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Office of the Revisor of Statutes

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.