2000 Minnesota Statutes

     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 45 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; 2000 c 294 s 
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