2006 Minnesota Statutes

144A.37 ALTERNATIVE NURSING HOME SURVEY PROCESS.
    Subdivision 1. Alternative nursing home survey schedules. (a) The commissioner of
health shall implement alternative procedures for the nursing home survey process as authorized
under this section.
(b) These alternative survey process procedures seek to: (1) use department resources more
effectively and efficiently to target problem areas; (2) use other existing or new mechanisms to
provide objective assessments of quality and to measure quality improvement; (3) provide for
frequent collaborative interaction of facility staff and surveyors rather than a punitive approach;
and (4) reward a nursing home that has performed very well by extending intervals between
full surveys.
(c) The commissioner shall pursue changes in federal law necessary to accomplish this
process and shall apply for any necessary federal waivers or approval. If a federal waiver is
approved, the commissioner shall promptly submit, to the house and senate committees with
jurisdiction over health and human services policy and finance, fiscal estimates for implementing
the alternative survey process waiver. The commissioner shall also pursue any necessary federal
law changes during the 107th Congress.
(d) The alternative nursing home survey schedule and related educational activities shall not
be implemented until funding is appropriated by the legislature.
    Subd. 2. Survey intervals. The commissioner of health must extend the time period between
standard surveys up to 30 months based on the criteria established in subdivision 4. In using the
alternative survey schedule, the requirement for the statewide average to not exceed 12 months
does not apply.
    Subd. 3. Compliance history. The commissioner shall develop a process for identifying
the survey cycles for skilled nursing facilities based upon the compliance history of the facility.
This process can use a range of months for survey intervals. At a minimum, the process must
be based on information from the last two survey cycles and shall take into consideration any
deficiencies issued as the result of a survey or a complaint investigation during the interval. A
skilled nursing facility with a finding of substandard quality of care or a finding of immediate
jeopardy is not entitled to a survey interval greater than 12 months. The commissioner shall alter
the survey cycle for a specific skilled nursing facility based on findings identified through the
completion of a survey, a monitoring visit, or a complaint investigation. The commissioner must
also take into consideration information other than the facility's compliance history.
    Subd. 4. Criteria for survey interval classification. (a) The commissioner shall provide
public notice of the classification process and shall identify the selected survey cycles for each
skilled nursing facility. The classification system must be based on an analysis of the findings
made during the past two standard survey intervals, but it only takes one survey or complaint
finding to modify the interval.
(b) The commissioner shall also take into consideration information obtained from residents
and family members in each skilled nursing facility and from other sources such as employees
and ombudsmen in determining the appropriate survey intervals for facilities.
    Subd. 5. Required monitoring. (a) The commissioner shall conduct at least one monitoring
visit on an annual basis for every skilled nursing facility which has been selected for a survey
cycle greater than 12 months. The commissioner shall develop protocols for the monitoring visits
which shall be less extensive than the requirements for a standard survey. The commissioner shall
use the criteria in paragraph (b) to determine whether additional monitoring visits to a facility
will be required.
(b) The criteria shall include, but not be limited to, the following:
(1) changes in ownership, administration of the facility, or direction of the facility's nursing
service;
(2) changes in the facility's quality indicators which might evidence a decline in the facility's
quality of care;
(3) reductions in staffing or an increase in the utilization of temporary nursing personnel; and
(4) complaint information or other information that identifies potential concerns for the
quality of the care and services provided in the skilled nursing facility.
    Subd. 6. Facilities not approved for extended survey intervals. The commissioner shall
establish a process for surveying and monitoring of facilities which require a survey interval of
less than 15 months. This information shall identify the steps that the commissioner must take to
monitor the facility in addition to the standard survey.
    Subd. 7. Impact on survey agency's budget. The implementation of an alternative survey
process for the state must not result in any reduction of funding that would have been provided to
the state survey agency for survey and enforcement activity based upon the completion of full
standard surveys for each skilled nursing facility in the state.
    Subd. 8. Educational activities. The commissioner shall expand the state survey agency's
ability to conduct training and educational efforts for skilled nursing facilities, residents and
family members, residents and family councils, long-term care ombudsman programs, and the
general public.
    Subd. 9. Evaluation. The commissioner shall develop a process for the evaluation of the
effectiveness of an alternative survey process conducted under this section.
History: 1Sp2001 c 9 art 5 s 13; 2002 c 379 art 1 s 113