Minnesota Session Laws - 2023, Regular Session

CHAPTER 75--S.F.No. 1384

An act

relating to health; enacting the Nurse and Patient Safety Act; modifying requirements related to hospital preparedness and incident response action plans to acts of violence; modifying eligibility for nursing facility employee scholarships; modifying eligibility for the health professional education loan forgiveness program; requiring the commissioner of health to study hospital staffing; requiring a report; modifying appropriations;

amending Minnesota Statutes 2022, sections 144.1501, subdivisions 1, 2, 3, 4; 144.566; 144.608, subdivision 1, as amended; 147A.08; 2023 S.F. 2995, article 20, sections 12, if enacted; 15, if enacted; 2, subdivision 31, if enacted.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin TITLE. new text end

new text begin This act shall be known as the Nurse and Patient Safety Act. new text end

Sec. 2.

Minnesota Statutes 2022, section 144.1501, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions apply.

(b) "Advanced dental therapist" means an individual who is licensed as a dental therapist under section 150A.06, and who is certified as an advanced dental therapist under section 150A.106.

(c) "Alcohol and drug counselor" means an individual who is licensed as an alcohol and drug counselor under chapter 148F.

(d) "Dental therapist" means an individual who is licensed as a dental therapist under section 150A.06.

(e) "Dentist" means an individual who is licensed to practice dentistry.

(f) "Designated rural area" means a statutory and home rule charter city or township that is outside the seven-county metropolitan area as defined in section 473.121, subdivision 2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.

(g) "Emergency circumstances" means those conditions that make it impossible for the participant to fulfill the service commitment, including death, total and permanent disability, or temporary disability lasting more than two years.

(h) new text begin "Hospital nurse" means an individual who is licensed as a registered nurse and who is providing direct patient care in a nonprofit hospital setting. new text end

new text begin (i) new text end "Mental health professional" means an individual providing clinical services in the treatment of mental illness who is qualified in at least one of the ways specified in section 245.462, subdivision 18.

deleted text begin (i) deleted text end new text begin (j) new text end "Medical resident" means an individual participating in a medical residency in family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

deleted text begin (j) deleted text end new text begin (k) new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse anesthetist, advanced clinical nurse specialist, or physician assistant.

deleted text begin (k) deleted text end new text begin (l) new text end "Nurse" means an individual who has completed training and received all licensing or certification necessary to perform duties as a licensed practical nurse or registered nurse.

deleted text begin (l) deleted text end new text begin (m) new text end "Nurse-midwife" means a registered nurse who has graduated from a program of study designed to prepare registered nurses for advanced practice as nurse-midwives.

deleted text begin (m) deleted text end new text begin (n) new text end "Nurse practitioner" means a registered nurse who has graduated from a program of study designed to prepare registered nurses for advanced practice as nurse practitioners.

deleted text begin (n) deleted text end new text begin (o) new text end "Pharmacist" means an individual with a valid license issued under chapter 151.

deleted text begin (o) deleted text end new text begin (p) new text end "Physician" means an individual who is licensed to practice medicine in the areas of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

deleted text begin (p) deleted text end new text begin (q) new text end "Physician assistant" means a person licensed under chapter 147A.

deleted text begin (q) deleted text end new text begin (r) new text end "Public health nurse" means a registered nurse licensed in Minnesota who has obtained a registration certificate as a public health nurse from the Board of Nursing in accordance with Minnesota Rules, chapter 6316.

deleted text begin (r) deleted text end new text begin (s) new text end "Qualified educational loan" means a government, commercial, or foundation loan for actual costs paid for tuition, reasonable education expenses, and reasonable living expenses related to the graduate or undergraduate education of a health care professional.

deleted text begin (s) deleted text end new text begin (t) new text end "Underserved urban community" means a Minnesota urban area or population included in the list of designated primary medical care health professional shortage areas (HPSAs), medically underserved areas (MUAs), or medically underserved populations (MUPs) maintained and updated by the United States Department of Health and Human Services.

Sec. 3.

Minnesota Statutes 2022, section 144.1501, subdivision 2, is amended to read:

Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness program account is established. The commissioner of health shall use money from the account to establish a loan forgiveness program:

(1) for medical residents, mental health professionals, and alcohol and drug counselors agreeing to practice in designated rural areas or underserved urban communities or specializing in the area of pediatric psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program at the undergraduate level or the equivalent at the graduate level;

(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care facility for persons with developmental disability; a hospital if the hospital owns and operates a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse is in the nursing home; a housing with services establishment as defined in section 144D.01, subdivision 4; or for a home care provider as defined in section 144A.43, subdivision 4; or agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program at the undergraduate level or the equivalent at the graduate level;

(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720 hours per year in their designated field in a postsecondary program at the undergraduate level or the equivalent at the graduate level. The commissioner, in consultation with the Healthcare Education-Industry Partnership, shall determine the health care fields where the need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory technology, radiologic technology, and surgical technology;

(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses who agree to practice in designated rural areas; deleted text begin and deleted text end

(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient encounters to state public program enrollees or patients receiving sliding fee schedule discounts through a formal sliding fee schedule meeting the standards established by the United States Department of Health and Human Services under Code of Federal Regulations, title 42, section 51, chapter 303 new text begin ; and new text end

new text begin (7) for nurses employed as a hospital nurse by a nonprofit hospital and providing direct care to patients at the nonprofit hospital new text end .

(b) Appropriations made to the account do not cancel and are available until expended, except that at the end of each biennium, any remaining balance in the account that is not committed by contract and not needed to fulfill existing commitments shall cancel to the fund.

Sec. 4.

Minnesota Statutes 2022, section 144.1501, subdivision 3, is amended to read:

Subd. 3.

Eligibility.

(a) To be eligible to participate in the loan forgiveness program, an individual must:

(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or education program to become a dentist, dental therapist, advanced dental therapist, mental health professional, alcohol and drug counselor, pharmacist, public health nurse, midlevel practitioner, registered nurse, or a licensed practical nurse. The commissioner may also consider applications submitted by graduates in eligible professions who are licensed and in practice; and

(2) submit an application to the commissioner of health. new text begin A nurse applying under subdivision 2, paragraph (a), clause (7), must also include proof that the applicant is employed as a hospital nurse. new text end

(b) An applicant selected to participate must sign a contract to agree to serve a minimum three-year full-time service obligation according to subdivision 2, which shall begin no later than March 31 following completion of required training, with the exception of new text begin : new text end

new text begin (1) new text end a nurse, who must agree to serve a minimum two-year full-time service obligation according to subdivision 2, which shall begin no later than March 31 following completion of required training new text begin ; new text end

new text begin (2) a nurse selected under subdivision 2, paragraph (a), clause (7), who must agree to continue as a hospital nurse for a minimum two-year service obligation; and new text end

new text begin (3) a nurse who agrees to teach according to subdivision 2, paragraph (a), clause (3), who must sign a contract to agree to teach for a minimum of two years new text end .

Sec. 5.

Minnesota Statutes 2022, section 144.1501, subdivision 4, is amended to read:

Subd. 4.

Loan forgiveness.

new text begin (a) new text end The commissioner of health may select applicants each year for participation in the loan forgiveness program, within the limits of available funding. In considering applications, the commissioner shall give preference to applicants who document diverse cultural competencies. The commissioner shall distribute available funds for loan forgiveness proportionally among the eligible professions according to the vacancy rate for each profession in the required geographic area, facility type, teaching area, patient group, or specialty type specified in subdivision 2 new text begin , except for hospital nurses new text end . The commissioner shall allocate funds for physician loan forgiveness so that 75 percent of the funds available are used for rural physician loan forgiveness and 25 percent of the funds available are used for underserved urban communities and pediatric psychiatry loan forgiveness. If the commissioner does not receive enough qualified applicants each year to use the entire allocation of funds for any eligible profession, the remaining funds may be allocated proportionally among the other eligible professions according to the vacancy rate for each profession in the required geographic area, patient group, or facility type specified in subdivision 2. Applicants are responsible for securing their own qualified educational loans. The commissioner shall select participants based on their suitability for practice serving the required geographic area or facility type specified in subdivision 2, as indicated by experience or training. The commissioner shall give preference to applicants closest to completing their training. new text begin Except as specified in paragraph (c), new text end for each year that a participant meets the service obligation required under subdivision 3, up to a maximum of four years, the commissioner shall make annual disbursements directly to the participant equivalent to 15 percent of the average educational debt for indebted graduates in their profession in the year closest to the applicant's selection for which information is available, not to exceed the balance of the participant's qualifying educational loans. Before receiving loan repayment disbursements and as requested, the participant must complete and return to the commissioner a confirmation of practice form provided by the commissioner verifying that the participant is practicing as required under subdivisions 2 and 3. The participant must provide the commissioner with verification that the full amount of loan repayment disbursement received by the participant has been applied toward the designated loans. After each disbursement, verification must be received by the commissioner and approved before the next loan repayment disbursement is made. Participants who move their practice remain eligible for loan repayment as long as they practice as required under subdivision 2.

new text begin (b) For hospital nurses, the commissioner of health shall select applicants each year for participation in the hospital nursing education loan forgiveness program, within limits of available funding for hospital nurses. Before receiving the annual loan repayment disbursement, the participant must complete and return to the commissioner a confirmation of practice form provided by the commissioner, verifying that the participant continues to meet the eligibility requirements under subdivision 3. The participant must provide the commissioner with verification that the full amount of loan repayment disbursement received by the participant has been applied toward the designated loans. new text end

new text begin (c) For each year that a participant who is a nurse and who has agreed to teach according to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner shall make annual disbursements directly to the participant equivalent to 15 percent of the average annual educational debt for indebted graduates in the nursing profession in the year closest to the participant's selection for which information is available, not to exceed the balance of the participant's qualifying educational loans. new text end

Sec. 6.

Minnesota Statutes 2022, section 144.566, is amended to read:

144.566 VIOLENCE AGAINST HEALTH CARE WORKERS.

Subdivision 1.

Definitions.

(a) The following definitions apply to this section and have the meanings given.

(b) "Act of violence" means an act by a patient or visitor against a health care worker that includes kicking, scratching, urinating, sexually harassing, or any act defined in sections 609.221 to 609.2241.

(c) "Commissioner" means the commissioner of health.

(d) "Health care worker" means any person, whether licensed or unlicensed, employed by, volunteering in, or under contract with a hospital, who has direct contact with a patient of the hospital for purposes of either medical care or emergency response to situations potentially involving violence.

(e) "Hospital" means any facility licensed as a hospital under section 144.55.

(f) "Incident response" means the actions taken by hospital administration and health care workers during and following an act of violence.

(g) "Interfere" means to prevent, impede, discourage, or delay a health care worker's ability to report acts of violence, including by retaliating or threatening to retaliate against a health care worker.

(h) "Preparedness" means the actions taken by hospital administration and health care workers to prevent a single act of violence or acts of violence generally.

(i) "Retaliate" means to discharge, discipline, threaten, otherwise discriminate against, or penalize a health care worker regarding the health care worker's compensation, terms, conditions, location, or privileges of employment.

new text begin (j) "Workplace violence hazards" means locations and situations where violent incidents are more likely to occur, including, as applicable, but not limited to locations isolated from other health care workers; health care workers working alone; health care workers working in remote locations; health care workers working late night or early morning hours; locations where an assailant could prevent entry of responders or other health care workers into a work area; locations with poor illumination; locations with poor visibility; lack of effective escape routes; obstacles and impediments to accessing alarm systems; locations within the facility where alarm systems are not operational; entryways where unauthorized entrance may occur, such as doors designated for staff entrance or emergency exits; presence, in the areas where patient contact activities are performed, of furnishings or objects that could be used as weapons; and locations where high-value items, currency, or pharmaceuticals are stored. new text end

Subd. 2.

deleted text begin Hospital duties deleted text end new text begin Action plans and action plan reviews required new text end .

deleted text begin (a) deleted text end All hospitals must design and implement preparedness and incident response action plans to acts of violence by January 15, 2016, and review new text begin and update new text end the plan at least annually thereafter. new text begin The plan must be in writing; specific to the workplace violence hazards and corrective measures for the units, services, or operations of the hospital; and available to health care workers at all times. new text end

new text begin Subd. 3. new text end

new text begin Action plan committees. new text end

deleted text begin (b) deleted text end A hospital shall designate a committee of representatives of health care workers employed by the hospital, including nonmanagerial health care workers, nonclinical staff, administrators, patient safety experts, and other appropriate personnel to develop preparedness and incident response action plans to acts of violence. The hospital shall, in consultation with the designated committee, implement the plans under deleted text begin paragraph (a) deleted text end new text begin subdivision 2 new text end . Nothing in this deleted text begin paragraph deleted text end new text begin subdivision new text end shall require the establishment of a separate committee solely for the purpose required by this subdivision.

new text begin Subd. 4. new text end

new text begin Required elements of action plans; generally. new text end

new text begin The preparedness and incident response action plans to acts of violence must include: new text end

new text begin (1) effective procedures to obtain the active involvement of health care workers and their representatives in developing, implementing, and reviewing the plan, including their participation in identifying, evaluating, and correcting workplace violence hazards, designing and implementing training, and reporting and investigating incidents of workplace violence; new text end

new text begin (2) names or job titles of the persons responsible for implementing the plan; and new text end

new text begin (3) effective procedures to ensure that supervisory and nonsupervisory health care workers comply with the plan. new text end

new text begin Subd. 5. new text end

new text begin Required elements of action plans; evaluation of risk factors. new text end

new text begin (a) The preparedness and incident response action plans to acts of violence must include assessment procedures to identify and evaluate workplace violence hazards for each facility, unit, service, or operation, including community-based risk factors and areas surrounding the facility, such as employee parking areas and other outdoor areas. Procedures shall specify the frequency that environmental assessments take place. new text end

new text begin (b) The preparedness and incident response action plans to acts of violence must include assessment tools, environmental checklists, or other effective means to identify workplace violence hazards. new text end

new text begin Subd. 6. new text end

new text begin Required elements of action plans; review of workplace violence incidents. new text end

new text begin The preparedness and incident response action plans to acts of violence must include procedures for reviewing all workplace violence incidents that occurred in the facility, unit, service, or operation within the previous year, whether or not an injury occurred. new text end

new text begin Subd. 7. new text end

new text begin Required elements of action plans; reporting workplace violence. new text end

new text begin The preparedness and incident response action plans to acts of violence must include: new text end

new text begin (1) effective procedures for health care workers to document information regarding conditions that may increase the potential for workplace violence incidents and communicate that information without fear of reprisal to other health care workers, shifts, or units; new text end

new text begin (2) effective procedures for health care workers to report a violent incident, threat, or other workplace violence concern without fear of reprisal; new text end

new text begin (3) effective procedures for the hospital to accept and respond to reports of workplace violence and to prohibit retaliation against a health care worker who makes such a report; new text end

new text begin (4) a policy statement stating the hospital will not prevent a health care worker from reporting workplace violence or take punitive or retaliatory action against a health care worker for doing so; new text end

new text begin (5) effective procedures for investigating health care worker concerns regarding workplace violence or workplace violence hazards; new text end

new text begin (6) procedures for informing health care workers of the results of the investigation arising from a report of workplace violence or from a concern about a workplace violence hazard and of any corrective actions taken; new text end

new text begin (7) effective procedures for obtaining assistance from the appropriate law enforcement agency or social service agency during all work shifts. The procedure may establish a central coordination procedure; and new text end

new text begin (8) a policy statement stating the hospital will not prevent a health care worker from seeking assistance and intervention from local emergency services or law enforcement when a violent incident occurs or take punitive or retaliatory action against a health care worker for doing so. new text end

new text begin Subd. 8. new text end

new text begin Required elements of action plans; coordination with other employers. new text end

new text begin The preparedness and incident response action plans to acts of violence must include methods the hospital will use to coordinate implementation of the plan with other employers whose employees work in the same health care facility, unit, service, or operation and to ensure that those employers and their employees understand their respective roles as provided in the plan. These methods must ensure that all employees working in the facility, unit, service, or operation are provided the training required by subdivision 10 and that workplace violence incidents involving any employee are reported, investigated, and recorded. new text end

new text begin Subd. 9. new text end

new text begin Required elements of action plans; training. new text end

new text begin (a) The preparedness and incident response action plans to acts of violence must include: new text end

new text begin (1) procedures for developing and providing the training required in subdivision 10 that permits health care workers and their representatives to participate in developing the training; and new text end

new text begin (2) a requirement for cultural competency training and equity, diversity, and inclusion training. new text end

new text begin (b) The preparedness and incident response action plans to acts of violence must include procedures to communicate with health care workers regarding workplace violence matters, including: new text end

new text begin (1) how health care workers will document and communicate to other health care workers and between shifts and units information regarding conditions that may increase the potential for workplace violence incidents; new text end

new text begin (2) how health care workers can report a violent incident, threat, or other workplace violence concern; new text end

new text begin (3) how health care workers can communicate workplace violence concerns without fear of reprisal; and new text end

new text begin (4) how health care worker concerns will be investigated, and how health care workers will be informed of the results of the investigation and any corrective actions to be taken. new text end

new text begin Subd. 10. new text end

new text begin Training required. new text end

deleted text begin (c) deleted text end A hospital deleted text begin shall deleted text end new text begin must new text end provide training to all health care workers employed or contracted with the hospital on safety during acts of violence. Each health care worker must receive safety training deleted text begin annually and upon hire deleted text end new text begin during the health care worker's orientation and before the health care worker completes a shift independently, and annually thereafter new text end . Training must, at a minimum, include:

(1) safety guidelines for response to and de-escalation of an act of violence;

(2) ways to identify potentially violent or abusive situations new text begin , including aggression and violence predicting factors new text end ; deleted text begin and deleted text end

(3) the hospital's deleted text begin incident response reaction plan and violence prevention plan deleted text end new text begin preparedness and incident response action plans for acts of violence, including how the health care worker may report concerns about workplace violence within each hospital's reporting structure without fear of reprisal, how the hospital will address workplace violence incidents, and how the health care worker can participate in reviewing and revising the plan; and new text end

new text begin (4) any resources available to health care workers for coping with incidents of violence, including but not limited to critical incident stress debriefing or employee assistance programs new text end .

new text begin Subd. 11. new text end

new text begin Annual review and update of action plans. new text end

deleted text begin (d) deleted text end new text begin (a) new text end As part of its annual review new text begin of preparedness and incident response action plans new text end required under deleted text begin paragraph (a) deleted text end new text begin subdivision 2 new text end , the hospital must review with the designated committee:

(1) the effectiveness of its preparedness and incident response action plans new text begin , including the sufficiency of security systems, alarms, emergency responses, and security personnel availability new text end ;

(2) new text begin security risks associated with specific units, areas of the facility with uncontrolled access, late night shifts, early morning shifts, and areas surrounding the facility such as employee parking areas and other outdoor areas; new text end

new text begin (3) new text end the most recent gap analysis as provided by the commissioner; deleted text begin and deleted text end

deleted text begin (3) deleted text end new text begin (4) new text end the number of acts of violence that occurred in the hospital during the previous year, including injuries sustained, if any, and the unit in which the incident occurred deleted text begin . deleted text end new text begin ; new text end

new text begin (5) evaluations of staffing, including staffing patterns and patient classification systems that contribute to, or are insufficient to address, the risk of violence; and new text end

new text begin (6) any reports of discrimination or abuse that arise from security resources, including from the behavior of security personnel. new text end

new text begin (b) As part of the annual update of preparedness and incident response action plans required under subdivision 2, the hospital must incorporate corrective actions into the action plan to address workplace violence hazards identified during the annual action plan review, reports of workplace violence, reports of workplace violence hazards, and reports of discrimination or abuse that arise from the security resources. new text end

new text begin Subd. 12. new text end

new text begin Action plan updates. new text end

new text begin Following the annual review of the action plan, a hospital must update the action plans to reflect the corrective actions the hospital will implement to mitigate the hazards and vulnerabilities identified during the annual review. new text end

new text begin Subd. 13. new text end

new text begin Requests for additional staffing. new text end

new text begin A hospital shall create and implement a procedure for a health care worker to officially request of hospital supervisors or administration that additional staffing be provided. The hospital must document all requests for additional staffing made because of a health care worker's concern over a risk of an act of violence. If the request for additional staffing to reduce the risk of violence is denied, the hospital must provide the health care worker who made the request a written reason for the denial and must maintain documentation of that communication with the documentation of requests for additional staffing. A hospital must make documentation regarding staffing requests available to the commissioner for inspection at the commissioner's request. The commissioner may use documentation regarding staffing requests to inform the commissioner's determination on whether the hospital is providing adequate staffing and security to address acts of violence, and may use documentation regarding staffing requests if the commissioner imposes a penalty under subdivision 17. new text end

new text begin Subd. 14. new text end

new text begin Disclosure of action plans. new text end

deleted text begin (e) deleted text end new text begin (a) new text end A hospital deleted text begin shall deleted text end new text begin must new text end make its new text begin most recent new text end action plans and deleted text begin the information listed in paragraph (d) deleted text end new text begin most recent action plan reviews new text end available to local law enforcement new text begin , all direct care staff new text end and, if any of its workers are represented by a collective bargaining unit, to the exclusive bargaining representatives of those collective bargaining units.

new text begin (b) Beginning January 1, 2025, a hospital must annually submit to the commissioner its most recent action plan and the results of the most recent annual review conducted under subdivision 11. new text end

new text begin Subd. 15. new text end

new text begin Legislative report required. new text end

new text begin (a) Beginning January 15, 2026, the commissioner must compile the information into a single annual report and submit the report to the chairs and ranking minority members of the legislative committees with jurisdiction over health care by January 15 of each year. new text end

new text begin (b) This subdivision does not expire. new text end

new text begin Subd. 16. new text end

new text begin Interference prohibited. new text end

deleted text begin (f) deleted text end A hospital, including any individual, partner, association, or any person or group of persons acting directly or indirectly in the interest of the hospital, deleted text begin shall deleted text end new text begin must new text end not interfere with or discourage a health care worker if the health care worker wishes to contact law enforcement or the commissioner regarding an act of violence.

new text begin Subd. 17. new text end

new text begin Penalties. new text end

deleted text begin (g) deleted text end new text begin Notwithstanding section 144.653, subdivision 6, new text end the commissioner may impose deleted text begin an administrative deleted text end new text begin a new text end fine of up to deleted text begin $250 deleted text end new text begin $10,000 new text end for failure to comply with the requirements of this deleted text begin subdivision deleted text end new text begin section new text end . new text begin The commissioner must allow the hospital at least 30 calendar days to correct a violation of this section before assessing a fine. new text end

Sec. 7.

Minnesota Statutes 2022, section 144.608, subdivision 1, as amended by Laws 2023, chapter 25, section 47, is amended to read:

Subdivision 1.

Trauma Advisory Council established.

(a) A Trauma Advisory Council is established to advise, consult with, and make recommendations to the commissioner on the development, maintenance, and improvement of a statewide trauma system.

(b) The council shall consist of the following members:

(1) a trauma surgeon certified by the American Board of Surgery or the American Osteopathic Board of Surgery who practices in a level I or II trauma hospital;

(2) a general surgeon certified by the American Board of Surgery or the American Osteopathic Board of Surgery whose practice includes trauma and who practices in a designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (f) deleted text end ;

(3) a neurosurgeon certified by the American Board of Neurological Surgery who practices in a level I or II trauma hospital;

(4) a trauma program nurse manager or coordinator practicing in a level I or II trauma hospital;

(5) an emergency physician certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine whose practice includes emergency room care in a level I, II, III, or IV trauma hospital;

(6) a trauma program manager or coordinator who practices in a level III or IV trauma hospital;

(7) a physician certified by the American Board of Family Medicine or the American Osteopathic Board of Family Practice whose practice includes emergency department care in a level III or IV trauma hospital located in a designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (f) deleted text end ;

(8) a nurse practitioner, as defined under section 144.1501, subdivision 1, deleted text begin paragraph (m), deleted text end or a physician assistant, as defined under section 144.1501, subdivision 1, deleted text begin paragraph (p), deleted text end whose practice includes emergency room care in a level IV trauma hospital located in a designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (f) deleted text end ;

(9) a physician certified in pediatric emergency medicine by the American Board of Pediatrics or certified in pediatric emergency medicine by the American Board of Emergency Medicine or certified by the American Osteopathic Board of Pediatrics whose practice primarily includes emergency department medical care in a level I, II, III, or IV trauma hospital, or a surgeon certified in pediatric surgery by the American Board of Surgery whose practice involves the care of pediatric trauma patients in a trauma hospital;

(10) an orthopedic surgeon certified by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery whose practice includes trauma and who practices in a level I, II, or III trauma hospital;

(11) the state emergency medical services medical director appointed by the Emergency Medical Services Regulatory Board;

(12) a hospital administrator of a level III or IV trauma hospital located in a designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (f) deleted text end ;

(13) a rehabilitation specialist whose practice includes rehabilitation of patients with major trauma injuries or traumatic brain injuries and spinal cord injuries as defined under section 144.661;

(14) an attendant or ambulance director who is an EMT, AEMT, or paramedic within the meaning of section 144E.001 and who actively practices with a licensed ambulance service in a primary service area located in a designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (f) deleted text end ; and

(15) the commissioner of public safety or the commissioner's designee.

Sec. 8.

Minnesota Statutes 2022, section 147A.08, is amended to read:

147A.08 EXEMPTIONS.

(a) This chapter does not apply to, control, prevent, or restrict the practice, service, or activities of persons listed in section 147.09, clauses (1) to (6) and (8) to (13) deleted text begin , deleted text end new text begin ; new text end persons regulated under section 214.01, subdivision 2 deleted text begin , deleted text end new text begin ; new text end or deleted text begin persons deleted text end new text begin midlevel practitioners, nurses, or nurse-midwives as new text end defined in section 144.1501, subdivision 1 deleted text begin , paragraphs (i), (k), and (l) deleted text end .

(b) Nothing in this chapter shall be construed to require licensure of:

(1) a physician assistant student enrolled in a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant or by its successor agency approved by the board;

(2) a physician assistant employed in the service of the federal government while performing duties incident to that employment; or

(3) technicians, other assistants, or employees of physicians who perform delegated tasks in the office of a physician but who do not identify themselves as a physician assistant.

Sec. 9.

new text begin DIRECTION TO COMMISSIONER OF HEALTH; NURSING WORKFORCE REPORT. new text end

new text begin (a) The commissioner of health must publish a public report on the current status of the state's nursing workforce employed by hospitals. In preparing the report, the commissioner shall utilize information collected in collaboration with the Board of Nursing as directed under Minnesota Statutes, sections 144.051 and 144.052, on Minnesota's supply of active licensed nurses and reasons licensed nurses are leaving direct care positions at hospitals; information collected and shared by the Minnesota Hospital Association on retention by hospitals of licensed nurses; information collected through an independent study on reasons licensed nurses are choosing not to renew their licenses and leaving the profession; and other publicly available data the commissioner deems useful. The commissioner may require hospitals to submit to the commissioner, or to the commissioner's designee, nurse staffing data for purposes of the independent study. new text end

new text begin (b) The commissioner may impose a fine of up to $1,000 on any hospital that fails to provide information required by the commissioner for purposes of the independent study under paragraph (a). A hospital is entitled to a hearing under Minnesota Statutes, section 144.653, subdivision 8, on any fine imposed under this section. new text end

new text begin (c) The commissioner must publish the report by January 1, 2026. new text end

Sec. 10.

new text begin USE OF APPROPRIATION; LOAN FORGIVENESS ADMINISTRATION. new text end

new text begin The commissioner of health may also use the appropriation in S.F. No. 2995, article 20, section 3, subdivision 2, paragraph (w), clause (3), if enacted during 2023 regular legislative session, for administering sections 2 to 5. new text end

Sec. 11.

new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES. new text end

new text begin The commissioner of human services must define as a direct educational expense the reasonable child care costs incurred by a nursing facility employee scholarship recipient while the recipient is receiving a wage from the scholarship sponsoring facility, provided the scholarship recipient is making reasonable progress, as defined by the commissioner, toward the educational goal for which the scholarship was granted. new text end

Sec. 12.

2023 S.F. No. 2995, article 20, section 2, subdivision 31, if enacted, is amended to read:

Subd. 31. Direct Care and Treatment - Mental Health and Substance Abuse

-0-

6,109,000

(a) Keeping Nurses at the Bedside Act; contingent appropriation. The appropriation in this subdivision is contingent upon legislative enactment new text begin by the 93rd Legislature new text end of deleted text begin 2023 Senate File 1384 by the 93rd Legislature deleted text end new text begin provisions substantially similar to 2023 S.F. No. 1561, the second engrossment, article 2 new text end .

(b) Base level adjustment. The general fund base is increased by $7,566,000 in fiscal year 2026 and increased by $7,566,000 in fiscal year 2027.

Sec. 13.

2023 S.F. No. 2995, article 20, section 12, if enacted, is amended to read:

Sec. 12. COMMISSIONER OF MANAGEMENT AND BUDGET

$

12,932,000

$

3,412,000

(a) Outcomes and evaluation consultation. $450,000 in fiscal year 2024 and $450,000 in fiscal year 2025 are for outcomes and evaluation consultation requirements.

(b) Department of Children, Youth, and Families. $11,931,000 in fiscal year 2024 and $2,066,000 in fiscal year 2025 are to establish the Department of Children, Youth, and Families. This is a onetime appropriation.

(c) Keeping Nurses at the Bedside Act impact evaluation; contingent appropriation. $232,000 in fiscal year 2025 is for the Keeping Nurses at the Bedside Act impact evaluation. This appropriation is contingent upon legislative enactment new text begin by the 93rd Legislature new text end of deleted text begin 2023 Senate File 1384 by the 93rd Legislature deleted text end new text begin a provision substantially similar to the impact evaluation provision in 2023 S.F. No. 2995, the third engrossment, article 3, section 22 new text end . This is a onetime appropriation and is available until June 30, 2029.

(d) Health care subcabinet. $551,000 in fiscal year 2024 and $664,000 in fiscal year 2025 are to hire an executive director for the health care subcabinet and to provide staffing and administrative support for the health care subcabinet.

(e) Base level adjustment. The general fund base is $1,114,000 in fiscal year 2026 and $1,114,000 in fiscal year 2027.

Sec. 14.

2023 S.F. No. 2995, article 20, section 15, if enacted, is amended to read:

Sec. 15. COMMISSIONER OF LABOR AND INDUSTRY.

$

deleted text begin 68,000 deleted text end new text begin -0- new text end

$

72,000

deleted text begin This deleted text end new text begin The new text end appropriation new text begin for fiscal year 2025 new text end is contingent upon legislative enactment deleted text begin of 2023 Senate File 1384 deleted text end by the 93rd Legislature new text begin of provisions substantially similar to 2023 S.F. No. 1561, the second engrossment, article 2, sections 6 and 9 new text end . This appropriation is available until June 30, 2025.

Base level adjustment. The general fund base is $1,793,000 in fiscal year 2026 and $1,790,000 in fiscal year 2027.

Sec. 15.

new text begin EFFECTIVE DATE. new text end

new text begin This act is effective July 1, 2023. new text end

Presented to the governor May 23, 2023

Signed by the governor May 26, 2023, 10:26 a.m.