1.1                          A bill for an act 
  1.2             relating to health; providing for an inactive status 
  1.3             of licensed beds in nursing homes; establishing a 
  1.4             two-year moratorium on certain nursing facility 
  1.5             monetary penalties; amending Minnesota Statutes 1998, 
  1.6             sections 144.122; 144A.01, by adding a subdivision; 
  1.7             256.9657, subdivision 1; 256B.0911, subdivision 6; and 
  1.8             256B.431, subdivisions 2r, 3a, and 22; proposing 
  1.9             coding for new law in Minnesota Statutes, chapter 144A.
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 1998, section 144.122, is 
  1.12  amended to read: 
  1.13     144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 
  1.14     (a) The state commissioner of health, by rule, may 
  1.15  prescribe reasonable procedures and fees for filing with the 
  1.16  commissioner as prescribed by statute and for the issuance of 
  1.17  original and renewal permits, licenses, registrations, and 
  1.18  certifications issued under authority of the commissioner.  The 
  1.19  expiration dates of the various licenses, permits, 
  1.20  registrations, and certifications as prescribed by the rules 
  1.21  shall be plainly marked thereon.  Fees may include application 
  1.22  and examination fees and a penalty fee for renewal applications 
  1.23  submitted after the expiration date of the previously issued 
  1.24  permit, license, registration, and certification.  The 
  1.25  commissioner may also prescribe, by rule, reduced fees for 
  1.26  permits, licenses, registrations, and certifications when the 
  1.27  application therefor is submitted during the last three months 
  2.1   of the permit, license, registration, or certification period.  
  2.2   Fees proposed to be prescribed in the rules shall be first 
  2.3   approved by the department of finance.  All fees proposed to be 
  2.4   prescribed in rules shall be reasonable.  The fees shall be in 
  2.5   an amount so that the total fees collected by the commissioner 
  2.6   will, where practical, approximate the cost to the commissioner 
  2.7   in administering the program.  All fees collected shall be 
  2.8   deposited in the state treasury and credited to the state 
  2.9   government special revenue fund unless otherwise specifically 
  2.10  appropriated by law for specific purposes. 
  2.11     (b) The commissioner may charge a fee for voluntary 
  2.12  certification of medical laboratories and environmental 
  2.13  laboratories, and for environmental and medical laboratory 
  2.14  services provided by the department, without complying with 
  2.15  paragraph (a) or chapter 14.  Fees charged for environment and 
  2.16  medical laboratory services provided by the department must be 
  2.17  approximately equal to the costs of providing the services.  
  2.18     (c) The commissioner may develop a schedule of fees for 
  2.19  diagnostic evaluations conducted at clinics held by the services 
  2.20  for children with handicaps program.  All receipts generated by 
  2.21  the program are annually appropriated to the commissioner for 
  2.22  use in the maternal and child health program. 
  2.23     (d) The commissioner, for fiscal years 1996 and beyond, 
  2.24  shall set license fees for hospitals and nursing homes that are 
  2.25  not boarding care homes at the following levels: 
  2.26  Joint Commission on Accreditation of Healthcare 
  2.27  Organizations (JCAHO hospitals)      $1,017
  2.28  Non-JCAHO hospitals                  $762 plus $34 per bed
  2.29  Nursing home                         $78 plus $19 per bed
  2.30     The license fees for nursing homes shall be based on the 
  2.31  number of licensed beds that are not on inactive status, as 
  2.32  defined under section 144A.01, subdivision 11. 
  2.33     For fiscal years 1996 and beyond, the commissioner shall 
  2.34  set license fees for outpatient surgical centers, boarding care 
  2.35  homes, and supervised living facilities at the following levels: 
  2.36  Outpatient surgical centers          $517
  3.1   Boarding care homes                  $78 plus $19 per bed
  3.2   Supervised living facilities         $78 plus $19 per bed.
  3.3      (e) Unless prohibited by federal law, the commissioner of 
  3.4   health shall charge applicants the following fees to cover the 
  3.5   cost of any initial certification surveys required to determine 
  3.6   a provider's eligibility to participate in the Medicare or 
  3.7   Medicaid program: 
  3.8   Prospective payment surveys for          $  900
  3.9   hospitals
  3.11  Swing bed surveys for nursing homes      $1,200
  3.13  Psychiatric hospitals                    $1,400
  3.15  Rural health facilities                  $1,100
  3.17  Portable X-ray providers                 $  500
  3.19  Home health agencies                     $1,800
  3.21  Outpatient therapy agencies              $  800
  3.23  End stage renal dialysis providers       $2,100
  3.25  Independent therapists                   $  800
  3.27  Comprehensive rehabilitation             $1,200
  3.28  outpatient facilities
  3.30  Hospice providers                        $1,700
  3.32  Ambulatory surgical providers            $1,800
  3.34  Hospitals                                $4,200
  3.36  Other provider categories or             Actual surveyor costs:
  3.37  additional resurveys required            average surveyor cost x
  3.38  to complete initial certification        number of hours for the
  3.39                                           survey process.
  3.40     These fees shall be submitted at the time of the 
  3.41  application for federal certification and shall not be 
  3.42  refunded.  All fees collected after the date that the imposition 
  3.43  of fees is not prohibited by federal law shall be deposited in 
  3.44  the state treasury and credited to the state government special 
  3.45  revenue fund. 
  3.46     Sec. 2.  Minnesota Statutes 1998, section 144A.01, is 
  3.47  amended by adding a subdivision to read: 
  3.48     Subd. 11.  [INACTIVE STATUS.] "Inactive status" means the 
  3.49  status of a licensed nursing home bed for which a nursing home 
  3.50  has notified the commissioner that it will not operate as a 
  3.51  nursing home bed. 
  4.1      Sec. 3.  [144A.051] [INACTIVE STATUS BEDS.] 
  4.2      Subdivision 1.  [INACTIVE STATUS.] A nursing home may place 
  4.3   licensed nursing home beds on inactive status by notifying the 
  4.4   commissioner in writing.  The notice to the commissioner shall 
  4.5   identify the specific beds and the total number of beds to be 
  4.6   placed on inactive status and the date upon which the nursing 
  4.7   home wishes the beds to become inactive. 
  4.8      Subd. 2.  [REMOVING FROM INACTIVE STATUS.] A nursing home 
  4.9   may remove licensed beds from inactive status by notifying the 
  4.10  commissioner.  If the nursing home is certified to participate 
  4.11  in the medical assistance program under chapter 256B, the 
  4.12  effective date of the removal of the beds from inactive status 
  4.13  is July 1 following the notification to the commissioner. 
  4.14     Subd. 3.  [USE OF INACTIVE STATUS BEDS.] A nursing home may 
  4.15  use a licensed nursing home bed on inactive status for any 
  4.16  purpose not otherwise prohibited by law. 
  4.17     Sec. 4.  [144A.101] [INFORMATION PROVIDED TO FACILITIES.] 
  4.18     (a) By August 1, 1999, and annually thereafter, the 
  4.19  commissioner shall provide to each licensed nursing facility 
  4.20  information on functions nonnursing staff may perform in order 
  4.21  to achieve flexibility and economy in facility operations.  This 
  4.22  information shall include, but not be limited to: 
  4.23     (1) a list of all feeding-related activities nonnursing 
  4.24  staff may engage in, including cutting food, arranging trays in 
  4.25  front of residents, and other related activities not prohibited 
  4.26  by federal or state law or rule; 
  4.27     (2) a list of activities nonnursing staff may perform for 
  4.28  residents who activate call buttons; and 
  4.29     (3) all other activities the commissioner is aware of that 
  4.30  can be performed by nonnursing staff to achieve flexibility and 
  4.31  economy in nursing facility operations. 
  4.32     (b) The commissioner shall cooperate with nursing facility 
  4.33  trade associations to develop and implement a best practices 
  4.34  system under which innovative methods of utilizing staff in 
  4.35  order to respond to worker shortages are shared among nursing 
  4.36  facilities statewide. 
  5.1      Sec. 5.  Minnesota Statutes 1998, section 256.9657, 
  5.3   subdivision 1, is amended to read: 
  5.4      Subdivision 1.  [NURSING HOME LICENSE SURCHARGE.] (a) 
  5.5   Effective July 1, 1993, each non-state-operated nursing home 
  5.6   licensed under chapter 144A shall pay to the commissioner an 
  5.7   annual surcharge according to the schedule in subdivision 4.  
  5.8   The surcharge shall be calculated as $620 per licensed bed, 
  5.9   excluding beds on inactive status as defined in section 144A.01, 
  5.10  subdivision 11.  If the number of licensed beds is reduced or if 
  5.11  beds are placed on inactive status, the surcharge shall be based 
  5.12  on the number of remaining licensed beds, excluding beds on 
  5.13  inactive status, the second month following the receipt of 
  5.14  timely notice by the commissioner of human services that beds 
  5.15  have been delicensed or placed on inactive status.  The nursing 
  5.16  home must notify the commissioner of health in writing when beds 
  5.17  are delicensed or placed on inactive status.  The commissioner 
  5.18  of health must notify the commissioner of human services within 
  5.19  ten working days after receiving written notification.  If the 
  5.20  notification is received by the commissioner of human services 
  5.21  by the 15th of the month, the invoice for the second following 
  5.22  month must be reduced to recognize the delicensing of beds or 
  5.23  placing of beds on inactive status.  Beds on layaway status 
  5.24  continue to be subject to the surcharge.  The commissioner of 
  5.25  human services must acknowledge a medical care surcharge appeal 
  5.26  within 30 days of receipt of the written appeal from the 
  5.27  provider. 
  5.28     (b) Effective July 1, 1994, the surcharge in paragraph (a) 
  5.29  shall be increased to $625. 
  5.30     Sec. 6.  Minnesota Statutes 1998, section 256B.0911, 
  5.31  subdivision 6, is amended to read: 
  5.32     Subd. 6.  [PAYMENT FOR PREADMISSION SCREENING.] (a) The 
  5.33  total screening payment for each county must be paid monthly by 
  5.34  certified nursing facilities in the county.  The monthly amount 
  5.35  to be paid by each nursing facility for each fiscal year must be 
  5.36  determined by dividing the county's annual allocation for 
  5.37  screenings by 12 to determine the monthly payment and allocating 
  6.1   the monthly payment to each nursing facility based on the number 
  6.2   of licensed beds, excluding beds on inactive status as defined 
  6.3   in section 144A.01, subdivision 11, in the nursing facility. 
  6.4      (b) Payments for screening activities are available to the 
  6.5   county or counties to cover staff salaries and expenses to 
  6.6   provide the screening function.  The lead agency shall employ, 
  6.7   or contract with other agencies to employ, within the limits of 
  6.8   available funding, sufficient personnel to conduct the 
  6.9   preadmission screening activity while meeting the state's 
  6.10  long-term care outcomes and objectives as defined in section 
  6.11  256B.0917, subdivision 1.  The local agency shall be accountable 
  6.12  for meeting local objectives as approved by the commissioner in 
  6.13  the CSSA biennial plan. 
  6.14     (c) Notwithstanding section 256B.0641, overpayments 
  6.15  attributable to payment of the screening costs under the medical 
  6.16  assistance program may not be recovered from a facility.  
  6.17     (d) The commissioner of human services shall amend the 
  6.18  Minnesota medical assistance plan to include reimbursement for 
  6.19  the local screening teams. 
  6.20     Sec. 7.  Minnesota Statutes 1998, section 256B.431, 
  6.21  subdivision 2r, is amended to read: 
  6.22     Subd. 2r.  [PAYMENT RESTRICTIONS ON LEAVE DAYS.] Effective 
  6.23  July 1, 1993, the commissioner shall limit payment for leave 
  6.24  days in a nursing facility to 79 percent of that nursing 
  6.25  facility's total payment rate for the involved resident.  For 
  6.26  purposes of Minnesota Rules, part 9505.0415, subpart 7, the 
  6.27  commissioner shall not count beds placed on inactive status, as 
  6.28  defined in section 144A.01, subdivision 11, as licensed beds or 
  6.29  occupied beds. 
  6.30     Sec. 8.  Minnesota Statutes 1998, section 256B.431, 
  6.31  subdivision 3a, is amended to read: 
  6.32     Subd. 3a.  [PROPERTY-RELATED COSTS AFTER JULY 1, 1985.] (a) 
  6.33  For rate years beginning on or after July 1, 1985, the 
  6.34  commissioner, by permanent rule, shall reimburse nursing 
  6.35  facility providers that are vendors in the medical assistance 
  6.36  program for the rental use of real estate and depreciable 
  7.1   equipment.  "Real estate" means land improvements, buildings, 
  7.2   and attached fixtures used directly for resident care.  
  7.3   "Depreciable equipment" means the standard movable resident care 
  7.4   equipment and support service equipment generally used in 
  7.5   long-term care facilities.  
  7.6      (b) In developing the method for determining payment rates 
  7.7   for the rental use of nursing facilities, the commissioner shall 
  7.8   consider factors designed to:  
  7.9      (1) simplify the administrative procedures for determining 
  7.10  payment rates for property-related costs; 
  7.11     (2) minimize discretionary or appealable decisions; 
  7.12     (3) eliminate any incentives to sell nursing facilities; 
  7.13     (4) recognize legitimate costs of preserving and replacing 
  7.14  property; 
  7.15     (5) recognize the existing costs of outstanding 
  7.16  indebtedness allowable under the statutes and rules in effect on 
  7.17  May 1, 1983; 
  7.18     (6) address the current value of, if used directly for 
  7.19  patient care, land improvements, buildings, attached fixtures, 
  7.20  and equipment; 
  7.21     (7) establish an investment per bed limitation; 
  7.22     (8) reward efficient management of capital assets; 
  7.23     (9) provide equitable treatment of facilities; 
  7.24     (10) consider a variable rate; and 
  7.25     (11) phase-in implementation of the rental reimbursement 
  7.26  method.  
  7.27     (c) No later than January 1, 1984, the commissioner shall 
  7.28  report to the legislature on any further action necessary or 
  7.29  desirable in order to implement the purposes and provisions of 
  7.30  this subdivision.  
  7.31     (d) For rate years beginning on or after July 1, 1987, a 
  7.32  nursing facility which has reduced licensed bed capacity after 
  7.33  January 1, 1986, or placed licensed beds on inactive status 
  7.34  under the provisions of chapter 144A, shall be allowed to: 
  7.35     (1) aggregate the applicable investment per bed limits 
  7.36  based on the number of beds licensed prior to the reduction or 
  8.1   placement of beds on inactive status; and 
  8.2      (2) establish capacity days for each rate year following 
  8.3   the licensure reduction or placement of beds on inactive status 
  8.4   based on the number of beds licensed beds, excluding beds on 
  8.5   inactive status, on the previous April 1 if the commissioner is 
  8.6   notified of the change by April 4.  The notification must 
  8.7   include a copy of the delicensure or inactive status request 
  8.8   that has been submitted to the commissioner of health. 
  8.9      (e) Until the rental reimbursement method is fully phased 
  8.10  in, a nursing facility whose final property-related payment rate 
  8.11  is the rental rate shall continue to have its property-related 
  8.12  payment rates established based on the rental reimbursement 
  8.13  method. 
  8.14     (f) For rate years beginning on or after July 1, 1989, the 
  8.15  interest expense that results from a refinancing of a nursing 
  8.16  facility's demand call loan, when the loan that must be 
  8.17  refinanced was incurred before May 22, 1983, is an allowable 
  8.18  interest expense if: 
  8.19     (1) the demand call loan or any part of it was in the form 
  8.20  of a loan that was callable at the demand of the lender; 
  8.21     (2) the demand call loan or any part of it was called by 
  8.22  the lender through no fault of the nursing facility; 
  8.23     (3) the demand call loan or any part of it was made by a 
  8.24  government agency operating under a statutory or regulatory loan 
  8.25  program; 
  8.26     (4) the refinanced debt does not exceed the sum of the 
  8.27  allowable remaining balance of the demand call loan at the time 
  8.28  of payment on the demand call loan and refinancing costs; 
  8.29     (5) the term of the refinanced debt does not exceed the 
  8.30  remaining term of the demand call loan, had the debt not been 
  8.31  subject to an on-call payment demand; and 
  8.32     (6) the refinanced debt is not a debt between related 
  8.33  organizations as defined in Minnesota Rules, part 9549.0020, 
  8.34  subpart 38. 
  8.35     Sec. 9.  Minnesota Statutes 1998, section 256B.431, 
  8.36  subdivision 22, is amended to read: 
  9.1      Subd. 22.  [CHANGES TO NURSING FACILITY REIMBURSEMENT.] The 
  9.2   nursing facility reimbursement changes in paragraphs (a) to (e) 
  9.3   apply to Minnesota Rules, parts 9549.0010 to 9549.0080, and this 
  9.4   section, and are effective for rate years beginning on or after 
  9.5   July 1, 1993, unless otherwise indicated. 
  9.6      (a) In addition to the approved pension or profit sharing 
  9.7   plans allowed by the reimbursement rule, the commissioner shall 
  9.8   allow those plans specified in Internal Revenue Code, sections 
  9.9   403(b) and 408(k). 
  9.10     (b) The commissioner shall allow as workers' compensation 
  9.11  insurance costs under section 256B.421, subdivision 14, the 
  9.12  costs of workers' compensation coverage obtained under the 
  9.13  following conditions: 
  9.14     (1) a plan approved by the commissioner of commerce as a 
  9.15  Minnesota group or individual self-insurance plan as provided in 
  9.16  section 79A.03; 
  9.17     (2) a plan in which: 
  9.18     (i) the nursing facility, directly or indirectly, purchases 
  9.19  workers' compensation coverage in compliance with section 
  9.20  176.181, subdivision 2, from an authorized insurance carrier; 
  9.21     (ii) a related organization to the nursing facility 
  9.22  reinsures the workers' compensation coverage purchased, directly 
  9.23  or indirectly, by the nursing facility; and 
  9.24     (iii) all of the conditions in clause (4) are met; 
  9.25     (3) a plan in which: 
  9.26     (i) the nursing facility, directly or indirectly, purchases 
  9.27  workers' compensation coverage in compliance with section 
  9.28  176.181, subdivision 2, from an authorized insurance carrier; 
  9.29     (ii) the insurance premium is calculated retrospectively, 
  9.30  including a maximum premium limit, and paid using the paid loss 
  9.31  retro method; and 
  9.32     (iii) all of the conditions in clause (4) are met; 
  9.33     (4) additional conditions are: 
  9.34     (i) the costs of the plan are allowable under the federal 
  9.35  Medicare program; 
  9.36     (ii) the reserves for the plan are maintained in an account 
 10.1   controlled and administered by a person which is not a related 
 10.2   organization to the nursing facility; 
 10.3      (iii) the reserves for the plan cannot be used, directly or 
 10.4   indirectly, as collateral for debts incurred or other 
 10.5   obligations of the nursing facility or related organizations to 
 10.6   the nursing facility; 
 10.7      (iv) if the plan provides workers' compensation coverage 
 10.8   for non-Minnesota nursing facilities, the plan's cost 
 10.9   methodology must be consistent among all nursing facilities 
 10.10  covered by the plan, and if reasonable, is allowed 
 10.11  notwithstanding any reimbursement laws regarding cost allocation 
 10.12  to the contrary; 
 10.13     (v) central, affiliated, corporate, or nursing facility 
 10.14  costs related to their administration of the plan are costs 
 10.15  which must remain in the nursing facility's administrative cost 
 10.16  category and must not be allocated to other cost categories; 
 10.17     (vi) required security deposits, whether in the form of 
 10.18  cash, investments, securities, assets, letters of credit, or in 
 10.19  any other form are not allowable costs for purposes of 
 10.20  establishing the facilities payment rate; and 
 10.21     (vii) for the rate year beginning on July 1, 1998, a group 
 10.22  of nursing facilities related by common ownership that 
 10.23  self-insures workers' compensation may allocate its directly 
 10.24  identified costs of self-insuring its Minnesota nursing facility 
 10.25  workers among those nursing facilities in the group that are 
 10.26  reimbursed under this section or section 256B.434.  The method 
 10.27  of cost allocation shall be based on the ratio of each nursing 
 10.28  facility's total allowable salaries and wages to that of the 
 10.29  nursing facility group's total allowable salaries and wages, 
 10.30  then similarly allocated within each nursing facility's 
 10.31  operating cost categories.  The costs associated with the 
 10.32  administration of the group's self-insurance plan must remain 
 10.33  classified in the nursing facility's administrative cost 
 10.34  category.  A written request of the nursing facility group's 
 10.35  election to use this alternate method of allocation of 
 10.36  self-insurance costs must be received by the commissioner no 
 11.1   later than May 1, 1998, to take effect July 1, 1998, or such 
 11.2   costs shall continue to be allocated under the existing cost 
 11.3   allocation methods.  Once a nursing facility group elects this 
 11.4   method of cost allocation for its workers' compensation 
 11.5   self-insurance costs, it shall remain in effect until such time 
 11.6   as the group no longer self-insures these costs; 
 11.7      (5) any costs allowed pursuant to clauses (1) to (3) are 
 11.8   subject to the following requirements: 
 11.9      (i) if the nursing facility is sold or otherwise ceases 
 11.10  operations, the plan's reserves must be subject to an 
 11.11  actuarially based settle-up after 36 months from the date of 
 11.12  sale or the date on which operations ceased.  The facility's 
 11.13  medical assistance portion of the total excess plan reserves 
 11.14  must be paid to the state within 30 days following the date on 
 11.15  which excess plan reserves are determined; 
 11.16     (ii) any distribution of excess plan reserves made to or 
 11.17  withdrawals made by the nursing facility or a related 
 11.18  organization are applicable credits and must be used to reduce 
 11.19  the nursing facility's workers' compensation insurance costs in 
 11.20  the reporting period in which a distribution or withdrawal is 
 11.21  received; 
 11.22     (iii) if reimbursement for the plan is sought under the 
 11.23  federal Medicare program, and is audited pursuant to the 
 11.24  Medicare program, the nursing facility must provide a copy of 
 11.25  Medicare's final audit report, including attachments and 
 11.26  exhibits, to the commissioner within 30 days of receipt by the 
 11.27  nursing facility or any related organization.  The commissioner 
 11.28  shall implement the audit findings associated with the plan upon 
 11.29  receipt of Medicare's final audit report.  The department's 
 11.30  authority to implement the audit findings is independent of its 
 11.31  authority to conduct a field audit. 
 11.32     (c) In the determination of incremental increases in the 
 11.33  nursing facility's rental rate as required in subdivisions 14 to 
 11.34  21, except for a refinancing permitted under subdivision 19, the 
 11.35  commissioner must adjust the nursing facility's property-related 
 11.36  payment rate for both incremental increases and decreases in 
 12.1   recomputations of its rental rate; 
 12.2      (d) A nursing facility's administrative cost limitation 
 12.3   must be modified as follows: 
 12.4      (1) if the nursing facility's licensed beds, excluding beds 
 12.5   on inactive status as defined in section 144A.01, subdivision 
 12.6   11, exceed 195 licensed beds, the general and administrative 
 12.7   cost category limitation shall be 13 percent; 
 12.8      (2) if the nursing facility's licensed beds, excluding beds 
 12.9   on inactive status, are more than 150 licensed beds, but less 
 12.10  than 196 licensed beds, the general and administrative cost 
 12.11  category limitation shall be 14 percent; or 
 12.12     (3) if the nursing facility's licensed beds, excluding beds 
 12.13  on inactive status, is less than 151 licensed beds, the general 
 12.14  and administrative cost category limitation shall remain at 15 
 12.15  percent. 
 12.16     (e) The care related operating rate shall be increased by 
 12.17  eight cents to reimburse facilities for unfunded federal 
 12.18  mandates, including costs related to hepatitis B vaccinations. 
 12.19     (f) For the rate year beginning on July 1, 1998, a group of 
 12.20  nursing facilities related by common ownership that self-insures 
 12.21  group health, dental, or life insurance may allocate its 
 12.22  directly identified costs of self-insuring its Minnesota nursing 
 12.23  facility workers among those nursing facilities in the group 
 12.24  that are reimbursed under this section or section 256B.434.  The 
 12.25  method of cost allocation shall be based on the ratio of each 
 12.26  nursing facility's total allowable salaries and wages to that of 
 12.27  the nursing facility group's total allowable salaries and wages, 
 12.28  then similarly allocated within each nursing facility's 
 12.29  operating cost categories.  The costs associated with the 
 12.30  administration of the group's self-insurance plan must remain 
 12.31  classified in the nursing facility's administrative cost 
 12.32  category.  A written request of the nursing facility group's 
 12.33  election to use this alternate method of allocation of 
 12.34  self-insurance costs must be received by the commissioner no 
 12.35  later than May 1, 1998, to take effect July 1, 1998, or those 
 12.36  self-insurance costs shall continue to be allocated under the 
 13.1   existing cost allocation methods.  Once a nursing facility group 
 13.2   elects this method of cost allocation for its group health, 
 13.3   dental, or life insurance self-insurance costs, it shall remain 
 13.4   in effect until such time as the group no longer self-insures 
 13.5   these costs. 
 13.6      Sec. 10.  [MORATORIUM ON MONETARY FINES.] 
 13.7      For the period July 1, 1999, to June 30, 2001, the 
 13.8   commissioner of health shall not impose a monetary fine on a 
 13.9   nursing facility licensed under Minnesota Statutes, chapter 
 13.10  144A, for violations of minimum staffing requirements under 
 13.11  Minnesota Statutes, section 144A.04, subdivision 7; Minnesota 
 13.12  Rules, part 4658.0510; or Code of Federal Regulations, title 42, 
 13.13  chapter IV, section 483.30, until the commissioner:  (1) 
 13.14  provides the facility with a suggested plan of action to hire 
 13.15  and train additional facility staff; and (2) allows the facility 
 13.16  120 days to carry out the plan.  If at the end of the 120-day 
 13.17  period the commissioner determines that the facility is still 
 13.18  out-of-compliance, the commissioner may impose a monetary 
 13.19  penalty unless the facility demonstrates to the satisfaction of 
 13.20  the commissioner that it has followed the action plan suggested 
 13.21  by the commissioner but has been unable to hire sufficient staff 
 13.22  to meet minimum staffing requirements.