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

                            CHAPTER 55-H.F.No. 1251 
                  An act relating to health; modifying nursing home 
                  qualification requirements; modifying requirements for 
                  medical assistance payment demonstration project for 
                  nursing homes; seeking change in federal policy; 
                  excluding certain licensed home care agencies from 
                  supplemental nursing services law; requiring a review 
                  and report on certain home care provider laws; 
                  amending Minnesota Statutes 2002, sections 144A.04, 
                  subdivision 3, by adding a subdivision; 144A.70, 
                  subdivision 6; 256B.434, subdivision 10. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 2002, section 144A.04, 
        subdivision 3, is amended to read: 
           Subd. 3.  [STANDARDS.] (a) The facility must meet the 
        minimum health, sanitation, safety and comfort standards 
        prescribed by the rules of the commissioner of health with 
        respect to the construction, equipment, maintenance and 
        operation of a nursing home.  The commissioner of health may 
        temporarily waive compliance with one or more of the standards 
        if the commissioner determines that: 
           (a) (1) temporary noncompliance with the standard will not 
        create an imminent risk of harm to a nursing home resident; and 
           (b) (2) a controlling person on behalf of all other 
        controlling persons: 
           (1) (i) has entered into a contract to obtain the materials 
        or labor necessary to meet the standard set by the commissioner 
        of health, but the supplier or other contractor has failed to 
        perform the terms of the contract and the inability of the 
        nursing home to meet the standard is due solely to that failure; 
        or 
           (2) (ii) is otherwise making a diligent good faith effort 
        to meet the standard. 
           The commissioner shall make available to other nursing 
        homes information on facility-specific waivers that are 
        granted.  The commissioner shall, upon the request of a 
        facility, extend a waiver granted to a specific facility to 
        other similarly situated facilities, if the commissioner 
        determines that these facilities also satisfy clauses (1) and 
        (2) and any other terms and conditions of the waiver.  
           The commissioner of health shall allow, by rule, a nursing 
        home to provide fewer hours of nursing care to intermediate care 
        residents of a nursing home than required by the present rules 
        of the commissioner if the commissioner determines that the 
        needs of the residents of the home will be adequately met by a 
        lesser amount of nursing care. 
           (b) A facility is not required to seek a waiver for room 
        furniture or equipment under paragraph (a) when responding to 
        resident-specific requests if the facility has discussed health 
        and safety concerns with the resident and the resident request 
        and discussion of health and safety concerns are documented in 
        the resident's patient record. 
           [EFFECTIVE DATE.] This section is effective July 1, 2003. 
           Sec. 2.  Minnesota Statutes 2002, section 144A.04, is 
        amended by adding a subdivision to read: 
           Subd. 11.  [INCONTINENT RESIDENTS.] Notwithstanding 
        Minnesota Rules, part 4658.0520, an incontinent resident must be 
        checked according to a specific time interval written in the 
        resident's care plan.  The resident's attending physician must 
        authorize in writing any interval longer than two hours unless 
        the resident, if competent, or a family member or legally 
        appointed conservator, guardian, or health care agent of a 
        resident who is not competent, agrees in writing to waive 
        physician involvement in determining this interval, and this 
        waiver is documented in the resident's care plan. 
           [EFFECTIVE DATE.] This section is effective July 1, 2003. 
           Sec. 3.  Minnesota Statutes 2002, section 144A.70, 
        subdivision 6, is amended to read: 
           Subd. 6.  [SUPPLEMENTAL NURSING SERVICES AGENCY.] 
        "Supplemental nursing services agency" means a person, firm, 
        corporation, partnership, or association engaged for hire in the 
        business of providing or procuring temporary employment in 
        health care facilities for nurses, nursing assistants, nurse 
        aides, and orderlies.  Supplemental nursing services agency does 
        not include an individual who only engages in providing the 
        individual's services on a temporary basis to health care 
        facilities.  Supplemental nursing services agency does not 
        include a professional home care agency licensed as a Class A 
        provider under section 144A.46 and rules adopted thereunder that 
        only provides staff to other home care providers. 
           Sec. 4.  Minnesota Statutes 2002, section 256B.434, 
        subdivision 10, is amended to read: 
           Subd. 10.  [EXEMPTIONS.] (a) To the extent permitted by 
        federal law, (1) a facility that has entered into a contract 
        under this section is not required to file a cost report, as 
        defined in Minnesota Rules, part 9549.0020, subpart 13, for any 
        year after the base year that is the basis for the calculation 
        of the contract payment rate for the first rate year of the 
        alternative payment demonstration project contract; and (2) a 
        facility under contract is not subject to audits of historical 
        costs or revenues, or paybacks or retroactive adjustments based 
        on these costs or revenues, except audits, paybacks, or 
        adjustments relating to the cost report that is the basis for 
        calculation of the first rate year under the contract. 
           (b) A facility that is under contract with the commissioner 
        under this section is not subject to the moratorium on licensure 
        or certification of new nursing home beds in section 144A.071, 
        unless the project results in a net increase in bed capacity or 
        involves relocation of beds from one site to another.  Contract 
        payment rates must not be adjusted to reflect any additional 
        costs that a nursing facility incurs as a result of a 
        construction project undertaken under this paragraph.  In 
        addition, as a condition of entering into a contract under this 
        section, a nursing facility must agree that any future medical 
        assistance payments for nursing facility services will not 
        reflect any additional costs attributable to the sale of a 
        nursing facility under this section and to construction 
        undertaken under this paragraph that otherwise would not be 
        authorized under the moratorium in section 144A.073.  Nothing in 
        this section prevents a nursing facility participating in the 
        alternative payment demonstration project under this section 
        from seeking approval of an exception to the moratorium through 
        the process established in section 144A.073, and if approved the 
        facility's rates shall be adjusted to reflect the cost of the 
        project.  Nothing in this section prevents a nursing facility 
        participating in the alternative payment demonstration project 
        from seeking legislative approval of an exception to the 
        moratorium under section 144A.071, and, if enacted, the 
        facility's rates shall be adjusted to reflect the cost of the 
        project. 
           (c) Notwithstanding section 256B.48, subdivision 6, 
        paragraphs (c), (d), and (e), and pursuant to any terms and 
        conditions contained in the facility's contract, a nursing 
        facility that is under contract with the commissioner under this 
        section is in compliance with section 256B.48, subdivision 6, 
        paragraph (b), if the facility is Medicare certified. 
           (d) Notwithstanding paragraph (a), if by April 1, 1996, the 
        health care financing administration has not approved a required 
        waiver, or the Centers for Medicare and Medicaid Services 
        otherwise requires cost reports to be filed prior to the 
        waiver's approval, the commissioner shall require a cost report 
        for the rate year. 
           (e) A facility that is under contract with the commissioner 
        under this section shall be allowed to change therapy 
        arrangements from an unrelated vendor to a related vendor during 
        the term of the contract.  The commissioner may develop 
        reasonable requirements designed to prevent an increase in 
        therapy utilization for residents enrolled in the medical 
        assistance program. 
           (f) A facility that has entered a contract under this 
        section must either participate in the quality improvement 
        program established by the commissioner, or submit information 
        on its own quality improvement process for the commissioner's 
        approval.  A nursing facility choosing the latter must report 
        annually on results for at least one key area. 
           [EFFECTIVE DATE.] This section is effective July 1, 2003. 
           Sec. 5.  [IMPOSITION OF FEDERAL CERTIFICATION REMEDIES.] 
           The commissioner of health shall pursue changes in federal 
        policy that mandate the imposition of federal sanctions without 
        providing an opportunity to correct deficiencies solely as the 
        result of previous deficiencies issued to a facility. 
           [EFFECTIVE DATE.] This section is effective July 1, 2003. 
           Sec. 6.  [CHANGES TO THE MEDICARE CONDITIONS OF 
        PARTICIPATION FOR HOME HEALTH AGENCIES.] 
           (a) The commissioner of health shall convene a working 
        group to consist of home care providers and other interested 
        individuals.  The first purpose of this group is to develop a 
        summary of federal home care agency regulations and laws that 
        hamper state flexibility and place burdens on the goal of 
        achieving a high quality of services, such as provisions 
        requiring rigid time frames for the completion of supervisory 
        visits by registered nurses and for the submission of home care 
        client assessment information.  The commissioner shall share 
        this summary with the legislature, other states, and national 
        groups that advocate for state interests.  The commissioner 
        shall work with officials of the federal government and with 
        members of the Minnesota congressional delegation to achieve 
        necessary changes in the law. 
           (b) The commissioner of health shall also review with this 
        working group the current licensure process for home care 
        providers and evaluate continued appropriateness of that 
        process.  This review shall consider federal certification 
        regulations for home care and hospice and the need to have 
        separate licensure provisions for certified facilities.  The 
        commissioner shall make recommendations to the legislature by 
        January 1, 2005. 
           Sec. 7.  [EFFECTIVE DATE.] 
           Sections 3 and 6 are effective the day following final 
        enactment. 
           Presented to the governor May 13, 2003 
           Signed by the governor May 16, 2003, 12:05 p.m.