospital or other entity required to 
be licensed pursuant to sections 144.50 to 144.58; a nursing 
home required to be licensed to serve adults pursuant to section 
144A.02; an agency, day care facility, or residential facility 
required to be licensed to serve adults pursuant to sections 
245.781 to 245.812; or a home health agency certified for 
participation in titles XVIII or XIX of the Social Security Act, 
United States Code, title 42, sections 1395 et seq care provider 
licensed under section 6. 
    (b) "Vulnerable adult" means any person 18 years of age or 
older: 
    (1) who is a resident or inpatient of a facility; 
    (2) who receives services at or from a facility required to 
be licensed to serve adults pursuant to sections 245.781 to 
245.812, except a person receiving outpatient services for 
treatment of chemical dependency or mental illness;  
    (3) who receives services from a home health agency 
certified for participation under titles XVIII or XIX of the 
Social Security Act, United States Code, title 42, sections 1395 
et seq and 1396 et seq care provider licensed under section 6; 
or 
    (4) who, regardless of residence or type of service 
received, is unable or unlikely to report abuse or neglect 
without assistance because of impairment of mental or physical 
function or emotional status. 
    (c) "Caretaker" means an individual or facility who has 
responsibility for the care of a vulnerable adult as a result of 
a family relationship, or who has assumed responsibility for all 
or a portion of the care of a vulnerable adult voluntarily, by 
contract, or by agreement. 
    (d) "Abuse" means: 
    (1) any act which constitutes a violation under sections 
609.221 to 609.223, 609.23 to 609.235, 609.322, 609.342, 
609.343, 609.344, or 609.345;  
    (2) nontherapeutic conduct which produces or could 
reasonably be expected to produce pain or injury and is not 
accidental, or any repeated conduct which produces or could 
reasonably be expected to produce mental or emotional distress;  
     (3) any sexual contact between a facility staff person and 
a resident or client of that facility; or 
     (4) the illegal use of a vulnerable adult's person or 
property for another person's profit or advantage, or the breach 
of a fiduciary relationship through the use of a person or a 
person's property for any purpose not in the proper and lawful 
execution of a trust, including but not limited to situations 
where a person obtains money, property, or services from a 
vulnerable adult through the use of undue influence, harassment, 
duress, deception, or fraud. 
     (e) "Neglect" means:  
     (1) failure by a caretaker to supply a vulnerable adult 
with necessary food, clothing, shelter, health care or 
supervision;  
     (2) the absence or likelihood of absence of necessary food, 
clothing, shelter, health care, or supervision for a vulnerable 
adult; or 
     (3) the absence or likelihood of absence of necessary 
financial management to protect a vulnerable adult against abuse 
as defined in paragraph (d), clause (4).  Nothing in this 
section shall be construed to require a health care facility to 
provide financial management or supervise financial management 
for a vulnerable adult except as otherwise required by law. 
    (f) "Report" means any report received by a local welfare 
agency, police department, county sheriff, or licensing agency 
pursuant to this section. 
    (g) "Licensing agency" means: 
    (1) the commissioner of health, for facilities as defined 
in clause (a) which are required to be licensed or certified by 
the department of health; 
    (2) the commissioner of human services, for facilities 
required by sections 245.781 to 245.813 to be licensed; 
    (3) any licensing board which regulates persons pursuant to 
section 214.01, subdivision 2; and 
    (4) any agency responsible for credentialing human services 
occupations. 
    Sec. 18.  [APPROPRIATION.] 
    $516,600 is appropriated from the general fund to the 
commissioner of health for the regulation of home care services, 
$191,000 to be available for the fiscal year ending June 30, 
1988, and $325,000 to be available until June 30, 1989. 
    Sec. 19.  [EFFECTIVE DATE.] 
    Sections 1 to 18 are effective the day following final 
enactment. 
    Approved June 2, 1987