.................... moves to amend H.F. No. 3648 as follows:
Delete everything after the enacting clause and insert:
"Section 1. Minnesota Statutes 2006, section 144.0724, subdivision 7, is amended to
Subd. 7. Notice of resident reimbursement classification.
A facility must elect
1.6 between the options in clauses (1) and (2) to provide notice to a resident of the resident's
1.7 case mix classification.
The commissioner of health shall provide to a nursing facility a notice for
each resident of the reimbursement classification established under subdivision 1. The
notice must inform the resident of the classification that was assigned, the opportunity
to review the documentation supporting the classification, the opportunity to obtain
clarification from the commissioner, and the opportunity to request a reconsideration of the
classification. The commissioner must
send transmit the
notice of resident classification
first class mail electronic means to the nursing facility
. A nursing facility is responsible
for the distribution of the notice to each resident, to the person responsible for the payment
of the resident's nursing home expenses, or to another person designated by the resident.
This notice must be distributed within three working days after the facility's receipt of the
1.18electronic file of
notice of case mix classifications
from the commissioner of health.
(2) A facility may choose to provide a classification notice, as prescribed by the
1.20 commissioner of health, to a resident upon receipt of the confirmation of the case mix
1.21 classification calculated by a facility or a corrected case mix classification as indicated on
1.22 the final validation report from the commissioner. A nursing facility is responsible for
1.23 the distribution of the notice to each resident, to the person responsible for the payment
1.24 of the resident's nursing home expenses, or to another person designated by the resident.
1.25 This notice must be distributed within three working days after the facility's receipt of the
1.26 validation report from the commissioner. If a facility elects this option, the commissioner
1.27 of health shall provide the facility with a list of residents and their case mix classifications
2.1 as determined by the commissioner. A nursing facility may make this election to be
2.2 effective on the day of implementation of the revised case mix system.
2.3 (3) After implementation of the revised case mix system, a nursing facility shall
2.4 elect a notice of resident reimbursement classification procedure as described in clause
2.5 (1) or (2) by reporting to the commissioner of health, as prescribed by the commissioner.
2.6 The election is effective July 1.
(b) If a facility submits a correction to the most recent assessment used to establish
a case mix classification conducted under subdivision 3 that results in a change in case
mix classification, the facility shall give written notice to the resident or the resident's
representative about the item that was corrected and the reason for the correction. The
notice of corrected assessment may be provided at the same time that the resident or
resident's representative is provided the resident's corrected notice of classification.
Sec. 2. Minnesota Statutes 2006, section 144A.073, as amended by Laws 2007, chapter
147, article 7, section 1, is amended to read:
2.15144A.073 EXCEPTIONS TO THE MORATORIUM; REVIEW.
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
2.23 facility on an existing site an existing facility
with a total cost exceeding ten percent of the
appraised value of the facility or $200,000, whichever is less. A renovation may include
2.25the replacement or upgrade of existing mechanical or electrical systems.
(d) "Replacement" means the
demolition, delicensure, reconstruction, or construction
2.27 of an addition to all or part of an existing construction of a complete new
(e) "Addition" means the construction of new space to an existing facility.
"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.
2.31 (g) "Phased project" means a proposal that identifies construction occurring with
2.32more than one distinct completion date. To be considered a distinct completion, each phase
2.33must have construction that is ready for resident use, as determined by the commissioner,
2.34that is not dependent on similar commissioner approval for future phases of construction.
2.35The commissioner of human services shall only allow rate adjustments for construction
3.1projects in phases if the proposal from a facility identifies construction in phases and each
3.2phase can be approved for use independent of the other phases.
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 commissioner shall publish in the State Register a request for proposals for nursing
home and certified boarding care home
to be licensed or certified under section
3.7 144A.071, subdivision 4a , clause (c) for conversion, relocation, renovation, replacement,
3.8upgrading, or addition
. The public notice of this funding and the request for proposals
must specify how the approval criteria will be prioritized by the commissioner. The notice
must describe the information that must accompany a request and state that proposals
must be submitted to the commissioner within
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.
3.14 money is appropriated for a year, the commissioner shall publish a notice to that effect,
3.15 and no proposals shall be requested.
If money is appropriated, the commissioner shall
initiate the application and review process described in this section at least
and up to four times each biennium, according to dates established by
3.18 rule. Authorized funds shall be allocated proportionally to the number of processes
3.19second application and review process must occur if remaining funds are either greater
3.20than $300,000 or more than 50 percent of the baseline appropriation for the biennium.
3.21Authorized funds may be awarded in full in the first review process of the biennium.
funds not encumbered
by an earlier process
within a biennium shall carry
subsequent iterations of the process. Authorization for expenditures does not
3.24 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,
(2) a description of the
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
3.31 required to exceed the cost threshold referred to in section
144A.071, subdivision 1 , to be
3.32 considered under this section proposed project
initial construction and remodeling costs;
site preparation costs;
3.35(iii) equipment and
the current estimated long-term financing costs of
the proposal, which
consists of is to include details of any proposed funding mechanism
4.3already arranged or being considered, including
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,
completed marketing study or underwriting review; and
estimated operating costs during the first two years after completion of the
(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
(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
(9) the proposed relocation plan for current residents if beds are to be closed
4.18 the Department of Human Services can estimate the total costs of a proposal according
4.19to section 144A.161
(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
commissioner of health may grant exceptions to the nursing home licensure or certification
moratorium for proposals that satisfy the requirements of this section. The commissioner
of health shall approve or disapprove a project. The commissioner of health shall base
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).
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
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
, 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
commissioner 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 commissioner, in consultation with
the commissioner of human services, shall evaluate proposals according to subdivision 4,
clauses (1), (2),
(3), and (9)
and other criteria established in rule. The commissioner
shall approve or disapprove a project within 90 days. 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. 3d. Project amendment authorized. Notwithstanding the provisions of
5.35 subdivision 3b:
6.1 (1) the commissioner may approve a request by a nursing facility located in the city
6.2 of Duluth with 48 licensed beds as of January 1, 2005, that received approval under this
6.3 section in 2002 for a moratorium exception project for amendment of the project design
6.5 (i) reduces the total amount of common space devoted to resident and family uses by
6.6 more than five percent if the total amount of common space in the facility, including that
6.7 added by the project, is at least 175 percent of the state requirement for common space; and
6.8 (ii) reduces the space for no more than two residents' living areas by increasing the
6.9 size of a majority of the single-bed rooms from the size in the project design as originally
6.10 approved and converting two single-bed rooms in the project design as originally
6.11 approved to one semi-private room; and
6.12 (2) the commissioner may approve a request by a nursing facility located in the city
6.13 of Duluth with 129 licensed beds as of January 1, 2005, that received approval under this
6.14 section in 2002 for a moratorium exception project for amendment of the project design
6.16 (i) reduces the total amount of common space devoted to resident and family uses by
6.17 more than five percent if the total amount of common space in the facility, including that
6.18 added by the project, is at least 175 percent of the state requirement for common space; and
6.19 (ii) reduces the space for no more than four residents' living areas by increasing the
6.20 size of a majority of the single-bed rooms from the size in the project design as originally
6.21 approved and converting four single-bed rooms in the project design as originally
6.22 approved to two semi-private rooms; and
6.23 (3) the amended project designs in clauses (1) and (2) must provide solutions to all
6.24 of the problems addressed by the original application that are at least as effective as the
6.25 original solutions.
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 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
7.2 the year 2000 by the state demographer, and according to items (i) to (iv): using data
7.3published according to requirements in section 144A.351;
7.4 (i) reduce beds in counties where the supply is high, relative to the statewide mean,
7.5 and increase beds in counties where the supply is low, relative to the statewide mean;
7.6 (ii) adjust the bed supply so as to create the greatest benefits in improving the
7.7 distribution of beds;
7.8 (iii) adjust the existing bed supply in counties so that the bed supply in a county
7.9 moves toward the statewide mean; and
7.10 (iv) adjust the existing bed supply so that the distribution of beds as projected for the
7.11 year 2020 would be consistent with projected need, based on the methodology outlined in
7.12 the Interagency Long-Term Care Committee's 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;
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;
(8) the extent to which the project increases the number of private or single bed
(9) the extent to which the applicant demonstrates the continuing need for nursing
facility care in the community and adjacent communities; and
(10) 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 and cost
report of the
Health Human Services
(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 licensure
(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
9.6 facility must be greater than 96 percent according to the most recent annual statistical
9.7 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
9.11 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.
Subd. 10. Extension of approval of moratorium exception. Notwithstanding
9.18 subdivision 3, the commissioner of health shall extend project approval for an additional
9.19 36 months for any proposed exception to the nursing home licensure and certification
9.20 moratorium if the proposal was approved under this section between July 1, 2001, and
9.21 June 30, 2003.
Subd. 11. Funding from expired and canceled proposals.
The commissioner shall
monitor the status of projects approved under this section to identify, in consultation
with each facility with an approved project, if projects will be canceled or will expire.
For projects that have been canceled or have expired, if originally approved after June 30,
2001, the commissioner's approval authority for the estimated annual state cost to medical
assistance shall carry forward and shall be available for the issuance of a new moratorium
round later in that fiscal year or in either of the following two fiscal years.
Sec. 3. Minnesota Statutes 2006, section 144A.11, subdivision 2, is amended to read:
Subd. 2. Mandatory proceedings. (a)
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.
10.3 (b) Notwithstanding paragraph (a), the commissioner is not required to revoke,
10.4suspend, or refuse to renew a facility's license if the facility corrects the violation.
10.5EFFECTIVE DATE.This section is effective the day following final enactment.
Amend the title accordingly