1.1                          A bill for an act
  1.2             relating to health; modifying the nursing facility 
  1.3             survey process; establishing a quality improvement 
  1.4             program; requiring annual quality improvement reports; 
  1.5             requiring the commissioner of health to seek federal 
  1.6             waivers and approvals; amending Minnesota Statutes 
  1.7             2002, sections 144A.10, subdivision 1a, by adding a 
  1.8             subdivision; 256.01, by adding a subdivision; 
  1.9             proposing coding for new law in Minnesota Statutes, 
  1.10            chapter 144A. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 2002, section 144A.10, 
  1.13  subdivision 1a, is amended to read: 
  1.14     Subd. 1a.  [TRAINING AND EDUCATION FOR NURSING FACILITY 
  1.15  PROVIDERS.] The commissioner of health must establish and 
  1.16  implement a prescribed process and program for providing 
  1.17  training and education to providers licensed by the Department 
  1.18  of Health, ~~either by itself or~~ in conjunction with the industry 
  1.19  trade associations, before using any new regulatory guideline, 
  1.20  regulation, interpretation, program letter or memorandum, or any 
  1.21  other materials used in surveyor training to survey licensed 
  1.22  providers.  The process should include, but is not limited to, 
  1.23  the following key components: 
  1.24     (1) facilitate the implementation of immediate revisions to 
  1.25  any course curriculum for nursing assistants which reflect any 
  1.26  new standard of care practice that has been adopted or 
  1.27  referenced by the Health Department concerning the issue in 
  1.28  question; 
  2.1      (2) conduct training of long-term care providers and health 
  2.2   department survey inspectors ~~either~~ jointly ~~or during the same~~ 
  2.3   ~~time frame~~ on the department's new expectations; and 
  2.4      (3) ~~within available resources~~ the commissioner shall 
  2.5   ~~cooperate in the development of clinical standards, work with~~ 
  2.6   ~~vendors of supplies and services regarding hazards, and identify~~ 
  2.7   ~~research of interest to the long-term care community~~ consult 
  2.8   with experts in the field to develop or make available training 
  2.9   resources on current standards of practice and the use of 
  2.10  technology.  
  2.11     Sec. 2.  Minnesota Statutes 2002, section 144A.10, is 
  2.12  amended by adding a subdivision to read: 
  2.13     Subd. 17.  [AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL 
  2.14  REPORT ON SURVEY PROCESS.] (a) The commissioner shall establish 
  2.15  a quality improvement program for the nursing facility survey 
  2.16  and complaint processes.  The commissioner must regularly 
  2.17  consult with consumers, consumer advocates, and representatives 
  2.18  of the nursing home industry and representatives of nursing home 
  2.19  employees in implementing the program.  The commissioner, 
  2.20  through the quality improvement program, shall submit to the 
  2.21  legislature an annual survey and certification quality 
  2.22  improvement report, beginning December 15, 2004, and each 
  2.23  December 15 thereafter.  
  2.24     (b) The report must include, but is not limited to, an 
  2.25  analysis of: 
  2.26     (1) the number, scope, and severity of citations by region 
  2.27  within the state; 
  2.28     (2) cross-referencing of citations by region within the 
  2.29  state and between states within the Centers for Medicare and 
  2.30  Medicaid Services region in which Minnesota is located; 
  2.31     (3) the number and outcomes of independent dispute 
  2.32  resolutions; 
  2.33     (4) the number and outcomes of appeals; 
  2.34     (5) compliance with timelines for survey revisits and 
  2.35  complaint investigations; 
  2.36     (6) techniques of surveyors in investigations, 
  3.1   communication, and documentation to identify and support 
  3.2   citations; 
  3.3      (7) compliance with timelines for providing facilities with 
  3.4   completed statements of deficiencies; and 
  3.5      (8) other survey statistics relevant to improving the 
  3.6   survey process. 
  3.7      (c) The report must also identify and explain 
  3.8   inconsistencies and patterns across regions of the state, 
  3.9   include analyses and recommendations for quality improvement 
  3.10  areas identified by the commissioner, consumers, consumer 
  3.11  advocates, and representatives of the nursing home industry and 
  3.12  nursing home employees, and provide action plans to address 
  3.13  problems that are identified. 
  3.14     Sec. 3.  [144A.101] [PROCEDURES FOR FEDERALLY REQUIRED 
  3.15  SURVEY PROCESS.] 
  3.16     Subdivision 1.  [APPLICABILITY.] This section applies to 
  3.17  survey certification and enforcement activities by the 
  3.18  commissioner related to regular, expanded, or extended surveys 
  3.19  under Code of Federal Regulations, title 42, part 488. 
  3.20     Subd. 2.  [STATEMENT OF DEFICIENCIES.] The commissioner 
  3.21  shall provide nursing facilities with draft statements of 
  3.22  deficiencies at the time of the survey exit process and shall 
  3.23  provide facilities with completed statements of deficiencies 
  3.24  within 15 working days of the exit process. 
  3.25     Subd. 3.  [SURVEYOR NOTES.] The commissioner, upon the 
  3.26  request of a nursing facility, shall provide the facility with 
  3.27  copies of formal surveyor notes taken during the survey, with 
  3.28  the exception of the resident, family, and staff interviews, at 
  3.29  the time the completed statement of deficiency is provided to 
  3.30  the facility.  The survey notes shall be redacted to protect the 
  3.31  confidentiality of individuals providing information to the 
  3.32  surveyors.  A facility requesting formal surveyor notes must 
  3.33  agree to pay the commissioner for the cost of copying and 
  3.34  redacting. 
  3.35     Subd. 4.  [POSTING OF STATEMENTS OF DEFICIENCIES.] The 
  3.36  commissioner, when posting statements of a nursing facility's 
  4.1   deficiencies on the agency Web site, must include in the posting 
  4.2   the facility's response to the citations.  The Web site must 
  4.3   also include the dates upon which deficiencies are corrected and 
  4.4   the date upon which a facility is considered to be in compliance 
  4.5   with survey requirements.  If deficiencies are under dispute, 
  4.6   the commissioner must note this on the Web site using a method 
  4.7   that clearly identifies for consumers which citations are under 
  4.8   dispute. 
  4.9      Subd. 5.  [SURVEY REVISITS.] The commissioner shall conduct 
  4.10  survey revisits within 15 calendar days of the date by which 
  4.11  corrections will be completed, as specified by the provider in 
  4.12  its plan of correction, in cases where category 2 or category 3 
  4.13  remedies are in place.  The commissioner may conduct survey 
  4.14  revisits by telephone or written communications for facilities 
  4.15  at which the highest scope and severity score for a violation 
  4.16  was level E or lower. 
  4.17     Subd. 6.  [FAMILY COUNCILS.] Nursing facility family 
  4.18  councils shall be interviewed as part of the survey process and 
  4.19  invited to participate in the exit conference. 
  4.20     Sec. 4.  Minnesota Statutes 2002, section 256.01, is 
  4.21  amended by adding a subdivision to read: 
  4.22     Subd. 21.  [INTERAGENCY AGREEMENT WITH DEPARTMENT OF 
  4.23  HEALTH.] The commissioner of human services shall amend the 
  4.24  interagency agreement with the commissioner of health to certify 
  4.25  nursing facilities for participation in the medical assistance 
  4.26  program, to require the commissioner of health, as a condition 
  4.27  of the agreement, to comply beginning July 1, 2005, with action 
  4.28  plans included in the annual survey and certification quality 
  4.29  improvement report required under section 144A.10, subdivision 
  4.30  17. 
  4.31     Sec. 5.  [PROGRESS REPORT.] 
  4.32     The commissioner of health shall include in the December 
  4.33  15, 2004, quality improvement report required under section 2 a 
  4.34  progress report and implementation plan for the following 
  4.35  legislatively directed activities: 
  4.36     (1) an analysis of the frequency of defensive documentation 
  5.1   and a plan, developed in consultation with the nursing home 
  5.2   industry, consumers, unions representing nursing home employees, 
  5.3   and advocates, to minimize defensive documentation; 
  5.4      (2) the nursing home providers workgroup established under 
  5.5   Laws 2003, First Special Session chapter 14, article 13c, 
  5.6   section 3; and 
  5.7      (3) progress in implementing the independent informal 
  5.8   dispute resolution process required under section 144A.10, 
  5.9   subdivision 16. 
  5.10     Sec. 6.  [RESUBMITTAL OF REQUESTS FOR FEDERAL WAIVERS AND 
  5.11  APPROVALS.] 
  5.12     (a) The commissioner of health shall seek federal waivers, 
  5.13  approvals, and law changes necessary to implement the 
  5.14  alternative nursing home survey process established under 
  5.15  Minnesota Statutes, section 144A.37. 
  5.16     (b) The commissioner of health shall seek changes in the 
  5.17  federal policy that mandates the imposition of federal sanctions 
  5.18  without providing an opportunity for a nursing facility to 
  5.19  correct deficiencies, solely as the result of previous 
  5.20  deficiencies issued to the nursing facility.