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

                            CHAPTER 312-S.F.No. 2896 
                  An act relating to health; requiring the commissioner 
                  to develop procedures for the nursing home survey 
                  process; allowing nursing homes to train and employ 
                  resident assistants to assist residents with eating 
                  and drinking; requiring various studies and reports; 
                  amending Laws 1999, chapter 245, article 3, section 
                  45; proposing coding for new law in Minnesota 
                  Statutes, chapter 144A; repealing Minnesota Statutes 
                  1998, section 144A.103; Minnesota Rules, part 
           Section 1.  [144A.62] [RESIDENT ATTENDANTS.] 
           Subdivision 1.  [ASSISTANCE WITH EATING AND DRINKING.] (a) 
        Upon federal approval, a nursing home may employ resident 
        attendants to assist with the activities authorized under 
        subdivision 2.  The resident attendant will not be counted in 
        the minimum staffing requirements under section 144A.04, 
        subdivision 7. 
           (b) The commissioner shall submit by May 15, 2000, a 
        request for a federal waiver necessary to implement this section.
           Subd. 2.  [DEFINITION.] "Resident attendant" means an 
        individual who assists residents in a nursing home with the 
        activities of eating and drinking.  A resident attendant does 
        not include an individual who: 
           (1) is a licensed health professional or a registered 
           (2) volunteers without monetary compensation; or 
           (3) is a registered nursing assistant. 
           Subd. 3.  [REQUIREMENTS.] (a) A nursing home may not use on 
        a full-time or other paid basis any individual as a resident 
        attendant in the nursing home unless the individual: 
           (1) has completed a training and competency evaluation 
        program encompassing the tasks the individual provides; 
           (2) is competent to provide feeding and hydration services; 
           (3) is under the supervision of the director of nursing. 
           (b) A nursing home may not use a current employee as a 
        resident attendant unless the employee satisfies the 
        requirements of paragraph (a) and volunteers to be used in that 
           Subd. 4.  [EVALUATION.] The training and competency 
        evaluation program may be facility based.  It must include, at a 
        minimum, the training and competency standards for eating and 
        drinking assistance contained in the nursing assistant training 
           Subd. 5.  [CRIMINAL BACKGROUND CHECK.] A person seeking 
        employment as a resident attendant is subject to the criminal 
        background check requirements. 
           Subd. 6.  [NONRETALIATION.] Employees shall not be subject 
        to disciplinary action if they choose not to volunteer under 
        this section. 
           Subd. 7.  [RESIDENT PROTECTIONS.] Resident attendants are 
        subject to requirements for volunteer feeding assistants in 
        Minnesota Rules, part 4658.0530. 
           Subd. 8.  [EXCEPTIONS.] A resident attendant may not be 
        assigned to feed any resident who: 
           (1) is at risk of choking while eating or drinking; 
           (2) presents significant behavior management challenges 
        while eating or drinking; or 
           (3) presents other risk factors that may require emergency 
           Sec. 2.  [NURSING HOME SURVEY PROCESS.] 
           (a) The commissioner of health, in consultation with the 
        long-term care ombudsman, nursing home consumer and advocacy 
        groups, nursing home provider organizations, unions representing 
        nursing home employees, and other health care professionals 
        shall examine state and federal rules and regulations governing 
        the provision of care in nursing homes and develop and 
        implement, upon receipt of necessary federal approval, 
        alternative procedures for the nursing home survey process.  The 
        commissioner shall pursue changes to federal law necessary to 
        accomplish this process and shall apply for any necessary 
        federal waivers or approval. 
           (b) If a federal waiver is required, the commissioner shall 
        submit the waiver request no later than May 15, 2000.  The 
        commissioner shall pursue any necessary federal law changes by 
        July 1, 2000.  The alternative procedures shall be implemented 
        January 1, 2001, or upon federal approval. 
           (c) The alternative procedures for the nursing home survey 
        process shall: 
           (1) reward nursing homes with very good performance by 
        extending intervals between full surveys based on criteria to be 
        established by the commissioner; 
           (2) use other existing or new mechanisms to provide 
        objective assessments of quality and to measure quality 
           (3) provide for frequent collaborative interaction of 
        facility staff and surveyors rather than a punitive approach; 
           (4) use department resources more effectively and 
        efficiently to target problem areas.  
           (d) Upon implementation of the alternative survey process, 
        the commissioner shall work in conjunction with industry 
        stakeholders to evaluate the qualitative benefits and 
        effectiveness of the new process and to ensure that the 
        resources of the health department are properly aligned with the 
        alternative survey process.  Prior to implementation of the 
        alternative survey process, the commissioner must provide 
        assurance to residents and family members that the new process 
        will not reduce or restrict the quality of care provided to all 
           Sec. 3.  Laws 1999, chapter 245, article 3, section 45, is 
        amended to read: 
           (a) Notwithstanding the provisions of Minnesota Rules, part 
        4658.0520, an incontinent resident must be checked according to 
        a specific time interval written in the resident's care plan.  
        The resident's attending physician must authorize in writing any 
        interval longer than two hours unless the resident, if 
        competent, or a family member or legally appointed conservator, 
        guardian, or health care agent of a resident who is not 
        competent, agrees in writing to waive physician involvement in 
        determining this interval. 
           (b) This section expires July 1, 2001. 
           Sec. 4.  [DEFENSIVE DOCUMENTATION.] 
           The commissioner of health, in consultation with the 
        nursing home industry, consumers, unions representing nursing 
        home employees, and advocates, shall develop and report to the 
        legislature by January 15, 2001, with a proposal to resolve the 
        issue of defensive documentation in nursing homes. 
           Sec. 5.  [FEDERAL WAIVER REQUEST.] 
           The commissioner of health shall seek a waiver from the 
        federal government to decrease the amount of paperwork nursing 
        homes must complete when a stay in a nursing home is less than 
        30 days. 
           The commissioners of health and human services, in 
        consultation with trade groups, consumers, advocates, unions 
        representing nursing home employees, and families, shall develop 
        and report to the legislature by January 15, 2001, with a 
        proposal to decrease regulations that impede direct care of 
        residents in nursing homes. 
           Sec. 7.  [REPEALER.] 
           Minnesota Statutes 1998, section 144A.103, is repealed.  
        Minnesota Rules, part 4658.0515, is repealed. 
           Sec. 8.  [EFFECTIVE DATE.] 
           Sections 1 and 2 are effective the day following final 
           Presented to the governor March 30, 2000 
           Signed by the governor April 3, 2000, 2:08 p.m.

Official Publication of the State of Minnesota
Revisor of Statutes