1.1                          A bill for an act 
  1.2             relating to health; modifying requirements relating to 
  1.3             home care providers and elderly housing with services 
  1.4             establishments; providing for licensure of elderly 
  1.5             housing with services home care providers; amending 
  1.6             Minnesota Statutes 1996, sections 144A.43, subdivision 
  1.7             4; 144A.45, subdivision 1; and 144A.46, subdivision 1; 
  1.8             proposing coding for new law in Minnesota Statutes, 
  1.9             chapter 144A. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 1996, section 144A.43, 
  1.12  subdivision 4, is amended to read: 
  1.13     Subd. 4.  [HOME CARE PROVIDER.] "Home care provider" means 
  1.14  an individual, organization, association, corporation, unit of 
  1.15  government, or other entity that is regularly engaged in the 
  1.16  delivery, directly or by contractual arrangement, of home care 
  1.17  services for a fee.  At least one home care service must be 
  1.18  provided directly, although additional home care services may be 
  1.19  provided by contractual arrangements.  "Home care provider" 
  1.20  includes a hospice program defined in section 144A.48.  "Home 
  1.21  care provider" does not include: 
  1.22     (1) any home care or nursing services conducted by and for 
  1.23  the adherents of any recognized church or religious denomination 
  1.24  for the purpose of providing care and services for those who 
  1.25  depend upon spiritual means, through prayer alone, for healing; 
  1.26     (2) an individual who only provides services to a relative; 
  1.27     (3) an individual not connected with a home care provider 
  2.1   who provides assistance with home management services or 
  2.2   personal care needs if the assistance is provided primarily as a 
  2.3   contribution and not as a business; 
  2.4      (4) an individual not connected with a home care provider 
  2.5   who shares housing with and provides primarily housekeeping or 
  2.6   homemaking services to an elderly or disabled person in return 
  2.7   for free or reduced-cost housing; 
  2.8      (5) an individual or agency providing home-delivered meal 
  2.9   services; 
  2.10     (6) an agency providing senior companion services and other 
  2.11  older American volunteer programs established under the Domestic 
  2.12  Volunteer Service Act of 1973, Public Law Number 98-288; 
  2.13     (7) an employee of a nursing home licensed under this 
  2.14  chapter or an employee of a boarding care home licensed under 
  2.15  sections 144.50 to 144.56 who provides emergency services to 
  2.16  individuals residing in an apartment unit attached to or other 
  2.17  residential setting that is on the same campus as the nursing 
  2.18  home or boarding care home; 
  2.19     (8) a member of a professional corporation organized under 
  2.20  sections 319A.01 to 319A.22 that does not regularly offer or 
  2.21  provide home care services as defined in subdivision 3; 
  2.22     (9) the following organizations established to provide 
  2.23  medical or surgical services that do not regularly offer or 
  2.24  provide home care services as defined in subdivision 3:  a 
  2.25  business trust organized under sections 318.01 to 318.04, a 
  2.26  nonprofit corporation organized under chapter 317A, a 
  2.27  partnership organized under chapter 323, or any other entity 
  2.28  determined by the commissioner; 
  2.29     (10) an individual or agency that provides medical supplies 
  2.30  or durable medical equipment, except when the provision of 
  2.31  supplies or equipment is accompanied by a home care service; 
  2.32     (11) an individual licensed under chapter 147; or 
  2.33     (12) an individual who provides home care services to a 
  2.34  person with a developmental disability who lives in a place of 
  2.35  residence with a family, foster family, or primary caregiver. 
  2.36     Sec. 2.  Minnesota Statutes 1996, section 144A.45, 
  3.1   subdivision 1, is amended to read: 
  3.2      Subdivision 1.  [RULES.] The commissioner shall adopt rules 
  3.3   for the regulation of home care providers pursuant to sections 
  3.4   144A.43 to 144A.49.  The rules shall include the following:  
  3.5      (a) provisions to assure, to the extent possible, the 
  3.6   health, safety and well-being, and appropriate treatment of 
  3.7   persons who receive home care services; 
  3.8      (b) requirements that home care providers furnish the 
  3.9   commissioner with specified information necessary to implement 
  3.10  sections 144A.43 to 144A.49; 
  3.11     (c) standards of training of home care provider personnel, 
  3.12  which may vary according to the nature of the services provided 
  3.13  or the health status of the consumer; 
  3.14     (d) standards for the central storage of medications by 
  3.15  licensed home care providers in elderly housing with services 
  3.16  establishments that are registered with the department of health 
  3.17  under chapter 144D; 
  3.18     (e) standards of supervision by a registered nurse or other 
  3.19  appropriate health care professionals of supervising personnel 
  3.20  providing home care services, which may vary according to the 
  3.21  nature of the services provided or the health status of the 
  3.22  consumer to require supervision on site at least every 62 days, 
  3.23  or more frequently if indicated by a clinical assessment, and in 
  3.24  accordance with sections 148.171 to 148.285 and rules adopted 
  3.25  thereunder; 
  3.26     (e) (f) requirements for the involvement of a consumer's 
  3.27  physician, the documentation of physicians' orders, if required, 
  3.28  and the consumer's treatment plan, and the maintenance of 
  3.29  accurate, current clinical records; 
  3.30     (f) (g) the establishment of different classes of licenses 
  3.31  for different types of providers and different standards and 
  3.32  requirements for different kinds of home care services; and 
  3.33     (g) (h) operating procedures required to implement the home 
  3.34  care bill of rights. 
  3.35     Sec. 3.  Minnesota Statutes 1996, section 144A.46, 
  3.36  subdivision 1, is amended to read: 
  4.1      Subdivision 1.  [LICENSE REQUIRED.] (a) A home care 
  4.2   provider may not operate in the state without a current license 
  4.3   issued by the commissioner of health.  A home care provider may 
  4.4   hold a separate license for each class of home care licensure.  
  4.5   If a home care provider holds more than one license, each 
  4.6   service agreement must identify under which license the client 
  4.7   is receiving services. 
  4.8      (b) Within ten days after receiving an application for a 
  4.9   license, the commissioner shall acknowledge receipt of the 
  4.10  application in writing.  The acknowledgment must indicate 
  4.11  whether the application appears to be complete or whether 
  4.12  additional information is required before the application will 
  4.13  be considered complete.  Within 90 days after receiving a 
  4.14  complete application, the commissioner shall either grant or 
  4.15  deny the license.  If an applicant is not granted or denied a 
  4.16  license within 90 days after submitting a complete application, 
  4.17  the license must be deemed granted.  An applicant whose license 
  4.18  has been deemed granted must provide written notice to the 
  4.19  commissioner before providing a home care service. 
  4.20     (c) Each application for a home care provider license, or 
  4.21  for a renewal of a license, shall be accompanied by a fee to be 
  4.22  set by the commissioner under section 144.122. 
  4.23     Sec. 4.  [144A.4605] [CLASS E ELDERLY HOUSING WITH SERVICES 
  4.24  HOME CARE PROVIDER.] 
  4.25     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  4.26  section, the terms defined in this subdivision have the meanings 
  4.27  given them: 
  4.28     (1) "Class E elderly housing with services home care 
  4.29  provider" means a home care provider who provides nursing 
  4.30  services or home health care aide services or both in an elderly 
  4.31  housing with services establishment as defined in chapter 144D. 
  4.32     (2) "Home health care aide" means an individual who 
  4.33  provides home health care aide services. 
  4.34     (3) "Home health care aide service" means a task that is 
  4.35  defined by rule adopted by the commissioner as a home health 
  4.36  aide or home care aide task and that is performed for a resident 
  5.1   of an elderly housing with services establishment. 
  5.2      Subd. 2.  [CLASS E ELDERLY HOUSING WITH SERVICES HOME CARE 
  5.3   LICENSE.] A home care provider operating an elderly housing with 
  5.4   services establishment may obtain a class E license if the 
  5.5   establishment meets the following requirements: 
  5.6      (1) nursing services or home health care aide services or 
  5.7   both under the class E license are provided solely to residents 
  5.8   of one or more elderly housing with services establishments 
  5.9   registered under chapter 144D; 
  5.10     (2) home health care aides are qualified to perform the 
  5.11  home health care aide services that are offered to the residents 
  5.12  of the elderly housing with services establishment.  
  5.13  Qualifications shall be established in accordance with 
  5.14  subdivision 3; 
  5.15     (3) periodic supervision of home health care aides is 
  5.16  provided as required by rule.  Tasks defined as home health aide 
  5.17  tasks shall be supervised on site by a registered nurse within 
  5.18  the first 14 days after initiation of services, and then at 
  5.19  intervals no greater than every 62 days, or more frequently if 
  5.20  indicated by a clinical assessment, and shall be supervised in 
  5.21  accordance with sections 148.171 to 148.285 and rules adopted 
  5.22  thereunder; 
  5.23     (4) client records shall include: 
  5.24     (i) a weekly summary of the client's status and home health 
  5.25  care services provided; 
  5.26     (ii) documentation each time medications are administered 
  5.27  to a client; and 
  5.28     (iii) documentation on the day of occurrence of any 
  5.29  significant change in the client's status or any significant 
  5.30  incident, such as a fall or refusal to take medications.  
  5.31  Except as specified in subclause (iii), entries must be signed 
  5.32  by the staff providing the services and entered into the record 
  5.33  no later than two weeks after the end of the service day; 
  5.34     (5) medication and treatment orders, if any, are included 
  5.35  in the client record and are renewed at least every six months, 
  5.36  or more frequently if indicated by a clinical assessment; 
  6.1      (6) the central storage of medications in an elderly 
  6.2   housing with services establishment is permitted under a system 
  6.3   </u>
  6.4   that is established by a registered nurse and addresses the 
  6.5   control of medications, handling of medications, medication 
  6.6   containers, medication records, and disposition of medications; 
  6.7   and 
  6.8      (7) the elderly housing with services establishment meets 
  6.9   the requirements for class E home care licensure established by 
  6.10  rules adopted under sections 144A.45 to 144A.48. 
  6.11     Subd. 3.  [TRAINING OR COMPETENCY EVALUATIONS 
  6.12  REQUIRED.] (a) A home health care aide must: 
  6.13     (1) satisfy the training or competency requirements 
  6.14  established by rule under sections 144A.45 to 144A.48; or 
  6.15     (2) be trained or determined competent by a registered 
  6.16  nurse in each home health care aide service offered to clients 
  6.17  in an elderly housing with services establishment as described 
  6.18  in paragraphs (b) to (f). 
  6.19     (b) Training for a home health care aide shall use a 
  6.20  curriculum approved by the commissioner of health for each 
  6.21  separate task the aide will perform. 
  6.22     (c) Competency evaluations may be completed on the site of 
  6.23  a registered elderly housing with services establishment or in a 
  6.24  client's residence. 
  6.25     (d) A registered nurse shall document each competency 
  6.26  evaluation. 
  6.27     (e) A home health care aide shall be trained or demonstrate 
  6.28  competency in the following topics: 
  6.29     (1) an overview of sections 144A.43 to 144A.49 and rules 
  6.30  adopted thereunder; 
  6.31     (2) recognition and handling of emergencies and use of 
  6.32  emergency services; 
  6.33     (3) reporting the maltreatment of vulnerable minors or 
  6.34  adults under sections 626.556 and 626.557; 
  6.35     (4) home care bill of rights; 
  6.36     (5) handling of clients' complaints and reporting of 
  6.37  complaints to the office of health facility complaints; 
  7.1      (6) services of the ombudsman for older Minnesotans; 
  7.2      (7) observation, reporting, and documentation of client 
  7.3   status and of the care or services provided; 
  7.4      (8) basic infection control; 
  7.5      (9) maintenance of a clean, safe, and healthy environment; 
  7.6      (10) communication skills; 
  7.7      (11) basic elements of body functioning and changes in body 
  7.8   function that must be reported to an appropriate health care 
  7.9   professional; 
  7.10     (12) physical, emotional, and developmental needs of 
  7.11  clients, and ways to work with clients who have problems in 
  7.12  these areas, including respect for the client, the client's 
  7.13  property, and the client's family; and 
  7.14     (13) safe transfer techniques and ambulation. 
  7.15     (f) A home health care aide who administers medication must 
  7.16  comply with rules relating to the administration of medication 
  7.17  by home health aides. 
  7.18     Subd. 4.  [LICENSE REQUIRED.] (a) An elderly housing with 
  7.19  services establishment registered under chapter 144D that is 
  7.20  required to obtain a home care license must obtain a class E 
  7.21  license according to this section or a class A license according 
  7.22  to rule. 
  7.23     (b) No later than December 31, 1997, a home care provider 
  7.24  with a class E assisted living program license issued prior to 
  7.25  August 1, 1997, shall comply with this section.  If the home 
  7.26  care provider's class E assisted living program license expires 
  7.27  prior to December 31, 1997, the provider shall comply with rules 
  7.28  relating to home care licensure until December 31, 1997, or 
  7.29  until compliance with this section is achieved, whichever comes 
  7.30  first. 
  7.31     Subd. 5.  [LICENSE FEES.] The licensure fees for class E 
  7.32  home care providers shall be as follows: 
  7.33     (1) $72 annually for those class E providers serving an 
  7.34  average of six or fewer clients, and for class E providers of 
  7.35  all sizes during the first year of operation; 
  7.36     (2) $125 annually for those class E providers serving an 
  8.1   average of seven to 15 clients; 
  8.2      (3) $200 annually for those class E providers serving an 
  8.3   average of 16 to 30 clients; 
  8.4      (4) $375 annually for those class E providers serving an 
  8.5   average of 31 to 50 clients; and 
  8.6      (5) $625 annually for those class E providers serving an 
  8.7   average of 50 or more clients. 
  8.8      Subd. 6.  [WAIVER.] Upon request of the home care provider, 
  8.9   the commissioner may waive the provisions of this section 
  8.10  relating to registered nurse duties. 
  8.11     Sec. 5.  [EFFECTIVE DATE.] 
  8.12     Section 4 is effective August 1, 1997.