HF 1797

as introduced - 91st Legislature (2019 - 2020) Posted on 03/02/2020 04:27pm

A bill for an act
relating to health; changing provisions for adequate care requirement; requiring a
report; amending Minnesota Statutes 2018, section 144A.04, subdivision 7;
proposing coding for new law in Minnesota Statutes, chapter 256R.

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

Section 1.

Minnesota Statutes 2018, section 144A.04, subdivision 7, is amended to read:

Subd. 7.

deleted text begin Minimum nursing staff deleted text end new text begin Adequate care new text end requirement.

The minimum staffing
standard for nursing personnel in certified nursing homes is as follows:

(a) The minimum number of new text begin productive new text end hours of nursing personnel to be provided in a
nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per
standardized resident day. Upon transition to the 34 group, RUG-III resident classification
system, the 0.95 hours per standardized resident day shall no longer apply.

deleted text begin (b) For purposes of this subdivision, "hours of nursing personnel" means the paid,
on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the
basis of any given 24-hour period. "Productive nursing hours" means all on-duty hours
during which nurses and nursing assistants are engaged in nursing duties. Examples of
nursing duties may be found in Minnesota Rules, part 4655.6400. Not included are vacations,
holidays, sick leave, in-service classroom training, or lunches. Also not included are the
nonproductive nursing hours of the in-service training director. In homes with more than
60 licensed beds, the hours of the director of nursing are excluded. "Standardized resident
day" means the sum of the number of residents in each case mix class multiplied by the
case mix weight for that resident class, as found in Minnesota Rules, part 9549.0059, subpart
2, calculated on the basis of a facility's census for any given day. For the purpose of
determining a facility's census, the commissioner of health shall exclude the resident days
claimed by the facility for resident therapeutic leave or bed hold days.
deleted text end

deleted text begin (c) Calculation of nursing hours per standardized resident day is performed by dividing
total hours of nursing personnel for a given period by the total of standardized resident days
for that same period.
deleted text end

deleted text begin (d) A nursing home that is issued a notice of noncompliance under section 144A.10,
subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for
each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.
deleted text end

new text begin (b) For purposes of this subdivision, "productive hours of nursing personnel" means the
hours of all nurses, nursing assistants, and therapeutic medication aides providing on-duty,
direct hands-on resident care, or other direct hands-on care nursing duties, calculated on
the basis of each 24-hour period. The hours not included in productive hours of nursing
personnel include but are not limited to: vacations, supplemental holiday pay, sick leave,
in-service classroom training, and the hours of in-service training. Also not included in
productive hours of nursing personnel are hours of service by the director of nursing, the
assistant director of nursing, social workers, the minimum data set nurse, and nursing hours
separately reimbursed under chapter 256R.
new text end

new text begin (c) For purposes of this subdivision, "standardized resident day" means the sum of the
number of residents in each case mix class multiplied by the case mix weight for that resident
class, as published by the department, calculated on the basis of a facility's census each day.
Changes of RUG class assignment shall not take effect until receipt of notification from the
commissioner of health. For the purpose of determining a facility's census, the commissioner
of health shall exclude the resident days claimed by the facility for resident therapeutic
leave or bed hold days.
new text end

new text begin (d) Calculation of productive nursing hours per resident day is performed by dividing
total productive hours of nursing personnel for each day by the number of residents on that
day. Calculation of productive nursing hours per standardized resident day is performed by
dividing total productive hours of nursing personnel for each day by the total of standardized
resident days for that day. Licensed nursing homes shall prepare monthly reports to the
commissioner according to instructions and on forms provided by the commissioner. The
filed reports are public documents and shall be posted in a prominent location at each nursing
home site for review by patients, visitors, and staff where applicable. Copies must be provided
to the facility's staff collective bargaining representative upon request.
new text end

new text begin (e) A nursing home with one or more instance in which the adequate care standard is
not met shall be issued a notice of noncompliance under section 144A.10, subdivision 5,
for a violation of this subdivision, and beginning April 15, 2020, shall be assessed a civil
fine according to clauses (1) to (3), subject to section 144A.10, subdivisions 7 and 8. For:
new text end

new text begin (1) the first occurrence of noncompliance in each six-month period, the fine shall be
$250;
new text end

new text begin (2) each of the second and third occurrence in each six-month period, the fine shall be
$500; and
new text end

new text begin (3) each occurrence over three occurrences in each six-month period, the fine shall be
$1,000. An "occurrence of noncompliance" means either a day during which the actual
staffing levels fall below the standard required in paragraph (a) or (b), or an occurrence in
which data reported under paragraph (d) are determined by the commissioner to be materially
inaccurate.
new text end

new text begin (f) The commissioner may allow exceptions to the definition of nursing staff to include
other direct care staff, waive notices of noncompliance, and waive fines under extraordinary
circumstances at the sole discretion of the commissioner.
new text end

new text begin (g) Fines collected under this subdivision shall be deposited in a special revenue account
and shall be used by the commissioner for grants for education and training of direct care
staff.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

new text begin [256R.461] NURSING FACILITY RATE INCREASES; NURSING HOME
PROVIDERS.
new text end

new text begin Beginning January 1, 2020, nursing facilities may apply to the commissioner and the
commissioner shall allow rate increases to nursing facilities to cover the costs of complying
with the standards in section 144A.04. Applications shall be submitted to the commissioner
in a manner determined by the commissioner. In determining allowable rate increases, the
commissioner shall consider:
new text end

new text begin (1) the standards in section 144A.04, subdivision 7;
new text end

new text begin (2) actual productive hours of direct care, average hourly cost of employed staff, and
resident days by RUGs classification reported on a facility's most recent annual statistical
and cost report under this chapter; and
new text end

new text begin (3) the facility's statement of the number of hours, by discipline, that are required to be
added to achieve adequate care in order to ensure compliance, not to exceed the difference
between the adequate care standard and previous levels by more than 20 percent.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end