1.1 	A bill for an act
1.2 	relating to human services; requiring the Department
1.3 	of Human Services to increase nursing facility and
1.4 	community services payment rates; appropriating money;
1.5 	amending Minnesota Statutes 2004, sections 256B.431,
1.6 	by adding a subdivision; proposing coding for new law
1.7 	in Minnesota Statutes, chapter 256B.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2004, section 256B.431, is
1.10 	amended by adding a subdivision to read:
1.11 		Subd. 40.Nursing facility rate increase for july 1, 2005
1.12 	and july 1, 2006. (a) For each of the rate years beginning July
1.13 	1, 2005, and July 1, 2006, the commissioner shall provide to
1.14 	each nursing facility reimbursed under this section or section
1.15 	256B.434 an adjustment equal to 3.0 percent of the total
1.16 	operating payment rate.
1.17 	(b) Money resulting from the rate adjustment under
1.18 	paragraph (a) must be used to:
1.19 	(1) increase wages and benefits and pay associated costs
1.20 	for employees except management fees, the administrator, and
1.21 	central office staff; or 
1.22 	(2) add staff, other than administrative personnel, above
1.23 	the facility's average staff complement for the previous year.
1.24 	(c) Money received by a facility as a result of the rate
1.25 	adjustment provided in paragraph (a), which must be used as
1.26 	provided in paragraph (b), must be used only for wage, benefit,
2.1 	and staff increases implemented on or after July 1, 2005, and
2.2 	must not be used for increases implemented prior to that date.
2.3 	(d) Nursing facilities may apply for the portions of the
2.4 	rate adjustment under paragraph (a), which must be used as
2.5 	provided in paragraph (b).  The application must be made to the
2.6 	commissioner and contain a plan by which the nursing facility
2.7 	will distribute the funds according to paragraph (b).  For
2.8 	nursing facilities in which the employees are represented by an
2.9 	exclusive bargaining representative, an agreement negotiated and
2.10 	agreed to by the employer and the exclusive bargaining
2.11 	representative constitutes the plan.  A negotiated agreement may
2.12 	constitute the plan only if the agreement is finalized after the
2.13 	date of enactment of all increases for the rate year and signed
2.14 	by both parties prior to submission to the commissioner.  The
2.15 	commissioner shall review the plan to ensure that the rate
2.16 	adjustments are used as provided in paragraph (b).  To be
2.17 	eligible, a facility must submit its distribution plan by
2.18 	December 31, 2005.  If a facility's distribution plan is
2.19 	effective after July 1, 2005, the portion of the rate
2.20 	adjustments, which must be used as provided in paragraph (b),
2.21 	are effective the same date as the facility's plan.
2.22 	(e) A copy of the approved distribution plan must be made
2.23 	available to all employees by giving each employee a copy or by
2.24 	posting a copy in an area of the nursing facility to which all
2.25 	employees have access.  If an employee does not receive the wage
2.26 	and benefit adjustment described in the facility's approved plan
2.27 	and is unable to resolve the problem with the facility's
2.28 	management or through the employee's union representative, the
2.29 	employee may contact the commissioner at an address or telephone
2.30 	number provided by the commissioner and included in the approved
2.31 	plan.
2.32 	(f) Notwithstanding section 256B.48, subdivision 1,
2.33 	paragraph (a), upon the request of a nursing facility, the
2.34 	commissioner may authorize the facility to raise per diem rates
2.35 	for private-pay residents on July 1 by the amount anticipated to
2.36 	be required upon implementation of the rate adjustments
3.1 	allowable under paragraph (a).  The commissioner shall require
3.2 	any amounts collected under this paragraph, which must be used
3.3 	as provided in paragraph (b), to be placed in an escrow account
3.4 	established for this purpose with a financial institution that
3.5 	provides deposit insurance until the medical assistance rate is
3.6 	finalized.  The commissioner shall conduct audits as necessary
3.7 	to ensure that:
3.8 	(1) the amounts collected are retained in escrow until
3.9 	medical assistance rates are increased to reflect the rate
3.10 	adjustment; and 
3.11 	(2) any amounts collected from private-pay residents in
3.12 	excess of the final medical assistance rate are repaid to the
3.13 	private-pay residents with interest at the rate used by the
3.14 	commissioner of revenue for the late payment of taxes and in
3.15 	effect on the date the distribution plan is approved by the
3.16 	commissioner of human services.

3.17 	Sec. 2. [256B.4351] ASSESSMENT FOR HEALTH INSURANCE.
3.18 		Subdivision 1.Nursing facility assessment. (a)
3.19 	Effective July 1, 2005, each nursing facility with rates set
3.20 	under sections 256B.431 and 256B.435 shall pay to the
3.21 	commissioner, on a monthly basis, an assessment of ten cents per
3.22 	staff hour worked each month, according to the payment procedure
3.23 	established by the commissioner.
3.24 	(b) Nursing facilities are exempt from the assessment in
3.25 	paragraph (a) if they:
3.26 	(1) provide health coverage that is actuarially equivalent
3.27 	to a qualified number two plan under section 62E.06;
3.28 	(2) pay for at least 80 percent of the cost of
3.29 	employee-only coverage; and 
3.30 	(3) have a participation rate of at least 70 percent of
3.31 	employees.
3.32 		Subd. 2.Health insurance purchasing pool account. The
3.33 	commissioner shall establish a health insurance purchasing pool
3.34 	account in the general fund and shall deposit all payments
3.35 	received under this section into that account.
3.36 		Subd. 3.Rate increase. Effective July 1, 2005, the
4.1 	commissioner shall increase rates of all nursing facilities
4.2 	reimbursed under sections 256B.431 and 256B.435 by an amount
4.3 	equal to the assessment paid under subdivision 1.  For
4.4 	facilities meeting the criteria in subdivision 1, paragraph (b),
4.5 	the commissioner shall increase reimbursement rates by an amount
4.6 	equal to the assessment that would have been paid had the
4.7 	facilities not been exempt.

4.8 	Sec. 3. [256B.4352] NURSING FACILITY HEALTH INSURANCE
4.9 	BOARD.
4.10 		Subdivision 1.Establishment. The commissioner of human
4.11 	services shall appoint a ten-member nursing facility health
4.12 	insurance board, consisting of five representatives of nursing
4.13 	facility operators and five representatives of nursing facility
4.14 	employees.  The commissioner shall provide technical support to
4.15 	the board.  The board is governed by section 15.0575.
4.16 		Subd. 2.Duties. The board shall:
4.17 	(1) design a self-insured health insurance purchasing pool
4.18 	that meets the criteria in subdivision 3;
4.19 	(2) develop a timeline and plan for implementation of the
4.20 	purchasing pool; and 
4.21 	(3) upon a legislative approval, implement and administer
4.22 	the purchasing pool.
4.23 		Subd. 3.Design of purchasing pool. The design for the
4.24 	health insurance purchasing pool must:
4.25 	(1) describe the health insurance coverage to be provided,
4.26 	the estimated cost of coverage to employees, and any
4.27 	cost-sharing requirements;
4.28 	(2) specify eligibility requirements for employees and
4.29 	nursing facilities;
4.30 	(3) specify the minimum levels of employer contributions
4.31 	toward the cost of health coverage;
4.32 	(4) require nursing facilities purchasing coverage through
4.33 	the pool to remain members of the pool for a specified minimum
4.34 	time period;
4.35 	(5) provide subsidies for the employee share of health
4.36 	insurance premiums; and 
5.1 	(6) specify how the funds provided through the assessment
5.2 	established under section 256B.436 will be allocated between a
5.3 	reserve fund and premium subsidies for employees.
5.4 		Subd. 4.Report to legislature. The board shall present
5.5 	a report to the legislature by December 15, 2005, on the design,
5.6 	implementation, and administration of a health insurance
5.7 	purchasing pool for nursing facility employees.

5.8 	Sec. 4. COMMUNITY SERVICES PROVIDER RATE INCREASES.
 5.9 	(a) The commissioner of human services shall increase
5.10 	reimbursement rates by 3.0 percent for each of the rate years
5.11 	beginning July 1, 2005, and July 1, 2006, effective for services
5.12 	rendered on or after that date.
5.13 	(b) The 3.0 percent annual rate increases described in this
5.14 	section must be provided to:
5.15 	(1) home and community-based waivered services for persons
5.16 	with mental retardation or related conditions under Minnesota
5.17 	Statutes, section 256B.501;
5.18 	(2) home and community-based waivered services for the
5.19 	elderly under Minnesota Statutes, section 256B.0915;
5.20 	(3) waivered services under community alternatives for
5.21 	disabled individuals under Minnesota Statutes, section 256B.49;
5.22 	(4) community alternative care waivered services under
5.23 	Minnesota Statutes, section 256B.49;
5.24 	(5) traumatic brain injury waivered services under
5.25 	Minnesota Statutes, section 256B.49;
5.26 	(6) nursing services and home health services under
5.27 	Minnesota Statutes, section 256B.0625, subdivision 6a;
5.28 	(7) personal care services and nursing supervision of
5.29 	personal care services under Minnesota Statutes, section
5.30 	256B.0625, subdivision 19a;
5.31 	(8) private duty nursing services under Minnesota Statutes,
5.32 	section 256B.0625, subdivision 7;
5.33 	(9) day training and habilitation services for adults with
5.34 	mental retardation or related conditions under Minnesota
5.35 	Statutes, sections 252.40 to 252.46;
5.36 	(10) alternative care services under Minnesota Statutes,
6.1 	section 256B.0913;
6.2 	(11) adult residential program grants under Minnesota
6.3 	Rules, parts 9535.2000 to 9535.3000;
6.4 	(12) adult and family community support grants under
6.5 	Minnesota Rules, parts 9535.1700 to 9535.1760;
6.6 	(13) the group residential housing supplementary service
6.7 	rate under Minnesota Statutes, section 256I.05, subdivision 1a;
6.8 	(14) adult mental health integrated fund grants under
6.9 	Minnesota Statutes, section 245.4661;
6.10 	(15) semi-independent living services under Minnesota
6.11 	Statutes, section 252.275, including SILS funding under county
6.12 	social services grants formerly funded under Minnesota Statutes,
6.13 	chapter 256I;
6.14 	(16) community support services for deaf and
6.15 	hard-of-hearing adults with mental illness who use or wish to
6.16 	use sign language as their primary means of communication; and 
6.17 	(17) living skills training programs for persons with
6.18 	intractable epilepsy who need assistance in the transition to
6.19 	independent living.
6.20 	(c) Providers that receive a rate increase under this
6.21 	section shall use the additional revenue to:
6.22 	(1) increase wages and benefits and pay associated costs
6.23 	for employees except management fees, the administrator, and
6.24 	central office staff; or 
6.25 	(2) add staff, other than administrative personnel, above
6.26 	the provider's average staff complement for the previous year.
6.27 	(d) For public employees, the portion of this increase
6.28 	reserved to increase wages and benefits for certain staff is
6.29 	available and pay rates shall be increased only to the extent
6.30 	that they comply with laws governing public employees collective
6.31 	bargaining.  Money received by a provider for pay increases
6.32 	under this section may be used only for increases implemented on
6.33 	or after the first day of the state fiscal year in which the
6.34 	increase is available and must not be used for increases
6.35 	implemented prior to that date.
6.36 	(e) A copy of the provider's plan for complying with
7.1 	paragraph (c) must be made available to all employees by giving
7.2 	each employee a copy or by posting a copy in an area of the
7.3 	provider's operation to which all employees have access.  If an
7.4 	employee does not receive the adjustment described in the plan
7.5 	and is unable to resolve the problem with the provider, the
7.6 	employee may contact the employee's union representative.  If
7.7 	the employee is not covered by a collective bargaining
7.8 	agreement, the employee may contact the commissioner at a
7.9 	telephone number provided by the commissioner and included in
7.10 	the provider's plan.

7.11 	Sec. 5. REPORTING OF STATISTICAL AND COST INFORMATION.
 7.12 	(a) Nursing facilities shall annually file a statistical
7.13 	and cost report on or before December 15 for the reporting
7.14 	period ending September 30.
7.15 	(b) Nursing facilities shall provide the information to the
7.16 	commissioner in no lesser detail than the information required
7.17 	on the form established by Minnesota Statutes, section 256B.440.
7.18 	(c) The commissioner may reject a report filed by the
7.19 	nursing facility under this section if the commissioner
7.20 	determines that the report has been filed in a form that is
7.21 	incomplete or inaccurate.  If a report is rejected or is not
7.22 	submitted in a timely manner, the commissioner shall reduce
7.23 	payments to a nursing facility to 85 percent of amounts due
7.24 	until the information is completely and accurately filed.  The
7.25 	reinstatement of withheld payments shall be retroactive for no
7.26 	more than 90 days.  A nursing facility whose report is rejected
7.27 	shall be given a notice of the rejection, the reasons for the
7.28 	rejection, and an opportunity to correct the report prior to any
7.29 	payment reduction.  A nursing facility that does not submit a
7.30 	report shall be given a prior written notice of the payment
7.31 	reduction.
7.32 	(d) The commissioner may determine, in consultation with
7.33 	stakeholders, additional items to be reported.

7.34 	Sec. 6. NURSING HOURS AND RATES.
 7.35 	(a) On July 1, 2005, the required minimum nursing hours in
7.36 	nursing facilities licensed in Minnesota shall be increased to
8.1 	4.1 per resident per day.
8.2 	(b) The minimum staffing ratios are 2.8 hours per resident
8.3 	day of certified nursing assistant (CNA) care and 1.3 hours per
8.4 	resident day of care by an LPN or RN, of which 0.75 is provided
8.5 	by an RN.
8.6 	(c) Staffing must be adjusted upward to meet residents'
8.7 	higher care needs.
8.8 	(d) Nursing facility payment rates must be reasonable and
8.9 	adequate to meet the costs that must be incurred by efficiently
8.10 	and economically operated facilities to conform with the
8.11 	requirements established in paragraphs (a), (b), and (c).

8.12 	Sec. 7. NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.
 8.13 	(a) The commissioner of health, in consultation with
8.14 	long-term care consumers, advocates, unions, and trade
8.15 	associations, shall review the content of the current curriculum
8.16 	for the training of nursing assistants and home health aides.
8.17 	(b) This review will identify how changes in the current
8.18 	training can improve students' caregiving skills, job
8.19 	satisfaction, and motivation to work in long-term care settings.
8.20 	These topics shall include, but not be limited to, working with
8.21 	challenging behaviors and terminal illnesses; improving
8.22 	communications with residents, families, and other employees;
8.23 	and understanding techniques for stress management and how
8.24 	stress in personal life can impact performance in the work
8.25 	setting.  The review will also assess how the curriculum can be
8.26 	improved to address more effectively the issues of cultural
8.27 	diversity among employees and cultural issues in employees'
8.28 	relationships with residents and clients.
8.29 	(c) By January 1, 2006, the commissioner shall submit the
8.30 	recommendations for updating the curriculum to the chairs of the
8.31 	legislative committees having jurisdiction over health care
8.32 	policy.  The recommendations shall include implementation
8.33 	timelines and cost estimates for curriculum development and
8.34 	implementation.

8.35 	Sec. 8. LONG-TERM CARE SYSTEM PLANNING AND REDESIGN.
 8.36 	(a) The commissioner of human services in consultation and
9.1 	coordination with the commissioner of health shall create a
9.2 	long-term care task force to develop a plan to reduce nursing
9.3 	facility bed capacity.  The goal is to develop a smaller,
9.4 	well-supported nursing home system while utilizing a variety of
9.5 	diverse services in the community.  The task force shall address
9.6 	the following areas:
9.7 	(1) develop explicit policy decisions for the future use of
9.8 	nursing homes for short-term and chronic care;
9.9 	(2) define specific steps to protect consumers from
9.10 	problems accessing nursing homes, community services, and
9.11 	extended hospitalization; and 
9.12 	(3) develop a plan to utilize savings to fund facility and
9.13 	community care workforce development.
9.14 	(b) The commissioner shall issue a report to the chairs of
9.15 	the legislative committees having jurisdiction over health care
9.16 	policy by December 15, 2007.

9.17 	Sec. 9. APPROPRIATIONS.
 9.18 	$....... is appropriated in fiscal years 2006 and 2007 from
9.19 	the general fund to the commissioner of human services for the
9.20 	purposes of sections 1 to 8.