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Minnesota Legislature

Office of the Revisor of Statutes

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

                            CHAPTER 247-H.F.No. 2246 
                  An act relating to health; modifying the nursing 
                  facility survey process; establishing a quality 
                  improvement program; requiring annual quality 
                  improvement reports; requiring the commissioner of 
                  health to seek federal waivers and approvals; amending 
                  Minnesota Statutes 2002, sections 144A.10, subdivision 
                  1a, by adding a subdivision; 256.01, by adding a 
                  subdivision; proposing coding for new law in Minnesota 
                  Statutes, chapter 144A. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 2002, section 144A.10, 
        subdivision 1a, is amended to read: 
           Subd. 1a.  [TRAINING AND EDUCATION FOR NURSING FACILITY 
        PROVIDERS.] The commissioner of health must establish and 
        implement a prescribed process and program for providing 
        training and education to providers licensed by the Department 
        of Health, either by itself or in conjunction with the industry 
        trade associations, before using any new regulatory guideline, 
        regulation, interpretation, program letter or memorandum, or any 
        other materials used in surveyor training to survey licensed 
        providers.  The process should include, but is not limited to, 
        the following key components: 
           (1) facilitate the implementation of immediate revisions to 
        any course curriculum for nursing assistants which reflect any 
        new standard of care practice that has been adopted or 
        referenced by the Health Department concerning the issue in 
        question; 
           (2) conduct training of long-term care providers and health 
        department survey inspectors either jointly or during the same 
        time frame on the department's new expectations; and 
           (3) within available resources the commissioner shall 
        cooperate in the development of clinical standards, work with 
        vendors of supplies and services regarding hazards, and identify 
        research of interest to the long-term care community consult 
        with experts in the field to develop or make available training 
        resources on current standards of practice and the use of 
        technology.  
           Sec. 2.  Minnesota Statutes 2002, section 144A.10, is 
        amended by adding a subdivision to read: 
           Subd. 17.  [AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL 
        REPORT ON SURVEY PROCESS.] (a) The commissioner shall establish 
        a quality improvement program for the nursing facility survey 
        and complaint processes.  The commissioner must regularly 
        consult with consumers, consumer advocates, and representatives 
        of the nursing home industry and representatives of nursing home 
        employees in implementing the program.  The commissioner, 
        through the quality improvement program, shall submit to the 
        legislature an annual survey and certification quality 
        improvement report, beginning December 15, 2004, and each 
        December 15 thereafter.  
           (b) The report must include, but is not limited to, an 
        analysis of: 
           (1) the number, scope, and severity of citations by region 
        within the state; 
           (2) cross-referencing of citations by region within the 
        state and between states within the Centers for Medicare and 
        Medicaid Services region in which Minnesota is located; 
           (3) the number and outcomes of independent dispute 
        resolutions; 
           (4) the number and outcomes of appeals; 
           (5) compliance with timelines for survey revisits and 
        complaint investigations; 
           (6) techniques of surveyors in investigations, 
        communication, and documentation to identify and support 
        citations; 
           (7) compliance with timelines for providing facilities with 
        completed statements of deficiencies; and 
           (8) other survey statistics relevant to improving the 
        survey process. 
           (c) The report must also identify and explain 
        inconsistencies and patterns across regions of the state, 
        include analyses and recommendations for quality improvement 
        areas identified by the commissioner, consumers, consumer 
        advocates, and representatives of the nursing home industry and 
        nursing home employees, and provide action plans to address 
        problems that are identified. 
           Sec. 3.  [144A.101] [PROCEDURES FOR FEDERALLY REQUIRED 
        SURVEY PROCESS.] 
           Subdivision 1.  [APPLICABILITY.] This section applies to 
        survey certification and enforcement activities by the 
        commissioner related to regular, expanded, or extended surveys 
        under Code of Federal Regulations, title 42, part 488. 
           Subd. 2.  [STATEMENT OF DEFICIENCIES.] The commissioner 
        shall provide nursing facilities with draft statements of 
        deficiencies at the time of the survey exit process and shall 
        provide facilities with completed statements of deficiencies 
        within 15 working days of the exit process. 
           Subd. 3.  [SURVEYOR NOTES.] The commissioner, upon the 
        request of a nursing facility, shall provide the facility with 
        copies of formal surveyor notes taken during the survey, with 
        the exception of interview forms, at the time of the exit 
        conference or at the time the completed statement of deficiency 
        is provided to the facility.  The survey notes shall be redacted 
        to protect the confidentiality of individuals providing 
        information to the surveyors.  A facility requesting formal 
        surveyor notes must agree to pay the commissioner for the cost 
        of copying and redacting. 
           Subd. 4.  [POSTING OF STATEMENTS OF DEFICIENCIES.] The 
        commissioner, when posting statements of a nursing facility's 
        deficiencies on the agency Web site, must include in the posting 
        the facility's response to the citations.  The Web site must 
        also include the dates upon which deficiencies are corrected and 
        the date upon which a facility is considered to be in compliance 
        with survey requirements.  If deficiencies are under dispute, 
        the commissioner must note this on the Web site using a method 
        that clearly identifies for consumers which citations are under 
        dispute. 
           Subd. 5.  [SURVEY REVISITS.] The commissioner shall conduct 
        survey revisits within 15 calendar days of the date by which 
        corrections will be completed, as specified by the provider in 
        its plan of correction, in cases where category 2 or category 3 
        remedies are in place.  The commissioner may conduct survey 
        revisits by telephone or written communications for facilities 
        at which the highest scope and severity score for a violation 
        was level E or lower. 
           Subd. 6.  [FAMILY COUNCILS.] Nursing facility family 
        councils shall be interviewed as part of the survey process and 
        invited to participate in the exit conference. 
           Sec. 4.  Minnesota Statutes 2002, section 256.01, is 
        amended by adding a subdivision to read: 
           Subd. 21.  [INTERAGENCY AGREEMENT WITH DEPARTMENT OF 
        HEALTH.] The commissioner of human services shall amend the 
        interagency agreement with the commissioner of health to certify 
        nursing facilities for participation in the medical assistance 
        program, to require the commissioner of health, as a condition 
        of the agreement, to comply beginning July 1, 2005, with action 
        plans included in the annual survey and certification quality 
        improvement report required under section 144A.10, subdivision 
        17. 
           Sec. 5.  [PROGRESS REPORT.] 
           The commissioner of health shall include in the December 
        15, 2004, quality improvement report required under section 2 a 
        progress report and implementation plan for the following 
        legislatively directed activities: 
           (1) an analysis of the frequency of defensive documentation 
        and a plan, developed in consultation with the nursing home 
        industry, consumers, unions representing nursing home employees, 
        and advocates, to minimize defensive documentation; 
           (2) the nursing home providers workgroup established under 
        Laws 2003, First Special Session chapter 14, article 13c, 
        section 3; and 
           (3) progress in implementing the independent informal 
        dispute resolution process required under Minnesota Statutes, 
        section 144A.10, subdivision 16. 
           Sec. 6.  [RESUBMITTAL OF REQUESTS FOR FEDERAL WAIVERS AND 
        APPROVALS.] 
           (a) The commissioner of health shall seek federal waivers, 
        approvals, and law changes necessary to implement the 
        alternative nursing home survey process established under 
        Minnesota Statutes, section 144A.37. 
           (b) The commissioner of health shall seek changes in the 
        federal policy that mandates the imposition of federal sanctions 
        without providing an opportunity for a nursing facility to 
        correct deficiencies, solely as the result of previous 
        deficiencies issued to the nursing facility. 
           Presented to the governor May 18, 2004 
           Signed by the governor May 26, 2004, 9:00 p.m.