Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 2002, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 252-H.F.No. 2531
An act relating to health; regulating hospice care
providers; providing criminal penalties; amending
Minnesota Statutes 2000, sections 13.381, subdivision
10; 144A.43, subdivisions 1, 3, 4; 144A.45,
subdivisions 1, 2; 144A.46, subdivisions 3a, 3b, 4;
144A.4605, subdivisions 2, 3; 145C.01, subdivision 7;
157.17, subdivision 2; 609.7495, subdivision 1;
626.5572, subdivision 6; Minnesota Statutes 2001
Supplement, section 144A.4605, subdivision 4;
proposing coding for new law in Minnesota Statutes,
chapter 144A; repealing Minnesota Statutes 2000,
section 144A.48.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2000, section 13.381,
subdivision 10, is amended to read:
Subd. 10. [HOME CARE AND HOSPICE PROGRAM PROVIDER.] Data
regarding a home care hospice program provider under sections
144A.43 to 144A.48 144A.47 are governed by section 144A.45.
Data regarding a hospice provider under sections 144A.75 to
144A.755 are governed by sections 144A.752 and 144A.754.
Sec. 2. Minnesota Statutes 2000, section 144A.43,
subdivision 1, is amended to read:
Subdivision 1. [APPLICABILITY.] The definitions in this
section apply to sections 144.699, subdivision 2, and 144A.43 to
144A.48 144A.47.
Sec. 3. Minnesota Statutes 2000, section 144A.43,
subdivision 3, is amended to read:
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 148.285;
(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, and shopping;
(9) medical social services;
(10) the provision of medical supplies and equipment when
accompanied by the provision of a home care service; and
(11) the provision of a hospice program as specified in
section 144A.48; and
(12) other similar medical services and health-related
support services identified by the commissioner in rule.
"Home care service" does not include the following
activities conducted by the commissioner of health or a board of
health as defined in section 145A.02, subdivision 2:
communicable disease investigations or testing; administering or
monitoring a prescribed therapy necessary to control or prevent
a communicable disease; or the monitoring of an individual's
compliance with a health directive as defined in section
144.4172, subdivision 6.
Sec. 4. Minnesota Statutes 2000, section 144A.43,
subdivision 4, is amended to read:
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 144A.48. "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 employee of a nursing home licensed under this
chapter or an employee of a boarding care home licensed under
sections 144.50 to 144.56 who responds to occasional emergency
calls from individuals residing in a residential setting that is
attached to or located on property contiguous to the nursing
home or boarding care home;
(8) a member of a professional corporation organized under
chapter 319B that does not regularly offer or provide home care
services as defined in subdivision 3;
(9) 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 317A, a
partnership organized under chapter 323, or any other entity
determined by the commissioner;
(10) 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;
(11) an individual licensed under chapter 147; or
(12) an individual who provides home care services to a
person with a developmental disability who lives in a place of
residence with a family, foster family, or primary caregiver.
Sec. 5. Minnesota Statutes 2000, section 144A.45,
subdivision 1, is amended to read:
Subdivision 1. [RULES.] The commissioner shall adopt rules
for the regulation of home care providers pursuant to sections
144A.43 to 144A.48 144A.47. 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 144A.43 to 144A.48 144A.47;
(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 for medication management which may vary
according to the nature of the services provided, the setting in
which the services are provided, or the status of the consumer.
Medication management includes the central storage, handling,
distribution, and administration of medications;
(e) standards for supervision of home care services
requiring supervision by a registered nurse or other appropriate
health care professional which must occur on site at least every
62 days, or more frequently if indicated by a clinical
assessment, and in accordance with sections 148.171 to 148.285
and rules adopted thereunder;
(f) standards for client evaluation or assessment which may
vary according to the nature of the services provided or the
status of the consumer;
(g) 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;
(h) 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
(i) operating procedures required to implement the home
care bill of rights.
Sec. 6. Minnesota Statutes 2000, section 144A.45,
subdivision 2, is amended to read:
Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner
shall:
(1) evaluate, monitor, and license home care providers in
accordance with sections 144A.45 to 144A.48 144A.47;
(2) inspect the office and records of a provider during
regular business hours without 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, for
violations of sections 144A.43 to 144A.48 144A.47 or the rules
adopted under those sections; and
(5) take other action reasonably required to accomplish the
purposes of sections 144A.43 to 144A.48 144A.47.
(b) In the exercise of the authority granted in sections
144A.43 to 144A.48 144A.47, the commissioner shall comply with
the applicable requirements of section 144.122, the Government
Data Practices Act, and the Administrative Procedure Act.
Sec. 7. Minnesota Statutes 2000, section 144A.46,
subdivision 3a, is amended to read:
Subd. 3a. [INJUNCTIVE RELIEF.] In addition to any other
remedy provided by law, the commissioner may bring an action in
district court to enjoin a person who is involved in the
management, operation, or control of a home care provider, or an
employee of the home care provider from illegally engaging in
activities regulated by sections 144A.43 to 144A.48 144A.47.
The commissioner may bring an action under this subdivision in
the district court in Ramsey county or in the district in which
a home care provider is providing services. The court may grant
a temporary restraining order in the proceeding if continued
activity by the person who is involved in the management,
operation, or control of a home care provider, or by an employee
of the home care provider, would create an imminent risk of harm
to a recipient of home care services.
Sec. 8. Minnesota Statutes 2000, section 144A.46,
subdivision 3b, is amended to read:
Subd. 3b. [SUBPOENA.] In matters pending before the
commissioner under sections 144A.43 to 144A.48 144A.47, the
commissioner may issue subpoenas and compel the attendance of
witnesses and the production of all necessary papers, books,
records, documents, and other evidentiary material. If a person
fails or refuses to comply with a subpoena or order of the
commissioner to appear or testify regarding any matter about
which the person may be lawfully questioned or to produce any
papers, books, records, documents, or evidentiary materials in
the matter to be heard, the commissioner may apply to the
district court in any district, and the court shall order the
person to comply with the commissioner's order or subpoena. The
commissioner of health may administer oaths to witnesses, or
take their affirmation. Depositions may be taken in or outside
the state in the manner provided by law for the taking of
depositions in civil actions. A subpoena or other process or
paper may be served upon a named person anywhere within the
state by an officer authorized to serve subpoenas in civil
actions, with the same fees and mileage and in the same manner
as prescribed by law for process issued out of a district
court. A person subpoenaed under this subdivision shall receive
the same fees, mileage, and other costs that are paid in
proceedings in district court.
Sec. 9. Minnesota Statutes 2000, section 144A.46,
subdivision 4, is amended to read:
Subd. 4. [RELATION TO OTHER REGULATORY PROGRAMS.] In the
exercise of the authority granted under sections 144A.43 to
144A.48 144A.47, 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 144A.44. The commissioner
of health shall not require a home care provider certified under
the Medicare program to comply with a rule adopted under section
144A.45 if the home care provider is required to comply with any
equivalent federal law or regulation relating to the same
subject matter. The commissioner of health shall specify in the
rules those provisions that are not applicable to certified home
care providers. To the extent possible, the commissioner shall
coordinate the inspections required under sections 144A.45
to 144A.48 144A.47 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 Laws 1987, chapter 378.
Sec. 10. Minnesota Statutes 2000, section 144A.4605,
subdivision 2, is amended to read:
Subd. 2. [ASSISTED LIVING HOME CARE LICENSE ESTABLISHED.]
A home care provider license category entitled assisted living
home care provider is hereby established. A home care provider
may obtain an assisted living license if the program meets the
following requirements:
(a) nursing services, delegated nursing services, other
services performed by unlicensed personnel, or central storage
of medications under the assisted living license are provided
solely for residents of one or more housing with services
establishments registered under chapter 144D;
(b) unlicensed personnel perform home health aide and home
care aide tasks identified in Minnesota Rules, parts 4668.0100,
subparts 1 and 2, and 4668.0110, subpart 1. Qualifications to
perform these tasks shall be established in accordance with
subdivision 3;
(c) periodic supervision of unlicensed personnel is
provided as required by rule;
(d) notwithstanding Minnesota Rules, part 4668.0160,
subpart 6, item D, client records shall include:
(1) daily records or a weekly summary of home care services
provided;
(2) documentation each time medications are administered to
a client; and
(3) documentation on the day of occurrence of any
significant change in the client's status or any significant
incident, such as a fall or refusal to take medications.
All entries must be signed by the staff providing the
services and entered into the record no later than two weeks
after the end of the service day, except as specified in clauses
(2) and (3);
(e) medication and treatment orders, if any, are included
in the client record and are renewed at least every 12 months,
or more frequently when indicated by a clinical assessment;
(f) the central storage of medications in a housing with
services establishment registered under chapter 144D is managed
under a system that is established by a registered nurse and
addresses the control of medications, handling of medications,
medication containers, medication records, and disposition of
medications; and
(g) in other respects meets the requirements established by
rules adopted under sections 144A.45 to 144A.48 144A.47.
Sec. 11. Minnesota Statutes 2000, section 144A.4605,
subdivision 3, is amended to read:
Subd. 3. [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.]
(a) Unlicensed personnel must:
(1) satisfy the training or competency requirements
established by rule under sections 144A.45 to 144A.48 144A.47;
or
(2) be trained or determined competent by a registered
nurse in each task identified under Minnesota Rules, part
4668.0100, subparts 1 and 2, when offered to clients in a
housing with services establishment as described in paragraphs
(b) to (e).
(b) Training for tasks identified under Minnesota Rules,
part 4668.0100, subparts 1 and 2, shall use a curriculum which
meets the requirements in Minnesota Rules, part 4668.0130.
(c) Competency evaluations for tasks identified under
Minnesota Rules, part 4668.0100, subparts 1 and 2, must be
completed and documented by a registered nurse.
(d) Unlicensed personnel performing tasks identified under
Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be
trained or demonstrate competency in the following topics:
(1) an overview of sections 144A.43 to 144A.48 144A.47 and
rules adopted thereunder;
(2) recognition and handling of emergencies and use of
emergency services;
(3) reporting the maltreatment of vulnerable minors or
adults under sections 626.556 and 626.557;
(4) home care bill of rights;
(5) handling of clients' complaints and reporting of
complaints to the office of health facility complaints;
(6) services of the ombudsman for older Minnesotans;
(7) observation, reporting, and documentation of client
status and of the care or services provided;
(8) basic infection control;
(9) maintenance of a clean, safe, and healthy environment;
(10) communication skills;
(11) basic elements of body functioning and changes in body
function that must be reported to an appropriate health care
professional; and
(12) physical, emotional, and developmental needs of
clients, and ways to work with clients who have problems in
these areas, including respect for the client, the client's
property, and the client's family.
(e) Unlicensed personnel who administer medications must
comply with rules relating to the administration of medications
in Minnesota Rules, part 4668.0100, subpart 2, except that
unlicensed personnel need not comply with the requirements of
Minnesota Rules, part 4668.0100, subpart 5.
Sec. 12. Minnesota Statutes 2001 Supplement, section
144A.4605, subdivision 4, is amended to read:
Subd. 4. [LICENSE REQUIRED.] (a) A housing with services
establishment registered under chapter 144D that is required to
obtain a home care license must obtain an assisted living home
care license according to this section or a class A or class E
license according to rule. A housing with services
establishment that obtains a class E license under this
subdivision remains subject to the payment limitations in
sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915,
subdivision 3, paragraph (g).
(b) A board and lodging establishment registered for
special services as of December 31, 1996, and also registered as
a housing with services establishment under chapter 144D, must
deliver home care services according to sections 144A.43 to
144A.48 144A.47, and may apply for a waiver from requirements
under Minnesota Rules, parts 4668.0002 to 4668.0240, to operate
a licensed agency under the standards of section 157.17. Such
waivers as may be granted by the department will expire upon
promulgation of home care rules implementing section 144A.4605.
(c) An adult foster care provider licensed by the
department of human services and registered under chapter 144D
may continue to provide health-related services under its foster
care license until the promulgation of home care rules
implementing this section.
(d) An assisted living home care provider licensed under
this section must comply with the disclosure provisions of
section 325F.72 to the extent they are applicable.
Sec. 13. [144A.75] [DEFINITIONS.]
Subdivision 1. [APPLICABILITY.] For the purposes of
sections 144A.75 to 144A.756, the following terms have the
meanings given them.
Subd. 2. [COMMISSIONER.] "Commissioner" means the
commissioner of health.
Subd. 3. [CORE SERVICES.] "Core services" means physician
services, registered nursing services, medical social services,
and counseling services. A hospice must ensure that at least
two core services are regularly provided directly by hospice
employees. A hospice provider may use contracted staff if
necessary to supplement hospice employees in order to meet the
needs of patients during peak patient loads or under
extraordinary circumstances.
Subd. 4. [COUNSELING SERVICES.] "Counseling services"
includes bereavement counseling provided after the patient's
death and spiritual and other counseling services for the
individual and the family while enrolled in hospice care.
Bereavement services must be provided according to a plan of
care that reflects the needs of the family for up to one year
following the death of the patient.
Subd. 5. [HOSPICE PROVIDER.] "Hospice 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 hospice
services for a fee to terminally ill hospice patients. A
hospice must provide all core services.
Subd. 6. [HOSPICE PATIENT.] "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 hospice medical director,
who alone or, when unable, through the individual's family has
voluntarily consented to and received admission to a hospice
provider.
Subd. 7. [HOSPICE PATIENT'S FAMILY.] "Hospice patient's
family" means relatives of the hospice patient, the hospice
patient's guardian or primary caregiver, or persons identified
by the hospice patient as having significant personal ties.
Subd. 8. [HOSPICE SERVICES; HOSPICE CARE.] "Hospice
services" or "hospice care" 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. These services are provided through a centrally
coordinated program that ensures continuity and consistency of
home and inpatient care that is provided directly or through an
agreement.
Subd. 9. [INTERDISCIPLINARY TEAM.] "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.
Subd. 10. [MEDICAL DIRECTOR.] "Medical director" means a
licensed physician who is knowledgeable about palliative
medicine and assumes overall responsibility for the medical
component of the hospice care program.
Subd. 11. [OTHER SERVICES.] "Other services" means
physical therapy, occupational therapy, speech therapy,
nutritional counseling, and volunteers.
Subd. 12. [PALLIATIVE CARE.] "Palliative care" means the
total active care of patients whose disease is not responsive to
curative treatment. Control of pain, of other symptoms, and of
psychological, social, and spiritual problems is paramount. The
goal of palliative care is the achievement of the best quality
of life for patients and their families.
Subd. 13. [RESIDENTIAL HOSPICE FACILITY.] "Residential
hospice facility" means a facility that resembles a
single-family home located in a residential area that directly
provides 24-hour residential and support services in a home-like
setting for hospice patients as an integral part of the
continuum of home care provided by a hospice and that houses:
(1) no more than eight hospice patients; or
(2) at least nine and no more than 12 hospice patients with
the approval of the local governing authority, notwithstanding
section 462.357, subdivision 8.
Subd. 14. [VOLUNTEER SERVICES.] "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 hospice patient's family,
and the hospice provider.
Sec. 14. [144A.751] [HOSPICE BILL OF RIGHTS.]
Subdivision 1. [STATEMENT OF RIGHTS.] An individual who
receives hospice care and the individual's family have the right
to:
(1) receive written information about rights in advance of
receiving hospice care or during the initial evaluation visit
before the initiation of hospice care, including what to do if
rights are violated;
(2) receive care and services according to a suitable
hospice plan of care and subject to accepted hospice care
standards and to take an active part in creating and changing
the plan and evaluating care and services;
(3) be told in advance of receiving care about the services
that will be provided, the disciplines that will furnish care,
the frequency of visits proposed to be furnished, other choices
that are available, and the consequence of these choices,
including the consequences of refusing these services;
(4) be told in advance, whenever possible, of any change in
the hospice plan of care and to take an active part in any
change;
(5) refuse services or treatment;
(6) know, in advance, any limits to the services available
from a provider, and the provider's grounds for a termination of
services;
(7) know in advance of receiving care whether the services
are covered by health insurance, medical assistance, or other
health programs, the charges for services that will not be
covered by Medicare, and the charges that the individual may
have to pay;
(8) know what the charges are for services, no matter who
will be paying the bill;
(9) know that there may be other services available in the
community, including other end of life services and other
hospice providers, and know where to go for information about
these services;
(10) choose freely among available providers and change
providers after services have begun, within the limits of health
insurance, medical assistance, or other health programs;
(11) have personal, financial, and medical information kept
private and be advised of the provider's policies and procedures
regarding disclosure of such information;
(12) be allowed access to records and written information
from records according to section 144.335;
(13) be served by people who are properly trained and
competent to perform their duties;
(14) be treated with courtesy and respect and to have the
patient's property treated with respect;
(15) be free from physical and verbal abuse;
(16) reasonable, advance notice of changes in services or
charges, including at least ten days' advance notice of the
termination of a service by a provider, except in cases where:
(i) the recipient of services engages in conduct that
alters the conditions of employment as specified in the
employment contract between the hospice provider and the
individual providing hospice services, or creates an abusive or
unsafe work environment for the individual providing home care
services; or
(ii) an emergency for the informal caregiver or a
significant change in the recipient's condition has resulted in
service needs that exceed the current service provider agreement
and that cannot be safely met by the hospice provider;
(17) a coordinated transfer when there will be a change in
the provider of services;
(18) voice grievances regarding treatment or care that is,
or fails to be, furnished, or regarding the lack of courtesy or
respect to the patient or the patient's property;
(19) know how to contact an individual associated with the
provider who is responsible for handling problems and to have
the provider investigate and attempt to resolve the grievance or
complaint;
(20) know the name and address of the state or county
agency to contact for additional information or assistance;
(21) assert these rights personally, or have them asserted
by the hospice patient's family when the patient has been judged
incompetent, without retaliation; and
(22) have pain and symptoms managed to the patient's
desired level of comfort.
Subd. 2. [INTERPRETATION AND ENFORCEMENT OF RIGHTS.] The
rights under this section are established for the benefit of
individuals who receive hospice care. A hospice provider may
not require a person to surrender these rights as a condition of
receiving hospice care. 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 hospice care, persons providing
hospice care, or hospice providers licensed under section
144A.753.
Subd. 3. [DISCLOSURE.] A copy of these rights must be
provided to an individual at the time hospice care is
initiated. The copy shall contain the address and telephone
number of the office of health facility complaints and the
office of the ombudsman for older Minnesotans and a brief
statement describing how to file a complaint with these
offices. Information about how to contact the office of the
ombudsman for older Minnesotans shall be included in notices of
change in client fees and in notices where hospice providers
initiate transfer or discontinuation of services.
Sec. 15. [144A.752] [REGULATION OF HOSPICE CARE.]
Subdivision 1. [RULES.] The commissioner shall adopt rules
for the regulation of hospice providers according to sections
144A.75 to 144A.755. The rules shall include the following:
(1) provisions to ensure, to the extent possible, the
health, safety, well-being, and appropriate treatment of persons
who receive hospice care;
(2) requirements that hospice providers furnish the
commissioner with specified information necessary to implement
sections 144A.75 to 144A.755;
(3) standards of training of hospice provider personnel;
(4) standards for medication management, which may vary
according to the nature of the hospice care provided, the
setting in which the hospice care is provided, or the status of
the patient;
(5) standards for hospice patient and hospice patient's
family evaluation or assessment, which may vary according to the
nature of the hospice care provided or the status of the
patient; and
(6) requirements for the involvement of a patient's
physician; documentation of physicians' orders, if required, and
the patient's hospice plan of care; and maintenance of accurate,
current clinical records.
Subd. 2. [REGULATORY FUNCTIONS.] (a) The commissioner
shall:
(1) evaluate, monitor, and license hospice providers
according to sections 144A.75 to 144A.755;
(2) inspect the office and records of a hospice provider
during regular business hours without advance notice to the
hospice provider;
(3) with the consent of the patient, visit the home where
services are being provided;
(4) issue correction orders and assess civil penalties
according to section 144.653, subdivisions 5 to 8, for
violations of sections 144A.75 to 144A.755 or rules adopted
thereunder; and
(5) take other action reasonably required to accomplish the
purposes of sections 144A.75 to 144A.755.
(b) In the exercise of the authority granted under this
section, the commissioner shall comply with the applicable
requirements of the Government Data Practices Act, the
Administrative Procedure Act, and other applicable law.
Subd. 3. [RELATION TO OTHER REGULATORY PROGRAMS.] In the
exercise of the authority granted under sections 144A.75 to
144A.755, the commissioner shall not duplicate or replace
standards and requirements imposed under another regulatory
program of the state. 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 hospice care or to enforce and protect the rights of
patients listed under section 144A.751. The commissioner shall
not require a hospice care provider certified under the Medicare
program and surveyed and enforced by the Minnesota department of
health, to comply with a rule adopted under this section if the
hospice provider is required to comply with any equivalent
federal law or regulation relating to the same subject matter.
The commissioner shall specify in the rules those provisions
that are not applicable to certified hospice providers.
Subd. 4. [MEDICAID REIMBURSEMENT.] Certification by the
federal Medicare program must not be a requirement of Medicaid
payment for room and board services delivered in a residential
hospice facility.
Sec. 16. [144A.753] [LICENSURE.]
Subdivision 1. [LICENSE REQUIRED; APPLICATION.] (a) A
hospice provider may not operate in the state without a valid
license issued by the commissioner.
(b) Within ten days after receiving an application for a
license, the commissioner shall acknowledge receipt of the
application in writing. The acknowledgment must indicate
whether the application appears to be complete or whether
additional information is required before the application is
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 hospice care.
(c) Each application for a hospice provider license, or for
a renewal of a license, shall be accompanied by a fee as follows:
(1) for revenues no more than $25,000, $125;
(2) for revenues greater than $25,000 and no more than
$100,000, $312.50;
(3) for revenues greater than $100,000 and no more than
$250,000, $625;
(4) for revenues greater than $250,000 and no more than
$350,000, $937.50;
(5) for revenues greater than $350,000 and no more than
$450,000, $1,250;
(6) for revenues greater than $450,000 and no more than
$550,000, $1,562.50;
(7) for revenues greater than $550,000 and no more than
$650,000, $1,875;
(8) for revenues greater than $650,000 and no more than
$750,000, $2,187.50;
(9) for revenues greater then $750,000 and no more than
$850,000, $2,500;
(10) for revenues greater than $850,000 and no more than
$950,000, $2,812.50;
(11) for revenues greater than $950,000 and no more than
$1,100,000, $3,125;
(12) for revenues greater than $1,100,000 and no more than
$1,275,000, $3,750;
(13) for revenues greater than $1,275,000 and no more than
$1,500,000, $4,375; and
(14) for revenues greater than $1,500,000, $5,000.
Subd. 2. [LICENSING REQUIREMENTS.] The commissioner shall
license hospice providers using the authorities under sections
144A.75 to 144A.755. To receive a license, a hospice provider
must:
(1) provide centrally coordinated core services in the home
and inpatient settings and make other services available, which
may be provided by employees or contracted staff;
(2) require that the medical components of the hospice care
program be under the direction of a licensed physician who
serves as medical director;
(3) require that the palliative care provided to a hospice
patient be under the direction of a licensed physician;
(4) utilize an interdisciplinary team that meets regularly
to develop, implement, and evaluate the hospice provider's plan
of care for each hospice patient and the patient's family.
Within 48 hours of admission, a licensee must enter a written
service agreement with the patient or the patient's responsible
person describing the cost of services. Services are provided
in accordance to the plan of care developed by the
interdisciplinary team. Changes in the services provided which
do not cause a change in fees do not require a written
modification of the service plan agreed to by the patient or the
patient's responsible person;
(5) provide accessible hospice care, 24 hours a day, seven
days a week;
(6) utilize an ongoing system of quality assurance;
(7) require that volunteer services be provided by
individuals who have completed a hospice volunteer training
program and are trained to provide the services required;
(8) provide a planned program of supportive services and
bereavement counseling available to patients and families during
hospice care and the bereavement period following the death of
the hospice patient; and
(9) require that inpatient services be provided directly or
by arrangement in a licensed hospital or nursing home or
residential hospice.
Subd. 3. [NOMENCLATURE.] A hospice provider may not
operate in the state or use the words "hospice," "hospice care,"
"hospice care program," or "hospice provider" without a valid
license issued by the commissioner. St. Anne Hospice in Winona
county may continue to use the name "hospice."
Sec. 17. [144A.754] [ENFORCEMENT.]
Subdivision 1. [ENFORCEMENT.] (a) 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 hospice
or for conduct detrimental to the welfare of a patient. Prior
to any suspension, revocation, or refusal to renew a license,
the hospice provider is entitled to notice and a hearing as
provided by chapter 14.
(b) 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 hospice
care by a provider for not more than 60 days if the commissioner
determines that the health or safety of a patient 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.
(c) The process of suspending or revoking a license must
include a plan for transferring affected patients to other
providers.
(d) The owner and managerial officials of a hospice
provider, the license of which has not been renewed or has been
revoked because of noncompliance with applicable law, are not
eligible to apply for and shall not be granted a license for
five years following the effective date of the nonrenewal or
revocation.
(e) The commissioner shall not issue a license to a hospice
provider if an owner or managerial official includes an
individual who was an owner or managerial official of a hospice
provider or other type of licensed home care provider whose
license was not renewed or was revoked as described in paragraph
(d) for five years following the effective date of nonrenewal or
revocation.
(f) Notwithstanding the provisions of paragraph (a), the
commissioner shall not renew or shall suspend or revoke the
license of a hospice provider that includes an individual as an
owner or managerial official who was an owner or managerial
official of a hospice provider whose license was not renewed or
was revoked as described in paragraph (d) for five years
following the effective date of the nonrenewal or revocation.
(g) The commissioner shall notify the hospice provider 30
days in advance of the date of nonrenewal, suspension, or
revocation of the license. Within ten days after the receipt of
this notification, the hospice provider may request, in writing,
that the commissioner stay the nonrenewal, revocation, or
suspension of the license. The hospice provider shall specify
the reasons for requesting the stay; the steps that will be
taken to attain or maintain compliance with the licensure laws;
any limits on the authority or responsibility of the owners or
managerial officials whose actions resulted in the notice of
nonrenewal, revocation, or suspension; and any other information
to establish that the continuing affiliation with these
individuals will not jeopardize patient health, safety, or
well-being. The commissioner shall determine whether the stay
will be granted within 30 days of receiving the provider's
request. The commissioner may propose additional restrictions
or limitations on the provider's license and require that the
granting of the stay be contingent upon compliance with those
provisions. The commissioner shall take into consideration the
following factors when determining whether the stay should be
granted:
(1) the threat that continued involvement of the owners and
managerial officials in the hospice provider poses to patient
health, safety, and well-being;
(2) the compliance history of the hospice provider; and
(3) the appropriateness of any limits suggested by the
hospice provider.
(h) If the commissioner grants the stay, the order shall
include any restrictions or limitations on the provider's
license. The failure of the provider to comply with any
restrictions or limitations shall result in the immediate
removal of the stay and the commissioner shall take immediate
action to suspend, revoke, or not renew the license.
(i) The provisions contained in paragraphs (d) and (e)
apply to any nonrenewal or revocation of a hospice provider
license occurring after the effective date of the rules adopted
under section 144A.752.
(j) For the purposes of this subdivision, owners of a
hospice provider are those individuals whose ownership interest
provides sufficient authority or control to affect or change
decisions related to the operation of the hospice provider. An
owner includes a sole proprietor, a general partner, or any
other individual whose individual ownership interest can affect
the management and direction of the policies of the hospice
provider. For the purposes of this subdivision, managerial
officials are those individuals who had the responsibility for
the ongoing management or direction of the policies, services,
or employees of the hospice provider relating to the areas of
noncompliance that led to the license revocation or nonrenewal.
Subd. 2. [INJUNCTIVE RELIEF.] In addition to any other
remedy provided by law, the commissioner may bring an action in
district court to enjoin a person who is involved in the
management, operation, or control of a hospice provider or an
employee of the hospice provider from illegally engaging in
activities regulated under sections 144A.75 to 144A.755. The
commissioner may bring an action under this subdivision in the
district court in Ramsey county or in the district in which a
hospice provider is providing hospice care. The court may grant
a temporary restraining order in the proceeding if continued
activity by the person who is involved in the management,
operation, or control of a hospice provider or an employee of
the hospice provider would create an imminent risk of harm to a
recipient of hospice care.
Subd. 3. [SUBPOENA.] In matters pending before the
commissioner under sections 144A.75 to 144A.755, the
commissioner may issue subpoenas and compel the attendance of
witnesses and the production of all necessary papers, books,
records, documents, and other evidentiary material. If a person
fails or refuses to comply with a subpoena or order of the
commissioner to appear or testify regarding any matter about
which the person may be lawfully questioned or to produce any
papers, books, records, documents, or evidentiary materials in
the matter to be heard, the commissioner may apply to the
district court in any district and the court shall order the
person to comply with the commissioner's order or subpoena. The
commissioner may administer oaths to witnesses or take their
affirmation. Depositions may be taken in or outside the state
in the manner provided by law for the taking of depositions in
civil actions. A subpoena or other process or paper may be
served upon a named person anywhere within the state by an
officer authorized to serve subpoenas in civil actions, with the
same fees and mileage and in the same manner as prescribed by
law for process issued out of a district court. A person
subpoenaed under this subdivision shall receive the same fees,
mileage, and other costs that are paid in proceedings in
district court.
Subd. 4. [TIME LIMITS FOR APPEALS.] To appeal the
assessment of civil penalties under section 144A.752,
subdivision 2, clause (4), a denial of a waiver or variance, and
an action against a license under subdivision 1, a hospice
provider must request a hearing no later than 15 days after the
provider receives notice of the action.
Subd. 5. [PRIOR CRIMINAL CONVICTIONS.] (a) Before the
commissioner issues an initial or renewal license, an owner or
managerial official is required to complete a background study
under section 144.057. No person may be involved in the
management, operation, or control of a hospice provider if the
person has been disqualified under the provisions of chapter
245A. Individuals disqualified under these provisions may
request a reconsideration, and if the disqualification is set
aside, are then eligible to be involved in the management,
operation, or control of the provider. For purposes of this
section, owners of a hospice provider subject to the background
check requirement are those individuals whose ownership interest
provides sufficient authority or control to affect or change
decisions related to the operation of the hospice provider. An
owner includes a sole proprietor, a general partner, or any
other individual whose individual ownership interest can affect
the management and direction of the policies of the hospice
provider. For the purposes of this section, managerial
officials subject to the background check requirement are those
individuals who provide "direct contact" as defined in section
245A.04 or those individuals who have the responsibility for the
ongoing management or direction of the policies, services, or
employees of the hospice provider. Data collected under this
subdivision are classified as private data under section 13.02,
subdivision 12.
(b) Employees, contractors, and volunteers of a hospice
provider are subject to the background study required by section
144.057. These individuals shall be disqualified under the
provisions of chapter 245A. Nothing in this section shall be
construed to prohibit a hospice provider from requiring
self-disclosure of criminal conviction information.
(c) Termination of an employee in good faith reliance on
information or records obtained under paragraph (a) or (b)
regarding a confirmed conviction does not subject the hospice
provider to civil liability or liability for unemployment
benefits.
Sec. 18. [144A.755] [INFORMATION AND REFERRAL SERVICES.]
The commissioner shall ensure that information and referral
services relating to hospice care are available in all regions
of the state. The commissioner shall collect and make available
information about available hospice care, sources of payment,
providers, and the rights of patients. The commissioner may
require hospice providers to provide information requested for
the purposes of this section as a condition of licensure. The
commissioner may publish and make available:
(1) general information describing hospice care 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. 19. [144A.756] [PENALTY.]
A person involved in the management, operation, or control
of a hospice provider who violates section 144A.753, subdivision
1, paragraph (a), is guilty of a misdemeanor. This section does
not apply to a person who had no legal authority to affect or
change decisions related to the management, operation, or
control of a hospice provider.
Sec. 20. Minnesota Statutes 2000, section 145C.01,
subdivision 7, is amended to read:
Subd. 7. [HEALTH CARE FACILITY.] "Health care facility"
means a hospital or other entity licensed under sections 144.50
to 144.58, a nursing home licensed to serve adults under section
144A.02, or a home care provider licensed under sections 144A.43
to 144A.48 144A.47, or a hospice provider licensed under
sections 144A.75 to 144A.755.
Sec. 21. Minnesota Statutes 2000, section 157.17,
subdivision 2, is amended to read:
Subd. 2. [REGISTRATION.] At the time of licensure or
license renewal, a boarding and lodging establishment or a
lodging establishment that provides supportive services or
health supervision services must be registered with the
commissioner, and must register annually thereafter. The
registration must include the name, address, and telephone
number of the establishment, the name of the operator, the types
of services that are being provided, a description of the
residents being served, the type and qualifications of staff in
the facility, and other information that is necessary to
identify the needs of the residents and the types of services
that are being provided. The commissioner shall develop and
furnish to the boarding and lodging establishment or lodging
establishment the necessary form for submitting the registration.
Housing with services establishments registered under
chapter 144D shall be considered registered under this section
for all purposes except that:
(1) the establishments shall operate under the requirements
of chapter 144D; and
(2) the criminal background check requirements of sections
299C.66 to 299C.71 apply. The criminal background check
requirements of section 144.057 apply only to personnel
providing home care services under sections 144A.43 to
144A.48 144A.47 and personnel providing hospice care under
sections 144A.75 to 144A.755.
Sec. 22. Minnesota Statutes 2000, section 609.7495,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For the purposes of this
section, the following terms have the meanings given them.
(a) "Facility" means any of the following:
(1) a hospital or other health institution licensed under
sections 144.50 to 144.56;
(2) a medical facility as defined in section 144.561;
(3) an agency, clinic, or office operated under the
direction of or under contract with the commissioner of health
or a community health board, as defined in section 145A.02;
(4) a facility providing counseling regarding options for
medical services or recovery from an addiction;
(5) a facility providing emergency shelter services for
battered women, as defined in section 611A.31, subdivision 3, or
a facility providing transitional housing for battered women and
their children;
(6) a facility as defined in section 626.556, subdivision
2, paragraph (f);
(7) a facility as defined in section 626.5572, subdivision
6, where the services described in that paragraph are provided;
(8) a place to or from which ambulance service, as defined
in section 144E.001, is provided or sought to be provided; and
(9) a hospice program provider licensed under section
144A.48 144A.753.
(b) "Aggrieved party" means a person whose access to or
egress from a facility is obstructed in violation of subdivision
2, or the facility.
Sec. 23. Minnesota Statutes 2000, section 626.5572,
subdivision 6, is amended to read:
Subd. 6. [FACILITY.] (a) "Facility" means a hospital or
other entity required to be licensed under sections 144.50 to
144.58; a nursing home required to be licensed to serve adults
under section 144A.02; a residential or nonresidential facility
required to be licensed to serve adults under sections 245A.01
to 245A.16; a home care provider licensed or required to be
licensed under section 144A.46; a hospice provider licensed
under sections 144A.75 to 144A.755; or a person or organization
that exclusively offers, provides, or arranges for personal care
assistant services under the medical assistance program as
authorized under sections 256B.04, subdivision 16, 256B.0625,
subdivision 19a, and 256B.0627.
(b) For home care providers and personal care attendants,
the term "facility" refers to the provider or person or
organization that exclusively offers, provides, or arranges for
personal care services, and does not refer to the client's home
or other location at which services are rendered.
Sec. 24. [EFFECTIVE DATE.]
(a) Section 15, subdivision 1, is effective the day
following final enactment.
(b) Sections 1 to 23, except section 15, subdivision 1, are
effective upon adoption of licensure rules. Minnesota Rules,
chapters 4668 and 4669, govern the licensure of hospices until
new rules are adopted. With enactment of Minnesota Statutes,
sections 144A.75 to 144A.756, licensure orders issued to
licensed hospices under Minnesota Statutes, section 144A.45, and
Minnesota Rules, chapters 4668 and 4669, shall remain valid and
shall be subject to the issuance of a penalty assessment for
failure to correct, under Minnesota Statutes, section 144A.752
(section 15).
Sec. 25. [REPEALER.]
Minnesota Statutes 2000, section 144A.48, is repealed
effective upon adoption of licensure rules under Minnesota
Statutes, section 144A.752, subdivision 1.
Presented to the governor March 20, 2002
Signed by the governor March 22, 2002, 2:05 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes