1999 Minnesota Statutes

CHAPTER 144A. Nursing homes and home care

     144A.01 Definitions. 

    Subdivision 1.    Scope.  For the purposes of sections 
 144A.01 to 144A.27, the terms defined in this section have the 
 meanings given them. 

    Subd. 2.    Commissioner of health.  "Commissioner of 
 health" means the state commissioner of health established by 
 section 144.011. 

    Subd. 3.    Board of examiners.  "Board of examiners" 
 means the board of examiners for nursing home administrators 
 established by section 144A.19. 

    Subd. 3a.    Certified.  "Certified" means certified for 
 participation as a provider in the Medicare or Medicaid programs 
 under title XVIII or XIX of the Social Security Act. 

    Subd. 4.    Controlling person.  "Controlling person" 
 means any public body, governmental agency, business entity, 
 officer, nursing home administrator, or director whose 
 responsibilities include the direction of the management or 
 policies of a nursing home.  "Controlling person" also means any 
 person who, directly or indirectly, beneficially owns any 
 interest in: 

    (a) Any corporation, partnership or other business 
 association which is a controlling person; 

    (b) The land on which a nursing home is located; 

    (c) The structure in which a nursing home is located; 

    (d) Any mortgage, contract for deed, or other obligation 
 secured in whole or part by the land or structure comprising a 
 nursing home; or 

    (e) Any lease or sublease of the land, structure, or 
 facilities comprising a nursing home. 

    "Controlling person" does not include: 

    (a) A bank, savings bank, trust company, savings 
 association, credit union, industrial loan and thrift company, 
 investment banking firm, or insurance company unless the entity 
 directly or through a subsidiary operates a nursing home; 

    (b) An individual state official or state employee, or a 
 member or employee of the governing body of a political 
 subdivision of the state which operates one or more nursing 
 homes, unless the individual is also an officer or director of a 
 nursing home, receives any remuneration from a nursing home, or 
 owns any of the beneficial interests not excluded in this 
 subdivision; 

    (c) A natural person who is a member of a tax-exempt 
 organization under section 290.05, subdivision 1, clause (i), 
 unless the individual is also an officer or director of a 
 nursing home, or owns any of the beneficial interests not 
 excluded in this subdivision; and 

    (d) A natural person who owns less than five percent of the 
 outstanding common shares of a corporation: 

    (1) whose securities are exempt by virtue of section 
 80A.15, subdivision 1, clause (f); or 

    (2) whose transactions are exempt by virtue of section 
 80A.15, subdivision 2, clause (b). 

    Subd. 4a.    Emergency.  "Emergency" means a situation 
 or physical condition that creates or probably will create an 
 immediate and serious threat to a resident's health or safety. 

    Subd. 5.    Nursing home.  "Nursing home" means a 
 facility or that part of a facility which provides nursing care 
 to five or more persons.  "Nursing home" does not include a 
 facility or that part of a facility which is a hospital, a 
 hospital with approved swing beds as defined in section 144.562, 
 clinic, doctor's office, diagnostic or treatment center, or a 
 residential program licensed pursuant to sections 245A.01 to 
 245A.16 or 252.28. 

    Subd. 6.    Nursing care.  "Nursing care" means health 
 evaluation and treatment of patients and residents who are not 
 in need of an acute care facility but who require nursing 
 supervision on an inpatient basis.  The commissioner of health 
 may by rule establish levels of nursing care. 

    Subd. 7.    Uncorrected violation.  "Uncorrected 
 violation" means a violation of a statute or rule or any other 
 deficiency for which a notice of noncompliance has been issued 
 and fine assessed and allowed to be recovered pursuant to 
 section 144A.10, subdivision 8.  

    Subd. 8.    Managerial employee.  "Managerial employee" 
 means an employee of a nursing home whose duties include the 
 direction of some or all of the management or policies of the 
 nursing home. 

    Subd. 9.    Nursing home administrator.  "Nursing home 
 administrator" means a person who administers, manages, 
 supervises, or is in general administrative charge of a nursing 
 home, whether or not the individual has an ownership interest in 
 the home, and whether or not the person's functions and duties 
 are shared with one or more individuals, and who is licensed 
 pursuant to section 144A.21. 

    Subd. 10.    Repeated violation.  "Repeated violation" 
 means the issuance of two or more correction orders, within a 
 12-month period, for a violation of the same provision of a 
 statute or rule. 

    HIST: 1976 c 173 s 1; 1977 c 305 s 45; 1980 c 509 s 43; 
 1Sp1981 c 4 art 1 s 79; 1982 c 633 s 1; 1Sp1985 c 3 s 5-7; 1986 
 c 444; 1989 c 282 art 2 s 24; art 3 s 6,7; 1995 c 202 art 1 s 25 

     144A.02 Licensure; penalty. 

    Subdivision 1.  No facility shall be used as a nursing home 
 to provide nursing care unless the facility has been licensed as 
 a nursing home.  The commissioner of health may license a 
 facility as a nursing home if the facility meets the criteria 
 established by sections 144A.02 to 144A.10, and the rules 
 promulgated thereunder.  A license shall describe the facility 
 to be licensed by address and by legal property description.  
 The license shall specify the location and square footage of the 
 floor space constituting the facility and shall incorporate by 
 reference the plans and specifications of the facility, which 
 plans and specifications shall be kept on file with the 
 commissioner of health.  The license may also specify the level 
 or levels of nursing care which the facility is licensed to 
 provide and shall state any conditions or limitations imposed on 
 the facility in accordance with the rules of the commissioner of 
 health. 

    Subd. 2.  A controlling person of a nursing home in 
 violation of this section is guilty of a misdemeanor.  The 
 provisions of this subdivision shall not apply to any 
 controlling person who had no legal authority to affect or 
 change decisions related to the operation of the nursing home. 

    HIST: 1976 c 173 s 2; 1977 c 305 s 45 

     144A.03 License application. 

    Subdivision 1.    Form; requirements.  The commissioner 
 of health by rule shall establish forms and procedures for the 
 processing of nursing home license applications.  An application 
 for a nursing home license shall include the following 
 information: 

    (a) The names and addresses of all controlling persons and 
 managerial employees of the facility to be licensed; 

    (b) The address and legal property description of the 
 facility; 

    (c) A copy of the architectural and engineering plans and 
 specifications of the facility as prepared and certified by an 
 architect or engineer registered to practice in this state; and 

    (d) Any other relevant information which the commissioner 
 of health by rule or otherwise may determine is necessary to 
 properly evaluate an application for license. 

    A controlling person which is a corporation shall submit 
 copies of its articles of incorporation and bylaws and any 
 amendments thereto as they occur, together with the names and 
 addresses of its officers and directors.  A controlling person 
 which is a foreign corporation shall furnish the commissioner of 
 health with a copy of its certificate of authority to do 
 business in this state.  An application on behalf of a 
 controlling person which is a corporation, association or a 
 governmental unit or instrumentality shall be signed by at least 
 two officers or managing agents of that entity. 

    Subd. 2.    Agents.  Each application for a nursing home 
 license or for renewal of a nursing home license shall specify 
 one or more controlling persons or managerial employees as 
 agents: 

    (a) Who shall be responsible for dealing with the 
 commissioner of health on all matters provided for in sections 
 144A.01 to 144A.16; and 

    (b) On whom personal service of all notices and orders 
 shall be made, and who shall be authorized to accept service on 
 behalf of all of the controlling persons of the facility, in 
 proceedings under sections 144A.06; 144A.10, subdivisions 4, 5, 
 and 7; 144A.11, subdivision 3; and 144A.15.  Notwithstanding any 
 law to the contrary, personal service on the designated person 
 or persons named in an application shall be deemed to be service 
 on all of the controlling persons or managerial employee of the 
 facility, and it shall not be a defense to any action arising 
 under sections 144A.06; 144A.10, subdivisions 4, 5 and 7; 
 144A.11, subdivision 3; and 144A.15, that personal service was 
 not made on each controlling person or managerial employee of 
 the facility.  The designation of one or more controlling 
 persons or managerial employees pursuant to this subdivision 
 shall not affect the legal responsibility of any other 
 controlling person or managerial employee under sections 144A.01 
 to 144A.16. 

    HIST: 1976 c 173 s 3; 1977 c 305 s 45; 1987 c 384 art 2 s 1 

     144A.04 Qualifications for license. 

    Subdivision 1.    Compliance required.  No nursing home 
 license shall be issued to a facility unless the commissioner of 
 health determines that the facility complies with the 
 requirements of this section. 

    Subd. 2.    Application.  The controlling persons of the 
 facility must comply with the application requirements specified 
 by section 144A.03 and the rules of the commissioner of health. 

    Subd. 2a.    Rules; locks.  The commissioner shall not 
 adopt any rule unconditionally prohibiting locks on patient room 
 doors in nursing homes.  The commissioner may adopt a rule 
 requiring locks to be consistent with the applicable rules 
 enforced by the state fire marshal.  

    Subd. 3.    Standards.  The facility must meet the 
 minimum health, sanitation, safety and comfort standards 
 prescribed by the rules of the commissioner of health with 
 respect to the construction, equipment, maintenance and 
 operation of a nursing home.  The commissioner of health may 
 temporarily waive compliance with one or more of the standards 
 if the commissioner determines that: 

    (a) Temporary noncompliance with the standard will not 
 create an imminent risk of harm to a nursing home resident; and 

    (b) A controlling person on behalf of all other controlling 
 persons: 

    (1) Has entered into a contract to obtain the materials or 
 labor necessary to meet the standard set by the commissioner of 
 health, but the supplier or other contractor has failed to 
 perform the terms of the contract and the inability of the 
 nursing home to meet the standard is due solely to that failure; 
 or 

    (2) Is otherwise making a diligent good faith effort to 
 meet the standard. 

    The commissioner of health shall allow, by rule, a nursing 
 home to provide fewer hours of nursing care to intermediate care 
 residents of a nursing home than required by the present rules 
 of the commissioner if the commissioner determines that the 
 needs of the residents of the home will be adequately met by a 
 lesser amount of nursing care. 

    Subd. 3a.    Rules; double beds.  The commissioner shall 
 not adopt any rule which unconditionally prohibits double beds 
 in a nursing home.  The commissioner may adopt rules setting 
 criteria for when double beds will be allowed.  

    Subd. 4.    Controlling person restrictions.  (a) The 
 controlling persons of a nursing home may not include any person 
 who was a controlling person of another nursing home during any 
 period of time in the previous two-year period:  

    (1) during which time of control that other nursing home 
 incurred the following number of uncorrected or repeated 
 violations: 

    (i) two or more uncorrected violations or one or more 
 repeated violations which created an imminent risk to direct 
 resident care or safety; or 

    (ii) four or more uncorrected violations or two or more 
 repeated violations of any nature for which the fines are in the 
 four highest daily fine categories prescribed in rule; or 

    (2) who was convicted of a felony or gross misdemeanor that 
 relates to operation of the nursing home or directly affects 
 resident safety or care, during that period. 

    (b) The provisions of this subdivision shall not apply to 
 any controlling person who had no legal authority to affect or 
 change decisions related to the operation of the nursing home 
 which incurred the uncorrected violations. 

    Subd. 4a.    Stay of adverse action required by 
 controlling person restrictions.  (a) In lieu of revoking, 
 suspending, or refusing to renew the license of a nursing home 
 with a controlling person disqualified by subdivision 4, 
 paragraph (a), clause (1), the commissioner may issue an order 
 staying the revocation, suspension, or nonrenewal of the nursing 
 home license.  The order may, but need not, be contingent upon 
 the nursing home's compliance with restrictions and conditions 
 imposed on the license to ensure the proper operation of the 
 nursing home and to protect the health, safety, comfort, 
 treatment, and well-being of the residents in the home.  The 
 decision to issue an order for stay must be made within 90 days 
 of the commissioner's determination that a controlling person is 
 disqualified by subdivision 4, paragraph (a), clause (1), from 
 operating a nursing home. 

    (b) In determining whether to issue a stay and to impose 
 conditions and restrictions, the commissioner shall consider the 
 following factors: 

    (1) the ability of the controlling persons to operate other 
 nursing homes in accordance with the licensure rules and laws; 

    (2) the conditions in the facility that received the number 
 and type of uncorrected or repeated violations described in 
 subdivision 4, paragraph (a), clause (1); and 

    (3) the conditions and compliance history of each of the 
 nursing homes operated by the controlling persons. 

    (c) The commissioner's decision to exercise the authority 
 under this subdivision in lieu of revoking, suspending, or 
 refusing to renew the license of the nursing home is not subject 
 to administrative or judicial review. 

    (d) The order for the stay of revocation, suspension, or 
 nonrenewal of the nursing home license must include any 
 conditions and restrictions on the nursing home license that the 
 commissioner deems necessary based upon the factors listed in 
 paragraph (b). 

    (e) Prior to issuing an order for stay of revocation, 
 suspension, or nonrenewal, the commissioner shall inform the 
 controlling persons, in writing, of any conditions and 
 restrictions that will be imposed.  The controlling persons 
 shall, within ten working days, notify the commissioner in 
 writing of their decision to accept or reject the conditions and 
 restrictions.  If the nursing home rejects any of the conditions 
 and restrictions, the commissioner shall either modify the 
 conditions and restrictions or take action to suspend, revoke, 
 or not renew the nursing home license. 

    (f) Upon issuance of the order for stay of revocation, 
 suspension, or nonrenewal, the controlling persons shall be 
 responsible for compliance with the conditions and restrictions 
 contained therein.  Any time after the conditions and 
 restrictions have been in place for 180 days, the controlling 
 persons may petition the commissioner for removal or 
 modification of the conditions and restrictions.  The 
 commissioner shall respond to the petition within 30 days of the 
 receipt of the written petition.  If the commissioner denies the 
 petition, the controlling persons may request a hearing under 
 the provisions of chapter 14.  Any hearing shall be limited to a 
 determination of whether the conditions and restrictions shall 
 be modified or removed.  At the hearing, the controlling persons 
 will have the burden of proof. 

    (g) The failure of the controlling persons to comply with 
 the conditions and restrictions contained in the order for stay 
 shall result in the immediate removal of the stay and the 
 commissioner shall take action to suspend, revoke, or not renew 
 the license. 

    (h) The conditions and restrictions are effective for two 
 years after the date they are imposed. 

    (i) Nothing in this subdivision shall be construed to limit 
 in any way the commissioner's ability to impose other sanctions 
 against a nursing home license under the standards set forth in 
 state or federal law whether or not a stay of revocation, 
 suspension, or nonrenewal is issued. 

    Subd. 5.    Administrators.  Except as otherwise 
 provided by this subdivision, a nursing home must have a full 
 time licensed nursing home administrator serving the facility.  
 Notwithstanding sections 144A.18 to 144A.27, in any nursing home 
 of less than 32 beds, the director of nursing services may also 
 serve as the licensed nursing home administrator without being 
 licensed as a nursing home administrator, provided the director 
 of nursing services has passed the state law and rules 
 examination administered by the board of examiners for nursing 
 home administrators and maintains evidence of completion of 20 
 hours of continuing education each year on topics pertinent to 
 nursing home administration.  Two nursing homes under common 
 ownership or management pursuant to a lease or management 
 contract having a total of 150 beds or less and located within 
 75 miles of each other may share the services of a licensed 
 administrator if the administrator divides the full-time work 
 week between the two facilities in proportion to the number of 
 beds in each facility.  Every nursing home shall have a 
 person-in-charge on the premises at all times in the absence of 
 the licensed administrator.  The name of the person in charge 
 must be posted in a conspicuous place in the facility.  The 
 commissioner of health shall by rule promulgate minimum 
 education and experience requirements for persons-in-charge, and 
 may promulgate rules specifying the times of day during which a 
 licensed administrator must be on the nursing home's premises.  
 In the absence of rules adopted by the commissioner governing 
 the division of an administrator's time between two nursing 
 homes, the administrator shall designate and post the times the 
 administrator will be on site in each home on a regular basis.  
 A nursing home may employ as its administrator the administrator 
 of a hospital licensed pursuant to sections 144.50 to 144.56 if 
 the individual is licensed as a nursing home administrator 
 pursuant to section 144A.20 and the nursing home and hospital 
 have a combined total of 150 beds or less and are located within 
 one mile of each other.  A nonproprietary retirement home having 
 fewer than 15 licensed nursing home beds may share the services 
 of a licensed administrator with a nonproprietary nursing home, 
 having fewer than 150 licensed nursing home beds, that is 
 located within 25 miles of the retirement home.  A nursing home 
 which is located in a facility licensed as a hospital pursuant 
 to sections 144.50 to 144.56, may employ as its administrator 
 the administrator of the hospital if the individual meets 
 minimum education and long term care experience criteria set by 
 rule of the commissioner of health. 

    Subd. 5a.    Shared administrators.  (a) Notwithstanding 
 subdivision 5, two nonprofit nursing homes may share the 
 services of a licensed administrator if the two homes have a 
 total of 60 beds or less and are located within 20 miles of each 
 other in St. Louis county.  The administrator must divide the 
 full-time work week between the two facilities in proportion to 
 the number of beds in each facility. 

    (b) Notwithstanding subdivision 5, the administrator of a 
 hospital licensed pursuant to sections 144.50 to 144.56 may 
 serve as the nursing home administrator of a hospital-attached 
 nursing home and another nursing home located within one mile if 
 the hospital and nursing homes are under common ownership, the 
 total nursing home beds do not exceed 152 beds, and the hospital 
 administrator is licensed pursuant to section 144A.20. 

    Subd. 6.    Managerial employee or licensed administrator; 
 employment prohibitions.  A nursing home may not employ as a 
 managerial employee or as its licensed administrator any person 
 who was a managerial employee or the licensed administrator of 
 another facility during any period of time in the previous 
 two-year period:  

    (a) During which time of employment that other nursing home 
 incurred the following number of uncorrected violations which 
 were in the jurisdiction and control of the managerial employee 
 or the administrator: 

    (1) two or more uncorrected violations or one or more 
 repeated violations which created an imminent risk to direct 
 resident care or safety; or 

    (2) four or more uncorrected violations or two or more 
 repeated violations of any nature for which the fines are in the 
 four highest daily fine categories prescribed in rule; or 

    (b) who was convicted of a felony or gross misdemeanor that 
 relates to operation of the nursing home or directly affects 
 resident safety or care, during that period. 

    Subd. 7.    Minimum nursing staff requirement.  
 Notwithstanding the provisions of Minnesota Rules, part 
 4655.5600, the minimum staffing standard for nursing personnel 
 in certified nursing homes is as follows: 

    (a) The minimum number of 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. 

    (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, parts 4655.5900, 4655.6100, and 
 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. 

    (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. 

    (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. 

    Subd. 7a.    Director of nursing services.  Except as 
 otherwise provided by this subdivision and subdivision 5, a 
 nursing home must have a full-time director of nursing services 
 who is assigned full time to the nursing services of the nursing 
 home.  For nursing homes with less than 32 beds, the director of 
 nursing services may also serve as the licensed nursing home 
 administrator without being licensed by the board of examiners 
 for nursing home administrators under sections 144A.19 to 
 144A.27.  For purposes of this requirement, "full time" means 
 working at least 35 hours per week.  The director of nursing 
 services of a nursing home may also serve as the director of 
 nursing services of a physically attached hospital if:  

    (1) the hospital has an average daily census of ten 
 patients or less in the most recent reporting year for which 
 data is available; 

    (2) the total combined beds of the hospital and nursing 
 home do not exceed 100; and 

    (3) the management of the two facilities is under the 
 control and direction of the same governing body. 

    Subd. 8.    Residents with AIDS or hepatitis.  A nursing 
 home must accept as a resident a person who is infected with the 
 human immunodeficiency virus or the hepatitis B virus unless the 
 facility cannot provide appropriate care for the person under 
 Minnesota Rules, part 4655.1500, subpart 2, or the person is 
 otherwise not eligible for admission under state laws and rules. 

    Subd. 9.    Cardiopulmonary resuscitation training.  
 Effective October 1, 1989, a nursing home must have on duty at 
 all times at least one staff member who is trained in single 
 rescuer adult cardiopulmonary resuscitation and who has 
 completed the initial training or a refresher course within the 
 previous two years. 

    Subd. 10.    Assessments for short-stay residents.  Upon 
 federal approval, a nursing home is not required to perform a 
 resident assessment on a resident expected to remain in the 
 facility for 30 days or less.  A short-stay resident 
 transferring from a hospital to a nursing home must have a plan 
 of care developed at the hospital before admission to the 
 nursing home.  If a short-stay resident remains in the nursing 
 home longer than 30 days, the nursing home must perform the 
 resident assessment in accordance with sections 144.072 to 
 144.0722 within 40 days of the resident's admission. 

    HIST: 1976 c 173 s 4; 1977 c 305 s 45; 1977 c 326 s 2; 1978 c 
 536 s 1; 1981 c 23 s 3; 1981 c 24 s 2; 1982 c 614 s 3; 1982 c 
 633 s 2,3; 1983 c 312 art 1 s 17; 1Sp1985 c 3 s 8,9; 1986 c 444; 
 1988 c 689 art 2 s 35; 1989 c 282 art 3 s 8-10; 1990 c 498 s 
 1,2; 1991 c 169 s 1; 1993 c 326 art 13 s 1,2; 1Sp1993 c 1 art 9 
 s 53; 1995 c 81 s 1; 1996 c 296 s 1; 1996 c 352 s 1; 1996 c 451 
 art 4 s 21; 1998 c 407 art 3 s 1; 1999 c 17 s 1,2 

     144A.05 License renewal. 

    Unless the license expires in accordance with section 
 144A.06 or is suspended or revoked in accordance with section 
 144A.11, a nursing home license shall remain effective for a 
 period of one year from the date of its issuance.  The 
 commissioner of health by rule shall establish forms and 
 procedures for the processing of license renewals.  The 
 commissioner of health shall approve a license renewal 
 application if the facility continues to satisfy the 
 requirements, standards and conditions prescribed by sections 
 144A.01 to 144A.16 and the rules promulgated thereunder.  The 
 commissioner shall not approve the renewal of a license for a 
 nursing home bed in a resident room with more than four beds.  
 Except as provided in section 144A.08, a facility shall not be 
 required to submit with each application for a license renewal 
 additional copies of the architectural and engineering plans and 
 specifications of the facility.  Before approving a license 
 renewal, the commissioner of health shall determine that the 
 facility's most recent balance sheet and its most recent 
 statement of revenues and expenses, as audited by the state 
 auditor, by a certified public accountant licensed by this state 
 or by a public accountant as defined in section 412.222, have 
 been received by the department of human services. 

    HIST: 1976 c 173 s 5; 1977 c 305 s 45; 1977 c 326 s 3; 1984 c 
 654 art 5 s 58; 1987 c 384 art 2 s 1; 1987 c 403 art 4 s 2 

     144A.06 Transfer of interests. 

    Subdivision 1.    Notice; expiration of license.  Any 
 controlling person who makes any transfer of a beneficial 
 interest in a nursing home shall notify the commissioner of 
 health of the transfer within 14 days of its occurrence.  The 
 notification shall identify by name and address the transferor 
 and transferee and shall specify the nature and amount of the 
 transferred interest.  On determining that the transferred 
 beneficial interest exceeds ten percent of the total beneficial 
 interest in the nursing home facility, the structure in which 
 the facility is located, or the land upon which the structure is 
 located, the commissioner may, and on determining that the 
 transferred beneficial interest exceeds 50 percent of the total 
 beneficial interest in the facility, the structure in which the 
 facility is located, or the land upon which the structure is 
 located, the commissioner shall require that the license of the 
 nursing home expire 90 days after the date of transfer.  The 
 commissioner of health shall notify the nursing home by 
 certified mail of the expiration of the license at least 60 days 
 prior to the date of expiration. 

    Subd. 2.    Relicensure.  The commissioner of health by 
 rule shall prescribe procedures for relicensure under this 
 section.  The commissioner of health shall relicense a nursing 
 home if the facility satisfies the requirements for license 
 renewal established by section 144A.05.  A facility shall not be 
 relicensed by the commissioner if at the time of transfer there 
 are any uncorrected violations.  The commissioner of health may 
 temporarily waive correction of one or more violations if the 
 commissioner determines that: 

    (a) Temporary noncorrection of the violation will not 
 create an imminent risk of harm to a nursing home resident; and 

    (b) A controlling person on behalf of all other controlling 
 persons: 

    (1) Has entered into a contract to obtain the materials or 
 labor necessary to correct the violation, but the supplier or 
 other contractor has failed to perform the terms of the contract 
 and the inability of the nursing home to correct the violation 
 is due solely to that failure; or 

    (2) Is otherwise making a diligent good faith effort to 
 correct the violation. 

    HIST: 1976 c 173 s 6; 1977 c 305 s 45; 1986 c 444 

     144A.07 Fees. 

    Each application for a license to operate a nursing home, 
 or for a renewal of license, except an application by the 
 Minnesota veterans home or the commissioner of human services 
 for the licensing of state institutions, shall be accompanied by 
 a fee to be prescribed by the commissioner of health pursuant to 
 section 144.122.  No fee shall be refunded. 

    HIST: 1976 c 173 s 7; 1977 c 305 s 45; 1984 c 654 art 5 s 58 

     144A.071 Moratorium on certification of nursing home 
  beds. 

    Subdivision 1.    Findings.  The legislature declares 
 that a moratorium on the licensure and medical assistance 
 certification of new nursing home beds and construction projects 
 that exceed $750,000 is necessary to control nursing home 
 expenditure growth and enable the state to meet the needs of its 
 elderly by providing high quality services in the most 
 appropriate manner along a continuum of care.  

    Subd. 1a.    Definitions.  For purposes of sections 
 144A.071 to 144A.073, the following terms have the meanings 
 given them: 

    (a) "attached fixtures" has the meaning given in Minnesota 
 Rules, part 9549.0020, subpart 6. 

    (b) "buildings" has the meaning given in Minnesota Rules, 
 part 9549.0020, subpart 7. 

    (c) "capital assets" has the meaning given in section 
 256B.421, subdivision 16. 

    (d) "commenced construction" means that all of the 
 following conditions were met:  the final working drawings and 
 specifications were approved by the commissioner of health; the 
 construction contracts were let; a timely construction schedule 
 was developed, stipulating dates for beginning, achieving 
 various stages, and completing construction; and all zoning and 
 building permits were applied for. 

    (e) "completion date" means the date on which a certificate 
 of occupancy is issued for a construction project, or if a 
 certificate of occupancy is not required, the date on which the 
 construction project is available for facility use. 

    (f) "construction" means any erection, building, 
 alteration, reconstruction, modernization, or improvement 
 necessary to comply with the nursing home licensure rules. 

    (g) "construction project" means: 

    (1) a capital asset addition to, or replacement of a 
 nursing home or certified boarding care home that results in new 
 space or the remodeling of or renovations to existing facility 
 space; 

    (2) the remodeling or renovation of existing facility space 
 the use of which is modified as a result of the project 
 described in clause (1).  This existing space and the project 
 described in clause (1) must be used for the functions as 
 designated on the construction plans on completion of the 
 project described in clause (1) for a period of not less than 24 
 months; or 

    (3) capital asset additions or replacements that are 
 completed within 12 months before or after the completion date 
 of the project described in clause (1). 

    (h) "new licensed" or "new certified beds" means: 

    (1) newly constructed beds in a facility or the 
 construction of a new facility that would increase the total 
 number of licensed nursing home beds or certified boarding care 
 or nursing home beds in the state; or 

    (2) newly licensed nursing home beds or newly certified 
 boarding care or nursing home beds that result from remodeling 
 of the facility that involves relocation of beds but does not 
 result in an increase in the total number of beds, except when 
 the project involves the upgrade of boarding care beds to 
 nursing home beds, as defined in section 144A.073, subdivision 
 1.  "Remodeling" includes any of the type of conversion, 
 renovation, replacement, or upgrading projects as defined in 
 section 144A.073, subdivision 1. 

    (i) "project construction costs" means the cost of the 
 facility capital asset additions, replacements, renovations, or 
 remodeling projects, construction site preparation costs, and 
 related soft costs.  Project construction costs also include the 
 cost of any remodeling or renovation of existing facility space 
 which is modified as a result of the construction project. 

    Subd. 2.    Moratorium.  The commissioner of health, in 
 coordination with the commissioner of human services, shall deny 
 each request for new licensed or certified nursing home or 
 certified boarding care beds except as provided in subdivision 3 
 or 4a, or section 144A.073.  "Certified bed" means a nursing 
 home bed or a boarding care bed certified by the commissioner of 
 health for the purposes of the medical assistance program, under 
 United States Code, title 42, sections 1396 et seq.  

    The commissioner of human services, in coordination with 
 the commissioner of health, shall deny any request to issue a 
 license under section 252.28 and chapter 245A to a nursing home 
 or boarding care home, if that license would result in an 
 increase in the medical assistance reimbursement amount.  

    In addition, the commissioner of health must not approve 
 any construction project whose cost exceeds $750,000 unless: 

    (a) any construction costs exceeding $750,000 are not added 
 to the facility's appraised value and are not included in the 
 facility's payment rate for reimbursement under the medical 
 assistance program; or 

    (b) the project: 

    (1) has been approved through the process described in 
 section 144A.073; 

    (2) meets an exception in subdivision 3 or 4a; 

    (3) is necessary to correct violations of state or federal 
 law issued by the commissioner of health; 

    (4) is necessary to repair or replace a portion of the 
 facility that was damaged by fire, lightning, groundshifts, or 
 other such hazards, including environmental hazards, provided 
 that the provisions of subdivision 4a, clause (a), are met; 

    (5) as of May 1, 1992, the facility has submitted to the 
 commissioner of health written documentation evidencing that the 
 facility meets the "commenced construction" definition as 
 specified in subdivision 1a, clause (d), or that substantial 
 steps have been taken prior to April 1, 1992, relating to the 
 construction project.  "Substantial steps" require that the 
 facility has made arrangements with outside parties relating to 
 the construction project and include the hiring of an architect 
 or construction firm, submission of preliminary plans to the 
 department of health or documentation from a financial 
 institution that financing arrangements for the construction 
 project have been made; or 

    (6) is being proposed by a licensed nursing facility that 
 is not certified to participate in the medical assistance 
 program and will not result in new licensed or certified beds. 

    Prior to the final plan approval of any construction 
 project, the commissioner of health shall be provided with an 
 itemized cost estimate for the project construction costs.  If a 
 construction project is anticipated to be completed in phases, 
 the total estimated cost of all phases of the project shall be 
 submitted to the commissioner and shall be considered as one 
 construction project.  Once the construction project is 
 completed and prior to the final clearance by the commissioner, 
 the total project construction costs for the construction 
 project shall be submitted to the commissioner.  If the final 
 project construction cost exceeds the dollar threshold in this 
 subdivision, the commissioner of human services shall not 
 recognize any of the project construction costs or the related 
 financing costs in excess of this threshold in establishing the 
 facility's property-related payment rate. 

    The dollar thresholds for construction projects are as 
 follows:  for construction projects other than those authorized 
 in clauses (1) to (6), the dollar threshold is $750,000.  For 
 projects authorized after July 1, 1993, under clause (1), the 
 dollar threshold is the cost estimate submitted with a proposal 
 for an exception under section 144A.073, plus inflation as 
 calculated according to section 256B.431, subdivision 3f, 
 paragraph (a).  For projects authorized under clauses (2) to 
 (4), the dollar threshold is the itemized estimate project 
 construction costs submitted to the commissioner of health at 
 the time of final plan approval, plus inflation as calculated 
 according to section 256B.431, subdivision 3f, paragraph (a). 

    The commissioner of health shall adopt rules to implement 
 this section or to amend the emergency rules for granting 
 exceptions to the moratorium on nursing homes under section 
 144A.073.  

    Subd. 3.    Exceptions authorizing an increase in beds.  
 The commissioner of health, in coordination with the 
 commissioner of human services, may approve the addition of a 
 new certified bed or the addition of a new licensed nursing home 
 bed, under the following conditions:  

    (a) to license or certify a new bed in place of one 
 decertified after July 1, 1993, as long as the number of 
 certified plus newly certified or recertified beds does not 
 exceed the number of beds licensed or certified on July 1, 1993, 
 or to address an extreme hardship situation, in a particular 
 county that, together with all contiguous Minnesota counties, 
 has fewer nursing home beds per 1,000 elderly than the number 
 that is ten percent higher than the national average of nursing 
 home beds per 1,000 elderly individuals.  For the purposes of 
 this section, the national average of nursing home beds shall be 
 the most recent figure that can be supplied by the federal 
 health care financing administration and the number of elderly 
 in the county or the nation shall be determined by the most 
 recent federal census or the most recent estimate of the state 
 demographer as of July 1, of each year of persons age 65 and 
 older, whichever is the most recent at the time of the request 
 for replacement.  An extreme hardship situation can only be 
 found after the county documents the existence of unmet medical 
 needs that cannot be addressed by any other alternatives; 

    (b) to certify or license new beds in a new facility that 
 is to be operated by the commissioner of veterans affairs or 
 when the costs of constructing and operating the new beds are to 
 be reimbursed by the commissioner of veterans affairs or the 
 United States Veterans Administration; 

    (c) to license or certify beds in a facility that has been 
 involuntarily delicensed or decertified for participation in the 
 medical assistance program, provided that an application for 
 relicensure or recertification is submitted to the commissioner 
 within 120 days after delicensure or decertification; 

    (d) to certify two existing beds in a facility with 66 
 licensed beds on January 1, 1994, that had an average occupancy 
 rate of 98 percent or higher in both calendar years 1992 and 
 1993, and which began construction of four attached assisted 
 living units in April 1993; or 

    (e) to certify four existing beds in a facility in Winona 
 with 139 beds, of which 129 beds are certified. 

    Subd. 3a. Repealed, 1992 c 513 art 7 s 135 

    Subd. 4.    Monitoring exceptions for replacement beds.  
 The commissioner of health, in coordination with the 
 commissioner of human services, shall implement mechanisms to 
 monitor and analyze the effect of the moratorium in the 
 different geographic areas of the state.  The commissioner of 
 health shall submit to the legislature, no later than January 
 15, 1984, and annually thereafter, an assessment of the impact 
 of the moratorium by geographic area, with particular attention 
 to service deficits or problems and a corrective action plan. 

    Subd. 4a.    Exceptions for replacement beds.  It is in 
 the best interest of the state to ensure that nursing homes and 
 boarding care homes continue to meet the physical plant 
 licensing and certification requirements by permitting certain 
 construction projects.  Facilities should be maintained in 
 condition to satisfy the physical and emotional needs of 
 residents while allowing the state to maintain control over 
 nursing home expenditure growth. 

    The commissioner of health in coordination with the 
 commissioner of human services, may approve the renovation, 
 replacement, upgrading, or relocation of a nursing home or 
 boarding care home, under the following conditions: 

    (a) to license or certify beds in a new facility 
 constructed to replace a facility or to make repairs in an 
 existing facility that was destroyed or damaged after June 30, 
 1987, by fire, lightning, or other hazard provided:  

    (i) destruction was not caused by the intentional act of or 
 at the direction of a controlling person of the facility; 

    (ii) at the time the facility was destroyed or damaged the 
 controlling persons of the facility maintained insurance 
 coverage for the type of hazard that occurred in an amount that 
 a reasonable person would conclude was adequate; 

    (iii) the net proceeds from an insurance settlement for the 
 damages caused by the hazard are applied to the cost of the new 
 facility or repairs; 

    (iv) the new facility is constructed on the same site as 
 the destroyed facility or on another site subject to the 
 restrictions in section 144A.073, subdivision 5; 

    (v) the number of licensed and certified beds in the new 
 facility does not exceed the number of licensed and certified 
 beds in the destroyed facility; and 

    (vi) the commissioner determines that the replacement beds 
 are needed to prevent an inadequate supply of beds. 

 Project construction costs incurred for repairs authorized under 
 this clause shall not be considered in the dollar threshold 
 amount defined in subdivision 2; 

    (b) to license or certify beds that are moved from one 
 location to another within a nursing home facility, provided the 
 total costs of remodeling performed in conjunction with the 
 relocation of beds does not exceed $750,000; 

    (c) to license or certify beds in a project recommended for 
 approval under section 144A.073; 

    (d) to license or certify beds that are moved from an 
 existing state nursing home to a different state facility, 
 provided there is no net increase in the number of state nursing 
 home beds; 

    (e) to certify and license as nursing home beds boarding 
 care beds in a certified boarding care facility if the beds meet 
 the standards for nursing home licensure, or in a facility that 
 was granted an exception to the moratorium under section 
 144A.073, and if the cost of any remodeling of the facility does 
 not exceed $750,000.  If boarding care beds are licensed as 
 nursing home beds, the number of boarding care beds in the 
 facility must not increase beyond the number remaining at the 
 time of the upgrade in licensure.  The provisions contained in 
 section 144A.073 regarding the upgrading of the facilities do 
 not apply to facilities that satisfy these requirements; 

    (f) to license and certify up to 40 beds transferred from 
 an existing facility owned and operated by the Amherst H. Wilder 
 Foundation in the city of St. Paul to a new unit at the same 
 location as the existing facility that will serve persons with 
 Alzheimer's disease and other related disorders.  The transfer 
 of beds may occur gradually or in stages, provided the total 
 number of beds transferred does not exceed 40.  At the time of 
 licensure and certification of a bed or beds in the new unit, 
 the commissioner of health shall delicense and decertify the 
 same number of beds in the existing facility.  As a condition of 
 receiving a license or certification under this clause, the 
 facility must make a written commitment to the commissioner of 
 human services that it will not seek to receive an increase in 
 its property-related payment rate as a result of the transfers 
 allowed under this paragraph; 

    (g) to license and certify nursing home beds to replace 
 currently licensed and certified boarding care beds which may be 
 located either in a remodeled or renovated boarding care or 
 nursing home facility or in a remodeled, renovated, newly 
 constructed, or replacement nursing home facility within the 
 identifiable complex of health care facilities in which the 
 currently licensed boarding care beds are presently located, 
 provided that the number of boarding care beds in the facility 
 or complex are decreased by the number to be licensed as nursing 
 home beds and further provided that, if the total costs of new 
 construction, replacement, remodeling, or renovation exceed ten 
 percent of the appraised value of the facility or $200,000, 
 whichever is less, the facility makes a written commitment to 
 the commissioner of human services that it will not seek to 
 receive an increase in its property-related payment rate by 
 reason of the new construction, replacement, remodeling, or 
 renovation.  The provisions contained in section 144A.073 
 regarding the upgrading of facilities do not apply to facilities 
 that satisfy these requirements; 

    (h) to license as a nursing home and certify as a nursing 
 facility a facility that is licensed as a boarding care facility 
 but not certified under the medical assistance program, but only 
 if the commissioner of human services certifies to the 
 commissioner of health that licensing the facility as a nursing 
 home and certifying the facility as a nursing facility will 
 result in a net annual savings to the state general fund of 
 $200,000 or more; 

    (i) to certify, after September 30, 1992, and prior to July 
 1, 1993, existing nursing home beds in a facility that was 
 licensed and in operation prior to January 1, 1992; 

    (j) to license and certify new nursing home beds to replace 
 beds in a facility acquired by the Minneapolis community 
 development agency as part of redevelopment activities in a city 
 of the first class, provided the new facility is located within 
 three miles of the site of the old facility.  Operating and 
 property costs for the new facility must be determined and 
 allowed under section 256B.431 or 256B.434; 

    (k) to license and certify up to 20 new nursing home beds 
 in a community-operated hospital and attached convalescent and 
 nursing care facility with 40 beds on April 21, 1991, that 
 suspended operation of the hospital in April 1986.  The 
 commissioner of human services shall provide the facility with 
 the same per diem property-related payment rate for each 
 additional licensed and certified bed as it will receive for its 
 existing 40 beds; 

    (l) to license or certify beds in renovation, replacement, 
 or upgrading projects as defined in section 144A.073, 
 subdivision 1, so long as the cumulative total costs of the 
 facility's remodeling projects do not exceed $750,000; 

    (m) to license and certify beds that are moved from one 
 location to another for the purposes of converting up to five 
 four-bed wards to single or double occupancy rooms in a nursing 
 home that, as of January 1, 1993, was county-owned and had a 
 licensed capacity of 115 beds; 

    (n) to allow a facility that on April 16, 1993, was a 
 106-bed licensed and certified nursing facility located in 
 Minneapolis to layaway all of its licensed and certified nursing 
 home beds.  These beds may be relicensed and recertified in a 
 newly-constructed teaching nursing home facility affiliated with 
 a teaching hospital upon approval by the legislature.  The 
 proposal must be developed in consultation with the interagency 
 committee on long-term care planning.  The beds on layaway 
 status shall have the same status as voluntarily delicensed and 
 decertified beds, except that beds on layaway status remain 
 subject to the surcharge in section 256.9657.  This layaway 
 provision expires July 1, 1998; 

    (o) to allow a project which will be completed in 
 conjunction with an approved moratorium exception project for a 
 nursing home in southern Cass county and which is directly 
 related to that portion of the facility that must be repaired, 
 renovated, or replaced, to correct an emergency plumbing problem 
 for which a state correction order has been issued and which 
 must be corrected by August 31, 1993; 

    (p) to allow a facility that on April 16, 1993, was a 
 368-bed licensed and certified nursing facility located in 
 Minneapolis to layaway, upon 30 days prior written notice to the 
 commissioner, up to 30 of the facility's licensed and certified 
 beds by converting three-bed wards to single or double 
 occupancy.  Beds on layaway status shall have the same status as 
 voluntarily delicensed and decertified beds except that beds on 
 layaway status remain subject to the surcharge in section 
 256.9657, remain subject to the license application and renewal 
 fees under section 144A.07 and shall be subject to a $100 per 
 bed reactivation fee.  In addition, at any time within three 
 years of the effective date of the layaway, the beds on layaway 
 status may be: 

    (1) relicensed and recertified upon relocation and 
 reactivation of some or all of the beds to an existing licensed 
 and certified facility or facilities located in Pine River, 
 Brainerd, or International Falls; provided that the total 
 project construction costs related to the relocation of beds 
 from layaway status for any facility receiving relocated beds 
 may not exceed the dollar threshold provided in subdivision 2 
 unless the construction project has been approved through the 
 moratorium exception process under section 144A.073; 

    (2) relicensed and recertified, upon reactivation of some 
 or all of the beds within the facility which placed the beds in 
 layaway status, if the commissioner has determined a need for 
 the reactivation of the beds on layaway status. 

    The property-related payment rate of a facility placing 
 beds on layaway status must be adjusted by the incremental 
 change in its rental per diem after recalculating the rental per 
 diem as provided in section 256B.431, subdivision 3a, paragraph 
 (d).  The property-related payment rate for a facility 
 relicensing and recertifying beds from layaway status must be 
 adjusted by the incremental change in its rental per diem after 
 recalculating its rental per diem using the number of beds after 
 the relicensing to establish the facility's capacity day 
 divisor, which shall be effective the first day of the month 
 following the month in which the relicensing and recertification 
 became effective.  Any beds remaining on layaway status more 
 than three years after the date the layaway status became 
 effective must be removed from layaway status and immediately 
 delicensed and decertified; 

    (q) to license and certify beds in a renovation and 
 remodeling project to convert 12 four-bed wards into 24 two-bed 
 rooms, expand space, and add improvements in a nursing home 
 that, as of January 1, 1994, met the following conditions:  the 
 nursing home was located in Ramsey county; had a licensed 
 capacity of 154 beds; and had been ranked among the top 15 
 applicants by the 1993 moratorium exceptions advisory review 
 panel.  The total project construction cost estimate for this 
 project must not exceed the cost estimate submitted in 
 connection with the 1993 moratorium exception process; 

    (r) to license and certify up to 117 beds that are 
 relocated from a licensed and certified 138-bed nursing facility 
 located in St. Paul to a hospital with 130 licensed hospital 
 beds located in South St. Paul, provided that the nursing 
 facility and hospital are owned by the same or a related 
 organization and that prior to the date the relocation is 
 completed the hospital ceases operation of its inpatient 
 hospital services at that hospital.  After relocation, the 
 nursing facility's status under section 256B.431, subdivision 
 2j, shall be the same as it was prior to relocation.  The 
 nursing facility's property-related payment rate resulting from 
 the project authorized in this paragraph shall become effective 
 no earlier than April 1, 1996.  For purposes of calculating the 
 incremental change in the facility's rental per diem resulting 
 from this project, the allowable appraised value of the nursing 
 facility portion of the existing health care facility physical 
 plant prior to the renovation and relocation may not exceed 
 $2,490,000; 

    (s) to license and certify two beds in a facility to 
 replace beds that were voluntarily delicensed and decertified on 
 June 28, 1991; 

    (t) to allow 16 licensed and certified beds located on July 
 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
 facility in Minneapolis, notwithstanding the licensure and 
 certification after July 1, 1995, of the Minneapolis facility as 
 a 147-bed nursing home facility after completion of a 
 construction project approved in 1993 under section 144A.073, to 
 be laid away upon 30 days' prior written notice to the 
 commissioner.  Beds on layaway status shall have the same status 
 as voluntarily delicensed or decertified beds except that they 
 shall remain subject to the surcharge in section 256.9657.  The 
 16 beds on layaway status may be relicensed as nursing home beds 
 and recertified at any time within five years of the effective 
 date of the layaway upon relocation of some or all of the beds 
 to a licensed and certified facility located in Watertown, 
 provided that the total project construction costs related to 
 the relocation of beds from layaway status for the Watertown 
 facility may not exceed the dollar threshold provided in 
 subdivision 2 unless the construction project has been approved 
 through the moratorium exception process under section 144A.073. 

    The property-related payment rate of the facility placing 
 beds on layaway status must be adjusted by the incremental 
 change in its rental per diem after recalculating the rental per 
 diem as provided in section 256B.431, subdivision 3a, paragraph 
 (d).  The property-related payment rate for the facility 
 relicensing and recertifying beds from layaway status must be 
 adjusted by the incremental change in its rental per diem after 
 recalculating its rental per diem using the number of beds after 
 the relicensing to establish the facility's capacity day 
 divisor, which shall be effective the first day of the month 
 following the month in which the relicensing and recertification 
 became effective.  Any beds remaining on layaway status more 
 than five years after the date the layaway status became 
 effective must be removed from layaway status and immediately 
 delicensed and decertified; 

    (u) to license and certify beds that are moved within an 
 existing area of a facility or to a newly constructed addition 
 which is built for the purpose of eliminating three- and 
 four-bed rooms and adding space for dining, lounge areas, 
 bathing rooms, and ancillary service areas in a nursing home 
 that, as of January 1, 1995, was located in Fridley and had a 
 licensed capacity of 129 beds; 

    (v) to relocate 36 beds in Crow Wing county and four beds 
 from Hennepin county to a 160-bed facility in Crow Wing county, 
 provided all the affected beds are under common ownership; 

    (w) to license and certify a total replacement project of 
 up to 49 beds located in Norman county that are relocated from a 
 nursing home destroyed by flood and whose residents were 
 relocated to other nursing homes.  The operating cost payment 
 rates for the new nursing facility shall be determined based on 
 the interim and settle-up payment provisions of Minnesota Rules, 
 part 9549.0057, and the reimbursement provisions of section 
 256B.431, except that subdivision 26, paragraphs (a) and (b), 
 shall not apply until the second rate year after the settle-up 
 cost report is filed.  Property-related reimbursement rates 
 shall be determined under section 256B.431, taking into account 
 any federal or state flood-related loans or grants provided to 
 the facility; 

    (x) to license and certify a total replacement project of 
 up to 129 beds located in Polk county that are relocated from a 
 nursing home destroyed by flood and whose residents were 
 relocated to other nursing homes.  The operating cost payment 
 rates for the new nursing facility shall be determined based on 
 the interim and settle-up payment provisions of Minnesota Rules, 
 part 9549.0057, and the reimbursement provisions of section 
 256B.431, except that subdivision 26, paragraphs (a) and (b), 
 shall not apply until the second rate year after the settle-up 
 cost report is filed.  Property-related reimbursement rates 
 shall be determined under section 256B.431, taking into account 
 any federal or state flood-related loans or grants provided to 
 the facility; 

    (y) to license and certify beds in a renovation and 
 remodeling project to convert 13 three-bed wards into 13 two-bed 
 rooms and 13 single-bed rooms, expand space, and add 
 improvements in a nursing home that, as of January 1, 1994, met 
 the following conditions:  the nursing home was located in 
 Ramsey county, was not owned by a hospital corporation, had a 
 licensed capacity of 64 beds, and had been ranked among the top 
 15 applicants by the 1993 moratorium exceptions advisory review 
 panel.  The total project construction cost estimate for this 
 project must not exceed the cost estimate submitted in 
 connection with the 1993 moratorium exception process; 

    (z) to license and certify up to 150 nursing home beds to 
 replace an existing 285 bed nursing facility located in St. 
 Paul.  The replacement project shall include both the renovation 
 of existing buildings and the construction of new facilities at 
 the existing site.  The reduction in the licensed capacity of 
 the existing facility shall occur during the construction 
 project as beds are taken out of service due to the construction 
 process.  Prior to the start of the construction process, the 
 facility shall provide written information to the commissioner 
 of health describing the process for bed reduction, plans for 
 the relocation of residents, and the estimated construction 
 schedule.  The relocation of residents shall be in accordance 
 with the provisions of law and rule; or 

    (aa) to allow the commissioner of human services to license 
 an additional 36 beds to provide residential services for the 
 physically handicapped under Minnesota Rules, parts 9570.2000 to 
 9570.3400, in a 198-bed nursing home located in Red Wing, 
 provided that the total number of licensed and certified beds at 
 the facility does not increase.  

    Subd. 5.    Report.  The commissioners of health and 
 human services shall report to the senate health care committee 
 and the house health and human services committee by January 15, 
 1986, and biennially thereafter regarding:  

    (1) projections on the number of elderly Minnesota 
 residents including medical assistance recipients; 

    (2) the number of residents most at risk for nursing home 
 placement; 

    (3) the needs for long-term care and alternative home and 
 noninstitutional services; 

    (4) availability of and access to alternative services by 
 geographic region; and 

    (5) the necessity or desirability of continuing, modifying, 
 or repealing the moratorium in relation to the availability and 
 development of the continuum of long-term care services.  

    Subd. 5a.    Cost estimate of a moratorium exception 
 project.  (a) For the purposes of this section and section 
 144A.073, the cost estimate of a moratorium exception project 
 shall include the effects of the proposed project on the costs 
 of the state subsidy for community-based services, nursing 
 services, and housing in institutional and noninstitutional 
 settings.  The commissioner of health, in cooperation with the 
 commissioner of human services, shall define the method for 
 estimating these costs in the permanent rule implementing 
 section 144A.073.  The commissioner of human services shall 
 prepare an estimate of the total state annual long-term costs of 
 each moratorium exception proposal. 

    (b) The interest rate to be used for estimating the cost of 
 each moratorium exception project proposal shall be the lesser 
 of either the prime rate plus two percentage points, or the 
 posted yield for standard conventional fixed rate mortgages of 
 the Federal Home Loan Mortgage Corporation plus two percentage 
 points as published in the Wall Street Journal and in effect 56 
 days prior to the application deadline.  If the applicant's 
 proposal uses this interest rate, the commissioner of human 
 services, in determining the facility's actual property-related 
 payment rate to be established upon completion of the project 
 must use the actual interest rate obtained by the facility for 
 the project's permanent financing up to the maximum permitted 
 under subdivision 6. 

    The applicant may choose an alternate interest rate for 
 estimating the project's cost.  If the applicant makes this 
 election, the commissioner of human services, in determining the 
 facility's actual property-related payment rate to be 
 established upon completion of the project, must use the lesser 
 of the actual interest rate obtained for the project's permanent 
 financing or the interest rate which was used to estimate the 
 proposal's project cost.  For succeeding rate years, the 
 applicant is at risk for financing costs in excess of the 
 interest rate selected. 

    Subd. 6.    Property-related payment rates of new beds.  
 The property-related payment rates of nursing home or boarding 
 care home beds certified or recertified under subdivision 3 or 
 4a, shall be adjusted according to Minnesota nursing facility 
 reimbursement laws and rules unless the facility has made a 
 commitment in writing to the commissioner of human services not 
 to seek adjustments to these rates due to property-related 
 expenses incurred as a result of the certification or 
 recertification.  Any licensure or certification action 
 authorized under repealed statutes which were approved by the 
 commissioner of health prior to July 1, 1993, shall remain in 
 effect.  Any conditions pertaining to property rate 
 reimbursement covered by these repealed statutes prior to July 
 1, 1993, remain in effect. 

    Subd. 7.    Submission of cost information.  Before 
 approval of final construction plans for a nursing home or a 
 certified boarding care home construction project, the licensee 
 shall submit to the commissioner of health an itemized statement 
 of the project construction cost estimates. 

    If the construction project includes a capital asset 
 addition, replacement, remodeling, or renovation of space such 
 as a hospital, apartment, or shared or common areas, the 
 facility must submit to the commissioner an allocation of 
 capital asset costs, soft costs, and debt information prepared 
 according to Minnesota Rules, chapter 9549. 

    Project construction cost estimates must be prepared by a 
 contractor or architect and other licensed participants in the 
 development of the project. 

    Subd. 8.    Final approval.  Before conducting the final 
 inspection of the construction project required by Minnesota 
 Rules, part 4660.0100, and issuing final clearances for use, the 
 licensee shall provide to the commissioner of health the total 
 project construction costs of the construction project.  If 
 total costs are not available, the most recent cost figures 
 shall be provided.  Final cost figures shall be submitted to the 
 commissioner when available.  The commissioner shall provide a 
 copy of this information to the commissioner of human services. 

    HIST: 1983 c 199 s 1; 1983 c 289 s 115 subd 1; 1984 c 654 art 
 5 s 58; 1984 c 655 art 1 s 28; 1Sp1985 c 3 s 10-12; 1987 c 186 s 
 15; 1987 c 403 art 4 s 3; 1Sp1987 c 4 art 2 s 1; 1988 c 689 art 
 2 s 36; 1989 c 209 art 2 s 1; 1989 c 282 art 3 s 11; 1990 c 472 
 s 1; 1990 c 612 s 6; 1991 c 93 s 1; 1991 c 292 art 4 s 1,2; art 
 7 s 25 subd 1,3; 1992 c 513 art 7 s 2,3; 1993 c 4 s 22; 1Sp1993 
 c 1 art 5 s 2; 1994 c 625 art 8 s 46; 1995 c 207 art 7 s 9-12; 
 1995 c 263 s 2; 1996 c 305 art 2 s 28; 1996 c 451 art 3 s 1,2; 
 1997 c 105 s 1; 1997 c 203 art 3 s 1,2,15; 1998 c 407 art 3 s 2 

     144A.073 Review of proposals requiring exceptions to the 
  moratorium. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the following terms have the meanings given them: 

    (a) "Conversion" means the relocation of a nursing home bed 
 from a nursing home to an attached hospital. 

    (b) "Relocation" means the movement of licensed nursing 
 home beds or certified boarding care beds as permitted under 
 subdivision 4, clause (3), and subdivision 5. 

    (c) "Renovation" means extensive remodeling of, or 
 construction of an addition to, a facility on an existing site 
 with a total cost exceeding ten percent of the appraised value 
 of the facility or $200,000, whichever is less. 

    (d) "Replacement" means the demolition, delicensure, 
 reconstruction, or construction of an addition to all or part of 
 an existing facility. 

    (e) "Upgrading" means a change in the level of licensure of 
 a bed from a boarding care bed to a nursing home bed in a 
 certified boarding care facility. 

    Subd. 2.    Request for proposals.  At the authorization 
 by the legislature of additional medical assistance expenditures 
 for exceptions to the moratorium on nursing homes, the 
 interagency committee shall publish in the State Register a 
 request for proposals for nursing home projects to be licensed 
 or certified under section 144A.071, subdivision 4a, clause 
 (c).  The public notice of this funding and the request for 
 proposals must specify how the approval criteria will be 
 prioritized by the advisory review panel, the interagency 
 long-term care planning committee, and the commissioner.  The 
 notice must describe the information that must accompany a 
 request and state that proposals must be submitted to the 
 interagency committee within 90 days of the date of 
 publication.  The notice must include the amount of the 
 legislative appropriation available for the additional costs to 
 the medical assistance program of projects approved under this 
 section.  If no money is appropriated for a year, the 
 interagency committee shall publish a notice to that effect, and 
 no proposals shall be requested.  If money is appropriated, the 
 interagency committee shall initiate the application and review 
 process described in this section at least twice each biennium 
 and up to four times each biennium, according to dates 
 established by rule.  Authorized funds shall be allocated 
 proportionally to the number of processes.  Funds not encumbered 
 by an earlier process within a biennium shall carry forward to 
 subsequent iterations of the process.  Authorization for 
 expenditures does not carry forward into the following 
 biennium.  To be considered for approval, a proposal must 
 include the following information: 

    (1) whether the request is for renovation, replacement, 
 upgrading, conversion, or relocation; 

    (2) a description of the problem the project is designed to 
 address; 

    (3) a description of the proposed project; 

    (4) an analysis of projected costs of the nursing facility 
 proposal, which are not required to exceed the cost threshold 
 referred to in section 144A.071, subdivision 1, to be considered 
 under this section, including initial construction and 
 remodeling costs; site preparation costs; financing costs, 
 including the current estimated long-term financing costs of the 
 proposal, which consists of estimates of the amount and sources 
 of money, reserves if required under the proposed funding 
 mechanism, annual payments schedule, interest rates, length of 
 term, closing costs and fees, insurance costs, and any completed 
 marketing study or underwriting review; and estimated operating 
 costs during the first two years after completion of the 
 project; 

    (5) for proposals involving replacement of all or part of a 
 facility, the proposed location of the replacement facility and 
 an estimate of the cost of addressing the problem through 
 renovation; 

    (6) for proposals involving renovation, an estimate of the 
 cost of addressing the problem through replacement; 

    (7) the proposed timetable for commencing construction and 
 completing the project; 

    (8) a statement of any licensure or certification issues, 
 such as certification survey deficiencies; 

    (9) the proposed relocation plan for current residents if 
 beds are to be closed so that the department of human services 
 can estimate the total costs of a proposal; and 

    (10) other information required by permanent rule of the 
 commissioner of health in accordance with subdivisions 4 and 8. 

    Subd. 3.    Review and approval of proposals.  Within 
 the limits of money specifically appropriated to the medical 
 assistance program for this purpose, the interagency long-term 
 care planning committee may recommend that the commissioner of 
 health grant exceptions to the nursing home licensure or 
 certification moratorium for proposals that satisfy the 
 requirements of this section.  The interagency committee shall 
 appoint an advisory review panel composed of representatives of 
 consumers and providers to review proposals and provide comments 
 and recommendations to the committee.  The commissioners of 
 human services and health shall provide staff and technical 
 assistance to the committee for the review and analysis of 
 proposals.  The interagency committee shall hold a public 
 hearing before submitting recommendations to the commissioner of 
 health on project requests.  The committee shall submit 
 recommendations within 150 days of the date of the publication 
 of the notice.  The commissioner of health shall approve or 
 disapprove a project within 30 days after receiving the 
 committee's recommendations.  The advisory review panel, the 
 committee, and the commissioner of health shall base their 
 recommendations, approvals, or disapprovals on a comparison and 
 ranking of proposals using only the criteria in subdivision 4 
 and in rules adopted by the commissioner.  The cost to the 
 medical assistance program of the proposals approved must be 
 within the limits of the appropriations specifically made for 
 this purpose.  Approval of a proposal expires 18 months after 
 approval by the commissioner of health unless the facility has 
 commenced construction as defined in section 144A.071, 
 subdivision 1a, paragraph (d).  The committee's report to the 
 legislature, as required under section 144A.31, must include the 
 projects approved, the criteria used to recommend proposals for 
 approval, and the estimated costs of the projects, including the 
 costs of initial construction and remodeling, and the estimated 
 operating costs during the first two years after the project is 
 completed. 

    Subd. 3a. Repealed, 1995 c 207 art 7 s 43 

    Subd. 3b.    Amendments to approved projects.  (a) 
 Nursing facilities that have received approval on or after July 
 1, 1993, for exceptions to the moratorium on nursing homes 
 through the process described in this section may request 
 amendments to the designs of the projects by writing the 
 commissioner within 18 months of receiving approval.  Applicants 
 shall submit supporting materials that demonstrate how the 
 amended projects meet the criteria described in paragraph (b). 

    (b) The commissioner shall approve requests for amendments 
 for projects approved on or after July 1, 1993, according to the 
 following criteria: 

    (1) the amended project designs must provide solutions to 
 all of the problems addressed by the original application that 
 are at least as effective as the original solutions; 

    (2) the amended project designs may not reduce the space in 
 each resident's living area or in the total amount of common 
 space devoted to resident and family uses by more than five 
 percent; 

    (3) the costs recognized for reimbursement of amended 
 project designs shall be the threshold amount of the original 
 proposal as identified according to section 144A.071, 
 subdivision 2, except under conditions described in clause (4); 
 and 

    (4) total costs up to ten percent greater than the cost 
 identified in clause (3) may be recognized for reimbursement if 
 the proposer can document that one of the following 
 circumstances is true: 

    (i) changes are needed due to a natural disaster; 

    (ii) conditions that affect the safety or durability of the 
 project that could not have reasonably been known prior to 
 approval are discovered; 

    (iii) state or federal law require changes in project 
 design; or 

    (iv) documentable circumstances occur that are beyond the 
 control of the owner and require changes in the design. 

    (c) Approval of a request for an amendment does not alter 
 the expiration of approval of the project according to 
 subdivision 3. 

    Subd. 3c.    Cost neutral relocation projects.  (a) 
 Notwithstanding subdivision 3, the interagency committee may at 
 any time accept proposals, or amendments to proposals previously 
 approved under this section, for relocations that are cost 
 neutral with respect to state costs as defined in section 
 144A.071, subdivision 5a.  The committee shall review these 
 applications and make recommendations to the commissioner within 
 90 days.  The committee must evaluate proposals according to 
 subdivision 4, clauses (1), (2), and (3), and other criteria 
 established in rule.  The commissioner shall approve or 
 disapprove a project within 30 days of receiving the committee's 
 recommendation.  Proposals and amendments approved under this 
 subdivision are not subject to the six-mile limit in subdivision 
 5, paragraph (e). 

    (b) For the purposes of paragraph (a), cost neutrality 
 shall be measured over the first three 12-month periods of 
 operation after completion of the project. 

    Subd. 4.    Criteria for review.  The following criteria 
 shall be used in a consistent manner to compare, evaluate, and 
 rank all proposals submitted.  Except for the criteria specified 
 in clause (3), the application of criteria listed under this 
 subdivision shall not reflect any distinction based on the 
 geographic location of the proposed project: 

    (1) the extent to which the proposal furthers state 
 long-term care goals, including the goals stated in section 
 144A.31, and including the goal of enhancing the availability 
 and use of alternative care services and the goal of reducing 
 the number of long-term care resident rooms with more than two 
 beds; 

    (2) the proposal's long-term effects on state costs 
 including the cost estimate of the project according to section 
 144A.071, subdivision 5a; 

    (3) the extent to which the proposal promotes equitable 
 access to long-term care services in nursing homes through 
 redistribution of the nursing home bed supply, as measured by 
 the number of beds relative to the population 85 or older, 
 projected to the year 2000 by the state demographer, and 
 according to items (i) to (iv): 

    (i) reduce beds in counties where the supply is high, 
 relative to the statewide mean, and increase beds in counties 
 where the supply is low, relative to the statewide mean; 

    (ii) adjust the bed supply so as to create the greatest 
 benefits in improving the distribution of beds; 

    (iii) adjust the existing bed supply in counties so that 
 the bed supply in a county moves toward the statewide mean; and 

    (iv) adjust the existing bed supply so that the 
 distribution of beds as projected for the year 2020 would be 
 consistent with projected need, based on the methodology 
 outlined in the interagency long-term care committee's 1993 
 nursing home bed distribution study; 

    (4) the extent to which the project improves conditions 
 that affect the health or safety of residents, such as narrow 
 corridors, narrow door frames, unenclosed fire exits, and wood 
 frame construction, and similar provisions contained in fire and 
 life safety codes and licensure and certification rules; 

    (5) the extent to which the project improves conditions 
 that affect the comfort or quality of life of residents in a 
 facility or the ability of the facility to provide efficient 
 care, such as a relatively high number of residents in a room; 
 inadequate lighting or ventilation; poor access to bathing or 
 toilet facilities; a lack of available ancillary space for 
 dining rooms, day rooms, or rooms used for other activities; 
 problems relating to heating, cooling, or energy efficiency; 
 inefficient location of nursing stations; narrow corridors; or 
 other provisions contained in the licensure and certification 
 rules; 

    (6) the extent to which the applicant demonstrates the 
 delivery of quality care, as defined in state and federal 
 statutes and rules, to residents as evidenced by the two most 
 recent state agency certification surveys and the applicants' 
 response to those surveys; 

    (7) the extent to which the project removes the need for 
 waivers or variances previously granted by either the licensing 
 agency, certifying agency, fire marshal, or local government 
 entity; and 

    (8) other factors that may be developed in permanent rule 
 by the commissioner of health that evaluate and assess how the 
 proposed project will further promote or protect the health, 
 safety, comfort, treatment, or well-being of the facility's 
 residents. 

    Subd. 5.    Replacement restrictions.  (a) Proposals 
 submitted or approved under this section involving replacement 
 must provide for replacement of the facility on the existing 
 site except as allowed in this subdivision.  

    (b) Facilities located in a metropolitan statistical area 
 other than the Minneapolis-St. Paul seven-county metropolitan 
 area may relocate to a site within the same census tract or a 
 contiguous census tract.  

    (c) Facilities located in the Minneapolis-St. Paul 
 seven-county metropolitan area may relocate to a site within the 
 same or contiguous health planning area as adopted in March 1982 
 by the metropolitan council.  

    (d) Facilities located outside a metropolitan statistical 
 area may relocate to a site within the same city or township, or 
 within a contiguous township.  

    (e) A facility relocated to a different site under 
 paragraph (b), (c), or (d) must not be relocated to a site more 
 than six miles from the existing site. 

    (f) The relocation of part of an existing first facility to 
 a second location, under paragraphs (d) and (e), may include the 
 relocation to the second location of up to four beds from part 
 of an existing third facility located in a township contiguous 
 to the location of the first facility.  The six-mile limit in 
 paragraph (e) does not apply to this relocation from the third 
 facility. 

    (g) For proposals approved on January 13, 1994, under this 
 section involving the replacement of 102 licensed and certified 
 beds, the relocation of the existing first facility to the new 
 location under paragraphs (d) and (e) may include the relocation 
 of up to 75 beds of the existing facility.  The six-mile limit 
 in paragraph (e) does not apply to this relocation. 

    Subd. 6.    Conversion restrictions.  Proposals 
 submitted or approved under this section involving conversion 
 must satisfy the following conditions: 

    (a) Conversion is limited to a total of five beds. 

    (b) An equivalent number of hospital beds must be 
 delicensed. 

    (c) The average occupancy rate in the existing nursing home 
 beds must be greater than 96 percent according to the most 
 recent annual statistical report of the department of health. 

    (d) The cost of remodeling the hospital rooms to meet 
 current nursing home construction standards must not exceed ten 
 percent of the appraised value of the nursing home or $200,000, 
 whichever is less. 

    (e) The conversion must not result in an increase in 
 operating costs. 

    Subd. 7.    Upgrading restrictions.  Proposals submitted 
 or approved under this section involving upgrading must satisfy 
 the following conditions: 

    (a) The facility must meet minimum nursing home care 
 standards. 

    (b) If beds are upgraded to nursing home beds, the number 
 of boarding care beds in a facility must not increase in the 
 future. 

    (c) The average occupancy rate in the existing nursing home 
 beds in an attached facility must be greater than 96 percent 
 according to the most recent annual statistical report of the 
 department of health. 

    Subd. 8.    Rulemaking.  The commissioner of health 
 shall adopt rules to implement this section.  The permanent 
 rules must be in accordance with and implement only the criteria 
 listed in this section.  The authority to adopt permanent rules 
 continues until July 1, 1996.  

    Subd. 9.    Budget request.  The commissioner of human 
 services, in consultation with the commissioner of finance, 
 shall include in each biennial budget request a line item for 
 the nursing home moratorium exception process.  If the 
 commissioner of human services does not request funding for this 
 item, the commissioner of human services must justify the 
 decision in the budget pages. 

    HIST: 1987 c 403 art 4 s 4; 1988 c 689 art 2 s 37-39; 1989 c 
 282 art 3 s 12; 1990 c 568 art 3 s 4; 1992 c 292 art 7 s 25; 
 1992 c 513 art 7 s 4-6; 1Sp1993 c 1 art 5 s 3-5; 1995 c 207 art 
 7 s 13-19; 1996 c 305 art 2 s 29; 1997 c 7 art 5 s 11; 1997 c 
 203 art 3 s 3,4; 1999 c 245 art 3 s 1 

     144A.08 Physical standards; penalty. 

    Subdivision 1.    Establishment.  The commissioner of 
 health by rule shall establish minimum standards for the 
 construction, maintenance, equipping and operation of nursing 
 homes.  The rules shall to the extent possible assure the 
 health, treatment, comfort, safety and well being of nursing 
 home residents. 

    Subd. 1a.    Corridor doors.  Nothing in the rules of 
 the commissioner of health shall require that each door entering 
 a sleeping room from a corridor in a nursing home with an 
 approved complete standard automatic fire extinguishing system 
 be constructed or maintained as self-closing or automatically 
 closing.  

    Subd. 1b.    Summer temperature and humidity.  A nursing 
 home, or part of a nursing home that includes resident-occupied 
 space, constructed after June 30, 1988, must meet the interior 
 summer design temperature and humidity recommendations in 
 chapter 7 of the 1982 applications of the handbook published by 
 the American Society of Heating, Refrigerating and 
 Air-Conditioning Engineers, Inc., as amended. 

    Subd. 2.    Report.  The controlling persons of a 
 nursing home shall, in accordance with rules established by the 
 commissioner of health, within 14 days of the occurrence, notify 
 the commissioner of health of any change in the physical 
 structure of a nursing home, which change would affect 
 compliance with the rules of the commissioner of health or with 
 sections 144A.01 to 144A.16. 

    Subd. 3.    Penalty.  Any controlling person who 
 establishes, conducts, manages or operates a nursing home which 
 incurs the following number of uncorrected or repeated 
 violations, in any two-year period: 

    (a) two or more uncorrected violations or one or more 
 repeated violations which created an imminent risk to direct 
 resident care or safety; or 

    (b) four or more uncorrected violations or two or more 
 repeated violations of any nature for which the fines are in the 
 four highest daily fine categories prescribed in rule, is guilty 
 of a misdemeanor. 

    The provisions of this subdivision shall not apply to any 
 controlling person who had no legal authority to affect or 
 change decisions as to the operation of the nursing home which 
 incurred the uncorrected or repeated violations. 

    HIST: 1976 c 173 s 8; 1977 c 305 s 45; 1981 c 360 art 2 s 5; 
 1982 c 633 s 4; 1Sp1985 c 3 s 13; 1987 c 384 art 2 s 1; 1988 c 
 689 art 2 s 40 

     144A.09 Facilities excluded. 

    Subdivision 1.    Spiritual means for healing.  Sections 
 144A.04, subdivision 5, and 144A.18 to 144A.27, and rules 
 adopted under sections 144A.01 to 144A.16 other than a rule 
 relating to sanitation and safety of premises, to cleanliness of 
 operation, or to physical equipment do not apply to a nursing 
 home conducted by and for the adherents of any recognized church 
 or religious denomination for the purpose of providing care and 
 treatment for those who select and depend upon spiritual means 
 through prayer alone, in lieu of medical care, for healing.  

    Subd. 2.    Religious society or order.  The provisions 
 of sections 144A.01 to 144A.27 shall not apply to a facility 
 operated by a religious society or order to provide nursing care 
 to 20 or fewer nonlay members of the order or society. 

    HIST: 1976 c 173 s 9; 1987 c 384 art 2 s 1; 1996 c 451 art 4 s 
 22; 1998 c 407 art 3 s 3 

     144A.10 Inspection; commissioner of health; fines. 

    Subdivision 1.    Enforcement authority.  The 
 commissioner of health is the exclusive state agency charged 
 with the responsibility and duty of inspecting all facilities 
 required to be licensed under section 144A.02.  The commissioner 
 of health shall enforce the rules established pursuant to 
 sections 144A.01 to 144A.16, subject only to the authority of 
 the department of public safety respecting the enforcement of 
 fire and safety standards in nursing homes and the 
 responsibility of the commissioner of human services under 
 sections 245A.01 to 245A.16 or 252.28. 

    The commissioner may request and must be given access to 
 relevant information, records, incident reports, or other 
 documents in the possession of a licensed facility if the 
 commissioner considers them necessary for the discharge of 
 responsibilities.  For the purposes of inspections and securing 
 information to determine compliance with the licensure laws and 
 rules, the commissioner need not present a release, waiver, or 
 consent of the individual.  The identities of patients or 
 residents must be kept private as defined by section 13.02, 
 subdivision 12. 

    Subd. 1a.    Training and education for nursing facility 
 providers.  The commissioner of health must establish and 
 implement a prescribed process and program for providing 
 training and education to providers licensed by the department 
 of health, either by itself or in conjunction with the industry 
 trade associations, before using any new regulatory guideline, 
 regulation, interpretation, program letter or memorandum, or any 
 other materials used in surveyor training to survey licensed 
 providers.  The process should include, but is not limited to, 
 the following key components: 

    (1) facilitate the implementation of immediate revisions to 
 any course curriculum for nursing assistants which reflect any 
 new standard of care practice that has been adopted or 
 referenced by the health department concerning the issue in 
 question; 

    (2) conduct training of long-term care providers and health 
 department survey inspectors either jointly or during the same 
 time frame on the department's new expectations; and 

    (3) within available resources the commissioner shall 
 cooperate in the development of clinical standards, work with 
 vendors of supplies and services regarding hazards, and identify 
 research of interest to the long-term care community.  

    Subd. 2.    Inspections.  The commissioner of health 
 shall inspect each nursing home to ensure compliance with 
 sections 144A.01 to 144A.16 and the rules promulgated to 
 implement them.  The inspection shall be a full inspection of 
 the nursing home.  If upon a reinspection provided for in 
 subdivision 5 the representative of the commissioner of health 
 finds one or more uncorrected violations, a second inspection of 
 the facility shall be conducted.  The second inspection need not 
 be a full inspection.  No prior notice shall be given of an 
 inspection conducted pursuant to this subdivision.  Any employee 
 of the commissioner of health who willfully gives or causes to 
 be given any advance notice of an inspection required or 
 authorized by this subdivision shall be subject to suspension or 
 dismissal in accordance with chapter 43A.  An inspection 
 required by a federal rule or statute may be conducted in 
 conjunction with or subsequent to any other inspection.  Any 
 inspection required by this subdivision may be in addition to or 
 in conjunction with the reinspections required by subdivision 
 5.  Nothing in this subdivision shall be construed to prohibit 
 the commissioner of health from making more than one unannounced 
 inspection of any nursing home during its license year.  The 
 commissioner of health shall coordinate inspections of nursing 
 homes with inspections by other state and local agencies 
 consistent with the requirements of this section and the 
 Medicare and Medicaid certification programs. 

    The commissioner shall conduct inspections and 
 reinspections of health facilities with a frequency and in a 
 manner calculated to produce the greatest benefit to residents 
 within the limits of the resources available to the 
 commissioner.  In performing this function, the commissioner may 
 devote proportionately more resources to the inspection of those 
 facilities in which conditions present the most serious concerns 
 with respect to resident health, treatment, comfort, safety, and 
 well-being.  

    These conditions include but are not limited to:  change in 
 ownership; frequent change in administration in excess of normal 
 turnover rates; complaints about care, safety, or rights; where 
 previous inspections or reinspections have resulted in 
 correction orders related to care, safety, or rights; and, where 
 persons involved in ownership or administration of the facility 
 have been indicted for alleged criminal activity.  Any facility 
 that has none of the above conditions or any other condition 
 established by the commissioner that poses a risk to resident 
 care, safety, or rights shall be inspected once every two years. 

    Subd. 3.    Reports; posting.  After each inspection or 
 reinspection required or authorized by this section, the 
 commissioner of health shall, by certified mail, send copies of 
 any correction order or notice of noncompliance to the nursing 
 home.  A copy of each correction order and notice of 
 noncompliance, and copies of any documentation supplied to the 
 commissioner of health or the commissioner of human services 
 under section 144A.03 or 144A.05 shall be kept on file at the 
 nursing home and shall be made available for viewing by any 
 person upon request.  Except as otherwise provided by this 
 subdivision, a copy of each correction order and notice of 
 noncompliance received by the nursing home after its most recent 
 inspection or reinspection shall be posted in a conspicuous and 
 readily accessible place in the nursing home.  No correction 
 order or notice of noncompliance need be posted until any 
 appeal, if one is requested by the facility, pursuant to 
 subdivision 8, has been completed.  All correction orders and 
 notices of noncompliance issued to a nursing home owned and 
 operated by the state or political subdivision of the state 
 shall be circulated and posted at the first public meeting of 
 the governing body after the order or notice is issued.  
 Confidential information protected by section 13.05 or 13.46, 
 shall not be made available or posted as provided in this 
 subdivision unless it may be made available or posted in a 
 manner authorized by chapter 13. 

    Subd. 4.    Correction orders.  Whenever a duly 
 authorized representative of the commissioner of health finds 
 upon inspection of a nursing home, that the facility or a 
 controlling person or an employee of the facility is not in 
 compliance with sections 144.411 to 144.417, 144.651, 144A.01 to 
 144A.16, or 626.557 or the rules promulgated thereunder, a 
 correction order shall be issued to the facility.  The 
 correction order shall state the deficiency, cite the specific 
 rule or statute violated, state the suggested method of 
 correction, and specify the time allowed for correction.  If the 
 commissioner finds that the nursing home had uncorrected or 
 repeated violations which create a risk to resident care, 
 safety, or rights, the commissioner shall notify the 
 commissioner of human services who shall require the facility to 
 use any efficiency incentive payments received under section 
 256B.431, subdivision 2b, paragraph (d), to correct the 
 violations and shall require the facility to forfeit incentive 
 payments for failure to correct the violations as provided in 
 section 256B.431, subdivision 2p.  The forfeiture shall not 
 apply to correction orders issued for physical plant 
 deficiencies. 

    Subd. 4a. Repealed, 1989 c 282 art 3 s 98 

    Subd. 5.    Reinspections.  A nursing home issued a 
 correction order under this section shall be reinspected at the 
 end of the period allowed for correction.  The reinspection may 
 be made in conjunction with the next annual inspection or any 
 other scheduled inspection.  If upon reinspection the 
 representative of the commissioner of health determines that the 
 facility has not corrected a violation identified in the 
 correction order, a notice of noncompliance with the correction 
 order shall be mailed by certified mail to the nursing home.  
 The notice shall specify the violations not corrected and the 
 fines assessed in accordance with subdivision 6. 

    Subd. 6.    Fines.  A nursing home which is issued a 
 notice of noncompliance with a correction order shall be 
 assessed a civil fine in accordance with a schedule of fines 
 established by the commissioner of health before December 1, 
 1983.  In establishing the schedule of fines, the commissioner 
 shall consider the potential for harm presented to any resident 
 as a result of noncompliance with each statute or rule.  The 
 fine shall be assessed for each day the facility remains in 
 noncompliance and until a notice of correction is received by 
 the commissioner of health in accordance with subdivision 7.  No 
 fine for a specific violation may exceed $500 per day of 
 noncompliance. 

    Subd. 6a. Repealed, 1989 c 155 s 5 

    Subd. 6b.    Fines for federal certification deficiencies. 
  If the commissioner determines that a nursing home or 
 certified boarding care home does not meet a requirement of 
 section 1919(b), (c), or (d), of the Social Security Act, or any 
 regulation adopted under that section of the Social Security 
 Act, the nursing home or certified boarding care home may be 
 assessed a civil fine for each day of noncompliance and until a 
 notice of correction is received by the commissioner under 
 subdivision 7.  Money collected because of these fines must be 
 applied to the protection of the health or property of residents 
 of nursing facilities the commissioner finds deficient.  A fine 
 for a specific deficiency may not exceed $500 for each day of 
 noncompliance.  The commissioner shall adopt rules establishing 
 a schedule of fines.  

    Subd. 6c.    Overlap of fines.  If a nursing home is 
 subject to fines under both subdivisions 6 and 6b for the same 
 requirement, condition, situation, or practice, the commissioner 
 shall assess either the fine provided by subdivision 6 or the 
 fine provided by subdivision 6b. 

    Subd. 6d.    Schedule of fines.  (a) The schedule of 
 fines for noncompliance with correction orders issued to nursing 
 homes that was adopted under the provisions of section 144A.10, 
 subdivision 6, and in effect on May 1, 1989, is effective until 
 repealed, modified, or superseded by rule.  

    (b) By September 1, 1990, the commissioner shall amend the 
 schedule of fines to increase to $250 the fines for violations 
 of section 144.651, subdivisions 18, 20, 21, 22, 27, and 30, and 
 for repeated violations.  

    (c) The commissioner shall adopt rules establishing the 
 schedule of fines for deficiencies in the requirements of 
 section 1919(b), (c), and (d), of the Social Security Act, or 
 regulations adopted under that section of the Social Security 
 Act. 

    Subd. 7.    Accumulation of fines.  A nursing home 
 shall promptly notify the commissioner of health in writing when 
 a violation noted in a notice of noncompliance is corrected.  
 Upon receipt of written notification by the commissioner of 
 health, the daily fine assessed for the deficiency shall stop 
 accruing.  The facility shall be reinspected within three 
 working days after receipt of the notification.  If upon 
 reinspection the representative of the commissioner of health 
 determines that a deficiency has not been corrected as indicated 
 by the notification of compliance the daily fine assessment 
 shall resume and the amount of fines which otherwise would have 
 accrued during the period prior to resumption shall be added to 
 the total assessment due from the nursing home.  The 
 commissioner of health shall notify the nursing home of the 
 resumption by certified mail.  The nursing home may challenge 
 the resumption as a contested case in accordance with the 
 provisions of chapter 14.  Recovery of the resumed fine shall be 
 stayed if a controlling person or a legal representative on 
 behalf of the nursing home makes a written request for a hearing 
 on the resumption within 15 days of receipt of the notice of 
 resumption.  The cost of a reinspection conducted pursuant to 
 this subdivision shall be added to the total assessment due from 
 the nursing home. 

    Subd. 8.    Recovery of fines; hearing.  Fines assessed 
 under this section shall be payable 15 days after receipt of the 
 notice of noncompliance and at 15 day intervals thereafter, as 
 the fines accrue.  Recovery of an assessed fine shall be stayed 
 if a controlling person or a legal representative on behalf of 
 the nursing home makes a written request for a hearing on the 
 notice of noncompliance within 15 days after the home's receipt 
 of the notice.  A hearing under this subdivision shall be 
 conducted as a contested case in accordance with chapter 14.  If 
 a nursing home, after notice and opportunity for hearing on the 
 notice of noncompliance, or on the resumption of the fine, does 
 not pay a properly assessed fine in accordance with this 
 subdivision, the commissioner of health shall notify the 
 commissioner of human services who shall deduct the amount from 
 reimbursement moneys due or to be due the facility under chapter 
 256B.  The commissioner of health may consolidate the hearings 
 provided for in subdivisions 7 and 8 in cases in which a 
 facility has requested hearings under both provisions.  The 
 hearings provided for in subdivisions 7 and 8 shall be held 
 within 30 days after the request for the hearing.  If a 
 consolidated hearing is held, it shall be held within 30 days of 
 the request which occurred last. 

    Subd. 8a.    Fine for misallocation of nursing staff.  
 Upon issuing a correction order to a nursing home under 
 subdivision 4 for a violation of Minnesota Rules, part 
 4655.5600, because of nursing staff performing duties such as 
 washing wheelchairs or beds of discharged residents, or other 
 housekeeping or laundry duties not related to the direct nursing 
 care of residents, the commissioner shall impose a civil fine of 
 $500 per day.  A fine under this subdivision accrues in 
 accordance with subdivision 6 and is subject to subdivision 8 
 for purposes of recovery and hearings. 

    Subd. 8b.    Resident advisory council.  Each nursing 
 home or boarding care home shall establish a resident advisory 
 council and a family council, unless fewer than three persons 
 express an interest in participating.  If one or both councils 
 do not function, the nursing home or boarding care home shall 
 document its attempts to establish the council or councils at 
 least once each calendar year.  This subdivision does not alter 
 the rights of residents and families provided by section 
 144.651, subdivision 27.  A nursing home or boarding care home 
 that is issued a notice of noncompliance with a correction order 
 for violation of this subdivision shall be assessed a civil fine 
 of $100 for each day of noncompliance. 

    Subd. 9.    Nonlimiting.  Nothing in this section shall 
 be construed to limit the powers granted to the commissioner of 
 health by section 144A.11. 

    Subd. 10.    Reporting to a medical examiner or coroner. 
  Whenever a duly authorized representative of the commissioner 
 of health has reasonable cause to believe that a resident has 
 died as a direct or indirect result of abuse or neglect, the 
 representative shall report that information to the appropriate 
 medical examiner or coroner and police department or county 
 sheriff.  The medical examiner or coroner shall complete an 
 investigation as soon as feasible and report the findings to the 
 police department or county sheriff, and to the commissioner of 
 health. 

    Subd. 11.    Facilities cited for immediate jeopardy.  
 (a) The provisions of this subdivision apply to Minnesota 
 nursing facilities: 

    (1) that received immediate jeopardy citations between 
 April 1, 1998, and January 13, 1999, for violations of 
 regulations governing the use of physical restraints; and 

    (2) on whose behalf the commissioner recommended to the 
 federal government that fines for these citations not be imposed 
 or be rescinded.  

    (b) The commissioner: 

    (1) shall grant all possible waivers for the continuation 
 of an approved nurse aide training program, an approved 
 competency evaluation program, or an approved nurse aide 
 training and competency evaluation program conducted by or on 
 the site of a facility referred to in this subdivision; and 

    (2) shall notify the board of nursing home administrators 
 by June 1, 1999, that the commissioner has recommended to the 
 federal government that fines not be imposed on the facilities 
 referred to in this subdivision or that any fines imposed on 
 these facilities for violations of regulations governing use of 
 physical restraints be rescinded. 

    Subd. 12.    Data on follow-up surveys.  (a) If 
 requested, and not prohibited by federal law, the commissioner 
 shall make available to the nursing home associations and the 
 public photocopies of statements of deficiencies and related 
 letters from the department pertaining to federal certification 
 surveys.  The commissioner may charge for the actual cost of 
 reproduction of these documents. 

    (b) The commissioner shall also make available on a 
 quarterly basis aggregate data for all statements of 
 deficiencies issued after federal certification follow-up 
 surveys related to surveys that were conducted in the quarter 
 prior to the immediately preceding quarter.  The data shall 
 include the number of facilities with deficiencies, the total 
 number of deficiencies, the number of facilities that did not 
 have any deficiencies, the number of facilities for which a 
 resurvey or follow-up survey was not performed, and the average 
 number of days between the follow up or resurvey and the exit 
 date of the preceding survey. 

    Subd. 13.    Nurse aide training waivers.  Because any 
 disruption or delay in the training and registration of nurse 
 aides may reduce access to care in certified facilities, the 
 commissioner shall grant all possible waivers for the 
 continuation of an approved nurse aide training and competency 
 evaluation program or nurse aide training program or competency 
 evaluation program conducted by or on the site of any certified 
 nursing facility or skilled nursing facility that would 
 otherwise lose approval for the program or programs.  The 
 commissioner shall take into consideration the distance to other 
 training programs, the frequency of other training programs, and 
 the impact that the loss of the onsite training will have on the 
 nursing facility's ability to recruit and train nurse aides. 

    Subd. 14.    Immediate jeopardy.  When conducting survey 
 certification and enforcement activities related to regular, 
 expanded, or extended surveys under Code of Federal Regulations, 
 title 42, part 488, the commissioner may not issue a finding of 
 immediate jeopardy unless the specific event or omission that 
 constitutes the violation of the requirements of participation 
 poses an imminent risk of life-threatening or serious injury to 
 a resident.  The commissioner may not issue any findings of 
 immediate jeopardy after the conclusion of a regular, expanded, 
 or extended survey unless the survey team identified the 
 deficient practice or practices that constitute immediate 
 jeopardy and the residents at risk prior to the close of the 
 exit conference. 

    Subd. 15.    Informal dispute resolution.  The 
 commissioner shall respond in writing to a request from a 
 nursing facility certified under the federal Medicare and 
 Medicaid programs for an informal dispute resolution within 30 
 days of the exit date of the facility's survey.  The 
 commissioner's response shall identify the commissioner's 
 decision regarding the continuation of each deficiency citation 
 challenged by the nursing facility, as well as a statement of 
 any changes in findings, level of severity or scope, and 
 proposed remedies or sanctions for each deficiency citation. 

    HIST: 1976 c 173 s 10; 1977 c 305 s 45; 1977 c 326 s 4,5; 1980 
 c 509 s 44; 1981 c 210 s 54; 1981 c 311 s 39; 1Sp1981 c 4 art 1 
 s 12; 1982 c 424 s 130; 1982 c 545 s 24; 1982 c 633 s 5; 1983 c 
 199 s 2-4; 1983 c 312 art 1 s 18; 1984 c 654 art 5 s 58; 1Sp1985 
 c 3 s 14-16; 1986 c 444; 1987 c 209 s 26,27; 1987 c 384 art 2 s 
 1; 1989 c 209 art 2 s 1; 1989 c 282 art 3 s 13-17; 1991 c 286 s 
 5,6; 1991 c 292 art 4 s 3; 1999 c 83 s 2; 1999 c 245 art 3 s 2-6 

     144A.102 Use of civil money penalties; waiver from state 
  and federal rules and regulations. 

    By January 2000, the commissioner of health shall work with 
 providers to examine state and federal rules and regulations 
 governing the provision of care in licensed nursing facilities 
 and apply for federal waivers and identify necessary changes in 
 state law to:  

    (1) allow the use of civil money penalties imposed upon 
 nursing facilities to abate any deficiencies identified in a 
 nursing facility's plan of correction; and 

    (2) stop the accrual of any fine imposed by the health 
 department when a follow-up inspection survey is not conducted 
 by the department within the regulatory deadline. 

    HIST: 1999 c 245 art 3 s 7 

     144A.103 Penalty for death of a resident. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, "abuse" and "neglect" have the meanings given in 
 section 626.5572, subdivisions 2 and 17. 

    Subd. 2.    Penalty.  Whenever the commissioner 
 substantiates that a situation existed that constituted abuse or 
 neglect by a nursing home and that could foreseeably result in 
 death or injury to a resident, and the abuse or neglect 
 contributed to the resident's death, the nursing home must be 
 assessed a civil fine of $1,000.  The assessment of a fine under 
 this section does not preclude the use of any other remedy.  

    Subd. 3.    Recovery of fines; hearing.  A nursing home 
 that is assessed a fine under this section must pay the fine no 
 later than 15 days after receipt of the notice of assessment.  
 The assessment shall be stayed if the nursing home makes a 
 written request for a hearing on the assessment within 15 days 
 after receipt of the notice of assessment.  After submission of 
 a timely request, a hearing must be conducted as a contested 
 case hearing under chapter 14 no later than 30 days after the 
 request.  If a nursing home does not pay the fine as required by 
 this section, the commissioner of health shall notify the 
 commissioner of human services, who shall deduct the amount of 
 the fine from reimbursement payments due or to be due the 
 nursing home under chapter 256B. 

    HIST: 1989 c 282 art 3 s 18; 1995 c 229 art 4 s 7 

     144A.105 Suspension of admissions. 

    Subdivision 1.    Circumstances for suspensions.  The 
 commissioner of health may suspend admissions to a nursing home 
 or certified boarding care home when:  

    (1) the commissioner has issued a penalty assessment or the 
 nursing home has a repeated violation for noncompliance with 
 section 144A.04, subdivision 7, or the portion of Minnesota 
 Rules, part 4655.5600, subpart 2, that establishes minimum 
 nursing personnel requirements; 

    (2) the commissioner has issued a penalty assessment or the 
 nursing home or certified boarding care home has repeated 
 violations for not maintaining a sufficient number or type of 
 nursing personnel to meet the needs of the residents, as 
 required by Minnesota Rules, parts 4655.5100 to 4655.6200; 

    (3) the commissioner has determined that an emergency 
 exists; 

    (4) the commissioner has initiated proceedings to suspend, 
 revoke, or not renew the license of the nursing home or 
 certified boarding care home; or 

    (5) the commissioner determines that the remedy of denial 
 of payment, as provided by subparagraph 1919(h)(2)(A)(i) of the 
 Social Security Act, is to be imposed under section 1919(h) of 
 the Social Security Act, or regulations adopted under that 
 section of the Social Security Act. 

    Subd. 2.    Order.  If the commissioner suspends 
 admissions under subdivision 1, the commissioner shall notify 
 the nursing home or certified boarding care home, by written 
 order, that admissions to the nursing home or certified boarding 
 care home will be suspended beginning at a time specified in the 
 order.  The suspension is effective no earlier than 48 hours 
 after the nursing home or certified boarding care home receives 
 the order, unless the order is due to an emergency under 
 subdivision 1, clause (3).  The order may be served on the 
 administrator of the nursing home or certified boarding care 
 home, or the designated agent in charge of the home, by personal 
 service or by certified or registered mail with a return receipt 
 of delivery.  The order shall specify the reasons for the 
 suspension, the corrective action required to be taken by the 
 nursing home or certified boarding care home, and the length of 
 time the suspension will be in effect.  The nursing home or 
 certified boarding care home shall not admit any residents after 
 the effective time of the order.  In determining the length of 
 time for the suspension, the commissioner shall consider the 
 reasons for the suspension, the performance history of the 
 nursing home, and the needs of the residents. 

    Subd. 3.    Conference.  After receiving the order for 
 suspension, the nursing home or certified boarding care home may 
 request a conference with the commissioner to present reasons 
 why the suspension should be modified or should not go into 
 effect.  The request need not be in writing.  If a conference is 
 requested within 24 hours after receipt of the order, the 
 commissioner shall hold the conference before the effective time 
 of the suspension, unless the order for suspension is due to an 
 emergency under subdivision 1, clause (3).  If a conference is 
 not requested within 24 hours after receipt of the order, the 
 nursing home or certified boarding care home may request a 
 conference and the commissioner shall schedule the conference as 
 soon as practicable.  The conference may be held in person or by 
 telephone.  After a conference, the commissioner may affirm, 
 rescind, or modify the order. 

    Subd. 4.    Correction.  The nursing home or certified 
 boarding care home shall notify the commissioner, in writing, 
 when any required corrective action has been completed.  The 
 commissioner may verify the corrective action by inspection 
 under section 144A.10.  The commissioner may extend the initial 
 suspension period by written notice to the nursing home or 
 certified boarding care home. 

    Subd. 5.    Notification of commissioner of human 
 services.  Whenever the commissioner suspends admissions to a 
 nursing home or certified boarding care home, the commissioner 
 shall notify the commissioner of human services of the order and 
 of any modifications to the order. 

    Subd. 6.    Hearing.  A nursing home or certified 
 boarding care home may appeal from an order for suspension of 
 admissions issued under subdivision 1.  To appeal, the nursing 
 home or certified boarding care home shall file with the 
 commissioner a written notice of appeal.  The appeal must be 
 received by the commissioner within ten days after the date of 
 receipt of the order for suspension by the nursing home or 
 certified boarding care home.  Within 15 calendar days after 
 receiving an appeal, the commissioner shall request assignment 
 of an administrative law judge under sections 14.48 to 14.56 to 
 conduct the hearing as soon as possible or according to 
 agreement of the parties.  Regardless of any appeal, the order 
 for suspension of admissions remains in effect until final 
 resolution of the appeal. 

    HIST: 1989 c 282 art 3 s 19 

     144A.11 License suspension or revocation; hearing; 
  relicensing. 

    Subdivision 1.    Optional proceedings.  The 
 commissioner of health may institute proceedings to suspend or 
 revoke a nursing home license, or may refuse to grant or renew 
 the license of a nursing home if any action by a controlling 
 person or employee of the nursing home: 

    (a) Violates any of the provisions of sections 144A.01 to 
 144A.08, 144A.13 or 144A.16, or the rules promulgated 
 thereunder; 

    (b) Permits, aids, or abets the commission of any illegal 
 act in the nursing home; 

    (c) Performs any act contrary to the welfare of a patient 
 or resident of the nursing home; or 

    (d) Obtains, or attempts to obtain, a license by fraudulent 
 means or misrepresentation. 

    Subd. 2.    Mandatory proceedings.  The commissioner of 
 health shall initiate proceedings within 60 days of notification 
 to suspend or revoke a nursing home license or shall refuse to 
 renew a license if within the preceding two years the nursing 
 home has incurred the following number of uncorrected or 
 repeated violations: 

    (1) two or more uncorrected violations or one or more 
 repeated violations which created an imminent risk to direct 
 resident care or safety; or 

    (2) four or more uncorrected violations or two or more 
 repeated violations of any nature for which the fines are in the 
 four highest daily fine categories prescribed in rule. 

    Subd. 2a.    Notice to residents.  Within five working 
 days after proceedings are initiated by the commissioner to 
 revoke, suspend, or not renew a nursing home license, the 
 controlling person of the nursing home or a designee must 
 provide to the commissioner and the ombudsman for older 
 Minnesotans the names of residents and the names and addresses 
 of the residents' guardians, representatives, and designated 
 family contacts.  The controlling person or designees must 
 provide updated information each month until the proceeding is 
 concluded.  If the controlling person or designee fails to 
 provide the information within this time, the nursing home is 
 subject to the issuance of a correction order and penalty 
 assessment under sections 144.653 and 144A.10.  Notwithstanding 
 those sections, any correction order issued under this 
 subdivision must require that the facility immediately comply 
 with the request for information and that as of the date of the 
 issuance of the correction order, the facility shall forfeit to 
 the state a $100 fine the first day of noncompliance and an 
 increase in the $100 fine by $50 increments for each day the 
 noncompliance continues.  Information provided under this 
 subdivision may be used by the commissioner or the ombudsman 
 only for the purpose of providing affected consumers information 
 about the status of the proceedings.  Within ten working days 
 after the commissioner initiates proceedings to revoke, suspend, 
 or not renew a nursing home license, the commissioner of health 
 shall send a written notice of the action and the process 
 involved to each resident of the nursing home and the resident's 
 legal guardian, representative, or designated family contact.  
 The commissioner shall provide the ombudsman with monthly 
 information on the department's actions and the status of the 
 proceedings.  

    Subd. 3.    Hearing.  No nursing home license may be 
 suspended or revoked, and renewal may not be denied, without a 
 hearing held as a contested case in accordance with chapter 14.  
 The hearing must commence within 60 days after the proceedings 
 are initiated.  If the controlling person designated under 
 section 144A.03, subdivision 2, as an agent to accept service on 
 behalf of all of the controlling persons of the nursing home has 
 been notified by the commissioner of health that the facility 
 will not receive an initial license or that a license renewal 
 has been denied, the controlling person or a legal 
 representative on behalf of the nursing home may request and 
 receive a hearing on the denial.  This hearing shall be held as 
 a contested case in accordance with chapter 14. 

    Subd. 3a.    Mandatory revocation.  Notwithstanding the 
 provisions of subdivision 3, the commissioner shall revoke a 
 nursing home license if a controlling person is convicted of a 
 felony or gross misdemeanor that relates to operation of the 
 nursing home or directly affects resident safety or care.  The 
 commissioner shall notify the nursing home 30 days in advance of 
 the date of revocation. 

    Subd. 4.    Relicensing.  If a nursing home license is 
 revoked a new application for license may be considered by the 
 commissioner of health when the conditions upon which revocation 
 was based have been corrected and satisfactory evidence of this 
 fact has been furnished to the commissioner of health.  A new 
 license may be granted after an inspection has been made and the 
 facility has been found to comply with all provisions of 
 sections 144A.01 to 144A.16 and the rules promulgated thereunder.

    HIST: 1976 c 173 s 11; 1977 c 305 s 45; 1982 c 424 s 130; 1982 
 c 633 s 6,7; 1Sp1985 c 3 s 17,18; 1986 c 444; 1987 c 384 art 2 s 
 1; 1989 c 282 art 3 s 20,21; 1993 c 326 art 13 s 3 

     144A.115 Violations; penalties. 

    Subdivision 1.    Operating without a license.  The 
 operation of a facility providing services required to be 
 licensed under sections 144A.02 to 144A.10 without a license is 
 a misdemeanor punishable by a fine of not more than $300. 

    Subd. 2.    Advertising without a license.  A person or 
 entity that advertises a facility required to be licensed under 
 sections 144A.02 to 144A.10 before obtaining a license is guilty 
 of a misdemeanor. 

    Subd. 3.    Other sanctions.  The sanctions in this 
 section do not restrict other available sanctions. 

    HIST: 1987 c 209 s 28 

     144A.12 Injunctive relief; subpoenas. 

    Subdivision 1.    Injunctive relief.  In addition to any 
 other remedy provided by law, the commissioner of health may 
 bring an action in the district court in Ramsey or Hennepin 
 county or in the district in which a nursing home is located to 
 enjoin a controlling person or an employee of the nursing home 
 from illegally engaging in activities regulated by sections 
 144A.01 to 144A.16.  A temporary restraining order may be 
 granted by the court in the proceeding if continued activity by 
 the controlling person or employee would create an imminent risk 
 of harm to a resident of the facility. 

    Subd. 2.    Subpoenas.  In all matters pending before 
 the commissioner under sections 144A.01 to 144A.16, the 
 commissioner of health shall have the power to issue subpoenas 
 and compel the attendance of witnesses and the production of all 
 necessary papers, books, records, documents and other 
 evidentiary material.  Any person failing or refusing to appear 
 or testify regarding any matter about which that person may be 
 lawfully questioned or to produce any papers, books, records, 
 documents or evidentiary materials in the matter to be heard, 
 after having been required by order of the commissioner of 
 health or by a subpoena of the commissioner of health to do so 
 may, upon application by the commissioner of health to the 
 district court in any district, be ordered by the court to 
 comply therewith.  The commissioner of health may issue 
 subpoenas and may administer oaths to witnesses, or take their 
 affirmation.  Depositions may be taken within or without the 
 state in the manner provided by law for the taking of 
 depositions in civil actions.  A subpoena or other process or 
 paper may be served upon any named person anywhere within the 
 state by any officer authorized to serve subpoenas in civil 
 actions, with the same fees and mileage and in the same manner 
 as prescribed by law for process issued out of the district 
 court of this state.  Fees and mileage and other costs of 
 persons subpoenaed by the commissioner of health shall be paid 
 in the same manner as for proceedings in district court. 

    HIST: 1976 c 173 s 12; 1977 c 305 s 45; 1986 c 444; 1987 c 384 
 art 2 s 1; 1989 c 282 art 3 s 22 

     144A.13 Complaints; resident's rights. 

    Subdivision 1.    Processing.  All matters relating to 
 the operation of a nursing home which are the subject of a 
 written complaint from a resident and which are received by a 
 controlling person or employee of the nursing home shall be 
 delivered to the facility's administrator for evaluation and 
 action.  Failure of the administrator within seven days of its 
 receipt to resolve the complaint, or alternatively, the failure 
 of the administrator to make a reply within seven days after its 
 receipt to the complaining resident stating that the complaint 
 did not constitute a valid objection to the nursing home's 
 operations, shall be a violation of section 144A.10.  If a 
 complaint directly involves the activities of a nursing home 
 administrator, the complaint shall be resolved in accordance 
 with this section by a person, other than the administrator, 
 duly authorized by the nursing home to investigate the complaint 
 and implement any necessary corrective measures. 

    Subd. 2.    Resident's rights.  The administrator of a 
 nursing home shall inform each resident in writing at the time 
 of admission of the right to complain to the administrator about 
 facility accommodations and services.  A notice of the right to 
 complain shall be posted in the nursing home.  The administrator 
 shall also inform each resident of the right to complain to the 
 commissioner of health.  No controlling person or employee of a 
 nursing home shall retaliate in any way against a complaining 
 nursing home resident and no nursing home resident may be denied 
 any right available to the resident under chapter 504B. 

    HIST: 1976 c 173 s 13; 1977 c 305 s 45; 1986 c 444; 1999 c 199 
 art 2 s 4 

     144A.135 Transfer and discharge appeals. 

    (a) The commissioner shall establish a mechanism for 
 hearing appeals on transfers and discharges of residents by 
 nursing homes or boarding care homes licensed by the 
 commissioner.  The commissioner may adopt permanent rules to 
 implement this section. 

    (b) Until federal regulations are adopted under sections 
 1819(f)(3) and 1919(f)(3) of the Social Security Act that govern 
 appeals of the discharges or transfers of residents from nursing 
 homes and boarding care homes certified for participation in 
 Medicare or medical assistance, the commissioner shall provide 
 hearings under sections 14.57 to 14.62 and the rules adopted by 
 the office of administrative hearings governing contested 
 cases.  To appeal the discharge or transfer, or notification of 
 an intended discharge or transfer, a resident or the resident's 
 representative must request a hearing in writing no later than 
 30 days after receiving written notice, which conforms to state 
 and federal law, of the intended discharge or transfer.  

    (c) Hearings under this section shall be held no later than 
 14 days after receipt of the request for hearing, unless 
 impractical to do so or unless the parties agree otherwise.  
 Hearings shall be held in the facility in which the resident 
 resides, unless impractical to do so or unless the parties agree 
 otherwise. 

    (d) A resident who timely appeals a notice of discharge or 
 transfer, and who resides in a certified nursing home or 
 boarding care home, may not be discharged or transferred by the 
 nursing home or boarding care home until resolution of the 
 appeal.  The commissioner can order the facility to readmit the 
 resident if the discharge or transfer was in violation of state 
 or federal law.  If the resident is required to be hospitalized 
 for medical necessity before resolution of the appeal, the 
 facility shall readmit the resident unless the resident's 
 attending physician documents, in writing, why the resident's 
 specific health care needs cannot be met in the facility. 

    (e) The commissioner and office of administrative hearings 
 shall conduct the hearings in compliance with the federal 
 regulations described in paragraph (b), when adopted.  

    (f) Nothing in this section limits the right of a resident 
 or the resident's representative to request or receive 
 assistance from the office of ombudsman for older Minnesotans or 
 the office of health facility complaints with respect to an 
 intended discharge or transfer. 

    HIST: 1989 c 282 art 3 s 26; 1991 c 286 s 7 

     144A.14 Voluntary receivership. 

    A majority in interest of the controlling persons of a 
 nursing home may at any time request the commissioner of health 
 to assume the operation of the nursing home through appointment 
 of a receiver.  Upon receiving a request for a receiver, the 
 commissioner of health may, if the commissioner deems 
 receivership desirable, enter into an agreement with a majority 
 in interest of the controlling persons, providing for the 
 appointment of a receiver to take charge of the facility under 
 conditions deemed appropriate by both parties.  The agreement 
 shall specify all terms and conditions of the receivership and 
 shall preserve all rights of the facility residents as granted 
 by law.  A receivership initiated in accordance with this 
 section shall terminate at the time specified by the parties or 
 at the time when either party notifies the other in writing that 
 the party wishes to terminate the receivership agreement. 

    HIST: 1976 c 173 s 14; 1977 c 305 s 45; 1986 c 444 

     144A.15 Involuntary receivership. 

    Subdivision 1.    Petition, notice.  In addition to any 
 other remedy provided by law, the commissioner of health may 
 petition the district court in Ramsey or Hennepin county or in 
 the district in which a nursing home or certified boarding care 
 home is located for an order directing the controlling persons 
 of the nursing home or certified boarding care home to show 
 cause why the commissioner of health or a designee should not be 
 appointed receiver to operate the facility.  The petition to the 
 district court shall contain proof by affidavit that the 
 commissioner of health has either commenced license suspension 
 or revocation proceedings, suspended or revoked a license, or 
 decided not to renew the nursing home license, or that 
 violations of section 1919(b), (c), or (d), of the Social 
 Security Act, or the regulations adopted under that section, or 
 violations of state law or rules, create an emergency.  The 
 order to show cause shall be returnable not less than five days 
 after service is completed and shall provide for personal 
 service of a copy to the nursing home administrator and to the 
 persons designated as agents by the controlling persons to 
 accept service on their behalf pursuant to section 144A.03, 
 subdivision 2. 

    Subd. 2.    Appointment of receiver, rental.  If, after 
 hearing, the court finds that involuntary receivership is 
 necessary as a means of protecting the health, safety or welfare 
 of a resident of a nursing home, the court shall appoint the 
 commissioner of health, or any other person designated by the 
 commissioner of health, as a receiver to take charge of the 
 facility.  The court shall determine a fair monthly rental for 
 the facility, taking into account all relevant factors including 
 the condition of the facility.  This rental fee shall be paid by 
 the receiver to the appropriate controlling persons for each 
 month that the receivership remains in effect.  Notwithstanding 
 any other law to the contrary, no payment made to a controlling 
 person by any state agency during a period of involuntary 
 receivership shall include any allowance for profit or be based 
 on any formula which includes an allowance for profit. 

    Subd. 2a.    Emergency procedure.  If it appears from 
 the petition filed under subdivision 1, or from an affidavit or 
 affidavits filed with the petition, or from testimony of 
 witnesses under oath when the court determines that this is 
 necessary, that there is probable cause to believe that an 
 emergency exists in a nursing home or certified boarding care 
 home, the court shall issue a temporary order for appointment of 
 a receiver within five days after receipt of the petition.  
 Notice of the petition shall be served personally on the nursing 
 home administrator and on the persons designated as agents by 
 the controlling persons to accept service on their behalf 
 according to section 144A.03, subdivision 2.  A hearing on the 
 petition shall be held within five days' after notice is served 
 unless the administrator or designated agent consents to a later 
 date.  After the hearing, the court may continue, modify, or 
 terminate the temporary order. 

    Subd. 3.    Powers and duties of receiver.  A nursing 
 home receiver appointed pursuant to this section shall with all 
 reasonable speed, but in any case, within 18 months after the 
 receivership order, provide for the orderly transfer of all the 
 nursing home's residents to other facilities or make other 
 provisions for their continued safety and health care.  The 
 receiver may correct or eliminate those deficiencies in the 
 facility which seriously endanger the life, health or safety of 
 the residents unless the correction or elimination of 
 deficiencies involves major alterations in the physical 
 structure of the nursing home.  The receiver shall, during this 
 period, operate the nursing home in a manner designed to 
 guarantee the safety and adequate health care of the residents.  
 The receiver shall take no action which impairs the legal rights 
 of a resident of the nursing home.  The receiver shall have 
 power to make contracts and incur lawful expenses.  The receiver 
 shall collect incoming payments from all sources and apply them 
 to the cost incurred in the performance of the receiver's 
 functions.  No security interest in any real or personal 
 property comprising the nursing home or contained within it, or 
 in any fixture of the facility, shall be impaired or diminished 
 in priority by the receiver.  The receiver shall pay all valid 
 obligations of the nursing home and shall deduct these expenses, 
 if appropriate, from rental payments owed to any controlling 
 person by virtue of the receivership. 

    Subd. 4.    Receiver's fee; liability; commissioner 
 assistance.  A nursing home receiver appointed pursuant to 
 this section shall be entitled to a reasonable receiver's fee as 
 determined by the court.  The receiver shall be liable only in 
 an official capacity for injury to person and property by reason 
 of the conditions of the nursing home.  The receiver shall not 
 be personally liable, except for gross negligence and 
 intentional acts.  The commissioner of health shall assist the 
 receiver in carrying out these duties. 

    Subd. 5.    Termination.  An involuntary receivership 
 imposed pursuant to this section shall terminate 18 months after 
 the date on which it was ordered or at any other time designated 
 by the court or upon the occurrence of any of the following 
 events: 

    (a) A determination by the commissioner of health that the 
 nursing home's license should be renewed or should not be 
 suspended or revoked; 

    (b) The granting of a new license to the nursing home; or 

    (c) A determination by the commissioner of health that all 
 of the residents of the nursing home have been provided 
 alternative health care, either in another facility or otherwise.

    Subd. 6. Repealed, 1992 c 513 art 8 s 59 

    HIST: 1976 c 173 s 15; 1977 c 305 s 45; 1986 c 444; 1989 c 282 
 art 3 s 23-25 

     144A.154 Rate recommendation. 

    The commissioner may recommend to the commissioner of human 
 services a review of the rates for a nursing home or boarding 
 care home that participates in the medical assistance program 
 that is in voluntary or involuntary receivership, and that has 
 needs or deficiencies documented by the department of health.  
 If the commissioner of health determines that a review of the 
 rate under section 256B.495 is needed, the commissioner shall 
 provide the commissioner of human services with: 

    (1) a copy of the order or determination that cites the 
 deficiency or need; and 

    (2) the commissioner's recommendation for additional staff 
 and additional annual hours by type of employee and additional 
 consultants, services, supplies, equipment, or repairs necessary 
 to satisfy the need or deficiency. 

    HIST: 1992 c 513 art 7 s 7 

     144A.155 Placement of monitor. 

    Subdivision 1.    Authority.  The commissioner may place 
 a person to act as a monitor in a nursing home or certified 
 boarding care home in any of the circumstances listed in clause 
 (1) or (2): 

    (1) in any situation for which a receiver may be appointed 
 under section 144A.15; or 

    (2) when the commissioner determines that violations of 
 sections 144.651, 144A.01 to 144A.16, 626.557, or section 
 1919(b), (c), or (d), of the Social Security Act, or rules or 
 regulations adopted under those provisions, require extended 
 surveillance to enforce compliance or protect the health, 
 safety, or welfare of the residents. 

    Subd. 2.    Duties of monitor.  The monitor shall 
 observe the operation of the home, provide advice to the home on 
 methods of complying with state and federal rules and 
 regulations, where documented deficiencies from the regulations 
 exist, and periodically shall submit a written report to the 
 commissioner on the ways in which the home meets or fails to 
 meet state and federal rules and regulations. 

    Subd. 3.    Selection of monitor.  The commissioner may 
 select as monitor an employee of the department or may contract 
 with any other individual to serve as a monitor.  The 
 commissioner shall publish a notice in the State Register that 
 requests proposals from individuals who wish to be considered 
 for placement as monitors and that sets forth the criteria for 
 selecting individuals as monitors.  The commissioner shall 
 maintain a list of individuals who are not employees of the 
 department who are interested in serving as monitors.  The 
 commissioner may contract with those individuals determined to 
 be qualified. 

    Subd. 4.    Payment of monitor.  A nursing home or 
 certified boarding care home in which a monitor is placed shall 
 pay to the department the actual costs associated with the 
 placement, unless payment would create an undue hardship for the 
 home. 

    HIST: 1989 c 282 art 3 s 27 

     144A.16 Cessation of operations. 

    If a nursing home voluntarily plans to cease operations or 
 to curtail operations to the extent that relocation of residents 
 is necessary, the controlling persons of the facility shall 
 notify the commissioner of health at least 90 days prior to the 
 scheduled cessation or curtailment.  The commissioner of health 
 shall cooperate with and advise the controlling persons of the 
 nursing home in the resettlement of residents.  Failure to 
 comply with this section shall be a violation of section 144A.10.

    HIST: 1976 c 173 s 16; 1977 c 305 s 45; 1987 c 209 s 29 

  144A.17 Repealed, 1983 c 260 s 68 

     144A.18 Administrator's licenses; penalty. 

    No person shall act as a nursing home administrator or 
 purport to be a nursing home administrator unless that person is 
 licensed by the board of examiners for nursing home 
 administrators.  A violation of this section is a misdemeanor. 

    HIST: 1976 c 173 s 18; 1986 c 444 

     144A.19 Board of examiners for administrators. 

    Subdivision 1.    Creation; membership.  There is hereby 
 created the board of examiners for nursing home administrators 
 which shall consist of the following members: 

    (a) a designee of the commissioner of health who shall be a 
 nonvoting member; 

    (b) a designee of the commissioner of human services who 
 shall be a nonvoting member; and 

    (c) the following members appointed by the governor: 

    (1) two members actively engaged in the management, 
 operation, or ownership of proprietary nursing homes; 

    (2) two members actively engaged in the management or 
 operation of nonprofit nursing homes; 

    (3) one member actively engaged in the practice of 
 medicine; 

    (4) one member actively engaged in the practice of 
 professional nursing; and 

    (5) three public members as defined in section 214.02. 

    Subd. 2.    Provisions.  Membership terms, compensation 
 of members, removal of members, the filling of membership 
 vacancies, fiscal year and reporting requirements, the provision 
 of staff, administrative services and office space, the review 
 and processing of complaints, the setting of board fees and 
 other provisions relating to board operations for the board of 
 examiners shall be as provided in chapter 214. 

    Subd. 3. Repealed, 1999 c 102 s 7 

    HIST: 1976 c 173 s 19; 1977 c 305 s 45; 1977 c 347 s 24; 1977 
 c 444 s 10; 1984 c 654 art 5 s 58; 1986 c 444; 1999 c 102 s 1 

     144A.20 Administrator qualifications. 

    Subdivision 1.    Criteria.  The board of examiners may 
 issue licenses to qualified persons as nursing home 
 administrators, and shall establish qualification criteria for 
 nursing home administrators.  No license shall be issued to a 
 person as a nursing home administrator unless that person: 

    (a) is at least 21 years of age and otherwise suitably 
 qualified; 

    (b) has satisfactorily met standards set by the board of 
 examiners, which standards shall be designed to assure that 
 nursing home administrators will be individuals who, by training 
 or experience are qualified to serve as nursing home 
 administrators; and 

    (c) has passed an examination approved by the board and 
 designed to test for competence in the subject matters referred 
 to in clause (b), or has been approved by the board of examiners 
 through the development and application of other appropriate 
 techniques. 

    Subd. 2. Repealed, 1999 c 102 s 7 

    HIST: 1976 c 173 s 20; 1986 c 444; 1996 c 451 art 4 s 23; 1999 
 c 102 s 2 

     144A.21 Administrator licenses. 

    Subdivision 1.    Transferability.  A nursing home 
 administrator's license shall not be transferable. 

    Subd. 2.    Rules; renewal.  The board of examiners by 
 rule shall establish forms and procedures for the processing of 
 license renewals.  A nursing home administrator's license may be 
 renewed only in accordance with the standards adopted by the 
 board of examiners pursuant to section 144A.24. 

    Subd. 3.  Repealed, 1977 c 444 s 21 

    Subd. 4.  Repealed, 1977 c 444 s 21 

    HIST: 1976 c 173 s 21; 1977 c 444 s 11 

     144A.22 Organization of board. 

    The board of examiners shall elect from its membership a 
 chair, vice-chair and secretary-treasurer, and shall adopt rules 
 to govern its proceedings.  Except as otherwise provided by law 
 the board of examiners shall employ and fix the compensation and 
 duties of an executive director and other necessary personnel to 
 assist it in the performance of its duties.  The executive 
 director shall be in the unclassified service and shall not be a 
 member of the board of examiners. 

    HIST: 1976 c 173 s 22; 1985 c 247 s 25; 1986 c 444; 1999 c 102 
 s 3 

     144A.23 Jurisdiction of board. 

    Except as provided in section 144A.04, subdivision 5, the 
 board of examiners shall have exclusive authority to determine 
 the qualifications, skill and fitness required of any person to 
 serve as an administrator of a nursing home.  The holder of a 
 license shall be deemed fully qualified to serve as the 
 administrator of a nursing home. 

    HIST: 1976 c 173 s 23 

     144A.24 Duties of the board. 

    The board of examiners shall: 

    (a) develop and enforce standards for nursing home 
 administrator licensing, which standards shall be designed to 
 assure that nursing home administrators will be individuals of 
 good character who, by training or experience, are suitably 
 qualified to serve as nursing home administrators; 

    (b) develop appropriate techniques, including examinations 
 and investigations, for determining whether applicants and 
 licensees meet the board's standards; 

    (c) issue licenses and permits to those individuals who are 
 found to meet the board's standards; 

    (d) establish and implement procedures designed to assure 
 that individuals licensed as nursing home administrators will 
 comply with the board's standards; 

    (e) receive and investigate complaints and take appropriate 
 action consistent with chapter 214, to revoke or suspend the 
 license or permit of a nursing home administrator or acting 
 administrator who fails to comply with sections 144A.18 to 
 144A.27 or the board's standards; 

    (f) conduct a continuing study and investigation of nursing 
 homes, and the administrators of nursing homes within the state, 
 with a view to the improvement of the standards imposed for the 
 licensing of administrators and improvement of the procedures 
 and methods used for enforcement of the board's standards; and 

    (g) approve or conduct courses of instruction or training 
 designed to prepare individuals for licensing in accordance with 
 the board's standards. Courses designed to meet license renewal 
 requirements shall be designed solely to improve professional 
 skills and shall not include classroom attendance requirements 
 exceeding 50 hours per year.  The board may approve courses 
 conducted within or without this state. 

    HIST: 1976 c 173 s 24; 1980 c 509 s 45; 1999 c 102 s 4 

  144A.25 Repealed, 1977 c 444 s 21 

     144A.251 Mandatory proceedings. 

    In addition to its discretionary authority to initiate 
 proceedings under section 144A.24 and chapter 214, the board of 
 examiners shall initiate proceedings to suspend or revoke a 
 nursing home administrator license or shall refuse to renew a 
 license if within the preceding two year period the 
 administrator was employed at a nursing home which during the 
 period of employment incurred the following number of 
 uncorrected violations, which violations were in the 
 jurisdiction and control of the administrator and for which a 
 fine was assessed and allowed to be recovered: 

    (a) Two or more uncorrected violations which created an 
 imminent risk of harm to a nursing home resident; or 

    (b) Ten or more uncorrected violations of any nature. 

    HIST: 1976 c 173 s 26; 1977 c 444 s 12; 1986 c 444 

     144A.252 Immunity. 

    Members of the board of examiners for nursing home 
 administrators and persons employed by the board or engaged in 
 the investigation of violations and in the preparation and 
 management of charges of violations of sections 144A.18 to 
 144A.27, or of rules adopted pursuant to sections 144A.18 to 
 144A.27 on behalf of the board, are immune from civil liability 
 and criminal prosecution for any actions, transactions, or 
 publication in execution of, or relating to, their duties under 
 sections 144A.18 to 144A.27 provided they are acting in good 
 faith. 

    HIST: 1999 c 102 s 5 

     144A.26 Reciprocity with other states. 

    The board of examiners may issue a nursing home 
 administrator's license, without examination, to any person who 
 holds a current license as a nursing home administrator from 
 another jurisdiction if the board finds that the standards for 
 licensure in the other jurisdiction are at least the substantial 
 equivalent of those prevailing in this state and that the 
 applicant is otherwise qualified. 

    HIST: 1976 c 173 s 27 

     144A.27 Acting administrators. 

    If a licensed nursing home administrator is removed from 
 the position by death or other unexpected cause, the controlling 
 persons of the nursing home suffering the removal may designate 
 an acting nursing home administrator who shall secure an acting 
 administrator's permit within 30 days of appointment as the 
 acting administrator. 

    HIST: 1976 c 173 s 28; 1986 c 444; 1987 c 403 art 4 s 5; 1999 
 c 102 s 6 

     144A.28 Severability. 

    Any part of sections 144A.18 to 144A.27 which is in 
 conflict with any act of Congress of the United States or any 
 rule of a federal agency, so as to deprive nursing homes of this 
 state of federal funds, shall be deemed void without affecting 
 the remaining provisions of sections 144A.18 to 144A.27. 

    HIST: 1976 c 173 s 29 

  144A.29 Repealed, 1999 c 102 s 7 

     144A.30 Pets in nursing homes. 

    Nursing homes may keep pet animals on the premises subject 
 to reasonable rules as to the care, type and maintenance of the 
 pet.  

    HIST: 1979 c 38 s 1 

     144A.31 Interagency long-term care planning committee. 

    Subdivision 1.    Interagency long-term care planning 
 committee.  The commissioners of health and human services 
 shall establish, by July 1, 1983, an interagency committee of 
 managerial employees of their respective departments who are 
 knowledgeable and employed in the areas of long-term care, 
 geriatric care, community services for the elderly, long-term 
 care facility inspection, or quality of care assurance.  The 
 number of interagency committee members shall not exceed twelve; 
 four members each to represent the commissioners of health and 
 human services and one member each to represent the 
 commissioners of state planning, housing finance, finance, and 
 the chair of the Minnesota board on aging.  The commissioner of 
 human services and the commissioner of health or their designees 
 shall annually alternate chairing and convening the committee.  
 The committee may utilize the expertise and time of other 
 individuals employed by each department as needed.  The 
 committee may recommend that the commissioners contract for 
 services as needed.  The committee shall meet as often as 
 necessary to accomplish its duties, but at least quarterly.  The 
 committee shall establish procedures, including public hearings, 
 for allowing regular opportunities for input from consumers of 
 long-term care services, advocates, trade associations, facility 
 administrators, county agency administrators, and other 
 interested persons.  

    Subd. 2. Repealed, 1991 c 292 art 7 s 26 

    Subd. 2a.    Duties.  The interagency committee shall 
 manage and implement the moratorium exception process in 
 accordance with sections 144A.071 and 144A.073. 

    Subd. 2b. Repealed, 1995 c 207 art 11 s 12 

    Subd. 3. Repealed, 1991 c 292 art 7 s 26 

    Subd. 4. Repealed, 1995 c 207 art 11 s 12 

    Subd. 5. Repealed, 1995 c 207 art 11 s 12 

    Subd. 6. Repealed, 1995 c 207 art 11 s 12 

    Subd. 7. Repealed, 1995 c 207 art 11 s 12 

    HIST: 1983 c 199 s 5; 1984 c 640 s 32; 1984 c 641 s 12; 1984 c 
 654 art 5 s 58; 1987 c 186 s 15; 1987 c 209 s 30; 1991 c 292 art 
 7 s 1; 1992 c 513 art 7 s 8; 1995 c 207 art 11 s 1 

     144A.33 Resident and family advisory council education. 

    Subdivision 1.    Educational program.  Each resident 
 and family council authorized under section 144.651, subdivision 
 27, shall be educated and informed about the following: 

    (1) care in the nursing home or board and care home; 

    (2) resident rights and responsibilities; 

    (3) resident and family council organization and 
 maintenance; 

    (4) laws and rules that apply to homes and residents; 

    (5) human relations; and 

    (6) resident and family self-help methods to increase 
 quality of care and quality of life in a nursing home or board 
 and care home. 

    Subd. 2.    Providing educational services.  The 
 Minnesota board on aging shall provide a grant-in-aid to a 
 statewide, independent, nonprofit, consumer-sponsored agency to 
 provide educational services to councils. 

    Subd. 3.    Funding of advisory council education.  A 
 license application or renewal fee for nursing homes and 
 boarding care homes under section 144.53 or 144A.07 must be 
 increased by $5 per bed to fund the development and education of 
 resident and family advisory councils. 

    Subd. 4.    Special account.  All money collected by the 
 commissioner of health under subdivision 3 must be deposited in 
 the state treasury and credited to a special account called the 
 nursing home advisory council fund.  Money credited to the fund 
 is appropriated to the Minnesota board on aging for the purposes 
 of this section. 

    Subd. 5.    Evaluation.  Each year the Minnesota board 
 on aging shall evaluate the programs and funding sources 
 established under this section. 

    HIST: 1985 c 267 s 1; 1987 c 403 art 2 s 13,14; 1995 c 207 art 
 9 s 19; 1997 c 7 art 2 s 16 

     144A.43 Definitions. 

    Subdivision 1.    Applicability.  The definitions in 
 this section apply to sections 144.699, subdivision 2, and 
 144A.43 to 144A.48. 

    Subd. 2.    Commissioner.  "Commissioner" means the 
 commissioner of health. 

    Subd. 3.    Home care service.  "Home care service" 
 means any of the following services when delivered in a place of 
 residence to a person whose illness, disability, or physical 
 condition creates a need for the service:  

    (1) nursing services, including the services of a home 
 health aide; 

    (2) personal care services not included under sections 
 148.171 to 148.285; 

    (3) physical therapy; 

    (4) speech therapy; 

    (5) respiratory therapy; 

    (6) occupational therapy; 

    (7) nutritional services; 

    (8) home management services when provided to a person who 
 is unable to perform these activities due to illness, 
 disability, or physical condition.  Home management services 
 include at least two of the following services:  housekeeping, 
 meal preparation, and shopping; 

    (9) medical social services; 

    (10) the provision of medical supplies and equipment when 
 accompanied by the provision of a home care service; 

    (11) the provision of a hospice program as specified in 
 section 144A.48; and 

    (12) other similar medical services and health-related 
 support services identified by the commissioner in rule.  

    "Home care service" does not include the following 
 activities conducted by the commissioner of health or a board of 
 health as defined in section 145A.02, subdivision 2:  
 communicable disease investigations or testing; administering or 
 monitoring a prescribed therapy necessary to control or prevent 
 a communicable disease; or the monitoring of an individual's 
 compliance with a health directive as defined in section 
 144.4172, subdivision 6. 

    Subd. 4.    Home care provider.  "Home care provider" 
 means an individual, organization, association, corporation, 
 unit of government, or other entity that is regularly engaged in 
 the delivery, directly or by contractual arrangement, of home 
 care services for a fee.  At least one home care service must be 
 provided directly, although additional home care services may be 
 provided by contractual arrangements.  "Home care provider" 
 includes a hospice program defined in section 144A.48.  "Home 
 care provider" does not include: 

    (1) any home care or nursing services conducted by and for 
 the adherents of any recognized church or religious denomination 
 for the purpose of providing care and services for those who 
 depend upon spiritual means, through prayer alone, for healing; 

    (2) an individual who only provides services to a relative; 

    (3) an individual not connected with a home care provider 
 who provides assistance with home management services or 
 personal care needs if the assistance is provided primarily as a 
 contribution and not as a business; 

    (4) an individual not connected with a home care provider 
 who shares housing with and provides primarily housekeeping or 
 homemaking services to an elderly or disabled person in return 
 for free or reduced-cost housing; 

    (5) an individual or agency providing home-delivered meal 
 services; 

    (6) an agency providing senior companion services and other 
 older American volunteer programs established under the Domestic 
 Volunteer Service Act of 1973, Public Law Number 98-288; 

    (7) an employee of a nursing home licensed under this 
 chapter or an employee of a boarding care home licensed under 
 sections 144.50 to 144.56 who responds to occasional emergency 
 calls from individuals residing in a residential setting that is 
 attached to or located on property contiguous to the nursing 
 home or boarding care home; 

    (8) a member of a professional corporation organized under 
 chapter 319B that does not regularly offer or provide home care 
 services as defined in subdivision 3; 

    (9) the following organizations established to provide 
 medical or surgical services that do not regularly offer or 
 provide home care services as defined in subdivision 3:  a 
 business trust organized under sections 318.01 to 318.04, a 
 nonprofit corporation organized under chapter 317A, a 
 partnership organized under chapter 323, or any other entity 
 determined by the commissioner; 

    (10) an individual or agency that provides medical supplies 
 or durable medical equipment, except when the provision of 
 supplies or equipment is accompanied by a home care service; 

    (11) an individual licensed under chapter 147; or 

    (12) an individual who provides home care services to a 
 person with a developmental disability who lives in a place of 
 residence with a family, foster family, or primary caregiver. 

    HIST: 1987 c 378 s 3; 1989 c 194 s 1; 1989 c 304 s 137; 1992 c 
 513 art 6 s 5,6; 1995 c 207 art 9 s 20; 1997 c 22 art 2 s 2,8; 
 1997 c 113 s 1 

     144A.44 Home care bill of rights. 

    Subdivision 1.    Statement of rights.  A person who 
 receives home care services has these rights: 

    (1) the right to receive written information about rights 
 in advance of receiving care or during the initial evaluation 
 visit before the initiation of treatment, including what to do 
 if rights are violated; 

    (2) the right to receive care and services according to a 
 suitable and up-to-date plan, and subject to accepted medical or 
 nursing standards, to take an active part in creating and 
 changing the plan and evaluating care and services; 

    (3) the right to be told in advance of receiving care about 
 the services that will be provided, the disciplines that will 
 furnish care, the frequency of visits proposed to be furnished, 
 other choices that are available, and the consequences of these 
 choices including the consequences of refusing these services; 

    (4) the right to be told in advance of any change in the 
 plan of care and to take an active part in any change; 

    (5) the right to refuse services or treatment; 

    (6) the right to know, in advance, any limits to the 
 services available from a provider, and the provider's grounds 
 for a termination of services; 

    (7) the right to know in advance of receiving care whether 
 the services are covered by health insurance, medical 
 assistance, or other health programs, the charges for services 
 that will not be covered by Medicare, and the charges that the 
 individual may have to pay; 

    (8) the right to know what the charges are for services, no 
 matter who will be paying the bill; 

    (9) the right to know that there may be other services 
 available in the community, including other home care services 
 and providers, and to know where to go for information about 
 these services; 

    (10) the right to choose freely among available providers 
 and to change providers after services have begun, within the 
 limits of health insurance, medical assistance, or other health 
 programs; 

    (11) the right to have personal, financial, and medical 
 information kept private, and to be advised of the provider's 
 policies and procedures regarding disclosure of such 
 information; 

    (12) the right to be allowed access to records and written 
 information from records in accordance with section 144.335; 

    (13) the right to be served by people who are properly 
 trained and competent to perform their duties; 

    (14) the right to be treated with courtesy and respect, and 
 to have the patient's property treated with respect; 

    (15) the right to be free from physical and verbal abuse; 

    (16) the right to reasonable, advance notice of changes in 
 services or charges; 

    (17) the right to a coordinated transfer when there will be 
 a change in the provider of services; 

    (18) the right to voice grievances regarding treatment or 
 care that is, or fails to be, furnished, or regarding the lack 
 of courtesy or respect to the patient or the patient's property; 

    (19) the right to know how to contact an individual 
 associated with the provider who is responsible for handling 
 problems and to have the provider investigate and attempt to 
 resolve the grievance or complaint; 

    (20) the right to know the name and address of the state or 
 county agency to contact for additional information or 
 assistance; and 

    (21) the right to assert these rights personally, or have 
 them asserted by the patient's family or guardian when the 
 patient has been judged incompetent, without retaliation. 

    Subd. 2.    Interpretation and enforcement of rights.  
 These rights are established for the benefit of persons who 
 receive home care services.  "Home care services" means home 
 care services as defined in section 144A.43, subdivision 3.  A 
 home care provider may not require a person to surrender these 
 rights as a condition of receiving services.  A guardian or 
 conservator or, when there is no guardian or conservator, a 
 designated person, may seek to enforce these rights.  This 
 statement of rights does not replace or diminish other rights 
 and liberties that may exist relative to persons receiving home 
 care services, persons providing home care services, or 
 providers licensed under Laws 1987, chapter 378.  A copy of 
 these rights must be provided to an individual at the time home 
 care services are initiated.  The copy shall also contain the 
 address and phone number of the office of health facility 
 complaints and the office of the ombudsman for older Minnesotans 
 and a brief statement describing how to file a complaint with 
 these offices.  Information about how to contact the office of 
 the ombudsman for older Minnesotans shall be included in notices 
 of change in client fees and in notices where home care 
 providers initiate transfer or discontinuation of services. 

    HIST: 1987 c 378 s 4; 1991 c 133 s 1; 1998 c 407 art 2 s 81 

     144A.45 Regulation of home care services. 

    Subdivision 1.    Rules.  The commissioner shall adopt 
 rules for the regulation of home care providers pursuant to 
 sections 144A.43 to 144A.48.  The rules shall include the 
 following:  

    (a) provisions to assure, to the extent possible, the 
 health, safety and well-being, and appropriate treatment of 
 persons who receive home care services; 

    (b) requirements that home care providers furnish the 
 commissioner with specified information necessary to implement 
 sections 144A.43 to 144A.48; 

    (c) standards of training of home care provider personnel, 
 which may vary according to the nature of the services provided 
 or the health status of the consumer; 

    (d) standards for medication management which may vary 
 according to the nature of the services provided, the setting in 
 which the services are provided, or the status of the consumer.  
 Medication management includes the central storage, handling, 
 distribution, and administration of medications; 

    (e) standards for supervision of home care services 
 requiring supervision by a registered nurse or other appropriate 
 health care professional which must occur on site at least every 
 62 days, or more frequently if indicated by a clinical 
 assessment, and in accordance with sections 148.171 to 148.285 
 and rules adopted thereunder; 

    (f) standards for client evaluation or assessment which may 
 vary according to the nature of the services provided or the 
 status of the consumer; 

    (g) requirements for the involvement of a consumer's 
 physician, the documentation of physicians' orders, if required, 
 and the consumer's treatment plan, and the maintenance of 
 accurate, current clinical records; 

    (h) the establishment of different classes of licenses for 
 different types of providers and different standards and 
 requirements for different kinds of home care services; and 

    (i) operating procedures required to implement the home 
 care bill of rights. 

    Subd. 2.    Regulatory functions.  (a) The commissioner 
 shall:  

    (1) evaluate, monitor, and license home care providers in 
 accordance with sections 144A.45 to 144A.48; 

    (2) inspect the office and records of a provider during 
 regular business hours without advance notice to the home care 
 provider; 

    (3) with the consent of the consumer, visit the home where 
 services are being provided; 

    (4) issue correction orders and assess civil penalties in 
 accordance with section 144.653, subdivisions 5 to 8, for 
 violations of sections 144A.43 to 144A.48 or the rules adopted 
 under those sections; and 

    (5) take other action reasonably required to accomplish the 
 purposes of sections 144A.43 to 144A.48. 

    (b) In the exercise of the authority granted in sections 
 144A.43 to 144A.48, the commissioner shall comply with the 
 applicable requirements of section 144.122, the Government Data 
 Practices Act, and the Administrative Procedure Act. 

    Subd. 3. Repealed, 1997 c 113 s 22 

    Subd. 4.    Medicaid reimbursement.  Notwithstanding the 
 provisions of section 256B.071 or state plan requirements to the 
 contrary, certification by the federal Medicare program must not 
 be a requirement of Medicaid payment for services delivered 
 under section 144A.4605. 

    HIST: 1987 c 378 s 5; 1989 c 282 art 2 s 25; 1991 c 286 s 8; 
 1997 c 113 s 2,3; 1998 c 254 art 1 s 30,31 

     144A.46 Licensure. 

    Subdivision 1.    License required.  (a) A home care 
 provider may not operate in the state without a current license 
 issued by the commissioner of health.  A home care provider may 
 hold a separate license for each class of home care licensure. 

    (b) Within ten days after receiving an application for a 
 license, the commissioner shall acknowledge receipt of the 
 application in writing.  The acknowledgment must indicate 
 whether the application appears to be complete or whether 
 additional information is required before the application will 
 be considered complete.  Within 90 days after receiving a 
 complete application, the commissioner shall either grant or 
 deny the license.  If an applicant is not granted or denied a 
 license within 90 days after submitting a complete application, 
 the license must be deemed granted.  An applicant whose license 
 has been deemed granted must provide written notice to the 
 commissioner before providing a home care service. 

    (c) Each application for a home care provider license, or 
 for a renewal of a license, shall be accompanied by a fee to be 
 set by the commissioner under section 144.122. 

    Subd. 2.    Exemptions.  The following individuals or 
 organizations are exempt from the requirement to obtain a home 
 care provider license: 

    (1) a person who is licensed as a registered nurse under 
 sections 148.171 to 148.285 and who independently provides 
 nursing services in the home without any contractual or 
 employment relationship to a home care provider or other 
 organization; 

    (2) a personal care assistant who provides services to only 
 one individual under the medical assistance program as 
 authorized under sections 256B.0625, subdivision 19, and 
 256B.04, subdivision 16; 

    (3) a person or organization that exclusively offers, 
 provides, or arranges for personal care assistant services to 
 only one individual under the medical assistance program as 
 authorized under sections 256B.0625, subdivision 19, and 
 256B.04, subdivision 16; 

    (4) a person who is licensed under sections 148.65 to 
 148.78 and who independently provides physical therapy services 
 in the home without any contractual or employment relationship 
 to a home care provider or other organization; 

    (5) a provider that is licensed by the commissioner of 
 human services to provide semi-independent living services under 
 Minnesota Rules, parts 9525.0500 to 9525.0660 when providing 
 home care services to a person with a developmental disability; 

    (6) a provider that is licensed by the commissioner of 
 human services to provide home and community-based services 
 under Minnesota Rules, parts 9525.2000 to 9525.2140 when 
 providing home care services to a person with a developmental 
 disability; 

    (7) a person or organization that provides only home 
 management services, if the person or organization is registered 
 under section 144A.461; or 

    (8) a person who is licensed as a social worker under 
 sections 148B.18 to 148B.289 and who provides social work 
 services in the home independently and not through any 
 contractual or employment relationship with a home care provider 
 or other organization. 

    An exemption under this subdivision does not excuse the 
 individual from complying with applicable provisions of the home 
 care bill of rights. 

    Subd. 3.    Enforcement.  (a) The commissioner may 
 refuse to grant or renew a license, or may suspend or revoke a 
 license, for violation of statutes or rules relating to home 
 care services or for conduct detrimental to the welfare of the 
 consumer.  Prior to any suspension, revocation, or refusal to 
 renew a license, the home care provider shall be entitled to 
 notice and a hearing as provided by sections 14.57 to 14.69.  In 
 addition to any other remedy provided by law, the commissioner 
 may, without a prior contested case hearing, temporarily suspend 
 a license or prohibit delivery of services by a provider for not 
 more than 60 days if the commissioner determines that the health 
 or safety of a consumer is in imminent danger, provided (1) 
 advance notice is given to the provider; (2) after notice, the 
 provider fails to correct the problem; (3) the commissioner has 
 reason to believe that other administrative remedies are not 
 likely to be effective; and (4) there is an opportunity for a 
 contested case hearing within the 60 days.  The process of 
 suspending or revoking a license must include a plan for 
 transferring affected clients to other providers.  

    (b) The owner and managerial officials, as defined in the 
 home care licensure rules, Minnesota Rules, chapter 4668, of a 
 home care provider whose Minnesota license has not been renewed 
 or has been revoked because of noncompliance with applicable law 
 or rule shall not be eligible to apply for nor will be granted a 
 license for five years following the effective date of the 
 nonrenewal or revocation. 

    (c) The commissioner shall not issue a license to a home 
 care provider if an owner or managerial official includes any 
 individual who was an owner or managerial official of a home 
 care provider whose Minnesota license was not renewed or was 
 revoked as described in paragraph (b) for five years following 
 the effective date of nonrenewal or revocation. 

    (d) Notwithstanding the provisions of paragraph (a), the 
 commissioner shall not renew, or shall suspend or revoke the 
 license of any home care provider which includes any individual 
 as an owner or managerial official who was an owner or 
 managerial official of a home care provider whose Minnesota 
 license was not renewed or was revoked as described in paragraph 
 (b) for five years following the effective date of the 
 nonrenewal or revocation.  The commissioner shall notify the 
 home care provider 30 days in advance of the date of nonrenewal, 
 suspension, or revocation of the license.  Within ten days after 
 the receipt of this notification, the home care provider may 
 request, in writing, that the commissioner stay the nonrenewal, 
 revocation, or suspension of the license.  The home care 
 provider shall specify the reasons for requesting the stay; the 
 steps that will be taken to attain or maintain compliance with 
 the licensure laws and regulations; any limits on the authority 
 or responsibility of the owners or managerial officials whose 
 actions resulted in the notice of nonrenewal, revocation, or 
 suspension; and any other information to establish that the 
 continuing affiliation with these individuals will not 
 jeopardize client health, safety, or well being.  The 
 commissioner shall determine whether the stay will be granted 
 within 30 days of receiving the provider's request.  The 
 commissioner may propose additional restrictions or limitations 
 on the provider's license and require that the granting of the 
 stay be contingent upon compliance with those provisions.  The 
 commissioner shall take into consideration the following factors 
 when determining whether the stay should be granted: 

    (1) the threat that continued involvement of the owners and 
 managerial officials in the home care provider poses to client 
 health, safety, and well being; 

    (2) the compliance history of the home care provider; and 

    (3) the appropriateness of any limits suggested by the home 
 care provider. 

 If the commissioner grants the stay, the order shall include any 
 restrictions or limitation on the provider's license.  The 
 failure of the provider to comply with any restrictions or 
 limitations shall result in the immediate removal of the stay 
 and the commissioner shall take immediate action to suspend, 
 revoke, or not renew the license. 

    (e) The provisions contained in paragraphs (b) and (c) 
 shall apply to any nonrenewal or revocation of a home care 
 license occurring after June 1, 1993, the effective date of the 
 home care licensure rules. 

    (f) For the purposes of this subdivision, owners of a home 
 care provider are those individuals whose ownership interest 
 provides sufficient authority or control to affect or change 
 decisions related to the operation of the home care provider.  
 An owner includes a sole proprietor, a general partner, or any 
 other individual whose individual ownership interest can affect 
 the management and direction of the policies of the home care 
 provider.  For the purposes of this subdivision, managerial 
 officials are those individuals who had the responsibility for 
 the ongoing management or direction of the policies, services, 
 or employees of the home care provider relating to the areas of 
 noncompliance which led to the license revocation or nonrenewal. 

    Subd. 3a.    Injunctive relief.  In addition to any 
 other remedy provided by law, the commissioner may bring an 
 action in district court to enjoin a person who is involved in 
 the management, operation, or control of a home care provider, 
 or an employee of the home care provider from illegally engaging 
 in activities regulated by sections 144A.43 to 144A.48.  The 
 commissioner may bring an action under this subdivision in the 
 district court in Ramsey county or in the district in which a 
 home care provider is providing services.  The court may grant a 
 temporary restraining order in the proceeding if continued 
 activity by the person who is involved in the management, 
 operation, or control of a home care provider, or by an employee 
 of the home care provider, would create an imminent risk of harm 
 to a recipient of home care services. 

    Subd. 3b.    Subpoena.  In matters pending before the 
 commissioner under sections 144A.43 to 144A.48, the commissioner 
 may issue subpoenas and compel the attendance of witnesses and 
 the production of all necessary papers, books, records, 
 documents, and other evidentiary material.  If a person fails or 
 refuses to comply with a subpoena or order of the commissioner 
 to appear or testify regarding any matter about which the person 
 may be lawfully questioned or to produce any papers, books, 
 records, documents, or evidentiary materials in the matter to be 
 heard, the commissioner may apply to the district court in any 
 district, and the court shall order the person to comply with 
 the commissioner's order or subpoena.  The commissioner of 
 health may administer oaths to witnesses, or take their 
 affirmation.  Depositions may be taken in or outside the state 
 in the manner provided by law for the taking of depositions in 
 civil actions.  A subpoena or other process or paper may be 
 served upon a named person anywhere within the state by an 
 officer authorized to serve subpoenas in civil actions, with the 
 same fees and mileage and in the same manner as prescribed by 
 law for process issued out of a district court.  A person 
 subpoenaed under this subdivision shall receive the same fees, 
 mileage, and other costs that are paid in proceedings in 
 district court. 

    Subd. 3c.    Time limits for appeals.  To appeal the 
 assessment of civil penalties under section 144A.45, subdivision 
 2, clause (4), a denial of a waiver or variance, and an action 
 against a license under subdivision 3, a provider must request a 
 hearing no later than 15 days after the provider receives notice 
 of the action. 

    Subd. 4.    Relation to other regulatory programs.  In 
 the exercise of the authority granted under sections 144A.43 to 
 144A.48, the commissioner shall not duplicate or replace 
 standards and requirements imposed under another state 
 regulatory program.  The commissioner shall not impose 
 additional training or education requirements upon members of a 
 licensed or registered occupation or profession, except as 
 necessary to address or prevent problems that are unique to the 
 delivery of services in the home or to enforce and protect the 
 rights of consumers listed in section 144A.44.  The commissioner 
 of health shall not require a home care provider certified under 
 the Medicare program to comply with a rule adopted under section 
 144A.45 if the home care provider is required to comply with any 
 equivalent federal law or regulation relating to the same 
 subject matter.  The commissioner of health shall specify in the 
 rules those provisions that are not applicable to certified home 
 care providers.  To the extent possible, the commissioner shall 
 coordinate the inspections required under sections 144A.45 to 
 144A.48 with the health facility licensure inspections required 
 under sections 144.50 to 144.58 or 144A.10 when the health care 
 facility is also licensed under the provisions of Laws 1987, 
 chapter 378. 

    Subd. 5.    Prior criminal convictions.  (a) Before the 
 commissioner issues an initial or renewal license, an owner or 
 managerial official shall be required to complete a background 
 study under section 144.057.  No person may be involved in the 
 management, operation, or control of a provider, if the person 
 has been disqualified under the provisions of chapter 245A.  
 Individuals disqualified under these provisions can request a 
 reconsideration, and if the disqualification is set aside are 
 then eligible to be involved in the management, operation or 
 control of the provider.  For purposes of this section, owners 
 of a home care provider subject to the background check 
 requirement are those individuals whose ownership interest 
 provides sufficient authority or control to affect or change 
 decisions related to the operation of the home care provider.  
 An owner includes a sole proprietor, a general partner, or any 
 other individual whose individual ownership interest can affect 
 the management and direction of the policies of the home care 
 provider.  For the purposes of this section, managerial 
 officials subject to the background check requirement are those 
 individuals who provide "direct contact" as defined in section 
 245A.04 or those individuals who have the responsibility for the 
 ongoing management or direction of the policies, services, or 
 employees of the home care provider.  Data collected under this 
 subdivision shall be classified as private data under section 
 13.02, subdivision 12. 

    (b) Employees, contractors, and volunteers of a home care 
 provider or hospice are subject to the background study required 
 by section 144.057.  These individuals shall be disqualified 
 under the provisions of chapter 245A and Minnesota Rules, parts 
 9543.3000 to 9543.3090.  Nothing in this section shall be 
 construed to prohibit a home care provider from requiring 
 self-disclosure of criminal conviction information. 

    (c)    Repealed by amendment, 1977 c 248 s 2  

    (d)    Repealed by amendment, 1977 c 248 s 2  

    (e) Termination of an employee in good faith reliance on 
 information or records obtained under paragraph (a) or (b) 
 regarding a confirmed conviction does not subject the home care 
 provider to civil liability or liability for reemployment 
 compensation benefits. 

    HIST: 1987 c 378 s 6; 1988 c 689 art 2 s 268; 1989 c 209 art 2 
 s 1; 1989 c 282 art 2 s 26; 1990 c 426 art 2 s 1; 1991 c 286 s 
 9,10; 1991 c 292 art 2 s 10; art 7 s 2; 1992 c 513 art 6 s 7-9; 
 1994 c 488 s 8; 1995 c 63 s 1; 1996 c 408 art 10 s 4; 1997 c 113 
 s 4,5; 1997 c 193 s 47; 1997 c 195 s 1; 1997 c 248 s 2; 1998 c 
 254 art 1 s 32; 1999 c 107 s 66; 1999 c 245 art 9 s 3 

     144A.4605 Assisted living home care provider. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the term "assisted living home care provider" means a 
 home care provider who provides nursing services, delegated 
 nursing services, other services performed by unlicensed 
 personnel, or central storage of medications solely for 
 residents of one or more housing with services establishments 
 registered under chapter 144D. 

    Subd. 2.    Assisted living home care license established. 
  A home care provider license category entitled assisted 
 living home care provider is hereby established.  A home care 
 provider may obtain an assisted living license if the program 
 meets the following requirements: 

    (a) nursing services, delegated nursing services, other 
 services performed by unlicensed personnel, or central storage 
 of medications under the assisted living license are provided 
 solely for residents of one or more housing with services 
 establishments registered under chapter 144D; 

    (b) unlicensed personnel perform home health aide and home 
 care aide tasks identified in Minnesota Rules, parts 4668.0100, 
 subparts 1 and 2, and 4668.0110, subpart 1.  Qualifications to 
 perform these tasks shall be established in accordance with 
 subdivision 3; 

    (c) periodic supervision of unlicensed personnel is 
 provided as required by rule; 

    (d) notwithstanding Minnesota Rules, part 4668.0160, 
 subpart 6, item D, client records shall include: 

    (1) daily records or a weekly summary of home care services 
 provided; 

    (2) documentation each time medications are administered to 
 a client; and 

    (3) documentation on the day of occurrence of any 
 significant change in the client's status or any significant 
 incident, such as a fall or refusal to take medications. 

    All entries must be signed by the staff providing the 
 services and entered into the record no later than two weeks 
 after the end of the service day, except as specified in clauses 
 (2) and (3); 

    (e) medication and treatment orders, if any, are included 
 in the client record and are renewed at least every 12 months, 
 or more frequently when indicated by a clinical assessment; 

    (f) the central storage of medications in a housing with 
 services establishment registered under chapter 144D is managed 
 under a system that is established by a registered nurse and 
 addresses the control of medications, handling of medications, 
 medication containers, medication records, and disposition of 
 medications; and 

    (g) in other respects meets the requirements established by 
 rules adopted under sections 144A.45 to 144A.48. 

    Subd. 3.    Training or competency evaluations required. 
  (a) Unlicensed personnel must: 

    (1) satisfy the training or competency requirements 
 established by rule under sections 144A.45 to 144A.48; or 

    (2) be trained or determined competent by a registered 
 nurse in each task identified under Minnesota Rules, part 
 4668.0100, subparts 1 and 2, when offered to clients in a 
 housing with services establishment as described in paragraphs 
 (b) to (e). 

    (b) Training for tasks identified under Minnesota Rules, 
 part 4668.0100, subparts 1 and 2, shall use a curriculum which 
 meets the requirements in Minnesota Rules, part 4668.0130. 

    (c) Competency evaluations for tasks identified under 
 Minnesota Rules, part 4668.0100, subparts 1 and 2, must be 
 completed and documented by a registered nurse. 

    (d) Unlicensed personnel performing tasks identified under 
 Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be 
 trained or demonstrate competency in the following topics: 

    (1) an overview of sections 144A.43 to 144A.48 and rules 
 adopted thereunder; 

    (2) recognition and handling of emergencies and use of 
 emergency services; 

    (3) reporting the maltreatment of vulnerable minors or 
 adults under sections 626.556 and 626.557; 

    (4) home care bill of rights; 

    (5) handling of clients' complaints and reporting of 
 complaints to the office of health facility complaints; 

    (6) services of the ombudsman for older Minnesotans; 

    (7) observation, reporting, and documentation of client 
 status and of the care or services provided; 

    (8) basic infection control; 

    (9) maintenance of a clean, safe, and healthy environment; 

    (10) communication skills; 

    (11) basic elements of body functioning and changes in body 
 function that must be reported to an appropriate health care 
 professional; and 

    (12) physical, emotional, and developmental needs of 
 clients, and ways to work with clients who have problems in 
 these areas, including respect for the client, the client's 
 property, and the client's family. 

    (e) Unlicensed personnel who administer medications must 
 comply with rules relating to the administration of medications 
 in Minnesota Rules, part 4668.0100, subpart 2, except that 
 unlicensed personnel need not comply with the requirements of 
 Minnesota Rules, part 4668.0100, subpart 5. 

    Subd. 4.    License required.  (a) A housing with 
 services establishment registered under chapter 144D that is 
 required to obtain a home care license must obtain an assisted 
 living home care license according to this section or a class A 
 or class E license according to rule.  A housing with services 
 establishment that obtains a class E license under this 
 subdivision remains subject to the payment limitations in 
 sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915, 
 subdivision 3, paragraph (g). 

    (b) A board and lodging establishment registered for 
 special services as of December 31, 1996, and also registered as 
 a housing with services establishment under chapter 144D, must 
 deliver home care services according to sections 144A.43 to 
 144A.48, and may apply for a waiver from requirements under 
 Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a 
 licensed agency under the standards of section 157.17.  Such 
 waivers as may be granted by the department will expire upon 
 promulgation of home care rules implementing section 144A.4605. 

    (c) An adult foster care provider licensed by the 
 department of human services and registered under chapter 144D 
 may continue to provide health-related services under its foster 
 care license until the promulgation of home care rules 
 implementing this section. 

    Subd. 5.    License fees.  The license fees for assisted 
 living home care providers shall be as follows: 

    (1) $125 annually for those providers serving a monthly 
 average of 15 or fewer clients, and for assisted living 
 providers of all sizes during the first year of operation; 

    (2) $200 annually for those providers serving a monthly 
 average of 16 to 30 clients; 

    (3) $375 annually for those providers serving a monthly 
 average of 31 to 50 clients; and 

    (4) $625 annually for those providers serving a monthly 
 average of 51 or more clients. 

    Subd. 6.    Waiver.  Upon request of the home care 
 provider, the commissioner may waive the provisions of this 
 section relating to registered nurse duties. 

    HIST: 1997 c 113 s 6; 1Sp1997 c 5 s 2; 1998 c 254 art 1 s 
 33,34; 1998 c 407 art 2 s 82; 1999 c 245 art 2 s 30 

     144A.461 Registration. 

    A person or organization that provides only home management 
 services defined as home care services under section 144A.43, 
 subdivision 3, clause (8), may not operate in the state without 
 a current certificate of registration issued by the commissioner 
 of health.  To obtain a certificate of registration, the person 
 or organization must annually submit to the commissioner the 
 name, address, and telephone number of the person or 
 organization and a signed statement declaring that the person or 
 organization is aware that the home care bill of rights applies 
 to their clients and that the person or organization will comply 
 with the bill of rights provisions contained in section 
 144A.44.  A person who provides home management services under 
 this section must, within 120 days after beginning to provide 
 services, attend an orientation session approved by the 
 commissioner that provides training on the bill of rights and an 
 orientation on the aging process and the needs and concerns of 
 elderly and disabled persons.  An organization applying for a 
 certificate must also provide the name, business address, and 
 telephone number of each of the individuals responsible for the 
 management or direction of the organization.  The commissioner 
 shall charge an annual registration fee of $20 for individuals 
 and $50 for organizations.  A home care provider that provides 
 home management services and other home care services must be 
 licensed, but licensure requirements other than the home care 
 bill of rights do not apply to those employees or volunteers who 
 provide only home management services to clients who do not 
 receive any other home care services from the provider.  A 
 licensed home care provider need not be registered as a home 
 management service provider, but must provide an orientation on 
 the home care bill of rights to its employees or volunteers who 
 provide home management services.  The commissioner may suspend 
 or revoke a provider's certificate of registration or assess 
 fines for violation of the home care bill of rights.  Any fine 
 assessed for a violation of the bill of rights by a provider 
 registered under this section shall be in the amount established 
 in the licensure rules for home care providers.  As a condition 
 of registration, a provider must cooperate fully with any 
 investigation conducted by the commissioner, including providing 
 specific information requested by the commissioner on clients 
 served and the employees and volunteers who provide services.  
 The commissioner may use any of the powers granted in sections 
 144A.43 to 144A.49 to administer the registration system and 
 enforce the home care bill of rights under this section. 

    HIST: 1992 c 513 art 6 s 10 

     144A.465 Licensure; penalty. 

    A person involved in the management, operation, or control 
 of a home care provider who violates section 144A.46, 
 subdivision 1, paragraph (a), is guilty of a misdemeanor.  This 
 section does not apply to a person who had no legal authority to 
 affect or change decisions related to the management, operation, 
 or control of a home care provider. 

    HIST: 1989 c 282 art 2 s 27 

     144A.47 Information and referral services. 

    The commissioner shall ensure that information and referral 
 services relating to home care are available in all regions of 
 the state.  The commissioner shall collect and make available 
 information about available home care services, sources of 
 payment, providers, and the rights of consumers.  The 
 commissioner may require home care providers to provide 
 information requested for the purposes of this section as a 
 condition of registration or licensure.  The commissioner may 
 publish and make available: 

    (1) general information describing home care services in 
 the state; 

    (2) limitations on hours, availability of services, and 
 eligibility for third-party payments, applicable to individual 
 providers; and 

    (3) other information the commissioner determines to be 
 appropriate. 

    HIST: 1987 c 378 s 7; 1995 c 207 art 9 s 21 

     144A.48 Hospice programs. 

    Subdivision 1.    Definitions.  For the purposes of this 
 section, the following terms have the meanings given to them: 

    (1) "Core services" means physician services, registered 
 nursing services, medical social services, pastoral care or 
 other counseling services, and volunteer services that are 
 provided either directly by the hospice program or through a 
 service contract or other arrangement; 

    (2) "Hospice patient" means an individual who has been 
 diagnosed as terminally ill with a probable life expectancy of 
 under one year, as documented by the individual's attending 
 physician, and who alone or, when unable, through the hospice 
 patient's family has voluntarily consented to and received 
 admission to a hospice program; 

    (3) "Hospice patient's family" means relatives of the 
 hospice patient, the hospice patient's guardian, primary 
 caregivers, or persons identified by the hospice patient as 
 having significant personal ties; 

    (4) "Hospice program" means palliative and supportive care 
 and other services provided by an interdisciplinary team under 
 the direction of an identifiable hospice administration to 
 terminally ill hospice patients and their families to meet the 
 physical, nutritional, emotional, social, spiritual, and special 
 needs experienced during the final stages of illness, dying, and 
 bereavement, through a centrally coordinated program that 
 ensures continuity and consistency of home and inpatient care 
 provided directly or through an agreement; 

    (5) "Interdisciplinary team" means a group of qualified 
 individuals with expertise in meeting the special needs of 
 hospice patients and their families, including, at a minimum, 
 those individuals who are providers of core services; 

    (6) "Palliative care" means care directed at managing the 
 symptoms experienced by the hospice patient and intended to 
 enhance the quality of life for the hospice patient and the 
 patient's family, but not directed at curing the illness; 

    (7) "Residential hospice facility" means a facility that 
 houses no more than eight hospice patients, located in a 
 residential area in a facility that resembles a single-family 
 home, that directly provides 24-hour residential and support 
 services in a home-like setting for hospice patients as an 
 integral part of the continuum of home care provided by a 
 hospice licensed under subdivision 2; and 

    (8) "Volunteer services" means services by volunteers who 
 provide a personal presence that augments a variety of 
 professional and nonprofessional services available to the 
 hospice patient, the patient's family, and the hospice program.  

    Subd. 2.    License requirements.  A hospice program may 
 not operate in the state or use the words "hospice" or "hospice 
 program" without a current license issued by the commissioner of 
 health.  The commissioner shall license hospice programs using 
 the powers and authorities contained in sections 144A.43 to 
 144A.47.  In addition a hospice program must provide: 

    (1) centrally coordinated hospice core services in the home 
 and inpatient settings; 

    (2) that the medical components of the hospice program are 
 under the direction of a licensed physician who serves as 
 medical director; 

    (3) that the palliative medical care provided to a hospice 
 patient is under the direction of the attending physician; 

    (4) an interdisciplinary team that meets regularly to 
 develop, implement, and evaluate the hospice program's plan of 
 care for each hospice patient and the patient's family; 

    (5) accessible hospice care, 24 hours a day, seven days a 
 week; 

    (6) an ongoing system of quality assurance; 

    (7) that volunteer services are provided by individuals who 
 have completed a hospice training program and are qualified to 
 provide the services; 

    (8) a planned program of supportive services available to 
 patients' families during the bereavement period; and 

    (9) that inpatient services are provided directly or by 
 arrangement in a licensed hospital or nursing home. 

    Subd. 3.    Required inspections.  The commissioner 
 shall inspect the hospice program, the home care and the 
 inpatient care provided by the hospice program to determine if 
 the requirements of sections 144A.45 to 144A.48 are met. 

    Subd. 4.    Rule authority.  The commissioner shall 
 promulgate rules to implement the provisions of this section. 

    Subd. 5.    License designation.  A license issued to a 
 home care provider meeting the requirements contained in this 
 section shall indicate that the provider is qualified to offer 
 hospice care. 

    Subd. 6.    Residential hospice.  A hospice program may 
 operate a residential hospice facility for hospice patients if 
 it is: 

    (1) licensed as a hospice program under this section; 

    (2) licensed as a class B supervised living facility under 
 section 144.50, subdivision 6, provided that: 

    (i) the residential hospice facility is not required to 
 obtain a program license from the department of human services 
 under Minnesota Rules, part 4665.0700; and 

    (ii) for purposes of the State Building Code and State 
 Uniform Fire Code, the facility meets group R, division 3, 
 occupancy requirements for six or less persons and group R, 
 division 1, occupancy requirements for seven to eight persons; 
 and 

    (3) in compliance with the fire protection provisions of 
 chapter 21 of the 1988 Life Safety Code, NFPA 101, for 
 facilities housing persons with impractical evacuation 
 capabilities, as a minimum. 

    HIST: 1987 c 378 s 8; 1992 c 595 s 23,24; 1998 c 254 art 1 s 
 35 

  144A.49 Repealed, 1997 c 113 s 22 

     144A.51 Definitions. 

    Subdivision 1.   Scope.  For the purposes of sections 
 144A.51 to 144A.54, the terms defined in this section have the 
 meanings given them. 

    Subd. 2.    Administrative agency or agency.  
 "Administrative agency" or "agency" means any division, 
 official, or employee of a state or local governmental agency, 
 but does not include: 

    (a) Any member of the senate or house of representatives; 

    (b) The governor or personal staff of the governor; 

    (c) Any instrumentality of the federal government of the 
 United States; or 

    (d) Any court or judge. 

    Subd. 3.    Director.  "Director" means the director of 
 the office of health facility complaints. 

    Subd. 4.    Health care provider.  "Health care 
 provider" means any professional licensed by the state to 
 provide medical or health care services who does provide the 
 services to a resident of a health facility or a residential 
 care home. 

    Subd. 5.    Health facility.  "Health facility" means a 
 facility or that part of a facility which is required to be 
 licensed pursuant to sections 144.50 to 144.58, and a facility 
 or that part of a facility which is required to be licensed 
 under any law of this state which provides for the licensure of 
 nursing homes. 

    Subd. 6.    Resident.  "Resident" means any resident or 
 patient of a health facility or a residential care home, or a 
 consumer of services provided by a home care provider, or the 
 guardian or conservator of the resident, patient, or consumer, 
 if one has been appointed. 

    Subd. 7.    Home care provider.  "Home care provider" 
 means a home care provider as defined in section 144A.43, 
 subdivision 4. 

    HIST: 1976 c 325 s 1; 1986 c 444; 1987 c 378 s 9,10; 1987 c 
 384 art 2 s 1; 1991 c 292 art 2 s 12; 1992 c 513 art 6 s 12-14 

     144A.52 Office of health facility complaints. 

    Subdivision 1.    Creation; administration.  The office 
 of health facility complaints is hereby created in the 
 department of health.  The office shall be headed by a director 
 appointed by the state commissioner of health.  

    The commissioner of health shall provide the office of 
 health facility complaints with office space, administrative 
 services and secretarial and clerical assistance. 

    Subd. 2.    Staff.  The director may appoint a deputy 
 director and one personal secretary to discharge the 
 responsibilities of the office.  Any deputy director or personal 
 secretary and all other employees of the office shall be 
 classified employees of the state commissioner of health. 

    Subd. 3.    Duties; delegation.  The director may 
 delegate to members of the staff any of the authority or duties 
 of the director except the duty of formally making 
 recommendations to the legislature, administrative agencies, 
 health facilities, residential care homes, health care 
 providers, home care providers, and the state commissioner of 
 health. 

    Subd. 4.    Training.  The director shall attempt to 
 include staff persons with expertise in areas such as law, 
 health care, social work, dietary needs, sanitation, financial 
 audits, health-safety requirements as they apply to health 
 facilities, residential care homes, and any other relevant 
 fields.  To the extent possible, employees of the office shall 
 meet federal training requirements for health facility surveyors.

    HIST: 1976 c 325 s 2; 1977 c 305 s 45; 1982 c 560 s 48; 1986 c 
 444; 1987 c 378 s 11; 1991 c 238 art 1 s 8; 1992 c 513 art 6 s 
 15,16 

     144A.53 Director; powers and duties. 

    Subdivision 1.    Powers.  The director may: 

    (a) Promulgate by rule, pursuant to chapter 14, and within 
 the limits set forth in subdivision 2, the methods by which 
 complaints against health facilities, health care providers, 
 home care providers, or residential care homes, or 
 administrative agencies are to be made, reviewed, investigated, 
 and acted upon; provided, however, that a fee may not be charged 
 for filing a complaint. 

    (b) Recommend legislation and changes in rules to the state 
 commissioner of health, governor, administrative agencies or the 
 federal government. 

    (c) Investigate, upon a complaint or upon initiative of the 
 director, any action or failure to act by a health care 
 provider, home care provider, residential care home, or a health 
 facility. 

    (d) Request and receive access to relevant information, 
 records, incident reports, or documents in the possession of an 
 administrative agency, a health care provider, a home care 
 provider, a residential care home, or a health facility, and 
 issue investigative subpoenas to individuals and facilities for 
 oral information and written information, including privileged 
 information which the director deems necessary for the discharge 
 of responsibilities.  For purposes of investigation and securing 
 information to determine violations, the director need not 
 present a release, waiver, or consent of an individual.  The 
 identities of patients or residents must be kept private as 
 defined by section 13.02, subdivision 12. 

    (e) Enter and inspect, at any time, a health facility or 
 residential care home and be permitted to interview staff; 
 provided that the director shall not unduly interfere with or 
 disturb the provision of care and services within the facility 
 or home or the activities of a patient or resident unless the 
 patient or resident consents.  

    (f) Issue correction orders and assess civil fines pursuant 
 to section 144.653 or any other law which provides for the 
 issuance of correction orders to health facilities or home care 
 provider, or under section 144A.45.  A facility's or home's 
 refusal to cooperate in providing lawfully requested information 
 may also be grounds for a correction order. 

    (g) Recommend the certification or decertification of 
 health facilities pursuant to Title XVIII or XIX of the United 
 States Social Security Act. 

    (h) Assist patients or residents of health facilities or 
 residential care homes in the enforcement of their rights under 
 Minnesota law.  

    (i) Work with administrative agencies, health facilities, 
 home care providers, residential care homes, and health care 
 providers and organizations representing consumers on programs 
 designed to provide information about health facilities to the 
 public and to health facility residents.  

    Subd. 2.    Complaints.  The director may receive a 
 complaint from any source concerning an action of an 
 administrative agency, a health care provider, a home care 
 provider, a residential care home, or a health facility.  The 
 director may require a complainant to pursue other remedies or 
 channels of complaint open to the complainant before accepting 
 or investigating the complaint. 

    The director shall keep written records of all complaints 
 and any action upon them.  After completing an investigation of 
 a complaint, the director shall inform the complainant, the 
 administrative agency having jurisdiction over the subject 
 matter, the health care provider, the home care provider, the 
 residential care home, and the health facility of the action 
 taken. 

    Subd. 3.    Recommendations.  If, after duly considering 
 a complaint and whatever material the director deems pertinent, 
 the director determines that the complaint is valid, the 
 director may recommend that an administrative agency, a health 
 care provider, a home care provider, a residential care home, or 
 a health facility should: 

    (a) Modify or cancel the actions which gave rise to the 
 complaint; 

    (b) Alter the practice, rule or decision which gave rise to 
 the complaint; 

    (c) Provide more information about the action under 
 investigation; or 

    (d) Take any other step which the director considers 
 appropriate. 

    If the director requests, the administrative agency, a 
 health care provider, a home care provider, residential care 
 home, or health facility shall, within the time specified, 
 inform the director about the action taken on a recommendation. 

    Subd. 4.    Referral of complaints.  If a complaint 
 received by the director relates to a matter more properly 
 within the jurisdiction of an occupational licensing board or 
 other governmental agency, the director shall forward the 
 complaint to that agency and shall inform the complaining party 
 of the forwarding.  The agency shall promptly act in respect to 
 the complaint, and shall inform the complaining party and the 
 director of its disposition.  If a governmental agency receives 
 a complaint which is more properly within the jurisdiction of 
 the director, it shall promptly forward the complaint to the 
 director, and shall inform the complaining party of the 
 forwarding.  If the director has reason to believe that an 
 official or employee of an administrative agency, a home care 
 provider, residential care home, or health facility has acted in 
 a manner warranting criminal or disciplinary proceedings, the 
 director shall refer the matter to the state commissioner of 
 health, the commissioner of human services, an appropriate 
 prosecuting authority, or other appropriate agency. 

    HIST: 1976 c 325 s 3; 1977 c 305 s 45; 1982 c 424 s 130; 1983 
 c 289 s 98; 1984 c 654 art 5 s 58; 1986 c 444; 1987 c 209 s 31; 
 1987 c 378 s 12; 1991 c 286 s 11; 1991 c 292 art 2 s 13; 1992 c 
 513 art 6 s 17-20; 1997 c 7 art 2 s 17 

     144A.54 Publication of recommendations; reports. 

    Subdivision 1.    Director; duties.  Except as otherwise 
 provided by this section, the director may determine the form, 
 frequency, and distribution of the conclusions and 
 recommendations.  The director shall transmit the conclusions 
 and recommendations to the state commissioner of health.  Before 
 announcing a conclusion or recommendation that expressly or by 
 implication criticizes an administrative agency, a health care 
 provider, a home care provider, a residential care home, or a 
 health facility, the director shall consult with that agency, 
 health care provider, home care provider, home, or facility.  
 When publishing an opinion adverse to an administrative agency, 
 a health care provider, a home care provider, a residential care 
 home, or a health facility, the director shall include in the 
 publication any statement of reasonable length made to the 
 director by that agency, health care provider, home care 
 provider, residential care home, or health facility in defense 
 or explanation of the action. 

    Subd. 2.    Annual report.  In addition to whatever 
 other reports the director may make, the director shall, at the 
 end of each year, report to the state commissioner of health 
 concerning the exercise of the director's functions during the 
 preceding year.  The state commissioner of health may, at any 
 time, request and receive information, other than resident 
 records, from the director. 

    Subd. 3.    Confidentiality.  In performing the duties 
 under Laws 1976, chapter 325, the director shall preserve the 
 confidentiality of resident records.  The director may release a 
 resident's records with the written approval of the resident who 
 is the subject of the records. 

    HIST: 1976 c 325 s 4; 1977 c 305 s 45; 1986 c 444; 1987 c 378 
 s 13; 1992 c 513 art 6 s 21; 1997 c 7 art 2 s 18,19 

  144A.55 Repealed, 1983 c 260 s 68 

     144A.61 Nursing assistant training. 

    Subdivision 1.    Authority.  The commissioner of 
 health, in consultation with the commissioner of human services, 
 shall implement the provisions of Public Law Number 100-203, the 
 Omnibus Budget Reconciliation Act of 1987, that relate to 
 training and competency evaluation programs, testing, and the 
 establishment of a registry for nursing assistants in nursing 
 homes and boarding care homes certified for participation in the 
 medical assistance or Medicare programs.  The commissioner of 
 health may adopt permanent rules that may be necessary to 
 implement Public Law Number 100-203 and provisions of this 
 section.  The commissioner of health may contract with outside 
 parties for the purpose of implementing the provisions of this 
 section.  At the request of the commissioner, the board of 
 nursing may establish training and competency evaluation 
 standards; review, evaluate, and approve curricula; review and 
 approve training programs; and establish a registry of nursing 
 assistants. 

    Subd. 2.    Nursing assistants.  For the purposes of 
 this section and section 144A.611 "nursing assistant" means a 
 nursing home or certified boarding care home employee, including 
 a nurse's aide or an orderly, who is assigned by the director of 
 nursing to provide or assist in the provision of nursing or 
 nursing-related services under the supervision of a registered 
 nurse.  "Nursing assistant" includes nursing assistants employed 
 by nursing pool companies but does not include a licensed health 
 professional.  

    Subd. 3.    Curricula.  The chancellor of vocational 
 technical education shall develop curricula to be used for 
 nursing assistant training programs for employees of nursing 
 homes and boarding care homes.  

    Subd. 3a.    Competency evaluation program.  The 
 commissioner of health shall approve the competency evaluation 
 program.  A competency evaluation must be administered to 
 persons who desire to be listed in the nursing assistant 
 registry.  The tests may only be administered by technical 
 colleges, community colleges, or other organizations approved by 
 the department of health.  The commissioner of health shall 
 approve a nursing assistant for the registry without requiring a 
 competency evaluation if the nursing assistant is in good 
 standing on a nursing assistant registry in another state. 

    Subd. 4.    Technical assistance.  The chancellor of 
 vocational technical education shall, upon request, provide 
 necessary and appropriate technical assistance in the 
 development of nursing assistant training programs. 

    Subd. 5.  Repealed, 1977 c 326 s 18 

    Subd. 6. Repealed, 1989 c 282 art 3 s 98 

    Subd. 6a.    Nursing assistants hired in 1990 and after. 
  Each nursing assistant hired to work in a nursing home or in 
 a certified boarding care home on or after January 1, 1990, must 
 have successfully completed an approved competency evaluation 
 prior to employment or an approved nursing assistant training 
 program and competency evaluation within four months from the 
 date of employment. 

    Subd. 7.    Violation, penalty.  Violation of this 
 section by a nursing home or certified boarding care home shall 
 be grounds for the issuance of a correction order.  Under the 
 provisions of sections 144.653 or 144A.10, the failure of the 
 nursing home or certified boarding care home to comply with the 
 correction order shall result in the assessment of a fine in the 
 amount of $300. 

    Subd. 8.    Exceptions.  Employees of nursing homes 
 conducted in accordance with the teachings of the body known as 
 the Church of Christ, Scientist, shall be exempt from the 
 requirements of this section and section 144A.611. 

    HIST: 1976 c 310 s 1; 1977 c 305 s 45; 1977 c 326 s 6,7; 1977 
 c 453 s 26; 1981 c 359 s 17; 1987 c 258 s 12; 1989 c 246 s 2; 
 1989 c 282 art 3 s 28; 1990 c 375 s 3; 1991 c 286 s 12-14; 1992 
 c 513 art 6 s 22,23; 1993 c 5 s 1; 1997 c 7 art 1 s 75; 1997 c 
 203 art 3 s 14; 1999 c 210 s 1,2 

     144A.611 Reimbursable expenses payable to nursing 
  assistants. 

    Subdivision 1.    Nursing homes and certified boarding 
 care homes.  The actual costs of tuition and reasonable 
 expenses for the competency evaluation or the nursing assistant 
 training program and competency evaluation approved under 
 section 144A.61, which are paid to nursing assistants pursuant 
 to subdivision 2, are a reimbursable expense for nursing homes 
 and certified boarding care homes under the provisions of 
 chapter 256B and the rules promulgated thereunder. 

    Subd. 2.    Nursing assistants.  A nursing assistant who 
 has completed an approved competency evaluation or an approved 
 training program and competency evaluation shall be reimbursed 
 by the nursing home or certified boarding care home for actual 
 costs of tuition and reasonable expenses for the competency 
 evaluation or the training program and competency evaluation 90 
 days after the date of employment, or upon completion of the 
 approved training program, whichever is later. 

    Subd. 3.    Rules.  The commissioner of human services 
 shall promulgate any rules necessary to implement the provisions 
 of this section.  The rules shall include, but not be limited to:

    (a) Provisions designed to prevent reimbursement by the 
 commissioner under this section and section 144A.61 to a nursing 
 home, certified boarding care home, or nursing assistant for the 
 assistant's simultaneous training in more than one approved 
 program; 

    (b) Provisions designed to prevent reimbursement by the 
 commissioner under this section and section 144A.61 to more than 
 one nursing home or certified boarding care home for the 
 training of any individual nursing assistant; and 

    (c) Provisions permitting the reimbursement by the 
 commissioner to nursing homes, certified boarding care homes, 
 and nursing assistants for the retraining of a nursing assistant 
 after an absence from the labor market of not less than 24 
 months. 

    HIST: 1976 c 310 s 2; 1977 c 326 s 9; 1984 c 654 art 5 s 58; 
 1986 c 444; 1989 c 282 art 3 s 29; 1991 c 286 s 15,16 

  144A.612 Repealed, 1995 c 229 art 4 s 22 

  144A.65 MS 1980 Expired 

  144A.66 MS 1980 Expired 

  144A.67 MS 1980 Expired