1.1.................... moves to amend H.F. No. 927, the A11-0177 amendment, as follows:
1.2Page 267, delete section 40, and insert:

1.3    "Sec. 40. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
1.4    Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
1.5medical assistance payments unless it refrains from all of the following:
1.6(a) Charging private paying residents rates for similar services which exceed those
1.7which are approved by the state agency for medical assistance recipients as determined by
1.8the prospective desk audit rate, except under the following circumstances:
1.9(1) the nursing facility may:
1.10(1) (i) charge private paying residents a higher rate for a private room,; and
1.11(2) (ii) charge for special services which are not included in the daily rate if medical
1.12assistance residents are charged separately at the same rate for the same services in
1.13addition to the daily rate paid by the commissioner.;
1.14(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge
1.15private paying residents rates up to two percent higher than the allowable payment rate
1.16determined by the commissioner for the RUGS group currently assigned to the resident;
1.17(3) effective October 1, 2012, through September 30, 2013, nursing facilities
1.18may charge private paying residents rates up to four percent higher than the allowable
1.19payment rate determined by the commissioner for the RUGS group currently assigned
1.20to the resident;
1.21(4) effective October 1, 2013, through September 30, 2014, nursing facilities may
1.22charge private paying residents rates up to six percent higher than the allowable payment
1.23rate determined by the commissioner for the RUGS group currently assigned to the
1.25(5) effective October 1, 2014, nursing facilities may charge private paying
1.26residents up to eight percent higher than the allowable payment rate determined by the
1.27commissioner for the RUGS group currently assigned to the resident; and
2.1(6) the higher private pay charges allowed in this paragraph shall be limited to actual
2.2costs per resident day, as determined by the commissioner, based on data provided in the
2.3statistical and cost report in section 256B.441.
2.4Nothing in this section precludes a nursing facility from charging a rate allowable
2.5under the facility's single room election option under Minnesota Rules, part 9549.0060,
2.6subpart 11. Services covered by the payment rate must be the same regardless of payment
2.7source. Special services, if offered, must be available to all residents in all areas of the
2.8nursing facility and charged separately at the same rate. Residents are free to select
2.9or decline special services. Special services must not include services which must be
2.10provided by the nursing facility in order to comply with licensure or certification standards
2.11and that if not provided would result in a deficiency or violation by the nursing facility.
2.12Services beyond those required to comply with licensure or certification standards must
2.13not be charged separately as a special service if they were included in the payment rate for
2.14the previous reporting year. A nursing facility that charges a private paying resident a rate
2.15in violation of this clause is subject to an action by the state of Minnesota or any of its
2.16subdivisions or agencies for civil damages. A private paying resident or the resident's legal
2.17representative has a cause of action for civil damages against a nursing facility that charges
2.18the resident rates in violation of this clause. The damages awarded shall include three
2.19times the payments that result from the violation, together with costs and disbursements,
2.20including reasonable attorneys' fees or their equivalent. A private paying resident or the
2.21resident's legal representative, the state, subdivision or agency, or a nursing facility may
2.22request a hearing to determine the allowed rate or rates at issue in the cause of action.
2.23Within 15 calendar days after receiving a request for such a hearing, the commissioner
2.24shall request assignment of an administrative law judge under sections 14.48 to 14.56 to
2.25conduct the hearing as soon as possible or according to agreement by the parties. The
2.26administrative law judge shall issue a report within 15 calendar days following the close
2.27of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed
2.28as boarding care facilities which are not certified as skilled or intermediate care facilities
2.29level I or II for reimbursement through medical assistance.
2.30(b) Fifty percent of the money resulting from the allowable private pay rate
2.31increases under paragraph (a) must be used for increases in compensation-related costs for
2.32employees directly employed by the nursing facility on or after the effective date of the
2.33rate adjustment, except:
2.34(1) the administrator;
2.35(2) persons employed in the central office of a corporation that has an ownership
2.36interest in the nursing facility or exercises control over the nursing facility; and
3.1(3) persons paid by the nursing facility under a management contract.
3.2(c) The wage adjustment that employees receive under this paragraph must be paid
3.3as an equal hourly wage increase for all eligible employees. All wage increases under
3.4this paragraph must be effective on the same date. This paragraph shall not apply to
3.5employees covered by a collective bargaining agreement.
3.6(d) The commissioner shall allow as compensation-related costs all costs for:
3.7(1) wages and salaries; and
3.8(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
3.10(e) Nursing facilities may apply for the portion of the rate adjustment under
3.11paragraph (a) that is subject to the requirements in paragraphs (b) and (c). The application
3.12must be submitted to the commissioner at least three months prior to the intended effective
3.13date of the private pay rate adjustment. The commissioner must respond to all applications
3.14within three weeks of receipt. The commissioner may waive the deadlines in this
3.15paragraph under extraordinary circumstances, to be determined at the sole discretion of
3.16the commissioner. The application must contain:
3.17(1) an estimate of the amounts of money that must be used as specified in paragraphs
3.18(b) and (c);
3.19(2) a statement of the amount of the wage increases the nursing facility will
3.20implement to use the funds available in clause (1) and a calculation demonstrating the
3.21estimated costs of the wage increases;
3.22(3) a description of how the nursing facility will notify eligible employees of
3.23the contents of the approved application, which must provide for giving each eligible
3.24employee a copy of the approved application, excluding the information required in clause
3.25(1), or posting a copy of the approved application, excluding the information required in
3.26clause (1), for a period of at least six weeks in an area of the nursing facility to which all
3.27eligible employees have access; and
3.28(4) instructions for employees who believe they have not received the wage
3.29increases specified in clause (2), as approved by the commissioner, and which must
3.30include a mailing address, e-mail address, and the telephone number that may be used by
3.31the employee to contact the commissioner or the commissioner's representative.
3.32(f) The commissioner shall ensure that cost increases in distribution plans under
3.33paragraph (f), clause (2), that may be included in approved applications, comply with the
3.34following requirements:
3.35(1) costs to be incurred during the applicable rate year resulting from wage and
3.36salary increases effective after October 1 of the previous rate year, and prior to the first
4.1day of the nursing facility's payroll period that includes October 1 of the current rate
4.2year, shall be allowed;
4.3(2) a portion of the costs resulting from tenure-related wage or salary increases
4.4may be considered to be allowable wage increases, according to formulas that the
4.5commissioner shall provide, where employee retention is above the average statewide rate
4.6of retention of direct care employees; and
4.7(3) for nursing facilities in which employees are represented by an exclusive
4.8bargaining representative, the commissioner shall approve the application only upon
4.9receipt of a letter of acceptance of the distribution plan, in regard to members of the
4.10bargaining unit, signed by the exclusive bargaining agent and dated after June 1 of the
4.11rate year in which the rate adjustment occurs. Upon receipt of the letter of acceptance, the
4.12commissioner shall deem all requirements of this section as having been met in regard to
4.13the members of the bargaining unit.
4.14(g)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
4.15to the facility, or from anyone acting in behalf of the applicant, as a condition of
4.16admission, expediting the admission, or as a requirement for the individual's continued
4.17stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
4.18as payment under the state plan. For residents on medical assistance, medical assistance
4.19payment according to the state plan must be accepted as payment in full for continued
4.20stay, except where otherwise provided for under statute;
4.21(2) requiring an individual, or anyone acting in behalf of the individual, to loan
4.22any money to the nursing facility;
4.23(3) requiring an individual, or anyone acting in behalf of the individual, to promise
4.24to leave all or part of the individual's estate to the facility; or
4.25(4) requiring a third-party guarantee of payment to the facility as a condition of
4.26admission, expedited admission, or continued stay in the facility.
4.27Nothing in this paragraph would prohibit discharge for nonpayment of services in
4.28accordance with state and federal regulations.
4.29(c) (h) Requiring any resident of the nursing facility to utilize a vendor of health
4.30care services chosen by the nursing facility. A nursing facility may require a resident
4.31to use pharmacies that utilize unit dose packing systems approved by the Minnesota
4.32Board of Pharmacy, and may require a resident to use pharmacies that are able to meet
4.33the federal regulations for safe and timely administration of medications such as systems
4.34with specific number of doses, prompt delivery of medications, or access to medications
4.35on a 24-hour basis. Notwithstanding the provisions of this paragraph, nursing facilities
5.1shall not restrict a resident's choice of pharmacy because the pharmacy utilizes a specific
5.2system of unit dose drug packing.
5.3(d) (i) Providing differential treatment on the basis of status with regard to public
5.5(e) (j) Discriminating in admissions, services offered, or room assignment on the
5.6basis of status with regard to public assistance or refusal to purchase special services.
5.7Discrimination in admissions discrimination, services offered, or room assignment shall
5.8include, but is not limited to:
5.9(1) basing admissions decisions upon assurance by the applicant to the nursing
5.10facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
5.11nor will seek information or assurances regarding current or future eligibility for public
5.12assistance for payment of nursing facility care costs; and
5.13(2) engaging in preferential selection from waiting lists based on an applicant's
5.14ability to pay privately or an applicant's refusal to pay for a special service.
5.15The collection and use by a nursing facility of financial information of any applicant
5.16pursuant to a preadmission screening program established by law shall not raise an
5.17inference that the nursing facility is utilizing that information for any purpose prohibited
5.18by this paragraph.
5.19(f) (k) Requiring any vendor of medical care as defined by section 256B.02,
5.20subdivision 7
, who is reimbursed by medical assistance under a separate fee schedule,
5.21to pay any amount based on utilization or service levels or any portion of the vendor's
5.22fee to the nursing facility except as payment for renting or leasing space or equipment
5.23or purchasing support services from the nursing facility as limited by section 256B.433.
5.24All agreements must be disclosed to the commissioner upon request of the commissioner.
5.25Nursing facilities and vendors of ancillary services that are found to be in violation of
5.26this provision shall each be subject to an action by the state of Minnesota or any of its
5.27subdivisions or agencies for treble civil damages on the portion of the fee in excess of that
5.28allowed by this provision and section 256B.433. Damages awarded must include three
5.29times the excess payments together with costs and disbursements including reasonable
5.30attorney's fees or their equivalent.
5.31(g) (l) Refusing, for more than 24 hours, to accept a resident returning to the same
5.32bed or a bed certified for the same level of care, in accordance with a physician's order
5.33authorizing transfer, after receiving inpatient hospital services.
5.34(m) For a period not to exceed 180 days, the commissioner may continue to make
5.35medical assistance payments to a nursing facility or boarding care home which is in
5.36violation of this section if extreme hardship to the residents would result. In these cases
6.1the commissioner shall issue an order requiring the nursing facility to correct the violation.
6.2The nursing facility shall have 20 days from its receipt of the order to correct the violation.
6.3If the violation is not corrected within the 20-day period the commissioner may reduce
6.4the payment rate to the nursing facility by up to 20 percent. The amount of the payment
6.5rate reduction shall be related to the severity of the violation and shall remain in effect
6.6until the violation is corrected. The nursing facility or boarding care home may appeal the
6.7commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
6.8cases. An appeal shall be considered timely if written notice of appeal is received by the
6.9commissioner within 20 days of notice of the commissioner's proposed action.
6.10In the event that the commissioner determines that a nursing facility is not eligible
6.11for reimbursement for a resident who is eligible for medical assistance, the commissioner
6.12may authorize the nursing facility to receive reimbursement on a temporary basis until the
6.13resident can be relocated to a participating nursing facility.
6.14Certified beds in facilities which do not allow medical assistance intake on July 1,
6.151984, or after shall be deemed to be decertified for purposes of section 144A.071 only. "
6.16Renumber the sections in sequence and correct the internal references
6.17Amend the title accordingly